Tag Archives: Deep vein thrombosis

Straight, No Chaser: Spotlight on Health Concerns When Traveling – Vaccines and Illnesses

June 14, 2017General Health and Wellness, Health Prevention844-SMA-TALK, Chronic obstructive pulmonary disease, Deep vein thrombosis, health, Limited liability company, Lung, Pulmonary embolism, Sterling Medical Advice, Sterling Medical Wellness, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, ThrombusJeffrey Sterling, MD

Traveling is exciting, but it presents multiple challenges to your health. To best meet these challenges, preparation is everything.

Before you travel and every time you travel, your surest means of protecting yourself is to confirm you are current on routine vaccines.

Your basic vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine and influenza.
Most international travelers will need immunizations to protect you from hepatitis A, polio, and typhoid.
Depending on where you’re international travels take you and the duration of your trip, you may need immunizations to protect you from hepatitis B, malaria, rabies and/or yellow fever.

The plane trip itself can be hazardous to your health. I encourage you to review the risks of flying.

Diseases have different patterns in how they spread and their resistance to medications in different countries. It is important to be aware of prominent diseases affecting the countries you plan to visit, because some may be uncommon in your home country. For Americans traveling abroad, such diseases include the following:

HIV/AIDS
Malaria: an infectious disease caused by a parasite, which invades the blood cells. It is notable for the presence of high fever, shaking chills, low blood count and a flu-like set of symptoms.
Pandemic/avian flu (aka as the bird flu): an infectious disease in birds caused by a virus that can spread to humans
Travelers’ diarrhea – the most common disease acquired by travelers.
Tuberculosis: an infectious disease involving the lungs, able to spread throughout the body

I strongly recommend that you develop a habit of checking the CDC travel site every time you prepare to travel internationally, including those of you coming from abroad into the United States. Detailed information on these diseases is available clicking the links, checking the search engine and at www.sterlingmedicaladvice.com.
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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Medical Issues You Encounter While Flying

February 8, 2017Head/Eyes/Ears/Nose/Throat, Hematology & Oncology/Blood Disorders/Cancer, Neurology, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This week’s Straight, No Chaser posts have focused on the dangers presents by blood clots. Flying long distances presents a specific risk for development of blood clots. However, the risks posed by flying aren’t limited to this consideration.
I’ve probably been engaged twenty times on airplanes to provide medical assistance. My favorite incident was when four doctors (and a nurse) simultaneously jumped to assistance as if everyone was some type of superhero. Of course, I wouldn’t be telling the story if I didn’t end up being the last man standing (due to my status as the emergency physician among the group – and yes, the patient was ok). Consider this your handy to do and to don’t if and when you’re traveling by air. You never know!
There are four quick considerations I’d like to share:
Blood clots:

Flights (and especially the long ones) increase your risk for deep venous thrombosis (DVTs). You can reduce this risk by frequently bending and rotating your ankles, drinking water whenever the opportunity presents and getting up intermittently to walk. Prevention is also important – this is why traveling while in the latter stages of pregnancy is especially problematic and why near-term women aren’t allowed to travel – and you thought it only had to do with early deliveries!
Headaches and earaches:

Air in your body (lungs, intestines, sinuses and eardrums, to name a few) expand when your plane ascends and contracts upon descent. The squeeze on descent is actually more frequent of an issue than gases expanding on ascent, but both situations present problems. In addition to exacerbating migraines, your eardrums can rupture from the squeeze. Of course, adults address this by holding their noses and blowing, thus ‘popping’ their ears (actually this equalizes the pressure on both sides of the eardrum, returning things back to normal). Kids suffer just as much as adults, but the younger ones aren’t able to release the pressure as easily. Thus, it’s true that you should allow them to chew or suck on something during descent. The passenger sitting next to you will thank you.
Fainting:

Fainting is a common occurrence on flights for many reasons. Faints and other mental status changes due to low blood sugar (hypoglycemia) are the most common episodes I’ve personally encountered on flights. My best advice here is to stay hydrated (This will help you prevent faints and problems with DVTs.) and if you’re diabetic, eat during the flight. Low sugar reactions are scary in the air, and the pilots are always wondering if they’ll need to do an emergency landing.
Respiratory disease:

This is an important consideration because the potential for bad outcomes are heightened. Those with asthma, blood clots in the lungs (pulmonary emboli) and COPD (chronic obstructive pulmonary disease aka chronic bronchitis and emphysema) need to discuss traveling with their physicians. The high altitude of flights results in thinner air, drier air and increasing viscosity of your blood, which can affect patients suffering from the conditions mentioned. A ruptured lung in a patient with bad COPD is a formula for disaster.
In short, fly smart and fly healthy. An airplane is a horrible place to be in harm’s way. And that doesn’t even include snakes on a plane.

