Tag Archives: Disorders

Straight, No Chaser: The Holiday Heart Syndrome

December 15, 2014Toxicology/Drugs, Cardiology/HeartStraight No Chaser, SterlingMedicalAdvice.com, Sterling Medical Advice, Mental disorder, Holiday Heart Syndrome, health, Disorders, Atrial fibrillation, 844-SMA-TALKJeffrey Sterling, MD

There’s something about the holiday season and flickering. We’re all aware that Christmas lights are meant to do so, but did you know that your heart is more inclined to flicker and flutter this time of year (sorry, but I’m not talking about mistletoe)? In a previous Straight, No Chaser, we discussed a mental consideration concerning the holiday season: the increased rate and risks of depression, known as The Holiday Blues. Unfortunately, health issues associated with the holidays don’t stop there. There are defined physical risks associated with the holidays as well. The disturbing aspect of today’s topic is you’re not immune to this even if you’re otherwise healthy.

Holiday heart syndrome is a real condition and has been described as such since the 1970s. It’s the result of eating and drinking alcohol too much (with or without excessive caffeine intake and a lack of sleep), which is exactly what we’re inclined to do this time of year. The combination of these indulgences places an undue level of strain on the heart, which causes the heart to develop an abnormal rhythm, most commonly atrial fibrillation. Interestingly, certain foods, alcohol and caffeine all have direct effects on the heart, and indirectly they can also affect the heart through increase of certain hormones (such as epinephrine) that stimulate the heart.
Curiously, holiday heart syndrome is notable for its occurrence in those without existent heart disease but can be especially concerning in uncovering existing disease or exacerbating disease in those having it. For example, someone with underlying cardiovascular disease featuring microclots can have such clots dislodge during an episode of atrial fibrillation, causing a stroke.
Fortunately, by far the common course of holiday heart syndrome is benign. The abnormal heart rates will slowly resolve as the levels and effects of alcohol and/or other substances decline. That said, the risk is such that you don’t just want to sleep off an occurrence.
The symptoms you’d have are pretty obvious, given that you’d have been eating and drinking to excess. You’d also note that your heart was racing and perhaps pounding, as if it was attempting to jump out of your chest. Heart rates in the 120s are pretty typical for holiday heart syndrome (a normal heart rate is between 70-100 beats per minute). This tidbit is important to know; if your heart rate is higher than this, something more serious could be occurring. Under either circumstance, you need to be evaluated and treated in the emergency room setting with hydration and observation of the heart rhythm and rate.

The lessons here are pretty straightforward:

Holiday heart syndrome suggests that indulgences that occur during the holidays can cause symptoms. By no means does it suggest that these symptoms are restricted to the holidays. Overindulgence in food and drink can cause abnormal heart rhythms at any time, including weekends, spring break, birthday or other celebrations, as well as holidays.
You’d be particularly interested in knowing that the combination of vodka and the energy drink Red Bull have been shown to make these symptoms more likely to occur.

Following alcohol-related abnormal heart rhythms, it is advisable for patients to avoid significant exertion because the excessive stimulation that raises epinephrine levels can precipitate recurrent and possibly more serious episodes. Most patients without underlying heart disease should be able to gradually resume full physical activity over the next few days. Once everything is back to normal, most patients do not require further therapy if they refrain from alcohol use. Patients with underlying heart disease, heart disease that’s discovered during evaluation, or those with severe symptoms on presentation (e.g., blackouts or simultaneous low blood pressure) may be candidates to receive certain heart medications.

At the end of the day, Holiday Heart Syndrome is yet another example of the virtue of enjoying life in moderation. Failure to do so can turn the holidays into the most dangerous time of the year. Cheers!
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. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Tips to Deal with Depression and The Holiday Blues

December 12, 2014Mental HealthSterlingMedicalAdvice.com, Straight No Chaser, Sterling Medical Advice, Mental health professional, Mental disorder, Major depressive disorder, health, Disorders, Depression, 844-SMA-TALKJeffrey Sterling, MD

I don’t mean to bring anyone down during what is supposed to be the ‘most wonderful time of the year’, but in reality there are many people hurting. For some, life’s tragedies happen this time of year the same as they might any other time. For others, this may have already happened, and this time of year is a permanent reminder of an unfortunate experience. For others still who struggle with depression, anxiety and mental illness all year, the holiday season can exacerbate these feelings and may make holidays especially long, depressing and potentially dangerous times.
Today’s Straight, No Chaser is not meant to drag you into the dumps but to empower you with tips to assist you in the event this is a difficult time for you. By the way, I’m extremely thankful that you’ve chosen to give me moments of your day and life. I take that gift seriously and hope you continue to find it a worthwhile use of your time.

