Tag Archives: health

What's the difference between phenylephrine and pseudoephedrine?

December 8, 2013Toxicology/DrugsDecongestant, health, Hypertension, Nasal congestion, Pharmacy, Phenylephrine, Pseudoephedrine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, SudafedJeffrey Sterling, MD

Unlike many things, this is a distinction with a difference, and one you should know. Both pseudoephedrine and phenylephrine are decongestants used to treat nasal congestion due to colds and allergies and other upper respiratory tract nuisances. The issue is pseudoephedrine can be made into methamphetamine. As a result, the U.S. Senate passed a bill restricting its sale. Pseudoephedrine products can still be purchased in limited quantities, but certain restrictions and other requirements are in place. In some states this includes requiring a prescription.
Regarding the difference between the two drugs, no studies have been done to confirm whether these two decongestants are equally effective, so we’re left to look at the chemical effects to judge.
There are some differences in the way the drugs are absorbed by the body:

The intestines will absorb only about 1/3 of the amount of phenylephrine in one tablet, while pseudoephedrine is 100% absorbed.
Phenylephrine’s effects do not last as long as those of pseudoephedrine. As a result, phenylephrine needs to be taken every four hours, while pseudoephedrine can be taken every four to six hours.

If you are considering trying either medication, discuss it with your physician or SMA consultant first. People with certain medical conditions such as diabetes, heart disease, high blood pressure, and overactive thyroid should not take products containing either of these ingredients. Also, people taking propranolol or certain antidepressants should avoid using these products.
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Straight, No Chaser: Do medications work differently in older people?

December 7, 2013Geriatrics/Elderly CareDrug, Drug interaction, Drugs and Medications, health, mental-health, Old age, Pharmaceutical drug, Pharmacy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The elderly are living longer and more productively. Part of being able to do so is by maintaining an understanding of how your actions affect you. One common action of many of the elderly is taking medications. You should be aware that medications have changing effects with aging, and there are many different reasons for that fact.
First of all, changes in our physiology due to aging make the effects of drugs less predictable and consistent than in younger people. A slower metabolism, increases in body fat and alterations in the function of the kidney and liver (major mechanisms for drug elimination) have important ramifications for what ingested substances will do. Thus, the elderly require more stringent monitoring of drug levels and effects, and you may find that your physician needs to adjust medication doses. This same consideration explains why side effects are more common among the elderly.
Be reminded the presence of other diseases brings additional effects and challenges. Just as with one’s own relatively diminished function, disease imposes the same type of changes onto the body. This can speed the presence of side effects and toxicity as well as adjust the effective dose of a medication.
Have you ever seen the individual with a small ‘army’ of medications? Think about it. The more medications one takes, the more likely drug interactions will ensue and changes in effectiveness in any single medication may occur. This effect incrementally increases with each additional drug one takes. Similarly, the more medications one is taking, the most likely one is to make a mistake in taking the correct medication at the right time. Now consider your independently living parents or grandparents. The elderly often are more prone to make these types of errors.
What can you do about this? Get organized, and get help! Those daily medication containers are good solutions to incorrectly dosing medications. If you’re especially organized, a log is great—not necessarily for you, but for the physician that will be trying to figure out why you’re dizzy or have an altered mental status if and when that occurs.
Talk with each doctor you see or a pharmacist about what to expect from the combination of medications you take; it can make your lives a lot less complicated.
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Straight, No Chaser: The Effects of PTSD on Children

December 6, 2013Mental Health, Pediatrics/Kids Health, Public HealthFacebook, health, mental-health, Posttraumatic stress disorder, Psychological trauma, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, WordPressJeffrey Sterling, MD

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.
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Straight, No Chaser: Post-Traumatic Stress Disorder Diagnosis and Treatment

December 5, 2013Mental HealthAnxiety, health, mental-health, Posttraumatic stress disorder, Psychological trauma, PTSD, Substance abuse, SymptomJeffrey Sterling, MD

For a review of PTSD signs, symptoms and those at risk, click here.
Not every traumatized person develops post-traumatic stress disorder (PTSD). In those that do, symptoms typically begin within three months of the incident but may present years afterward. The severity of symptoms is such that they must last more than a month to be considered PTSD. There is significant variation in outcome in those with PTSD; some recover within six months, and in some the condition becomes chronic.
To be diagnosed with PTSD, a person must have the following symptom complex for at least one month:

At least one re-experiencing symptom (including flashbacks, scary thoughts or nightmares)
At least three avoidance symptoms (a pathologic response to stay away from or forget the episode)
At least two hyperarousal symptoms (a constant state of being on edge, sensitive and prone to overreact)

Additionally, PTSD is often accompanied by depression, substance abuse, or other anxiety disorders.
PTSD is typically treated with either psychotherapy (“talk” therapy), medications, or both. Mental health professionals will review and discuss all treatment options with you prior to initiating therapy, because some people will need to try more than one variety to discover what works for their symptoms.
If someone with PTSD is going through ongoing trauma, such as an abusive relationship, both the PTSD and the current problems need to be treated. Other ongoing problems can include panic disorder, depression, substance abuse, and suicidal feelings.
The U.S. Food and Drug Administration (FDA) has approved two medications for treating adults with PTSD, sertraline (Zoloft), and paroxetine (Paxil). Both of these medications are also used to treat depression. In PTSD, they help control symptoms such as sadness, worry, anger, and the feeling of numbness inside. Taking these medications often make it easier to go through psychotherapy.
Sometimes people taking these medications have side effects at the beginning of therapy, but they usually go away. Any side effects or unusual reactions should be reported to a doctor immediately. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects. The most common side effects of antidepressants like sertraline and paroxetine are the following:

Headache
Nausea (feeling sick to your stomach)
Sleeplessness or drowsiness
Agitation (feeling jittery)
Sexual problems (occurs in both sexes), including reduced sex drive and problems having and enjoying sex.

Doctors may also prescribe other types of medications, such as benzodiazepines (commonly used for relaxation and as a sleep aid), antipsychotics and other antidepressants. There is little information on how well these work for people with PTSD.
If you believe you suffer from PTSD, it’s very simple. Please get evaluated and get the help you need.
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Straight, No Chaser: The Do's and Don't of Treating Frostbite

December 4, 2013EnvironmentalCirculatory system, Fahrenheit, First Aid, Frostbite, health, Hypothermia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Thermoregulation, United StatesJeffrey Sterling, MD

There’s a cold front coming. You can’t avoid the exposure. Some of you will end up cold as ice (and twice as nice?). Would you really know what to do if you caught frostbite? I thought not, and the bad news is some of your instinctive tendencies are exactly what you ought not to do in this situation. Here are some do’s and don’ts if you ever find yourself or a loved one in this particularly precarious position.
The Do’s
A lot of this depends on the circumstances.

Give warm fluids if possible.
If the person is wet, remove wet clothing.
If s/he is wearing tight clothing, remove whatever’s constricting.
Move to as warm of a climate as feasible; if not possible, then shelter the person from the cold. Avoid movement of the frostbitten parts to the extent possible.
Gently separate affected fingers and toes, and if you can, wrap them loosely in sterile dressing.
If you have transportation, get to an emergency room as soon as possible.
If immediate care or transportation is not available, soak the affected areas in warm (preferably circulating and never hot) water. Alternatively, place warm coverings to affected areas for up to 30 minutes at a time. If skin is soft and feeling returns, you’ve done a good job.
- Be mindful that burning pain and swelling will occur during rewarming.
Apply dry, loose and preferably sterile dressings to the frostbitten areas. Keep frostbitten fingers or toes separated with dressings.
Delay rewarming if you are not in an area safe from the risk of refreezing. Refreezing of thawed extremities is even more dangerous than the initial freeze.

DO NOT

Rub or massage the frostbitten area.
Peel or pop any blisters that may be present.
Use dry heat, such as from a hair dryer, a radiation, heating pad, electric blanket or campfire. These heat source may be ok to keep the rest of you warm (particularly your core), but this type of direct heat can further damage frostbitten tissue.
Rewarm until you can be sure it can stay thawed.
Smoke or drink alcohol during recovery. These activities can interfere with blood circulation and cause additional problems.

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

November 30, 2013Mental HealthFacebook, health, Posttraumatic stress disorder, Psychological trauma, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, United States, WordPressJeffrey Sterling, MD

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.