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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Why Are Athletes At Such Risk For Pulmonary Embolus?

February 7, 2017Cardiology/Heart, Respiratory/Lungs844-SMA-TALK, Anderson Varejao, Behind the Curtain, Chris Bosh, Deep vein thrombosis, Derrick Thomas, DVT, Jerome Kersey, Pulmonary embolism, Serena Williams, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition)Jeffrey Sterling, MD

Let’s begin today’s Straight, No Chaser by being sure not to overstate the case. All things being equal, young healthy individuals and superbly conditioned athletes have diminished risks for diseases across the board. However, all things aren’t equal. The nature of being a professional athlete and many of the tasks associated with being a professional athlete have resulted in some very high-profile cases of pulmonary emboli (PE).

Former NBA star Jerome Kersey of the Portland Trailblazers died last year from a PE.
NBA stars Chris Bosh of the Miami Heat and Mirza Teletovic of the Brooklyn Nets were diagnosed with pulmonary emboli and missed most of last season.
Former NFL star of the Kansas City Chiefs Derrick Thomas died from a PE in 1989.

Tennis superstar Serena Williams lost a year of her prime (and nearly her life) from a PE in 2010.
Cleveland Cavaliers center Anderson Varejao suffered a similar health scare during the 2012-13 season.

Straight, No Chaser has previously discussed deep vein thrombosis (DVT) and pulmonary embolism. It’s the risks that bear paying attention to; athletes and their activities increase the susceptibility to DVTs and PEs.

Driving or flying long distances. Athletes scan the globe competing. Any activity requiring you to be inactive for greater than four hourly increases the risk of developing a DVT. That risk increases the longer one remains inactive.
Dehydration. The advent of sports and rehydration drinks has reduced this risk, but one should appreciate that with the amount of perspiration occurring during athletic events, the risk of dehydration is present. Dehydration can directly lead to increasing the thickness of blood, which makes the development of clots more likely.
Hormones. Those taking birth control pills that contain estrogen have an increased risk of DVTs and PEs.
Immobilization: Any injury, cast or brace that results in immobility will allow your blood to pool and increase your risk of a DVT or PE.
Injuries. Any injury to a vein or a severe muscle injury can increase the risk for developing DVT.
Surgeries: Surgeries combine a few independent risks for DVTs, such as immobilization, the risks of dehydration and injuries to vein.

All things considered, professional athletes remain young and healthy. The occasional occurrence of these life-threatening conditions serves as a warning for us all to be aware of the risks. If world-class athletes are subject to the above risks, then the rest of us certainly are. Be informed and take appropriate precautions.
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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Pulmonary Embolus (A Blood Clot in the Lungs)

February 6, 2017Cardiology/Heart, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, hygiene, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

When I was a young, wide-eyed medical student, I learned that in a large number of cases, when people died from unexplained cases, the autopsies would often show the patient died from a pulmonary embolus. Of course this immediately sent the message that this condition gets missed a lot and is often deadly when missed. In fact, although estimates suggest these conditions affect 300,000 to 600,000 people in the United States, the exact number of people affected by DVT (deep venous thrombosis, discussed in this Straight, No Chaser) and PE isn’t known due to how often these conditions go undiscovered.

The problem is pretty straightforward. Your blood flows throughout the body, delivering oxygen and nutrients to your organs and tissues. This is necessary for normal function. If there’s a disruption in your blood flood, there will be problems. A pulmonary embolism (PE) is a sudden blockage in one or more lung arteries. This typically occurs by a clot that travels through the bloodstream to the lungs from elsewhere in the body (usually the legs, thighs or pelvis), which then gets lodged in the small arteries of the lung.
Pulmonary embolism is a serious, life threatening condition. Basically, if your blood flood through the lungs is blocked, the rest of your blood will be deprived of oxygen.
PEs can cause any or all of the following.