Here’s five tips for your holiday mental health:

Remove yourself from stressful environments and avoid situations you know will create conflict, mental duress and/or danger. I can not emphasize this enough. If you put yourself in a bad situation, you can not be surprised when bad things happen.’
Find support. Specifically, have ‘go-to’ friends and family that provide you comforting support. There’s a time and place for tough love, but in the midst of depression or suicidal ideation, ‘buck up’ is not good advice. Know where your support lies and be sure (in advance) that it will be accessible if you need it.
Find success and happiness where it is. During the holidays, people tend to lament what isn’t. That’s not a formula for success. Yes, all of your family may not be around, but celebrating happy memories with the ones you can often fills the room with the joyous presence of loved ones not around. Enjoy the pleasures and successes you do have access to, whether big or small. Focusing on the positive keep you positive.
If you’re struggling, admit it. You already know you’re hurting. Often the first step to getting past it is acknowledging it. Once done, then you can put coping mechanisms in place to address your feelings.
Avoid holiday activities that will create post-holiday angst. This applies to eating, drinking, shopping and personal interactions. Some use the holiday as an excuse to overindulge as if the consequences won’t be there afterwards. Reread #1 above.

Know when you need professional help. If your support system doesn’t sufficiently address your needs, and you’re feeling severely depressed, can’t function or are suicidal or homicidal, find a physician or mental health professional ASAP. Of course, you can always contact your SterlingMedicalAdvice.com expert. If you type mental health, depression or other keywords into the search bar above, you can access many other Straight, No Chaser blogs on behavioral health concerns that may provide you the support you need. I wish you all the best today and throughout the year, and hopefully the picture above will reflect the only type of blues you’ll have to deal with this year.
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. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: The Holiday Blues – Tips to Deal with Depression and Stress This Time of Year

November 28, 2013Mental HealthSterling Medical Advice, mental-health, Mental health professional, Mental disorder, Major depressive disorder, health, Disorders, Depression, SterlingMedicalAdvice.com, Suicidal ideation, Straight No ChaserJeffrey Sterling, MD

I don’t mean to bring anyone down during what is supposed to be the ‘most wonderful time of the year’, but in reality there are many people hurting. For some, life’s tragedies happen this time of year the same as they might any other time. For others, this may have already happened, and this time of year is a permanent reminder of an unfortunate experience. For others still who struggle with depression, anxiety and mental illness all year, the holiday season can exacerbate these feelings and may make holidays especially long, depressing and potentially dangerous times.
My goal today is not to drag you into the dumps but to empower you with tips to assist you in the event this is a difficult time for you. By the way, I’m extremely thankful that you’ve chosen to give me moments of your day and life. I take that gift seriously and hope you continue to find it a worthwhile use of your time.
Here’s five tips for your holiday mental health:

Remove yourself from stressful environments and avoid situations you know will create conflict, mental duress and/or danger. I can not emphasize this enough. If you put yourself in a bad situation, you can not be surprised when bad things happen.’
Find support. Specifically, have ‘go-to’ friends and family that provide you comforting support. There’s a time and place for tough love, but in the midst of depression or suicidal ideation, ‘buck up’ is not good advice. Know where your support lies and be sure (in advance) that it will be accessible if you need it.
Find success and happiness where it is. During the holidays, people tend to lament what isn’t. That’s not a formula for success. Yes, all of your family may not be around, but celebrating happy memories with the ones you can often fills the room with the joyous presence of loved ones not around. Enjoy the pleasures and successes you do have access to, whether big or small. Focusing on the positive keep you positive.
If you’re struggling, admit it. You already know you’re hurting. Often the first step to getting past it is acknowledging it. Once done, then you can put coping mechanisms in place to address your feelings.
Avoid holiday activities that will create post-holiday angst. This applies to eating, drinking, shopping and personal interactions. Some use the holiday as an excuse to overindulge as if the consequences won’t be there afterwards. Reread #1 above.

