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Straight, No Chaser: The Affordable Care Act and The Math of the US Healthcare System

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As we begin 2014 with the implementation of the Affordable Care Act and states’ implementation of Medicaid expansion (well in most of the country), it bears reviewing why this was necessary. Joining me in this conversation is Dr. Bill Vostinak, a prominent orthopedist.
Prior to approval of the Affordable Care Act, and in spite of the loud and incorrect proclamations that we have the “best healthcare system in the world,” the U.S. would have been easily challenged on its purported effectiveness of our healthcare system based on a simple review of the following objective data points. (Our apologies in advance to those who value opinions over facts—or math.)

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Let’s start by appreciating just how much the U.S. has been spending on our healthcare system and what type of access Americans have had to it.
The U.S., by a large margin, has the highest healthcare expenditures in the world. We spend approximately 17% ($1 in every $6) of our gross domestic product (GDP) on healthcare. The next closest nation spends 11%. (For clarification, that’s an incremental increase from the above chart of 2000.)
Despite our exorbitant national costs, only 84.9% of U.S. citizens have healthcare insurance. That translates to 50 million Americans who were uninsured prior to today. We rank 33rd in the world.
Have you ever heard the quote that “85% of Americans are happy with their healthcare?”  (Congratulations if that statement applies to you.) Do you realize that in a nation of over 320 million, that leaves 48 million Americans unhappy? Even if you got past the “48,000,000″ number, which is a massive number of citizens, consider the 85% number.
This is America. 85% is barely a B-grade in school. Is that the standard we seek? And … do the math. Notice the nearly exact match, likely not coincidental, between the number of individuals dissatisfied with their healthcare and the number of uninsured Americans. Basically, you’re satisfied if you have insurance, and if you don’t … not so much. Alternatively, 85% satisfaction may be based on the perception of insurance carrying the individual’s burden of medical costs.
Now let’s move to quality.
In an infamous ranking of healthcare systems around the world, the World Health Organization (WHO) ranked the U.S. system 38th based on routine outcomes-based metrics such as disability-adjusted life expectancy, speed of service, protection of privacy, quality of amenities, and fairness of financial contribution. WHO Ranking
Amid predictable criticism of the U.S. regarding the WHO study, Bloomberg performed its own analysis  and discovered that among advanced economies, the U.S. spends the most on healthcare (on a relative cost basis) with the worst outcome. Bloomberg ranked the U.S. 46th among all nations in efficiency given the average expenditure of $8,608 per year per individual. Bloomberg Report
In terms of infant mortality, about 11,300 newborns die each year within 24 hours of their birth in the U.S., with 50 percent more first-day deaths than all other industrialized countries combined. Infant Mortality
Save the Children’s 14th annual “State of the World’s Mothers” report ranked the U.S. 30th out of 168 countries in terms of best places to be a mother. Criteria included child mortality, maternal mortality, economic status of women, educational achievement and political representation of women. SaveTheChildren.org
An important distinguishing factor in comparing U.S. healthcare with other systems is tying it to employment rather than citizenship. Labor and other costs of American goods and services make it difficult for American corporation to compete in world markets. Add the large fixed cost of healthcare, and competing is nearly impossible.
It is reprehensible to suggest that the effort to cover 50 million uninsured Americans is some socialist plot or anything other than the humane thing to do. Let’s just stop with the selfishness and nonsense about there being no value to the efforts being made to improve access to/quality of healthcare (which reintroduces preventive and mental healthcare considerations) than we had previously. If you don’t believe us, just do the math. Even after a full implementation of the ACA, estimates suggest than some 20 million Americans will still be uninsured.
America is alone among the major industrial nations of the world in not having universal healthcare. That’s the collective decision of the country. Hopefully, these most recent steps through the ACA will represent significant steps toward efficiency, effectiveness and full inclusion. So, how do other countries deliver quality care for less? We’ll save that for another discussion.
Feel free to ask your SMA expert consultant if you have any questions on this topic.
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Straight, No Chaser: When Good Drugs Do Bad—Drug Interactions

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“Be sure to let your doctor know if you grow a third foot.”
Ok, well maybe that is about the only side effect you haven’t heard at the end of one of those commercials that seem to spend half of its time describing the side effects. If you pay attention to a pharmaceutical commercial, though, you’ll appreciate that even though medicines do a world of good, sometimes they cause significant problems. Those problems can become sped up or magnified by the effects of taking several drugs at a time. Alternatively, combinations of medications may make one or more of the drugs less effective. Regarding the medicines you’re taking, you should be clear if drug interactions can be minor and insignificant or serious and  life-threatening. Let’s review the various types of drug interactions.
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Drug/drug interactions: Two or more different drugs taken together may interact and cause an unwanted effect or change how the drug acts in the body. Here are some common examples:

  • An individual who already takes a sedative (e.g., sleeping pill) to help combat insomnia develops an exacerbation of their seasonal allergies. To treat the allergies, they decide to take an over-the-counter (OTC) antihistamine (like diphenhydramine, branded as Benadryl). Diphenhydramine also may cause drowsiness, so the combination of the medications may pose a danger to the person, especially if s/he is operating heavy machinery, such as driving a car.
  • Caffeine (which is a drug) in everyday foods—such as coffee and chocolate—also can interact with certain other drugs. In fact, caffeine is known to interact with over 80 different drugs, including about a dozen with which it produces serious effects. These include commonly used medications like aspirin, ciprofloxacin (branded as Cipro), guafenesin (the generic name for your favorite cough medicines) and diazepam (branded as Valium).
  • Nicotine (another drug) in tobacco products can interact with other medications, especially nicotine-replacement products. So if you’re taking medicine to help with your smoking cessation efforts, and you’re still smoking, you’re making the problem worse!

Drug/food interactions: If you’re a fan of grapefruit or chocolate, then it’s likely that your physician has cautioned you on drug/food interactions. These occur when certain foods or beverages interfere with the metabolism of certain medications. In the example of grapefruit, it’s known to interfere with metabolism of medications used to lower cholesterol levels (called statins). This can lead to adverse drug effects and actual liver damage. Other examples are to be found in the many foods (e.g., red wine, aged cheese) that affect the antidepressant class of drugs known as MAO inhibitors.
Drug/condition interactions: You see these all the time. Many different medication instructions warn you not to take them if you have certain medical conditions, as the medications may make the medical condition worse. Prominent examples include over-the-counter cold, cough and flu remedies that advise you not to take if you have heart disease or high blood pressure. Also if you have kidney or liver disease, any medicine that gets metabolized via one of those routes may have difficulty and delays in getting metabolized and excreted, leading to longer than desired activity of the given drug.
Drug/alcohol interactions: This is actually a subcategory of the drug/drug interaction because alcohol is a drug. It deserves special mention because drinking alcohol while taking certain medications can cause adverse effects related to the additive effects of alcohol and various drugs. Any medication involving the central nervous system or one’s mental state would likely be worsened by alcohol.
The best way to guard against these concerns is to discuss any new medications with your physician or pharmacist prior to taking them. Be smart about medicines you’re putting in your body and don’t be cavalier about them; the wrong combinations can turn a medicine into a toxin.
One final note: don’t be lulled into complacency by herbal preparations as some form of replacement. Herbals are still medicines and work via the same active ingredient as the pharmaceutical drug they’re replacing. As such, they are subject to cause the same types of problems listed above. Even more concerning is that as a class, comparatively less research has been done on herbals. Therefore, the full extent of side effects and drug interactions is not defined. Not knowing the full extend of an herbal medicine’s side effect profile isn’t the same as saying the herbal doesn’t have side effects, and you shouldn’t interpret things that way.
Feel free to contact your SMA expert consultant for any questions you may 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. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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Straight, No Chaser: The Inevitable Disease (Assuming You Live Long Enough)

 osteoarthritisOA

Actually, humans have a few different “inevitable” diseases, but today we’re discussing arthritis, specifically degenerative joint disease (osteoarthritis). For this conversation, the inevitability of arthritis is based in the gradual wear and tear on your joints. It seems our design includes an expiration date on our joints. By now, you’re likely wondering why. The answer is in the definition.
Arthritis is inflammation of one or more of your joints.

  • Inflammation is a process of some form of attack to an area, producing symptoms that usually include redness, swelling, warmth and pain.
  • A joint is the area where two bones meet.

It stands to reason that when regular use becomes wear and tear, ongoing inflammation ensues, the structure of your bones and joints changes and function decreases. This is why you see decreased movement and deformities in the involved joints of arthritics.
What I just described was a reasonable description of osteoarthritis, the most common form of arthritis, but in fact there are over 100 different types of arthritis. Given its importance in helping you understand and treat yourself and/or your loved one with arthritis, let’s review the common and distinguishing mechanisms.
cartilage
Arthritis involves the breakdown of cartilage, which is the tissue coating the ends of two bones at a joint. Its purpose is to keep the bones in place and moving smoothly. When cartilage is damaged, the bones rub together. This damage results in pain, swelling, stiffness, warmth and redness—inflammation.
The causes of this inflammation are broad but typically center on four mechanisms:

  • The aging process itself causes sufficient wear and tear on the body, including bones and cartilage, such that the joints will suffer. This represents the most common form of arthritis: degenerative joint disease, aka osteoarthritis.
  • When you break bones, especially near a joint, the resulting damage and/or insufficient healing will expedite the development of arthritis.
  • When you develop certain infections, they can occur in the bones/joints or target those areas. This also can lead to arthritis.
  • The body’s immune system sometimes mistakenly views certain parts of the body as foreign. When this occurs, it will attack healthy tissue, including bones and cartilage. These conditions are known as autoimmune disorders, and they cause inflammation and can lead to acute and chronic arthritis.