Permanent damage to the lung
Damage to other organs in your body from not getting enough oxygen
Death

The risk of death from PEs should not be underestimated. If left untreated approximately 30% of those with PEs will die. Imagine the horror we’d express we were exposed to an infection that killed 3 of every 10 individuals affected, and the risk was as great as is presented by the frequency of DVTs and PEs.
A particular problem with PEs is our general inclination toward waiting for diseases to appear and then seek treatment, instead of being proactive and pursuing prevention. Half of those with PEs will have no symptoms. Thus if you have risks factors or wait until you have been told you have clots in your legs to start reducing your risk, your exposure is much more dramatic.

If you do have symptoms of a PE, they can include the following: shortness of breath, chest pain or coughing up blood; these symptoms may appear suddenly and severely. Symptoms of a DVT/blood clot (e.g. in your legs) include warmth, swelling, pain, tenderness and redness.
The goal of treatment is to break up the clots and to prevent other clots from forming – this is not the same as dissolving the clots, which is a very aggressive and risky step only taken in certain specific, immediately life-threatening situations. The good news is that a prompt diagnosis and proper treatment can save lives and help prevent the complications of PE. Unfortunately, such success is not guaranteed once a PE develops.
The next Straight, No Chaser will look at the unique risks athletes have that place them at risk for blood clots and PEs.
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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Blood Clots in Your Legs – Deep Venous Thrombosis (DVT)

February 5, 2017Cardiology/Heart, Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, hygiene, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you’re a sports fan, you’re likely aware of the death of a 52-year-old former star of the NBA’s Portland Trailblazers, Jerome Kersey, followed two days after by the discovery of the same condition in a current star of the NBA’s Miami Heat, Chris Bosh. You may also recall tennis superstar Serena Williams’ career was once placed on hold for a year. The condition from which they all suffered was pulmonary embolus (blood clots in the lungs). Straight, No Chaser will discuss those in the next two posts, but today we will address the condition that most often precedes the development of clots in the lungs.

A blood clot represents a blockage of a blood vessel somewhere in the body, usually the lower extremities (legs and thighs), the lungs (pulmonary embolus) or the brain (a stroke). Today we’ll discuss the variety that occurs in the lower extremities, which are generally referred to as deep venous thrombosis (DVTs). In case you’re thinking that a clot in the leg doesn’t sound as bad as a clot in the lungs or the head, you’re correct – until you understand that DVTs break off and travel to other body sites, leading to blockage elsewhere (This is called embolism.).
Today’s challenges are to appreciate the risks of developing DVTs and the symptoms. Risk factors include the following:

Birth control pills or other estrogen use (this combined with cigarette smoking pushes the risk even higher)
Cancer
Cigarette smoking
Family history of blood clots
Obesity
Prolonged immobilization
Recent pelvic or leg fracture
Recent surgery (most often the pelvis or lower extremities)
Recent travel involving long periods of sitting
Certain medical conditions, most notably lupus

Symptoms most commonly are in one leg or the other and reflect the fact that the vein is being blocked. These include pain, swelling, redness and warmth. The above picture is not typical. The presentation is usually much more subtle.
Diagnosis and treatment are relatively straightforward as long as they occur in time (meaning before the clots have broken off). Diagnosis is usually accomplished by an ultrasound of the lower extremities; once discovered, you’ll be placed on blood thinners. It’s important to know that blood thinners prevent the formation of new clots. They do not dissolve existing clots. That’s usually not necessary, as many DVTs simply dissolve. If it doesn’t, DVTs that embolize are life-threatening (more so from the pelvis and thigh than the legs). Unfortunately pulmonary emboli are among the most missed medical diagnoses and causes of death.
Try to manage your controllable risk factors, and be aware – especially when you’re dealing with a risk factor that you can’t control (like surgery).
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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Spotlight on Health Concerns When Traveling – Vaccines and Illnesses

June 15, 2016General Health and Wellness, Health Prevention844-SMA-TALK, Chronic obstructive pulmonary disease, Deep vein thrombosis, health, Limited liability company, Lung, Pulmonary embolism, Sterling Medical Advice, Sterling Medical Wellness, SterlingMedicalAdvice.com, Straight No Chaser, ThrombusJeffrey Sterling, MD

Traveling is exciting, but it presents multiple challenges to your health. To best meet these challenges, preparation is everything.

Before you travel and every time you travel, your surest means of protecting yourself is to confirm you are current on routine vaccines.

