Tag Archives: Death

Straight, No Chaser: Suicide and Suicide Risks in College Students

August 25, 2017General Health and Wellness, Genital/Urinary, Mental Health, Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide prevention, There are 72 Hours in a DayJeffrey Sterling, MD

I just had the privilege of spending time at my alma mater addressing issues on behalf of students and mental health services. Among many other things discussed, I was shocked by the extent to which college suicides have become present on college campuses. I wonder when things changed. Isn’t college supposed to be the “best four years of your life?” It really doesn’t take much though to appreciate how this becomes the case.

Suicide is the second leading cause of death among college-age students in the United States and the third leading cause among those aged 15-24. There are approximately 1,100 deaths by suicide occurring in this age group each year. A recent study from Johns Hopkins and the University of Maryland went in-depth in surveying and analyzing why students may have thoughts on suicide. Here is a summary of some of the study’s findings:

12% of those studied admitted that they had thought of committing suicide.
Of this group of 12%, approximately 25% of them said they had those thoughts repeatedly.
Depression and lack of social support appeared to be major factors contributing to thoughts of suicide.

If you actually think about it, college brings together a lot of risks for suicide.

Late adolescence and early adulthood represents the period of highest risk of developing a major psychiatric disorder.
The academic environment can be a stress-producing inferno for some, who may find themselves overwhelmed and feeling lost and as if they have nowhere to turn.
For many, the college experience represents the first time many are away from home and/or completely detached from the family and friends they’ve had their entire lives. Unless and until a sufficient new social network is established, levels of isolation can be overwhelming.
Even among those with social networks, the academic failure and any social rejection that may occur could be perceived by students as having life-long consequences, so much so that hopelessness and thoughts of suicide could set into a young adult’s mind.

Practically, how might you consider the risk in any one individual? The presence of any of these risk factors should prompt implementation of a support system to counter feelings of suicide.

It shouldn’t be difficult to appreciate how the lack of social support is one of the most powerful predictors of persistent suicidal thoughts. Someone who expresses or has feelings of being unappreciated, unloved and uninvolved with family and friends should be considered at risk – even in the absence of any other risk factors.
A history of clinically diagnosed depression or other psychiatric diagnoses
The exposure to domestic violence (either witnessing or having been abused) in childhood
Having a mother with a history of clinical depression

There are many Straight, No Chaser posts that address suicide prevention, diagnosis and treatment. Feel free to use the search box on the right for additional information.If you are a college student or a family member of a college student, you would do well to review your college’s support system and learn about services and support available for those in need of mental/behavioral health services. College should represent the beginning of one’s adult life, not the place where it ends.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Life, Death and Grief

June 13, 2017Mental Health, Public Health844-SMA-TALK, Acceptance, Anger, Bargaining, Behind the Curtain, Death, Delayed grief, Denial, Depression, Emotion, Grief, Grief Loss and Bereavement, Kübler-Ross model, mental-health, Mourning, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

It’s never easy discussing death. Bereavement is the state of mourning and sadness we endure after the death of a loved one. Grief is that process we endure, either in anticipation of death or in bereavement. Humans have been shown to systematically show grief in a predictable way. This Kubler-Ross model famously describes the response of those dying.

Denial, accompanied with simultaneous emotional numbness
Anger over the loss
Bargaining, as if the possibility of staying alive exists
Depression and intense mourning
Acceptance

The real point of bringing up the grieving process is to point out that the loss of a loved one is an extremely dangerous time for those left behind. In fact, the death of a spouse is the single highest risk factor for one’s own death. I’m sure many of us can think back to an elderly couple who died months apart.
The period of bereavement is a time when people need to come together, provide support and take care of each other. It’s very important that you and your loved ones know that the emotions you will experience are universal and normal. Try to keep that in mind when the time comes. Be reminded that normal grief can last over a year. Don’t feel abnormal because of the difficulties you may be having moving on. It’s healthy to work through your pain.
Common psychological thought describe four trajectories we take in bereavement.