You’ve heard of many different forms of arthritis. If you know anyone with any of the following diseases, they likely have arthritis as part of (if not the predominant feature of) the disease.

  • Ankylosing spondylitis
  • Gonococcal (i.e., due to gonorrhea) arthritis and other arthritis due to other bacterial infections
  • Gout
  • Juvenile rheumatoid arthritis (in children) and rheumatoid arthritis (in adults)
  • Psoriatic arthritis
  • Reactive arthritis (Reiter syndrome)
  • Scleroderma
  • Systemic lupus erythematosus (SLE)

The inflammation and other symptoms usually go away if you can find and treat the cause. If it doesn’t go away, or if it goes untreated, chronic arthritis will develop.
Here are the various conversations you should have with your physicians regarding arthritis:

  • “I have a family history of arthritis. Should I be concerned?”
  • “I have a newly swollen joint but didn’t strain or sprain anything.”
  • “All of a sudden my joint (or joints) have really started hurting.”
  • “My skin in my (knee, elbow or other joint) is very hot and very red.”
  • “I have arthritis, and now I’m having problems moving my joint.”
  • “I have arthritis, and the swelling is much worse.”
  • “I have arthritis, and my pain has lasted more than three days.”
  • “I have arthritis, and I have developed a fever plus my joints are really aching.”
  • “I have arthritis, and I seem to be losing weight.”

This afternoon, I’ll discuss general treatment of arthritis and tips you can use to help yourself or your loved one with arthritis. I welcome any questions or comments you may have on this topic.
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Straight, No Chaser: The Intersection of Health and Happiness, aka Merry Christmas!

 healthhappiness

Today is Christmas, and we want to celebrate the best parts of you! Even better, do that for yourself and allow that to translate into better health. We have previously discussed your bad habits and how they negatively impact your health. Click here for that discussion. The literature on negative energy and health is well documented and robust. In short, avoid negativity and those that bring it to you! That said, we’re following our own advice and going positive today. That’s the other half of the “health and emotions” equation:

STATE OF MIND = STATE OF BODY.

So here we go.

Research from the Harvard School of Public Health (Go, Crimson!) led by Laura Kubzansky, Associate Profession of Society, Human Development and Health, identified personal attributes that actually do translate into better health. Specifically these personality traits have been shown to help avoid or healthfully manage depression, diabetes, heart attacks, strokes and other diseases.
Her landmark 2007 study followed over 6,000 men and women for over 20 years, discovering that a sense of enthusiasm, hopefulness, engagement in life and the ability to face life’s stresses with emotional balance appears to reduce the risk of coronary heart disease. Her studies have also demonstrated that children with a positive outlook and ability to focus on a task at age seven are in better health with fewer illnesses 30 years later. An additional finding of hers is that optimism cuts the risk of coronary heart disease in half.
This isn’t that hard. It just requires a rewiring of some of our outlook on life. Make a change today. Become a more positive person; become a healthier person! Incorporate these mental lifestyle changes and reap the benefits.

  • Emotional vitality: a sense of enthusiasm, hopefulness, engagement
  • Optimism: the perspective that good things will happen and that one’s actions account for the good things that occur in life
  • Supportive networks of family and friends
  • Good “self-regulation,” i.e., bouncing back from stressful challenges and knowing that things will eventually look up again
  • Healthy behaviors such as physical activity and eating well
  • Avoidance of risky behaviors such as unsafe sex, drinking alcohol to excess, and regular overeating

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Speaking of Christmas, the Straight, No Chaser team greatly appreciates your readership, support and feedback. In a matter of a few months, over 3,000 of you both follow us and like us on Facebook. We’ve had readers in over 105 countries around the world. Most of all you’ve helped us successfully launch www.SterlingMedicalAdvice.com (SMA). We’ll continue to give you information to make a difference in your lives. Please continue to share your stories. It is very fulfilling and fascinating to hear how these efforts have made a difference in your lives. Feel free to continue to send us topic requests. We generally find a way to work them into the schedule.

Thank you so much, Merry Christmas, Happy Hanukkah, Happy Kwanzaa, peace and blessings throughout the holiday season.

Feel free to ask your SMA expert consultant if you have any questions on this post.