Your basic vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine and influenza.
Most international travelers will need immunizations to protect you from hepatitis A, polio, and typhoid.
Depending on where you’re international travels take you and the duration of your trip, you may need immunizations to protect you from hepatitis B, malaria, rabies and/or yellow fever.

The plane trip itself can be hazardous to your health. I encourage you to review the risks of flying.

HIV/AIDS
Malaria: an infectious disease caused by a parasite, which invades the blood cells. It is notable for the presence of high fever, shaking chills, low blood count and a flu-like set of symptoms.
Pandemic/avian flu (aka as the bird flu): an infectious disease in birds caused by a virus that can spread to humans
Travelers’ diarrhea – the most common disease acquired by travelers.
Tuberculosis: an infectious disease involving the lungs, able to spread throughout the body

I strongly recommend that you develop a habit of checking the CDC travel site every time you prepare to travel internationally, including those of you coming from abroad into the United States. Detailed information on these diseases is available clicking the links, checking the search engine and at www.sterlingmedicaladvice.com.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
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: The Medical Issues You Encounter While Flying

February 10, 2016Head/Eyes/Ears/Nose/Throat, Hematology & Oncology/Blood Disorders/Cancer, Neurology, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is an important consideration because the potential for bad outcomes are heightened. Those with asthma, blood clots in the lungs (pulmonary emboli) and COPD (chronic obstructive pulmonary disease aka chronic bronchitis and emphysema) need to discuss traveling with their physicians. The high altitude of flights results in thinner air, drier air and increasing viscosity of your blood, which can affect patients suffering from the conditions mentioned. A ruptured lung in a patient with bad COPD is a formula for disaster.
In short, fly smart and fly healthy. An airplane is a horrible place to be in harm’s way. And that doesn’t even include snakes on a plane.

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: Why Are Athletes At Such Risk For Pulmonary Embolus?

February 9, 2016Cardiology/Heart, Respiratory/Lungs844-SMA-TALK, Anderson Varejao, Behind the Curtain, Chris Bosh, Deep vein thrombosis, Derrick Thomas, DVT, Jerome Kersey, Pulmonary embolism, Serena Williams, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Former NBA star Jerome Kersey of the Portland Trailblazers died last year from a PE.
NBA stars Chris Bosh of the Miami Heat and Mirza Teletovic of the Brooklyn Nets were diagnosed with pulmonary emboli and missed most of last season.
Former NFL star of the Kansas City Chiefs Derrick Thomas died from a PE in 1989.

Tennis superstar Serena Williams lost a year of her prime (and nearly her life) from a PE in 2010.
Cleveland Cavaliers center Anderson Varejao suffered a similar health scare during the 2012-13 season.

Driving or flying long distances. Athletes scan the globe competing. Any activity requiring you to be inactive for greater than four hourly increases the risk of developing a DVT. That risk increases the longer one remains inactive.
Dehydration. The advent of sports and rehydration drinks has reduced this risk, but one should appreciate that with the amount of perspiration occurring during athletic events, the risk of dehydration is present. Dehydration can directly lead to increasing the thickness of blood, which makes the development of clots more likely.
Hormones. Those taking birth control pills that contain estrogen have an increased risk of DVTs and PEs.
Immobilization: Any injury, cast or brace that results in immobility will allow your blood to pool and increase your risk of a DVT or PE.
Injuries. Any injury to a vein or a severe muscle injury can increase the risk for developing DVT.
Surgeries: Surgeries combine a few independent risks for DVTs, such as immobilization, the risks of dehydration and injuries to vein.

All things considered, professional athletes remain young and healthy. The occasional occurrence of these life-threatening conditions serves as a warning for us all to be aware of the risks. If world-class athletes are subject to the above risks, then the rest of us certainly are. Be informed and take appropriate precautions.
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: Pulmonary Embolus (A Blood Clot in the Lungs)

February 8, 2016Cardiology/Heart, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, hygiene, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Permanent damage to the lung
Damage to other organs in your body from not getting enough oxygen
Death