Know when you need professional help. If your support system doesn’t sufficiently address your needs, and you’re feeling severely depressed, can’t function or are suicidal or homicidal, find a physician or mental health professional ASAP. Of course, you can always contact your SterlingMedicalAdvice.com expert. If you type mental health, depression or other keywords into the search bar above, you can access many other Straight, No Chaser blogs on behavioral health concerns that may provide you the support you need. I wish you all the best today and throughout the year, and hopefully the picture below will reflect the only type of blues you’ll have to deal with this year.
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. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: When Eating Goes Wrong, Part I – Anorexia

November 26, 2013Mental Healthmental-health, Straight No Chaser, SterlingMedicalAdvice.com, Sterling Medical Advice, health, Eating disorder, Eating, Disorders, Disease, Diet, Anorexia nervosaJeffrey Sterling, MD

Our society doesn’t do the job it should in promoting a normal image of health. The typically promoted American ideal of beauty sets standards that lead many to pursue unrealistic means of meeting that ideal. In the setting of an actual American population that is obese by medical standards, this becomes even more of a problem, as individuals give up on realistic goals and settle into unhealthy eating habits that lead to disease due to obesity.
Most people are aware of two eating disorders–on the low side (obesity is another conversation): anorexia and bulimia. It is important to note that eating disorders are real medical and mental diseases. It is equally important to understand that they can be treated. It is vitally important to understand that when left untreated these disorders lead to a much higher incidence of death than in those without these conditions. These diseases cause severe disturbances in one’s diet, so much so that individuals spiral out of control toward severe disease and death in many instances. Sufferers of eating disorders often have a distorted self-image and ongoing concerns about weight and appearance. (This is as true for those pathologically overweight and in denial as it is for those pathologically underweight.)
Today, I’ll discuss anorexia. Anorexia nervosa is an eating disorder with nearly a 20 times greater likelihood of death that those in the general population of a similar age. Why, you ask? Simply put, they’re suffering the consequences of starving themselves. Anorexics have a maniacal and relentless pursuit of thinness, even in the face of being extremely thin. They couple an unwillingness to maintain a healthy weight with an intense fear of gaining weight. They possess a distorted view of their bodies and severely restrict their eating in response. They are obsessed.
Other symptoms and habits of anorexics include a lack of menstruation (among females, though men suffer from anorexia, too), binge-eating followed by extreme dieting and excessive exercise, misuse of diuretics, laxatives, enema and diet medications. The medical manifestations of anorexia are serious and can include osteoporosis or osteopenia (bone thinning), anemia, brittle hair and nails, dry skin, infertility, chronically low blood pressure, lethargy and fatigue, and heart and brain damage. It’s worth noting again that people die from anorexia. It is to be taken seriously.
The key components of treating eating disorders in general are stopping the behavior, reducing excessive exercise and maintaining or establishing adequate nutrition. The pursuit of adequate nutrition is vital enough that when patients develop dehydration and chemical imbalances (i.e., electrolyte abnormalities), they need hospitalization to correct deficiencies.
Specific management of anorexia involves addressing the psychological issues related to the eating disorder, obtaining a healthy weight, and consuming sufficient nutrition. This may involve various forms of behavioral therapy and medication. Regarding medication use, although some (such as antipsychotics or antidepressants) have been effective in addressing issues related to anorexia such as depression and anxiety, no medication has been proven effective in reversing weight loss and promoting weight gain back to a healthy/normal level. Similarly, behavioral therapy has been shown to assist in addressing the roots causes of anorexia but insufficient in addressing the medical issues that the disease contributed to or caused. Ultimately, it appears that a combination of medications, other medical interventions and behavioral therapy is the most effective course. As is the case with most illnesses, the earlier treatment is initiated, the better the outcome tends to be.
Please maintain a sufficient sensitivity toward those with anorexia. It’s a life-threatening condition, not the punch line of a joke about someone’s appearance.
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“What should I look for as an indicator of poor mental health in children?”

October 16, 2013Health Prevention, Pediatrics/Kids Health, Mental HealthThere are 72 Hours in a Day, Symptom, Straight No Chaser, SterlingMedicalAdvice.com, Sterling Medical Advice, SMA, mental-health, Mental health professional, health, Disorders, Behind the Curtain, 844-SMA-TALKJeffrey Sterling, MD

Introduction

Today’s questions related to mental health in children.

“What should I look for in my child as an indicator of mental health issues?”

Today’s question is simple. The answer certainly is not. Be aware of changes in your child’s emotional, behavioral, and/or mental functioning. Remember that children often express sadness and feelings of depression in the form of anger, through outbursts, tantrums, etc. If the symptoms persist for more than a month, seek evaluation from your child’s doctor or a mental health professional. Sooner is better than later.

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Straight, No Chaser: Depression Quick Tips – How to Avoid It, When to Get Help

August 20, 2013Health Prevention, Medical TreatmentAddictions, Support Groups, Suicide, Recreational drug use, Mood, mental-health, Major depressive disorder, health, Disorders, Depression, Articles and ResearchJeffrey Sterling, MD

As a physician, I’m not willing to advise you on how to ‘care’ for yourself at home if you’re clinically depressed. I can discuss how to avoid depression (to the extent possible) and what warning signs should prompt emergent access to care. If you’re good at accomplishing the items listed below, you have less of a chance of being unhappy and clinically depressed.