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

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Straight, No Chaser: Alcohol Abuse and Alcoholism

Signs-That-You-are-Probably-An-Alcoholic

With all the focus of late on other forms of drug use and abuse (e.g., methamphetamine, marijuana), alcohol abuse seems to be lacking the attention it deserves. Fully one in six people in the United States has a drinking problem. In this segment of the Straight, No Chaser series on alcohol, we will explore problem drinking.
For an additional personal look at if you drink too much, click here.
“Problem drinking” is a way of describing alcohol intake that causes problems with your functioning. Alcohol abuse is an episode or continued excessive alcohol consumption that causes problems with your daily living activities, such as family or job responsibilities. Of course, a single episode of alcohol abuse can cost you your life if you’re an impaired driver who runs into a tree or some other calamity befalls you.
Alcoholism is alcohol dependence, which is comprised of two separate considerations:

  • Physical addiction to a drug is defined by tolerance and withdrawal symptoms. Tolerance is when you become acclimated to the same dose of drug, meaning, in this case, the same amount of liquor no longer gives you the same buzz. Withdrawal symptoms occur when you experience effects from no longer having the drug in your system.
  • Mental addiction to alcohol is illustrated by its increasingly prominent role in your life. Your life becomes centered around the pursuit and consumption of alcohol. It creates problems with your physical, mental and social health, controlling your life and relationships.

Many of you ask if alcoholism is hereditary. Hereditary means a specific thing medically, so the answer is no. However, we believe genes play a role and increase the risk of alcoholism. It is most likely that genetics “load the gun,” but environment “pulls the trigger.”
Regarding environment, there’s no fixed equation to if and when you’ll become dependent, but there is a correlation with certain activity and an increased risk. Consider the following activities as suggestive of a significant risk for development alcoholism:

  • Men who have 15 or more drinks a week (One drink is either a 12-ounce bottle of beer, a 5-ounce glass of wine or a 1.5 ounce shot of liquor.)
  • Women who have 12 or more drinks a week
  • Anyone who has five or more drinks at a time at least once a week
  • Anyone who has a parent with alcoholism

Here are some less hard signs, but these situations also have been shown to increase risk, according to the National Institutes of Health:

  • You are a young adult under peer pressure
  • You have a behavioral health disorder such as depression, bipolar disorder, anxiety disorders, or schizophrenia
  • You have easy access to alcohol
  • You have low self-esteem
  • You have problems with relationships
  • You live a stressful lifestyle
  • You live in a culture in which alcohol use is more common and accepted

Feel free to contact your SMA expert consultant if you have any questions 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. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: What You Can Do To Manage Hypothermia and Serious Cold Exposure

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Is this the most famous illustration of frostbite? Do you remember the movie reference?

I’ll admit that my orientation is different than yours. I’ll argue that your orientation should be closer to mine. What’s the difference, you may ask? I’ve actually seen the consequences of your unfortunate actions, and these consequences occur with a much greater frequency than you may imagine. “An ounce of prevention is worth a pound of cure” isn’t just a catchy quote from Ben Franklin. It’s an “Oops, I should’ve had a V-8 moment” when you’re in front of me, my nurses and big invasive medical treatment options in an emergency room.
Cold exposure is a good example of this. We’ve previously discussed frostbite, but there must be more to the story than frostbite. Frostbite is not a necessary pit stop on the way to very bad things happening due to cold exposure. More importantly, for as bad as frostbite is, there are worse things that can happen to you from cold exposure. This is a relatively important conversation. You need more tools at your disposal than “Just bundle up.” We’ll explore these tools in two parts: basic care and emergency care.
The Basics – Prevention

  • Layers of loose clothing are better. Wear more than one pair of socks, at least until you’re back indoors.
  • Use a hat that actually covers your scalp. (Major heat loss occurs through the scalp.)
  • Use a hat that covers your ears and a scarf that covers your nose. (These areas are prone to frostbite.)
  • Wear mittens. They are better for protecting your fingers than gloves.
  • People greatly underestimate the effect of the combinations of being cold and wet or being exposed to cold and windy conditions. If you have water-resistant, wind-proof options, use them.
  • If you know you’re going to be exposed to the cold for a significant period of time, eat up and rest up beforehand. Avoid alcohol and cigarettes prior to and during such journeys.

Treatment You Can Do If Exposed:

  • Know what symptoms could be a result of hypothermia. Check previous posts for a refresher.
  • Your first step is to call 911, especially if any mental status changes (e.g., confusion) are present. Time is of the essence.
  • Do you know CPR? Refer here for a very easy refresher (you’ll commit it to memory in 2 minutes) of when to use it and how to perform it.
  • Can you get inside? Cover yourself with warm blankets and drink warm (nonalcoholic) fluids if possible. Remove wet and tight clothing (and cover back up with dry ones if possible).
  • You’re stuck outside? You should be thinking about reducing exposure to the cold, the wind and any wetness as much as possible. Don’t forget to provide a layer between the backside and the ground. Prioritize covering the scalp.
  • Think about giving or receiving a hug as a means of warmth. If you have access to warm compresses or towels, preferentially apply to the armpits, groin, neck and chest.