If you do have symptoms of a PE, they can include the following: shortness of breath, chest pain or coughing up blood; these symptoms may appear suddenly and severely. Symptoms of a DVT/blood clot (e.g. in your legs) include warmth, swelling, pain, tenderness and redness.
The goal of treatment is to break up the clots and to prevent other clots from forming – this is not the same as dissolving the clots, which is a very aggressive and risky step only taken in certain specific, immediately life-threatening situations. The good news is that a prompt diagnosis and proper treatment can save lives and help prevent the complications of PE. Unfortunately, such success is not guaranteed once a PE develops.
The next Straight, No Chaser will look at the unique risks athletes have that place them at risk for blood clots and PEs.
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: Blood Clots in Your Legs – Deep Venous Thrombosis (DVT)

February 6, 2016Cardiology/Heart, Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, hygiene, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Birth control pills or other estrogen use (this combined with cigarette smoking pushes the risk even higher)
Cancer
Cigarette smoking
Family history of blood clots
Obesity
Prolonged immobilization
Recent pelvic or leg fracture
Recent surgery (most often the pelvis or lower extremities)
Recent travel involving long periods of sitting
Certain medical conditions, most notably lupus

Symptoms most commonly are in one leg or the other and reflect the fact that the vein is being blocked. These include pain, swelling, redness and warmth. The above picture is not typical. The presentation is usually much more subtle.
Diagnosis and treatment are relatively straightforward as long as they occur in time (meaning before the clots have broken off). Diagnosis is usually accomplished by an ultrasound of the lower extremities; once discovered, you’ll be placed on blood thinners. It’s important to know that blood thinners prevent the formation of new clots. They do not dissolve existing clots. That’s usually not necessary, as many DVTs simply dissolve. If it doesn’t, DVTs that embolize are life-threatening (more so from the pelvis and thigh than the legs). Unfortunately pulmonary emboli are among the most missed medical diagnoses and causes of death.
Try to manage your controllable risk factors, and be aware – especially when you’re dealing with a risk factor that you can’t control (like surgery).
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: The Medical Issues You Encounter While Flying

February 26, 2015Head/Eyes/Ears/Nose/Throat, Hematology & Oncology/Blood Disorders/Cancer, Neurology, Respiratory/Lungs, Health Prevention844-SMA-TALK, Deep vein thrombosis, DVT, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This week’s Straight, No Chaser posts have focus on the dangers presents by blood clots. Flying long distances presents a specific risk for development of blood clots. However, the risks posed by flying aren’t limited to this consideration.
I’ve probably been engaged twenty times on airplanes to provide medical assistance. My favorite incident was when four doctors (and a nurse) simultaneously jumped to assistance as if everyone was some type of superhero. Of course, I wouldn’t be telling the story if I didn’t end up being the last man standing (due to my status as the emergency physician among the group – and yes, the patient was ok). Consider this your handy to do and to don’t if and when you’re traveling by air. You never know!
There are four quick considerations I’d like to share:
Blood clots:

Straight, No Chaser: Why Are Athletes At Such Risk For Pulmonary Embolus?

February 25, 2015Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs844-SMA-TALK, Anderson Varejao, Chris Bosh, Deep vein thrombosis, Derrick Thomas, DVT, Jerome Kersey, Pulmonary embolism, Serena Williams, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Former NBA star Jerome Kersey of the Portland Trailblazers died last week from a PE.
NBA stars Chris Bosh of the Miami Heat and Mirza Teletovic of the Brooklyn Nets were diagnosed with pulmonary emboli and will miss the rest of the season.
Former NFL star of the Kansas City Chiefs Derrick Thomas died from a PE in 1989.

Tennis superstar Serena Williams lost a year of her prime (and nearly her life) from a PE in 2010.
Cleveland Cavaliers center Anderson Varejao suffered a similar health scare during the 2012-13 season.

Driving or flying long distances. Athletes scan the globe competing. Any activity requiring you to be inactive for greater than four hourly increases the risk of developing a DVT. That risk increases the longer one remains inactive.
Dehydration. The advent of sports and rehydration drinks has reduced this risk, but one should appreciate that with the amount of perspiration occurring during athletic events, the risk of dehydration is present. Dehydration can directly lead to increasing the thickness of blood, which makes the development of clots more likely.
Hormones. Those taking birth control pills that contain estrogen have an increased risk of DVTs and PEs.
Immobilization: Any injury, cast or brace that results in immobility will allow your blood to pool and increase your risk of a DVT or PE.
Injuries. Any injury to a vein or a severe muscle injury can increase the risk for developing DVT.
Surgeries: Surgeries combine a few independent risks for DVTs, such as immobilization, the risks of dehydration and injuries to vein.