Resilience – the attempt to ‘stay strong’ through it all
Recovery – evolution toward a healthy honoring and appreciation of the life of the lost
Chronic dysfunction – the unfortunate circumstance of being stuck in the mourning process such that it cripples your existence
Delayed grief or trauma – the subsequent release and expression of those suppressed emotions

Grief is to be considered a necessary and healthy part of a recovery process that we should learn to embrace. Here’s hoping you find the path to celebrating the lives of your loved ones when they’ve made the final transition.
I welcome any questions you may have.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Suicide Data 2016 – Understand the Threat

November 28, 2016Mental Health, Public Health844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

There are amazing, shocking and saddening facts about suicide. It is equally amazing that we aren’t discussing this as an epidemic. After a period of nearly consistent decline in suicide rates in the United States from 1986 through 1999, suicide rates have increased almost steadily from 1999 through 2014.
Consider the following information provided by the Centers for Disease Control and Prevention and the National Vital Statistics System.

There were an average of 105 suicides a day in the U.S. (over 38,000 for 2010).
An estimated 8.3 million adults reported having suicidal thoughts in the past year.
Suicide is the third leading cause of death among those aged 15-24, the second among those aged 25-34, the fourth among those aged 35-54, and the eighth among persons aged 55-64.
From 1999 through 2014, the age-adjusted suicide rate in the United States increased 24%, from 10.5 to 13.0 per 100,000 population, with the pace of increase greater after 2006.
Suicide rates increased from 1999 through 2014 for both males and females and for all ages 10–74.
The percent increase in suicide rates for females was greatest for those aged 10–14, and for males, those aged 45–64.

For those committing suicide:

33.3% tested positive for alcohol.
23% tested positive for antidepressants.
20.8% tested positive for opiates (such as heroin and prescription pain killers).
There is one suicide for every 25 attempts.

There are some topics that aren’t amenable to Blogs. Depression and suicide are among them. They can’t be done justice. What I can try to do is break components of the conversation into bite size pieces and give you information to work with. I’ll do this in three parts. Above, I’ve shown you the magnitude of suicide. In the next post, I will help you understand what clinical depression looks like, then finally, I’ll review some Quick Tips to help you prevent falling into the deepest levels of depression and to help you know when immediate attention is required. Just remember: this isn’t the type of depression that involves having a bad day. I’m talking about when your downward mood interferes with your activities of daily living. I’m describing depression that introduces suicide and homicide as an option. If you don’t read these for yourself, read them for knowledge. Someone you know may be affected.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Suicide and Suicide Risks in College Students

August 31, 2016General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

12% of those studied admitted that they had thought of committing suicide.
Of this group of 12%, approximately 25% of them said they had those thoughts repeatedly.
Depression and lack of social support appeared to be major factors contributing to thoughts of suicide.

If you actually think about it, college brings together a lot of risks for suicide.

Late adolescence and early adulthood represents the period of highest risk of developing a major psychiatric disorder.
The academic environment can be a stress-producing inferno for some, who may find themselves overwhelmed and feeling lost and as if they have nowhere to turn.
For many, the college experience represents the first time many are away from home and/or completely detached from the family and friends they’ve had their entire lives. Unless and until a sufficient new social network is established, levels of isolation can be overwhelming.
Even among those with social networks, the academic failure and any social rejection that may occur could be perceived by students as having life-long consequences, so much so that hopelessness and thoughts of suicide could set into a young adult’s mind.

Practically, how might you consider the risk in any one individual? The presence of any of these risk factors should prompt implementation of a support system to counter feelings of suicide.

It shouldn’t be difficult to appreciate how the lack of social support is one of the most powerful predictors of persistent suicidal thoughts. Someone who expresses or has feelings of being unappreciated, unloved and uninvolved with family and friends should be considered at risk – even in the absence of any other risk factors.
A history of clinically diagnosed depression or other psychiatric diagnoses
The exposure to domestic violence (either witnessing or having been abused) in childhood
Having a mother with a history of clinical depression

There are many Straight, No Chaser posts that address suicide prevention, diagnosis and treatment. Feel free to use the search box on the right for additional information.If you are a college student or a family member of a college student, you would do well to review your college’s support system and learn about services and support available for those in need of mental/behavioral health services. College should represent the beginning of one’s adult life, not the place where it ends.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Suicide Data – Understand the Threat

November 30, 2015Mental Health, Public Health844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