Your take home message is death from hypothermia can be avoided with the knowledge and application of basic fundamental considerations. Even better, you can usually choose to avoid exposure to bitterly cold conditions. I hope you find this information useful and never need to use it.
This is part of a series on medical conditions resulting from cold exposure.

  • Click here for a discussion of frostbite.
  • Click here for a discussion of the symptoms of and risks for hypothermia

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.

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Straight, No Chaser: Hypothermia (Low Body Temperature)

hypothermia

This is part of a series on cold-related medical disorders.

  • To review the Do’s and Don’ts of Frostbite, click here.

Hypothermia is low body temperature. It’s not the “Oh, it’s cold outside” type of cold, but it is the “Oh, your life is in danger!” variety. Medically, hypothermia is a core body temperature below 95 °F (35 °C), and it can be produced by either an absolute cold exposure or sufficient heat loss beyond the body’s ability to generate a response.

What you want to know about hypothermia is the conditions and risks that set you up for it. Anyone can get hypothermia if you’re exposed to bad enough conditions, including the following:

  • Being outside without sufficient clothing in cold conditions
  • Being outside with wet clothing in cold and windy conditions
  • Excessive exertion or insufficient food or fluids while in cold and/or windy conditions
  • Excessive cold water exposure (e.g. immersion while ice fishing or boating)

Persons most likely to get hypothermic include the very old or young and those who are chronically ill or malnourished. Persons of normal health can get hypothermia if excessively fatigued or under the influence of alcohol or other drugs.
Typical symptoms of hypothermia include weakness, drowsiness, confusion and lack of coordination. Skin becomes cold, pale and frostbitten. Shivering becomes obvious and uncontrollable. Eventually, the heart and breathing rates will slow, and mental ability will progressively fade. Ultimately, the body can go into shock, and the heart and brain can cease functioning. Prolonged exposure will result in death if untreated.
For now I will leave you with the following considerations.

  • If you find someone in the cold who is not responding, don’t assume s/he’s dead.
  • Placing someone in direct heat, such as is given via a heating pad or lamp, or in hot water is not the approach and should not be done.
  • Do not give alcohol to someone exposed to extreme cold.

In the next post in this series we will discuss treatment and prevention strategies for extreme cold exposure.
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.

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Straight, No Chaser: The Effects of PTSD on Children

PTSD-And-Children

This is part of a series on post-traumatic stress disorder (PTSD).

  • For a review of PTSD signs, symptoms and those at risk, click here.
  • For a review of PTSD diagnosis and treatment, click here.

Children are exposed to the same stimuli that creates post-traumatic stress disorder (PTSD), including physical abuse, sexual assault and the effects of war, but they may have different responses and  symptoms than adults. Symptoms unique to children typically involve developmental regression and may include the following:

  • Clinginess
  • Bedwetting
  • Cessation of speech
  • Acting out the scary event

Teens may become disruptive, disrespectful, or destructive, and they may express guilt or engage in revenge.
It is very important to get counseling for children that have experienced a traumatic event. The effects may be subtle but could be devastating and long-lasting.
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.

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We're in the Giving Mood: Free Subscriptions to SterlingMedicalAdvice.com

New Logo

Ok, we’ve lost it, and we’re giving it away for FREE! We’re so excited about SterlingMedicalAdvice.com that we’re giving it away for the month of December! If you like us on Facebook or follow us on Twitter at @asksterlingmd or follow the Straight, No Chaser blog at www.jeffreysterlingmd.com you can then go to www.SterlingMedicalAdvice.com and receive a free December subscription to our service (you will receive a SterlingAdviceSM plan).
Try it for free, and experience the difference personalized healthcare consulting can make in your family’s life. Thank for your support, and Happy Holidays.
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.

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Straight, No Chaser: Post-Traumatic Stress Disorder – Signs, Symptoms and Those at Risk