Straight, No Chaser: "Abnormally" Foul-Smelling Stools

November 29, 2013GastrointestinalConditions and Diseases, Crohn's disease, Digestion, Digestive Disorders, Disease, Food, health, Intestine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Obligatory disclaimer: this blog is in response to a reader request (Thank you?), not a commentary on the quality of your Thanksgiving cuisine… and we’re off…
There’s an obvious joke here about the native smell of stools, but that’s not what we’ll be discussing today. Most people are aware of how their stools normally smell. How should you react when your stools are abnormally foul-smelling?
Let’s address this conversation by understanding what normally produces the smell and consistency, what causes changes in the smell and what should prompt you to get evaluated.
Normally your stools smell the way they do because of a combination of them being waste products of certain food (which once digested and impacted by resident bacteria in your lower intestines release foul-smelling by-products) and releasing flatulence (gas).
It should stand to reason that conditions that change either the composition of your stools (e.g. a change in your diet), the presence of bacteria in your lower intestines (e.g. taking antibiotics) or conditions changing the production of gas or absorption of your food would lead to foul-smelling stools, and indeed these are common causes.
There are significant medical conditions associated with the above, including the following:

Celiac disease – Gluten foods damage the part of the small intestine that absorbs nutrients; this malabsorption leads to abnormal stools.
Cystic fibrosis
Food allergies/Lactose and other carbohydrate intolerance (or allergies) – These conditions also leads to malabsorption.
Inflammatory bowel disease (e.g. Crohn’s disease, ulcerative colitis) – Among other things, these conditions inflame the intestines, limiting absorption and leading to diarrhea and foul-smelling stools.
Medication/multivitamin overdose
Pancreatitis

Foul-smelling stools should always warrant concern and reflection on whether any dietary changes might have caused the change. Here are some signs that, if present should prompt a visit to the ER or a conversation with your SterlingMedicalAdvice.com expert.

Abdominal pain
Black, bloody or pale stools
Fever and/or chills
Unintended weight loss

Finally, as long as I have your attention, remember to wash your hands and fully cook your meats. These simple preventable steps can ward off many conditions that affect your digestive tract.
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Straight, No Chaser: The Holiday Blues – Tips to Deal with Depression and Stress This Time of Year

November 28, 2013Mental HealthDepression, Disorders, health, Major depressive disorder, Mental disorder, Mental health professional, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideationJeffrey 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.
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Straight, No Chaser: When Eating Goes Wrong, Part I – Anorexia

November 26, 2013Mental HealthAnorexia nervosa, Diet, Disease, Disorders, Eating, Eating disorder, health, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey 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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Straight No Chaser: Warning Signs of Cancer – Take CAUTION

November 23, 2013General Health and Wellness, Hematology & Oncology/Blood Disorders/CancerAmerican Cancer Society, Cancer, Facebook, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Symptom, Twitter, WordPressJeffrey Sterling, MD

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.
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"Why would my doctor tell me not to take cough medicine for my cold or flu?"

November 20, 2013General Health and Wellness, Infectious Disease, Medical TreatmentBronchitis, Cough, Cough medicine, health, Influenza, Mucokinetics, Pharmaceutical drug, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, SymptomJeffrey Sterling, MD

The first thing to appreciate about cough and cold preparations is they only provide relief of symptoms. The body itself is providing the actual healing of what is usually a viral infection. The cough associated with a cold, flu or bronchitis will go away on its own (sooner rather than later, assuming you’re not smoking while sick; smoking further inflames your airways, thus stimulating coughing).
The nuisance symptoms of a cough often are most disturbing at night while you’re trying to sleep. Cough suppressants (antitussives) are medications that reduce your cough reflex. Additionally, you will often see the word ‘expectorant’ associated with cough medications; this component helps to hydrate and thus thin the mucus, making it easier for the body to expel.
So… some physicians prefer to allow the body to work these issues out on its own. It is common to be told to only take cough medications at night to help you sleep, unless you need to take them to also get through your day.
Also, be reminded that all medications have side effects; you may recall that drug allergies or adverse drug reactions (which were covered here) may be additional reasons that your physician may not want you to take cough and cold preparations. If you have any questions in real time, you may always contact your physician or your SterlingMedicalAdvice.com consultant.
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From the Health Library of SterlingMedicalAdvice.com: "My doctor said I was a high-risk asthmatic. What does that mean?"

November 17, 2013General Health and Wellness, Respiratory/LungsAsthma, Bispebjerg, Conditions and Diseases, health, Pregnancy, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition)Jeffrey Sterling, MD

If you have an asthmatic in your life, it’s important to know that asthmatics die. The risk of death is higher in certain asthmatics. If you or your loved one is in this subset of asthmatics, you really must be diligent in avoiding those triggers that cause asthma attacks. You must also be attentive and consistent in taking your ‘controller’ medicines.
These circumstances define a high risk asthmatic:

A history of sudden severe asthma attacks
Prior need to be intubated (placed on a respiratory aka breathing machine)
Prior admission to a hospital ICU (intensive care unit)
Greater than one admission or two ER visits in the past year
An ER visit within the last month
Needing to use two or more inhalers per month
Current or recent oral steroid use
Illicit drug use
Concomitant cardiopulmonary or psychosocial disease

For more on asthma from Straight, No Chaser, click here and here.