Avoid alcohol and other mood-altering drugs.
Eat healthily.
Exercise regularly.
Get enough sleep.
Remove yourself from negativity, including your choices in friends, mates and work environments.
Surround yourself with positivity, including your choices in friends, mates and work environments (Please note this is a different consideration than the previous bullet point.).
Learn how to relax and where to go to relax (These considerations include such things as yoga, meditation and your religion/spirituality, not the business end of a bottle or drug use.).

Look out for these potential warning signs for suicide: Remember that approximately 30% of suicides are preceded by the individual declaring intent. Be alert for the following additional considerations:

Increasing levels of depression, withdrawal, reckless behavior, alcohol and other drug use, and/or desperation.
Notice activity that could be a prelude to a suicide attempt, such as obtaining knives, firearms or large quantities of medication.
Changing one’s will and settling one’s life affairs in the midst of depression
Ongoing comments about lack of worth and desire to end it all.

The following considerations should prompt an immediate visit to an emergency room or other treatment facility.

You have a compelling, overwhelming feeling that you want to hurt yourself, with or without an actual plan.
You have a compelling, overwhelming feeling that you want to hurt someone else, with or without an actual plan.
You hear voices or see things or people who are not there.
You find yourself crying often and uncontrollably for no apparent cause.
Your depression has affected your activities of daily living (work, school, consistent forms of recreation or family life) for longer than 2 weeks.
You think your current medications are affecting you abnormally and are possibly contributing to making you feel depressed.
You have been told or believe that you should cut back on drinking or other drug use.

I wish you and your loved ones all the best in avoiding and/or dealing with this disastrous condition. I welcome any comments, thoughts or questions.

Straight, No Chaser: Are You Depressed and/or Suicidal?

August 20, 2013Health Prevention, Mental HealthToni Braxton, Suicide, Mood, mental-health, Major depressive disorder, health, Disorders, DepressionJeffrey Sterling, MD

I have a strong distaste for do-it-yourself websites that want to ‘screen’ you for depression. Folks, if you’re wondering whether you’re clinically depressed, you don’t need validation from some makeshift online questionnaire. That said, if you’d like to learn something, go ahead and find one. More importantly, seek assistance immediately from a qualified counselor or therapist. They do wonderful work and can get through to you before you get to yourself. Instead of a quiz, I will simply give you common signs and symptoms consistent with the diagnosis. Note the progression in the symptoms. The bottom line is: odds are, you already know if you need help. Yes, there are different depression syndromes; I’m not getting into that. You and a psychiatrist or therapist can sort that out. Don’t be reassured by a quiz when you already know better.
You may be depressed if…

You feel sad, hopeless, empty, or numb to the point where you wallow in these emotions, and they dominate your existence.
You have a loss of interest in your normal activities of daily living. It’s not just that you don’t enjoy things. You don’t even want to be bothered with them. You don’t want sex. You don’t enjoy your friends. You don’t want recreation. You can’t eat. You can’t sleep, or you can’t stop sleeping. You can’t breathe (because of your crippling anxiety). You might actually be depressed if you have these symptoms and didn’t get the ideas from listening to the lyrics of a Toni Braxton song.
You find yourself exceedingly irritable and/or anxious. These feelings are explosive and over the top. You’re waiting, ready and looking for a reason to embrace gloom, doom or anger.
You have difficulty moving forward and making decisions. This occurs for many reasons. Your attention may be shot. Your interests aren’t there. You’re overwhelmed. Stuck in a rut is not only where you are, it’s where you want to be.
You feel worthless and blame yourself for any and everything. Again, these feelings are explosive, dramatic and over the top.
You have thoughts of death and suicide. This is where things get beyond scary. You may simply have a passive wishing that things would end and a belief that your friends, family and the rest of the world would be ‘better off’ without you. You may have fleeting voices that aren’t your own suggesting or commanding suicide as an option. You may see visions of people telling you to harm yourself. You may have an active plan. When depression gets to this point, nothing good is going to happen without intervention. Never allow someone to make such comments and then pretend as if they were insincere.

Now consider these most common precipitants for suicide:

Problems with one’s intimate partner
Problems with one’s physical health
Problems with one’s job
Problems with one’s finances

You will have a lot better chance getting someone help at a warning stage than preventing someone from doing something once they have a weapon in their hands. Approximately 30% of suicides result after the individual has expressed an intent to do so. Listen up… Take the signs of depression and any expressed thoughts of suicide seriously.
I welcome your comments, thoughts or questions.

Straight, No Chaser: Suicide Data – Understand the Threat

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

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.

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