ptsd-1

I deal with disease and death everyday as an Emergency Physician, and it’s dehumanizing on many levels. Imaging having to pronounce someone dead despite giving your version of a superhuman effort to resuscitate them and then having to deliver the news to a family deep in prayer and holding on to strings of hope. Oh yeah, and then you immediately get to return to a room filled with patients and families oblivious to anything you’re dealing with as an individual, who are completely immersed in their personal situations and often complaining because “you took too long.” Imagine the lives of morticians or cemetery workers, having to stare at and feel the remains of the dead all day everyday. Imagine the lives of those habitually raped or viciously beaten by a loved one as a child. And, of course, there are the soldiers. Over 7.5 million Americans are thought to be suffering from post-traumatic stress disorder (PTSD), approximately one in every 40 individuals.
Traumatic and post-traumatic stress are not only able to affect your reality, but to adjust your reality. The body’s normal “fight-or-flight” response to danger or extremely stressful situations can evolve into abnormalities in your behavior if you are continually immersed in these environments. One such as the emergency physician may become desensitized and/or empowered to address situations that would make otherwise normal individuals recoil, or one may become overly sensitive, hyper-stressed and prone to a fight response to lesser stimuli—or no stimuli at all.
There are three categories of symptoms of PTSD, which are easily remembered by thinking of a hyperactive “fight-or-flight” response: reliving traumatic experiences, avoiding circumstances or situations that remind one of the experience, and reacting out of hyperarousal to stimuli suggestive of the experience.

  • Reliving can involve flashbacks, scary thoughts and nightmares. Victims have been known to actually re-experience the physical and mental episodes, complete with palpitations, sweating, jitteriness and severe anxiety. Such experiences can become incapacitating.
  • Avoidance is in many ways the opposite end of the “fight or flight” syndrome. In this example, avoidance isn’t just being proactive and staying away from reminders of the experience, but it can escalate to loss of emotions or even recollection of the event. This isn’t a strategic decision; it’s a defense mechanism gone haywire. As an example, imagine the near-drowning victim who refuses to even sit on the beach.
  • Hyperarousal leads one to be on edge, sensitive and prone to overreact. In contrast to the other two symptoms listed, hyperarousal tends to be a constant state of being. PTSD victims with hyperarousal describe themselves as easily angered and always stressed.

Many if not most of us will experience traumatic events in our lives sufficient enough to cause tremendous stress. There are circumstances that enhance the risk of developing PTSD.

  • Childhood trauma is especially dangerous in that the developing brain can respond “appropriately” in coding for abnormal circumstances and exposures. Subsequent trauma can trigger PTSD-quality responses.
  • Women are more likely to develop PTSD than men.
  • Mental illness may abnormally shape responses to traumatic events.
  • There is some evidence that susceptibility to the disorder may run in families. Individual differences in the brain or genes may predispose an individual.
  • The relative absence of social support and a functional network is a severe risk.

Conversely, if you have strong coping mechanisms, you may be able to lower your risk for developing PTSD after trauma. Consider the following protective factors:

  • A predisposition toward optimism
  • The ability and inclination to seek out support from others, ranging from friends, family and/or an active support group
  • A mental orientation that you “performed well” in the face of the danger
  • A mental orientation of learning from the experience instead of allowing the experience to define you
  • Sufficient mental fortitude to be able to carry on in the face of the symptoms (fear, anxiety) that follow the event

The presence of these “resilience factors” does not suggest that those suffering from PTSD are lacking in any way; it suggests the best opportunities for you to avoid succumbing to the enormous pressures that exist.

  • Check here for a discussion of the diagnosis and treatment of PTSD.
  • Check here for a discussion of the effects of PTSD on children.
  • Check here for a discussion of the effects of PTSD on communities after mass trauma.

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Straight, No Chaser: When Eating Goes Wrong, Part II – Bulimia

Bulimia…-nerviosa-1bulimia

If you read Part I of this conversation on eating disorders (anorexia nervosa), you will recall that eating disorders are a mix of an abnormal body image combined with abnormal behaviors that lead to medical consequences.
The ‘Bizz-Buzz’ of bulimia nervosa is ‘binge-purge.’ What that means is bulimics engage in frequent episodes of eating excessive amounts of food (bingeing) followed by one of several methods of eliminating what was just ingested (purging). This methods include forced vomiting (most common), use of diuretics or laxatives, fasting or excessive exercise. It is important to note that the bulimic feels a lack of control over these episodes.
Bulimia is an especially dangerous disease because it usually occurs in secret, and victims are able to hide it. This means symptoms will typically be further along when discovered. Bulimics usually manage to maintain a normal or healthy weight despite their behavior and may appear to be the person who ‘never gains weight’ despite ‘eating like a horse.’ This is a key differentiator between bulimia and anorexia. Otherwise, the two diseases do share some of the same psychological pathology, including the fear of weight gain and the unhappiness with physical appearance.
Treatment considerations for bulimia are similar to those for other eating disorders. A combination of psychotherapy, reestablishment of normal nutritional intake and medications usually leads to marked improvement. Again, the particular challenge with bulimics is discovering the condition in the first place. As with anorexia nervosa, treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. Medications may include antidepressants, such as fluoxetine (Prozac), if the patient also has depression or anxiety.
Let’s recap by revisiting where we started with our conversation on anorexia. 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. The levels of stress, anxiety and depression resulting from this reality sometimes leads to eating disorders. Remember, eating disorders aren’t just habits. They are life-threatening conditions. If you or a loved one is suffering, please seek help immediately.
Post-script: If you’re wondering about the lead picture of the teeth, you’re viewing the effects of all that regurgitated acid on the enamel layer of your teeth.  I know. It’s not your best look.
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.