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Straight, No Chaser: Ruptured Eardrums

November 16, 2013Head/Eyes/Ears/Nose/ThroatConditions and Diseases, Ear, Ear Nose and Throat, Eardrum, health, Otitis media, Perforated eardrum, Sound, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The manufacturers of Q-Tips used to run a commercial in which they said “Never place anything in your ear smaller than your elbow.” I wonder why they stopped the commercial, because it pretty much summarizes how I feel about the situation.
Perforated tympanic membranes (aka ruptured eardrums) are holes in the sheet-like tissue that separates the ear canal from the middle ear. They are not a lot of fun. Because the ear is responsible for both hearing and balance, rupture can cause decreases of both. Common symptoms include pain, decreased hearing and bleeding.
Several different things can causes this, including the following:

infections (otitis media)
an imbalance between the two sides of the eardrum (if it becomes too severe, you’ll suffer what’s known as barotrauma), as seen in diving and air travel
direct trauma from placing objects in your ear (Put those cotton swabs and down!) or from a severe blow to the head/face
blast injuries (called acoustic trauma), caused by sudden, loud noises (e.g. explosions and gun shots; what’s actually happening here is a sound wave is damaging the ear drum)

Most tympanic membrane perforations heal spontaneously. If the injury causing this was penetrating, your physician may refer you to an ear, nose, and throat specialist within 24 hours. You must be careful to avoid getting water in the ear. You won’t typically receive antibiotics for a ruptured eardrum unless the rupture is due to infection or forceful water injury, such as is seen in water skiing.
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From the Health Library of SterlingMedicalAdvice.com: "Why would my doctor tell me not to take a decongestant?"

November 13, 2013Head/Eyes/Ears/Nose/ThroatDecongestant, Decongestants, Facebook, FAQ, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), Twitter, Upper respiratory tract infections, WordPressJeffrey Sterling, MD

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.

From the Health Library of SterlingMedicalAdvice.com: "Is skin glue as good for stitches for laceration repair?"

November 7, 2013Skin/Dermatology, Traumadermabond, Facebook, health, skin adhesive, SMA, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), Twitter, WordPressJeffrey Sterling, MD

So your child has been cut. S/he is writhing in pain and anxiety and lives in deathly fear of needles. The doctor tells you that you have options. Your child can be strapped down, sedated or… the laceration can be repaired with some variety of ‘medical glue’? Let’s briefly look at what it means to use a skin adhesive for laceration repair.

The main advantage to skin glue is that it is quickly applied and virtually painless to use if applied correctly. Occasionally a small amount of burning will be felt after application.
There are no needles, papooses, or putting the child to sleep.
The main disadvantage to skin glue is that sometimes the cosmetic result may not be as good as with stitches, especially if the laceration is in an area of high skin tension or if it’s in an area where the child can pick the wound apart. It is very important to understand that if you can’t control your child to the extent to if s/he picks at the wound, you can’t come back and get stitches later.
In short, in most instances it’s as good of an option as stitches.

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: "If I stop smoking, what does this do to my risk for heart disease and stroke?"

November 6, 2013Cardiology/Heart, General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer, NeurologyCardiovascular disease, Coronary disease, Facebook, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), Twitter, WordPressJeffrey Sterling, MD

There are immediate and longterm benefits to smoking cessation that extend beyond just lowering your risk for lung cancer. Consider the following regarding lowering your risk for heart disease and stroke, and make the change to make yourself healthier.

Within 1 year of smoking cessation, your excess risk of coronary heart disease, heart attack, and stroke has dropped to less than half that of a smoker.
Within 5–15 years after stopping, your risk of stroke has declined to that of a non-smoker.
At 15 years after stopping, your risk of coronary heart disease is that of a person who has never smoked.

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.

Straight, No Chaser: Bell's Palsy

November 5, 2013Head/Eyes/Ears/Nose/Throat, NeurologyBell, Bell's palsy, Facebook, Facial nerve, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), Twitter, WordPressJeffrey Sterling, MD

Bell’s palsy is a paralysis of the facial nerve, caused by inflammation or other irritation to the nerve. This paralysis causes muscle weakness in one side of the face.
Patients often find themselves unable to close one of the eyelids or wrinkle one side of the forehead/face. The eyes may become dry due to inability to blink. One side of the mouth may drool and droop. The sense of taste may change. Sounds may become louder, and headache may develop.

Bell’s palsy is treated with steroids and artificial tears.

The prognosis for individuals with Bell’s palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of symptoms and most recover completely, returning to normal inside of 3-6 months. For some, the symptoms may last longer, and in a few cases, the symptoms may never completely disappear.
By the way, in case you’re wondering about the picture, the right side of the picture (the left side of the patient’s face) is the side affected. He can neither wrinkle his forehead nor close his eye, both of which are functions of the cranial nerve. And no, this is not a stroke.
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: Does drug use cause kidney damage?

November 2, 2013Detoxification, Genital/Urinary, Toxicology/DrugsAcute tubular necrosis, Facebook, health, Kidney, Renal failure, Sterling Medical Advice, Twitter, Waste, WordPressJeffrey Sterling, MD

Each kidney filters about 1700 liters of blood per day and concentrates fluid and waste products into about one liter of urine per day. Because of this, the kidneys receive more exposure to toxic substances in the body than almost any other organ. Therefore, they are highly susceptible to injury from toxic substances.
Inflammation from immune response to drugs may injure the structures of the kidney, usually causing various types of glomerulonephritis or acute tubular necrosis (tissue death). Injury to the kidney may result in short-term damage with minimal or no symptoms. It may also be life threatening from bleeding and associated shock, or it may result in acute renal failure or chronic renal failure.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. 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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Straight, No Chaser: Save a Life, Save a Trip, Save Your Cash!

November 1, 2013Public HealthEmergency department, health, Limited liability company, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United States, WordPressJeffrey Sterling, MD

In the last 20+ years of caring for patients in emergency rooms (ERs) in communities all over the country, and in 12 years of healthcare consulting in 36 states and countries, my team and I have had the unique privilege of serving all age groups, genders, and health conditions, from sprains to strains, moans and groans, sniffles and whistles, trauma and the flu.
However, in the ER setting, well over half of the people we see every single day would say they could have saved themselves the trip and the cost “…if I only knew.” Straight, No Chaser has given me the privilege to talk with you in a relaxed environment about urgent and non-urgent issues that concern you. It has been fun for me, especially because you have responded in a way that lets me know that my goal of empowering you with knowledge to make your own healthcare and financial decisions for you and your family is being realized. Because this works for your health and your wallet, I have expanded the service from Straight, No Chaser to http://www.SterlingMedicalAdvice.com. Not only will you have access to thousands of tips, fun facts, and frequently asked questions about the full spectrum of health topics, you will also have access to your own personal healthcare consulting team. That’s right, you can chat 24/7 with experts in medicine as well as fitness, dentistry, nutrition, mental health, pharmacy, and other healthcare entities.
So, when the time comes that you need to make an informed decision for yourself and/or your family member, we’re here for you. If this turns out as we desire, this service will become part of the national healthcare system and may be covered by your current insurance interests or as an employee benefit. Beginning today, November 1 at 12 noon Eastern Daylight Time, join me and hundreds of other healthcare experts who have signed up to turn the tide in our country by putting the power of your health back in your hands and saving you the time and costs of unnecessary visits to the emergency room and pharmacy. A subscription counts as payment toward your deductible (if you have insurance) and equates to less than a third of what Americans pay out-of-pocket EVERY YEAR for ER and doctor visits. Try us, and discover the difference having a team at your fingertips will make in your health. We at SterlingMedicalAdvice.com are looking forward to keeping the knowledge flowing,
Jeffrey Sterling, MD
President and CEO
SterlingMedicalAdvice.com
Your Personal and Immediate 24-Hour HealthCare Consultants

Straight, No Chaser: Providing Corporate HealthCare Solutions

October 31, 2013General Health and WellnessBusiness, health, Health informatics, Healthcare, Pfizer, Smoking cessation, Sterling Medical Advice, SterlingMedicalAdvice.comJeffrey Sterling, MD

SterlingMedicalAdvice.com has just saved a client corporation a projected $2.4 million in healthcare expenses over previous costs. What can we do for you? Our health information and advice services, wellness and smoking cessation modules are designed with optimizing healthcare savings while retaining quality. Contact us at sales@sterlingmedicaladvice.com or 1-866-ADVICE3 for details. Try us, and experience the difference personal healthcare consulting can make for you, your family or your business.

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