Straight, No Chaser: Pulmonary Embolus (A Blood Clot in the Lungs)

February 24, 2015Cardiology/Heart, Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs, Health Prevention844-SMA-TALK, Deep vein thrombosis, DVT, hygiene, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Permanent damage to the lung
Damage to other organs in your body from not getting enough oxygen
Death

If you do have symptoms of a PE, they can include the following: shortness of breath, chest pain or coughing up blood; these symptoms may appear suddenly and severely. Symptoms of a DVT/blood clot (e.g. in your legs) include warmth, swelling, pain, tenderness and redness.
The goal of treatment is to break up the clots and to prevent other clots from forming – this is not the same as dissolving the clots, which is a very aggressive and risky step only taken in certain specific, immediately life-threatening situations. The good news is that a prompt diagnosis and proper treatment can save lives and help prevent the complications of PE. Unfortunately, such success is not guaranteed once a PE develops.
The next Straight, No Chaser will look at the unique risks athletes have that place them at risk for blood clots and PEs.
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.
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Straight, No Chaser: Blood Clots in Your Legs – Deep Venous Thrombosis (DVT)

February 23, 2015Cardiology/Heart, Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs844-SMA-TALK, Deep vein thrombosis, DVT, hygiene, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you’re a sports fan, you’re likely aware of the death last week of a 52 year old former star of the NBA’s Portland Trailblazers, Jerome Kersey, followed two days after by the discovery of the same condition in a current star of the NBA’s Miami Heat, Chris Bosh. You may also recall tennis superstar Serena Williams’ career was once placed on hold for a year. The condition from which they all suffered was pulmonary embolus (blood clots in the lungs). Straight, No Chaser will discuss those in the next two posts, but today we will address the condition that most often precedes the development of clots in the lungs.

A blood clot represents a blockage of a blood vessel somewhere in the body, usually the lower extremities (legs and thighs), the lungs (pulmonary embolus) or the brain (a stroke). Today we’ll discuss the variety that occurs in the lower extremities, which are generally referred to as deep venous thrombosis (DVTs). In case you’re thinking that a clot in the leg doesn’t sound as bad as a clot in the lungs or the head, you’re correct – until you understand that DVTs break off and travel to other body sites, leading to blockage elsewhere (This is called embolism.).
Today’s challenges are to appreciate the risks of developing DVTs and the symptoms. Risk factors include the following:

Birth control pills or other estrogen use (this combined with cigarette smoking pushes the risk even higher)
Cancer
Cigarette smoking
Family history of blood clots
Obesity
Prolonged immobilization
Recent pelvic or leg fracture
Recent surgery (most often the pelvis or lower extremities)
Recent travel involving long periods of sitting
Certain medical conditions, most notably lupus

Symptoms most commonly are in one leg or the other and reflect the fact that the vein is being blocked. These include pain, swelling, redness and warmth. The above picture is not typical. The presentation is usually much more subtle.
Diagnosis and treatment are relatively straightforward as long as they occur in time (meaning before the clots have broken off). Diagnosis is usually accomplished by an ultrasound of the lower extremities; once discovered, you’ll be placed on blood thinners. It’s important to know that blood thinners prevent the formation of new clots. They do not dissolve existing clots. That’s usually not necessary, as many DVTs simply dissolve. If it doesn’t, DVTs that embolize are life-threatening (more so from the pelvis and thigh than the legs). Unfortunately pulmonary emboli are among the most missed medical diagnoses and causes of death.
Try to manage your controllable risk factors, and be aware when you’re dealing with a risk factor that you can’t control (like surgery).
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: Spotlight on Health Concerns When Traveling – Vaccines and Illnesses

February 16, 2014General Health and Wellness, Health Prevention844-SMA-TALK, Chronic obstructive pulmonary disease, Deep vein thrombosis, health, Limited liability company, Lung, Pulmonary embolism, Sterling Medical Advice, Sterling Medical Wellness, SterlingMedicalAdvice.com, Straight No Chaser, ThrombusJeffrey Sterling, MD

Traveling is exciting, but it presents multiple challenges to your health. To best meet these challenges, preparation is everything.

Before you travel and every time you travel, your surest means of protecting yourself is to confirm you are current on routine vaccines.