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I just got prescribed an antidepressant. About what should I be concerned?

antidepressant_medications_sign AntidepressantsCartoon4

For the answer to this concern, let’s go straight to the Food and Drug Administration’s (FDA) site, which roughly states the following:
Antidepressants are safe and popular, but research and case history demonstrate that they may have unintentional effects on some people, especially adolescents and young adults. During the first one to two months of initial treatment, patients of all ages taking antidepressants should be watched closely.
Possible side effects to look for are the following:

  • suicidal thoughts or behavior
  • worsening depression that gets worse
  • unusual changes in behavior such as insomnia, agitation, or withdrawal from normal social situations.

If you or a loved one witness or exhibit any of these types of changes shortly after taking antidepressants, please seek medical help immediately. A life could be in the balance.
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.

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Straight No Chaser: Warning Signs of Cancer – Take CAUTION

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Cancer. The Big C. The medical ‘death sentence’. No diagnosis scares as much as cancer, which is why it is so important that you be as empowered as possible. Be reminded that if you fall into certain risk categories, please get screened. Because many cancers are asymptotic during early stages, screening and early detection gives one the best possible chance for a good outcome.
In the event that symptoms are present, it’s helpful for you to know what typical symptoms are. Courtesy of the American Cancer Society, here is a mnemonic that teaches signs and symptoms to alert you to the possibility of cancer. Think ‘CAUTION’.

  • Change in bowel or bladder habits
  • A sore that does not heal
  • Unusual bleeding or discharge
  • Thickening or lump in the breast, testicles, or elsewhere
  • Indigestion or difficulty swallowing
  • Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore
  • Nagging cough or hoarseness

Additional symptoms that may be suggestive include unexplained weight loss, persistent headaches, nausea, vomiting, fatigue or pain, repeated infections and fever. Given that these non-specific symptoms could be due to many other things, as a cancer consideration, typical recommendations are to get these types of symptoms evaluated if they’ve been present for more than two weeks.
Just remember, cancer is something you want to detect, not ignore. If you wait until it’s too late, then, well it’ll be too late.
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.

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Straight, No Chaser: Your Questions About Taking a Daily Aspirin

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Thanks for your enthusiastic response to yesterday’s post on taking an aspirin.  Today, I’ll follow up with some of your questions.
So you’ve been told to take a daily aspirin to reduce your risk of a heart attack because you likely fell into one a high-risk category. Here are some logistical considerations about what to do.
1) Is there a better time of day to take an aspirin?
Recent data suggests that most heart attacks occur early in the morning. The best time to take an aspirin is relatively soon before you have that heart attack. However, since your heart doesn’t give you a heart attack alarm clock (and many of us aren’t especially mindful of heart attack recognition), the best move would seem to be to take an aspirin before going to bed, and recent research supports that an aspirin taken before going to bed offers the most protection from a heart attack. There are limitations to doing this (e.g. taking aspirin on an empty stomach if you have a history of ulcers may not prove to be the most pleasant thing), and you should discuss such timing with your physician.
2) Is there a better dose of aspirin to take?
That’s a question your physician will answer and is dependent on your personal situation. That said, doses as low as 75-81 mg have been shown to be effective. You may be placed on any dose up to 325 mg/day. It really is important to take an aspirin dose recommended by your physician for this consideration.
3) Is it better to chew or swallow an aspirin?
Chewing an aspirin is the quickest way to achieve effective blood levels. In case you were thinking about taking an alka-seltzer (which contains aspirin), that’s also good – but it’s just not as good as chewing an aspirin.
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.

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Should I Take a Daily Aspirin?

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So… I’m stuck on a desert island, and I’m allowed to take two medications. I’m pretty sure aspirin is going to be one of them. This begs the question “Who should take a daily aspirin?”
The answer is actually easy: anyone and only anyone whose physician recommends it. The better question is when will your physician recommend it?
The benefits of aspirin in reducing heart attack risk have been known and well described for quite a while now, and you should check this list to see if you’d benefit from taking a daily aspirin. Truth be told, it’s of such importance that if you’re of a certain age, you should have this conversation with your physician at your next physical exam. Here’s a partial list that will get you a daily aspirin or very strongly considered for one.