There are amazing, shocking and saddening facts about suicide. It is equally amazing that we aren’t discussing this as an epidemic. Consider the following information provided by the Centers for Disease Control and Prevention:
There were an average of 105 suicides a day in the U.S. (over 38,000 for 2010).
An estimated 8.3 million adults reported having suicidal thoughts in the past year.
Suicide is the third leading cause of death among those aged 15-24, the second among those aged 25-34, the fourth among those aged 35-54, and the eighth among persons aged 55-64.
For those committing suicide:

33.3% tested positive for alcohol.
23% tested positive for antidepressants.
20.8% tested positive for opiates (such as heroin and prescription pain killers).
There is one suicide for every 25 attempts.

There are some topics that aren’t amenable to Blogs. Depression and suicide are among them. They can’t be done justice. What I can try to do is break components of the conversation into bite size pieces and give you information to work with. I’ll do this in three parts. Above, I’ve shown you the magnitude of suicide. In the next post, I will help you understand what clinical depression looks like, then finally, I’ll review some Quick Tips to help you prevent falling into the deepest levels of depression and to help you know when immediate attention is required. Just remember: this isn’t the type of depression that involves having a bad day. I’m talking about when your downward mood interferes with your activities of daily living. I’m describing depression that introduces suicide and homicide as an option. If you don’t read these for yourself, read them for knowledge. Someone you know may be affected.
I welcome any questions, comments or thoughts.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Suicide and Suicide Risks in College Students

July 28, 2015General Health and Wellness844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

12% of those studied admitted that they had thought of committing suicide.
Of this group of 12%, approximately 25% of them said they had those thoughts repeatedly.
Depression and lack of social support appeared to be major factors contributing to thoughts of suicide.

If you actually think about it, college brings together a lot of risks for suicide.

Late adolescence and early adulthood represents the period of highest risk of developing a major psychiatric disorder.
The academic environment can be a stress-producing inferno for some, who may find themselves overwhelmed and feeling lost and as if they have nowhere to turn.
For many, the college experience represents the first time many are away from home and/or completely detached from the family and friends they’ve had their entire lives. Unless and until a sufficient new social network is established, levels of isolation can be overwhelming.
Even among those with social networks, the academic failure and any social rejection that may occur could be perceived by students as having life-long consequences, so much so that hopelessness and thoughts of suicide could set into a young adult’s mind.

Practically, how might you consider the risk in any one individual? The presence of any of these risk factors should prompt implementation of a support system to counter feelings of suicide.

It shouldn’t be difficult to appreciate how the lack of social support is one of the most powerful predictors of persistent suicidal thoughts. Someone who expresses or has feelings of being unappreciated, unloved and uninvolved with family and friends should be considered at risk – even in the absence of any other risk factors.
A history of clinically diagnosed depression or other psychiatric diagnoses
The exposure to domestic violence (either witnessing or having been abused) in childhood
Having a mother with a history of clinical depression

Straight, No Chaser: How Do You Want to Die?

February 20, 2015General Health and Wellness, Health Prevention844-SMA-TALK, Death, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

People tend to take that question one of two ways. Some view the question as morbid, and others view it as empowering. The truth of the matter is we’re all empowered to some extent over the conditions that lead to the end of life. Although we can’t control death, our actions (or inactions) can bring us closer to it or take us away from it. Even with a terminal diagnosis such as cancer, there are scores of courageous patients whose lives have been extended and whose last days have been lived on their own terms.
The Straight, No Chaser message here is to some extent, we all have a say in how we die. Of course some deaths occur in an unpredictable manner, but even then many of us put ourselves in situations where bad things can happen. Even some people who get hit by trucks do so because they were jaywalking. Even those who die in their sleep still did so due to a heart attack, blood clot or some other disease that was preventable or could have been forestalled.

The better course of action is to take charge of your life and thus take charge of your death. Be proactive. In all probability, the way you live your live will define the length of your life and the quality of your death.

Here’s where you should trust me a bit. Even if you theoretically know some of the things I know about the end of life, you probably haven’t seen the things I’ve seen.

You know that smoking cigarettes leads to emphysema, COPD and lung cancer, but that’s not nearly the same as seeing someone die while coughing up blood and gasping for their last breaths.
You know that drug use and alcoholism are bad for you, but that’s not nearly the same as seeing someone with liver cancer or cirrhosis die while drowning in the toxins the body is no longer able to clear.
You know that driving without seat beats is dangerous, but you don’t want to experience the whimper of someone with the excruciating pain from breaking so many bones in their body that death is viewed as a respite.
You know that safe sex makes sense, but you can’t imagine the horrific appearance of death caused by the esoteric and relentless microorganisms that prey on those with compromised immunity from advanced AIDS.

There are a near infinite amount of additional examples, but the points remain the same.

Consciously or not, you make decisions about your ongoing health, length of your life and circumstances surrounding your death.
You are empowered to control these considerations more than you likely realize.

This picture of a child from National Geographic is applicable to each of us to varying degrees. Whatever potential life expectancy we have, it’s a starting point that can be improved upon or diminished, based on how we care for ourselves. The lead question was “How do you want to die?” but perhaps the answer is found in its companion question: “How will you choose to live?”
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: In The News – A Struggle Between Death and Life

January 28, 2014General Health and Wellness844-SMA-TALK, Death, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Death is a part of life. The more sensibly both are handled, the better off you, your loved ones and society will be in the short and the long term. Challenges in handling death and dying exist whether death is expected or dramatic and untimely. One of the main purposes of this blog is to help you live and die well, empowered and knowledgeable about how to handle various situations when death comes to you.

In the news this week was the culmination of the difficult eight-week struggle between authorities, hospitals officials, laws, statutes, judges and family members, all making decisions about a young pregnant woman’s life—or in this case death. In Fort Worth, Texas, family members of the apparently brain-dead, 33 year-old Mrs. Marlise Muñoz rallied for her to rest in peace as was her stated but not documented wish. The hospital sought to enforce a Texas law aimed to protect her 22-week pregnancy though medically unviable and discovered to be abnormal.

Finally through court order, the wishes of the young woman were granted. The hospital removed her from life supports.

Imagine the horror endured by the family each day of those eight weeks. Imagine having daily visits with your loved one, now functionally a corpse, not allowed the dignity to rest in peace. How prepared are you and your family to address a similar situation if tragedy strikes today and the same questions swirl around your comatose or vegetative body? Have you thought about how you want the powers that be to proceed? Have you written it down? Have you legalized the document? Have you designated a power of attorney/trusted friend and given him or her a copy of the advance directive? Have you informed your family of your wishes?

Even though you read all of the Straight, No Chaser blogs, on occasion you need help. We offer you 844-SMA-TALK and www.SterlingMedicalAdvice.com so you are able to regularly and emergently contact your Personal Healthcare Consultant and diligently work toward your health goals.

You might leave sooner than planned. Sometimes in the emergency room we do see miracles, but more often we see the end of life. What we don’t want for you and your loved ones is stress on top of grief or a lifetime of memories about the horrific, extended death of a loved one. Take a look at this post for more details. Make it easier on yourself and your family … and authorities. Don’t delay.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Suicide Data – Understand the Threat

August 20, 2013Mental Health, Public HealthBipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

33.3% tested positive for alcohol.
23% tested positive for antidepressants.
20.8% tested positive for opiates (such as heroin and prescription pain killers).
There is one suicide for every 25 attempts.

Females are more likely than males to have had suicidal thoughts, but suicide among males is four times higher than among females (in other words, females think about it and try more often, but males complete the act more often.).
Among Native Americans aged 15-34, suicide is the second leading cause of death, fully 2.5 times higher than the national average.
There are some topics that aren’t amenable to Blogs. Depression and suicide are among them. They can’t be done justice. What I can try to do is break components of the conversation into bite size pieces and give you information to work with. I’ll do this in three parts. Above, I’ve shown you the magnitude of suicide. In the next post, I will help you understand what clinical depression looks like, then finally, I’ll review some Quick Tips to help you prevent falling into the deepest levels of depression and to help you know when immediate attention is required. Just remember: this isn’t the type of depression that involves having a bad day. I’m talking about when your downward mood interferes with your activities of daily living. I’m describing depression that introduces suicide and homicide as an option. If you don’t read these for yourself, read them for knowledge. Someone you know may be affected.
I welcome any questions, comments or thoughts.

Straight, No Chaser: The Grief of it All

August 15, 2013Mental Health, Public HealthAcceptance, Anger, Bargaining, Death, Delayed grief, Denial, Depression, Emotion, Grief, Grief Loss and Bereavement, Kübler-Ross model, mental-health, MourningJeffrey Sterling, MD

Denial, accompanied with simultaneous emotional numbness
Anger over the loss
Bargaining, as if the possibility of staying alive exists
Depression and intense mourning
Acceptance

Resilience – the attempt to ‘stay strong’ through it all
Recovery – evolution toward an healthy honoring and appreciation of the life of the lost
Chronic dysfunction – the unfortunate circumstance of being stuck in the mourning process such that it cripples your existence
Delayed grief or trauma – the subsequent release and expression of those suppressed emotions

Grief is to be considered a necessary and healthy part of a recovery process that we should learn to embrace.

Straight, No Chaser: Spider Bites – Emergency Room Adventures, Part I

August 8, 2013Medical Treatment, Health PreventionBrown recluse spider, Death, Latrodectus, Missouri, Spider, Spider bite, Texas, United StatesJeffrey Sterling, MD

And I thought I was done with stuff biting you for a while… Everything’s bigger in Texas, they say. I recall the first time I saw a banana spider. The thing seemed to be as big as my fist. The only thing more surprising than that was discovering that wasps actually kill and eat spiders. I thought it was supposed to be the other way around… Anyway, I’m typing this immediately after seeing a patient who’s working around the house (or farm or barn as the case is around here), and he put his hand in the woodshed and got bit by a big spider with a red hourglass appearance. Of course, the mother’s excited and wants to know if he’s going to die. The father’s not too concerned because he was just in Missouri a month ago and was bitten by a spider that looked like it had a violin on its back (You can’t make this stuff up!).

Not a day goes by when I don’t see several patients bitten or stung by various insects, including fire ants, mosquitos, bees, wasps, ticks, scorpions and spiders. Usually everyone’s worried about a Staph infection. It’s important to note that only four American species of spiders are known to be dangerous to humans. However, there are only two types of spiders that are worth mentioning as a cause of significant disease.

Black widow spider bites are even more interesting when they’re not eating their mates after procreation (fun fact: North American black widow spiders don’t usually do that; it’s actually the Australian brand that does). They prefer to avoid humans, hanging out in outhouses, garages and the like. They become aggressive when disturbed (particularly if there’s an egg sac around), and if you’ve been bitten, it was by a female. You’ll know it was a black widow because of its red hourglass underside.

The black widow spider injects a powerful nerve toxin into humans. Once bitten, you’ll feel pain, but the real symptoms are likely to start about 20” later. Among other things, this venom produces symptoms that mimic appendicitis. Patients can develop abdominal pain and rigidity, tremor, weakness, chest pain, shortness of breath, dizziness and fainting. People at the extremes of age are more at risk for serious complications. Otherwise, reactions are rarely life threatening.

The brown recluse spider is native to the Midwest and Southeastern U.S. You’ll recognize this one by its distinctive violin pattern on its back near where its legs attach. As the name suggests, they’re not at all aggressive and tend to bite only when it’s pressed against its victim’s skin. These spiders like warm and dry environments (think attics, closets, basements, porches, barns and woodpiles).

The Brown recluse also injects a powerful venom – more so than a rattlesnake – who’s lethality is only limited because it’s such a small creature. Its venom rapidly destroys the cells it’s injected into, causing necrosis and tissue death (This is decreased as having a ‘volcano-like’ appearance at the bite site. The lead picture is a demonstration of this.). This destruction has secondary effects in humans, including kidney damage and failure, red blood cell and platelet (your clotting cells) destruction, formation of blood clots, coma and death (rarely). Deaths have only been reported in children less than age seven by the brown recluse.

Here’s your Quick Tip do’s and no’s for Spider Bites:

Do’s

Get to the ER. Not your Doctor’s office. Not the Urgent Care.
Elevate the area above your heart.
Wash with soap and cool water.
Tylenol for pain.
Apply ice.

No’s

No waiting to see if it gets better.
No heat.
No suction.
No cutting away tissue.
No tourniquets.

Straight, No Chaser: Violent Crimes – Gunshot and Stab Wounds

August 1, 2013Medical Treatment, Skin/Dermatology, Trauma, Health PreventionAbdominal Trauma, Ballistic trauma, Death, Gun shot wounds, Gunshots, health, Medical examiner, Penetrating Trauma, Spinal cord injury, Stab wounds, WoundJeffrey Sterling, MD

Penetrating trauma (PT) is of such magnitude in this country that it is nearly impossible to do it justice in short form. This is primarily a medical blog, and as such I’ll defer addressing the politics of it all. The fact remains that gunshot and stab wounds take an astounding toll on human life in the U.S, with over 16,000 homicides annually (approximately 45 deaths every day). The ramifications of these wounds encompass much more than medical considerations, but I’ll devote this space to discussing basics of penetrating trauma.
What Happens
By design, intentional stab and gunshot wound aim to kill. Just as I noted in discussing the blunt trauma seen in motor vehicle crashes, any area of the body can be shot or stabbed. Unintentional injuries are also a source of common emergency room presentations. Major ERs and Trauma Centers are known within the industry as the ‘knife and gun clubs’.
Penetrating injuries to virtually all areas (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshots wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone).

PT that reaches blood vessels can cause fatal bleeding. In the abdomen, the liver is the most commonly injured organ because of its large size and can bleed enough to cause shock and death.
PT that reaches the spinal cord can cause paralysis and death.
PT to the brain can cause all manners of dysfunction, including loss of speech, motion, sensation, bodily functions, paralysis and death.
PT to the chest can cause puncture, rupture and/or loss of lung and heart function, leading to a pretty rapid death.

Be reminded that although both gunshot wounds and stab wounds involve penetration and may puncture your internal organs, gunshots are more prone to deeper penetration with higher energy and may create exit wounds, causing damage throughout its course.
What You Can Do
Here are the things you must consider after becoming a victim of penetrating trauma.

Get to safety. Perpetrators of penetrating trauma meant to hurt you and often mean for you to be dead. They may be looking to finish the job. I’ve been involved in many scenarios where individuals came to the ER to do just that.
Once you’re safe, immediately call 911 regardless of how you feel. You may be in shock and your body will fight feverishly to normalize how you feel – right up until you crash. In other words, you can’t trust how you feel. Another vital consideration about getting medical attention rapidly is what we call ‘The Golden Hour’. The opportunity to address many of the truly life threatening considerations in penetrating trauma is best done within the first 60 minutes of the injury.
Once you’re safe, apply pressure (clean towels) to any bleeding sites. Cover yourself with blankets as needed to preserve heat.
Avoid movement. Gunshot wounds are associated with spinal cord injuries, so movement could be dangerous.

What You Should Expect
Treatment of penetrating trauma is very dramatic and necessarily regimented due to the early lack of knowledge of the depth and location of injuries. As such, assessment and treatment protocols generally are in place for the region of the body penetrated. The first consideration is always ensuring that the patient’s Airway is intact, Breathing is still ongoing, and Circulation (blood flow) is sufficient (The ‘ABCs’ of Trauma management). After that, use of x-rays, CT scans and other radiologic modalities to identify the location and extent of injuries will be employed based on the stability of the patient. Sometimes immediate surgical intervention is needed.
This is another situation where prevention is the best course of action. Avoiding injuries when possible should go without saying but often does not. Gun safety for gun owners is crucial to avoid unintentional injuries. Attention to detail is very important when handling guns and knives. Unintentional injuries tend to occur when handlers of these weapons get too comfortable. Unfortunately, once penetrating trauma has occurred, it seems like a game of chance. For every person who is told “If that bullet was one more inch to the right, you’d be paralyzed (or dead)”, another family has to be told to make arrangements. Unfortunately, my father was the victim of a random fatal gunshot wound when I was six years old, so I know that story all too well.
If you remember anything from this blog post, remember time is of the essence. Get your loved one to us inside of ‘The Golden Hour’ to give the best chance of a good outcome.