Your basic vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine and influenza.
Most international travelers will need immunizations to protect you from hepatitis A, polio, and typhoid.
Depending on where you’re international travels take you and the duration of your trip, you may need immunizations to protect you from hepatitis B, malaria, rabies and/or yellow fever.

The plane trip itself can be hazardous to your health. I encourage you to review the risks of flying.

HIV/AIDS
Malaria: an infectious disease caused by a parasite, which invades the blood cells. It is notable for the presence of high fever, shaking chills, low blood count and a flu-like set of symptoms.
Pandemic/avian flu (aka as the bird flu): an infectious disease in birds caused by a virus that can spread to humans
Travelers’ diarrhea – the most common disease acquired by travelers.
Tuberculosis: an infectious disease involving the lungs, able to spread throughout the body

I strongly recommend that you develop a habit of checking the CDC travel site every time you prepare to travel internationally, including those of you coming from abroad into the United States. Detailed information on these diseases is available clicking the links, checking the search engine and at www.sterlingmedicaladvice.com.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
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.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Medical Issues You Encounter While Flying

February 15, 2014General Health and Wellness844-SMA-TALK, Chronic obstructive pulmonary disease, Deep vein thrombosis, health, Limited liability company, Lung, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, ThrombusJeffrey Sterling, MD

I’ve probably been engaged twenty times on airplanes to provide medical assistance. My favorite incident was when four doctors (and a nurse) simultaneously jumped to assistance as if everyone was some type of superhero. Of course, I wouldn’t be telling the story if I didn’t end up being the last man standing (due to my status as the emergency physician among the group – and yes, the patient was ok). Consider this your handy to do and to don’t if and when you’re traveling by air. You never know!
There are four quick considerations I’d like to share:
Blood clots: Flights (and especially the long ones) increase your risk for deep venous thrombosis (DVTs). You can reduce this risk by frequently bending and rotating your ankles, drinking water whenever the opportunity presents and getting up intermittently to walk. Prevention is also important – this is why traveling while in the latter stages of pregnancy is especially problematic and why near-term women aren’t allowed to travel (and you thought it only had to do with early deliveries!).
Headaches and earaches: Air in your body (lungs, intestines, sinuses and eardrums, to name a few) expand when your plane ascends and contracts upon descent. The squeeze on descent is actually more frequent of an issue than gases expanding on ascent, but both situations present problems. In addition to exacerbating migraines, your eardrums can rupture from the squeeze. Of course, adults address this by holding their noses and blowing, thus ‘popping’ their ears (actually this equalizes the pressure on both sides of the eardrum, returning things back to normal). Kids suffer just as much as adults, but the younger ones aren’t able to release the pressure as easily. Thus, it’s true that you should allow them to chew or suck on something during descent. The passenger sitting next to you will thank you.
Fainting: Fainting is a common occurrence on flights for many reasons. Faints and other mental status changes due to hypoglycemia are the most common episodes I’ve personally encountered on flights. My best advice here is to stay hydrated (This will help you prevent faints and problems with DVTs.) and if you’re diabetic, eat during the flight. Low sugar reactions are scary in the air, and the pilots are always wondering if they’ll need to do an emergency landing.
Respiratory disease: This is an important consideration because the potential for bad outcomes are heightened. Those with asthma, blood clots in the lungs (pulmonary emboli) and COPD (chronic obstructive pulmonary disease aka chronic bronchitis and emphysema) need to discuss traveling with their physicians. The high altitude of flights results in thinner air, drier air and increasing viscosity of your blood, which can affect patients suffering from the conditions mentioned. A ruptured lung in a patient with bad COPD is a formula for disaster.
In short, fly smart and fly healthy. An airplane is a horrible place to be in harm’s way. And that doesn’t even include snakes on a plane.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Medical Issues You Encounter While Flying

September 20, 2013General Health and Wellness, Health PreventionChronic obstructive pulmonary disease, Deep vein thrombosis, health, Limited liability company, Lung, Pulmonary embolism, Thrombus, WordPressJeffrey Sterling, MD