  • If you’ve previously had a heart attack
  • If you’ve had a coronary artery stent or surgery
  • If you’ve previously had a stroke (caused by a blood clot) or TIA (transient ischemia attack, aka ‘mini-stroke’).
  • You’re a male over 50.
  • You’re a female over 60.
  • You have a bad risk factor profile (i.e. You smoke, have diabetes, high blood pressure or high cholesterol levels, are overweight, don’t exercise or have a personal or family history of heart disease)

The above list actually isn’t exhaustive but is sufficient for most individuals’  ability to remember to start a conversation with their physician.  These considerations will be measured against others that would suggest you shouldn’t be taking a daily aspirin (e.g. allergy, bleeding ulcers, a bleeding disorder or if you’re taking certain other medications).
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.

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From the Health Library of SterlingMedicalAdvice.com: "When should I be worried about a vaginal discharge?"

VagDCchart

With the incidence of bacterial vaginosis and sexually transmitted infections, one would think the easy answer would be “always”, but it’s not quite that simple.
Some females normally have a discharge, and part of ‘being worried’ or not is knowing what’s normal for you. Discharges that are foul-smelling, colored, bloody, or accompanying genital rashes or sores should definitely be evaluated. Certainly, new discharges should be evaluated in an effort to help you understand if this is something physiologic or abnormal.
For the full blog on this topic, visit us at SterlingMedicalAdvice.com. 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, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

 

From the Health Library of SterlingMedicalAdvice.com: "What are psychosocial disorders?"

psychosocial

 
Our latest reader submission strikes at the heart of the age-old concern about the relationship between our environment and our mind. It is important to appreciate that mental illness is often influenced by external factors, such as environmental stimulants. When we describe psychosocial disorders, we’re talking about mental illness precipitated by these factors. These factors include everything from family, religion, friends and cultural considerations. Yes, the situations you place yourself in can be hazardous to your health!
For the full blog on this topic, visit us at SterlingMedicalAdvice.com. 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, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
 

From the Health Library of SterlingMedicalAdvice.com: "Why do I get those big tender knots in my neck?"

cervical lymph-node swelling from a posterior lateral squamouscell head_lymphnodes2

First of all, thank you for the continued reader submissions.
Cervical (that is, neck) lymph nodes (small oval organs located in various parts of the body that help the body fight infections; aka ‘swollen glands’) are the topic of the day.  Cervical adenopathy (aka lymphadenopathy) is the presence of swollen, tender lymph nodes in the neck.  They can represent the following:

  • The body’s response to a primary infection in the neck;
  • The body’s response to a local infection around the neck (such as the ears or throat); and/or
  • The body’s response to diseases widespread throughout the body (such as with mononucleosis, tuberculosis, and other diseases, such as HIV).

Just remember that infections are by far the most common cause of tender lymph nodes in the neck and get them checked if your other symptoms are concerning enough to you.  Of course, you could always contact your personalized health consultant at www.SterlingMedicalAdvice.com as well, and we’ll help you work through your concerns.
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, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

From the Health Library of SterlingMedicalAdvice.com: "What is a spinal tap, and why is it done?"

LP

A lumbar puncture (spinal tap) is performed to obtain cerebrospinal fluid (CSF – the naturally occurring fluid that bathes the spinal cord) from the spinal column, usually to evaluate for the presence of infection (as in meningitis), but it can also detect other conditions such as multiple sclerosis, Guillain-Barre syndrome or cancer involving the spinal cord. In some instances, a lumbar puncture is a treatment; medicines and anesthetics can be placed in the cerebrospinal fluid via lumbar puncture, or it can be used to lower the pressure in the brain caused when too much fluid is present.
Here’s a video that would be helpful to view before you or a family member has a lumbar puncture. It is provided courtesy of Cure Search for Children’s Cancer.

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From the Health Library of SterlingMedicalAdvice.com: "Why would my doctor tell me not to take a decongestant?"

decon

Thanks for all the reader submissions on Blog and FAQ ideas. Here’s my first response.
Based on how ubiquitous cold and flu remedies are, you would think they were the safest medications known to man. That’s actually not the case and in some instances can be quite far from the truth. The reason for this is simple. Decongestants work by manipulating blood vessels. Specifically, they narrow nasal blood vessels, creating more room for air flow and mucous drainage while reducing swelling and other effects of inflammation. This is a major part of how you treat upper respiratory viral infections like colds and the flu; antibiotics don’t work against viruses.
Unfortunately, if you have certain medical issues, you should not take decongestants. Here’s a list situations that can make it dangerous to take decongestants:

  • Allergies to pseudo-ephedrine
  • Children under age 4
  • Diabetes
  • Glaucoma
  • High blood pressure
  • Heart disease
  • Kidney disease
  • Prostate disease
  • Pregnant
  • Breast feeding women
  • Thyroid disease

So … even if it’s an over the counter preparation, if you’re not sure, head over to the pharmacist before you make that purchase at the store. Of course, you can always connect with your SterlingMedicalAdvice.com consultant as well.
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, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

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