I’ve probably been engaged twenty times on airplanes to provide medical assistance. My favorite incident was when four doctors (and a nurse) simultaneously jumped to assistance as if everyone was some type of superhero. Of course, I wouldn’t be telling the story if I didn’t end up being the last man standing (due to my status as the emergency physician among the group – and yes, the patient was ok). Consider this your handy to do and to don’t if and when you’re traveling by air. You never know!
There are four quick considerations I’d like to share:
Blood clots: Flights (and especially the long ones) increase your risk for deep venous thrombosis (DVTs – discussed in detail here). You can reduce this risk by frequently bending and rotating your ankles, drinking water whenever the opportunity presents and getting up intermittently to walk. Prevention is also important – this is why traveling while in the latter stages of pregnancy is especially problematic and why near-term women aren’t allowed to travel (and you thought it only had to do with early deliveries!).
Headaches and earaches: Air in your body (lungs, intestines, sinuses and eardrums, to name a few) expand when your plane ascends and contracts upon descent. The squeeze on descent is actually more frequent of an issue than gases expanding on ascent, but both situations present problems. In addition to exacerbating migraines, your eardrums can rupture from the squeeze. Of course, adults address this by holding their noses and blowing, thus ‘popping’ their ears (actually this equalizes the pressure on both sides of the eardrum, returning things back to normal). Kids suffer just as much as adults, but the younger ones aren’t able to release the pressure as easily. Thus, it’s true that you should allow them to chew or suck on something during descent. The passenger sitting next to you will thank you.
Fainting: Fainting is a common occurrence on flights for many reasons. Faints and other mental status changes due to hypoglycemia are the most common episodes I’ve personally encountered on flights. My best advice here is to stay hydrated (This will help you prevent faints and problems with DVTs.) and if you’re diabetic, eat during the flight. Low sugar reactions are scary in the air, and the pilots are always wondering if they’ll need to do an emergency landing.
Respiratory disease: This is an important consideration because the potential for bad outcomes are heightened. Those with asthma, blood clots in the lungs (pulmonary emboli) and COPD (chronic obstructive pulmonary disease aka chronic bronchitis and emphysema) need to discuss traveling with their physicians. The high altitude of flights results in thinner air, drier air and increasing viscosity of your blood, which can affect patients suffering from the conditions mentioned. A ruptured lung in a patient with bad COPD is a formula for disaster.
In short, fly smart and fly healthy. An airplane is a horrible place to be in harm’s way. And that doesn’t even include snakes on a plane.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Blood Clots in Your Legs – Deep Venous Thrombosis (DVT)

September 18, 2013Hematology & Oncology/Blood Disorders/Cancer, Medical Treatment, Musculoskeletal SystemBlood, Cardiovascular Disorders, Conditions and Diseases, Deep vein thrombosis, health, Pulmonary embolism, Thrombus, Vascular DisordersJeffrey Sterling, MD

When patients talk about blood clots, they’re describing a blockage of a blood vessel somewhere in the body, usually the lower extremities (legs and thighs), the lungs (pulmonary embolus) or the brain. Today we’ll discuss the variety that occurs in the lower extremities, which are generally referred to as deep venous thrombosis (DVTs). In case you’re thinking that a clot in the leg doesn’t sound as bad as a clot in the lungs or the head, you’re correct – until you understand that DVTs break off and travel to other body sites, leading to blockage elsewhere (This is called embolism.).
Your challenge is to appreciate the risks of developing DVTs and the symptoms. Risk factors include the following:

Birth control pills or other estrogen use (this combined with cigarette smoking pushes the risk even higher)
Cancer
Cigarette smoking
Family history of blood clots
Obesity
Prolonged immobilization
Recent pelvic or leg fracture
Recent surgery (most often the pelvis or lower extremities)
Recent travel involving long periods of sitting
Certain medical conditions, most notably lupus

Symptoms most commonly are in one leg or the other, and reflect the fact that the vein is being blocked. These include pain, swelling, redness and warmth.
Diagnosis and treatment are relatively straightforward as long as they occur in time (meaning before the clots have broken off). Diagnosis is usually accomplished by an ultrasound of the lower extremities; once discovered, you’ll be placed on blood thinners. It’s important to know that blood thinners prevent the formation of new clots. They do not dissolve existing clots. That’s usually not necessary, as many DVTs simply dissolve. If it doesn’t, DVTs that embolize are life-threatening (more so from the pelvis and thigh than the legs). Unfortunately pulmonary emboli are among the most missed medical diagnoses and causes of death. Try to manage your controllable risk factors, and be aware when you’re dealing with a risk factor that you can’t control (like surgery).
I welcome any questions or comments.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress