Tag Archives: health

Cigar Smoking: Facts and Fiction

Cardiology/Heart, Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs, Health Prevention, , , , , , ,

Fidel-Castro-smoking-ciga-001 mouth_cancer_cr

It’s the latest, greatest, coolest past-time.  Endorsed and practiced by celebrities the world over, cigar smoking has clearly and successfully marketed itself as a convenience of the successful.  Even the notion that the ‘best’ cigars are forbidden fruit (i.e. come from Cuba) adds to the allure if and when you’re able to wrap your lips around one.  I wasn’t surprised, but it’s worth noting that beyond the success stories received from those of you who have successfully stopped cigarette smoking, the next set of questions involved whether cigar smoking is a safe alternative.
Since you have little old me taking on an $8 billion a year industry and the wrath of the very passionate, I have no recourse but to arm myself with some data – cold, hard facts.

  • 49% of all cigars sold are large cigars.  A single large cigar contains as much tobacco as an entire pack of cigarettes.
  • Cigar use is on the rise, with over 13 million people identifying as current users.
  • 15% of male students in grades 9-12 are current users.
  • African-Americans have the highest rate of cigar smoking (among ethnicities/races), with a 7.7% user rate.

You want to know the effects of cigar smoking?  Let’s cut to the chase.
Here are the five “SURGEON GENERAL WARNING” text-only labels, one of which must be displayed on all cigar packaging and advertisements.  This is done on a rotating basis.

  1. Cigar Smoking Can Cause Cancers Of The Mouth and Throat, Even if You Do Not Inhale.
  2. Cigar Smoking Can Cause Lung Cancer and Heart Disease.
  3. Tobacco Use Increases the Risk of Infertility, Stillbirth and Low Birth Weight.
  4. Cigars Are Not A Safe Alternative To Cigarettes.
  5. Tobacco Smoke Increases The Risk of Lung Cancer And Heart Disease, Even In Nonsmokers. 

Beyond what the Surgeon General requires, here are some additional facts:

  • All tobacco smoke contains more than 60 chemicals that can cause cancer, and cigar smoke is no exception.
  • Regular cigar smoking increases your risk for the following cancers: lung, esophagus, larynx (your voice box), and oral cavity (lips, tongue, mouth and throat).
  • Cigar smoking is linked to gum disease and tooth decay and loss.
  • In addition to lung cancer, heavy cigar smoking increases the risk for emphysema and chronic bronchitis.

The bottom line?

Cigar smoking is not a safe alternative to cigarette smoking.

There is no level of cigar smoking that does not pose health risks.

As always, it’s not my chore to convince you to do or not to do; freedom of choice is a beautiful thing.  That said, be advised that if you read this blog, you will be an informed consumer.  I welcome your comments or questions.
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Straight No Chaser: Got Hemorrhoids?

Gastrointestinal, Genital/Urinary, , , , , , , , , , ,

hemorrhoid Bath reading

Yes, you do.  I can hear you now.  Aww, doc!  Why are you talking about this first thing in the morning?  Well, a lot of you have them 24 hours a day, so now is as good as a time as any.  I know this topic is a pain (no pun intended), but you should consider reading this before your next bowel movement.
Let’s talk about hemorrhoids, and we’re gonna make this simple.
1. What are they?  Hemorrhoids are swollen veins either inside (internal hemorrhoids) or outside (external hemorrhoids) the anal canal.  It’s not uncommon for people to have both types at the same time.  You should wonder if you have them if and when you experience pain, bleeding and itching to the perianal area.
2. Why do you get them?  It’s all about pressure.  The blood that is circulating to the skin near the anus finds itself in outpoutchings when you strain and stretch the skin while having a bowel movement.  Pregnancy is another time when hemorrhoids become common.  I’ve literally seen hemorrhoids form before my eyes during the straining of childbirth.  The table is set for that in advance, as the pressure of the last two trimesters on the pelvic vessels also causes development of hemorrhoids.  The same goes for the obese.  Plus, you sit too much.
3. How can I prevent them?  You should start with ensuring that you’re eating a high fiber diet (fruits, vegetables and whole grains), exercising and drinking a lot of water.  Becoming constipated and having to strain is a sure way to developing hemorrhoids.  Does anyone remember Al Bundy from Married with Children?  Notice how he always took a newspaper to the toilet?  That’s the other part of prevention.  Allowing your bowel movements to occur on their time-table without you straining keeps you without hemorrhoids.
4. How can I treat them?  The problem with hemorrhoids is they hurt, and hurting causes a vicious cycle.  Because they hurt (and bleed), you don’t want to have another bowel movement.  If you’re not having bowel movements, chances are you’ll get constipated.  If you get constipated, you’ll have to strain and endure pain.  And the cycle continues…  So, in order to break the cycle – WASH yourself (like the young lady in the lead picture).

  • Water (sitz bath)
  • Analgesics (pain medication, either topically or by mouth)
  • Stool softeners
  • High fiber diet

5. How will your physician treat them?  Treatment in an emergency room setting is largely dependent on whether or not the external hemorrhoid has developed a blood clot (as shown in the lead picture).  These are the type that are especially painful and are called thrombosed external hemorrhoids.

  • Non-thrombosed internal hemorrhoids usually are initially treated conservatively as described above.
  • Sometimes internal hemorrhoids will need to be tied off with a surgical band, eliminating the blood supply to the hemorrhoid and forcing it to shrink or fall away.  Alternatively, the tissue around the internal hemorrhoid may be surgically scarred (ouch!) to the same effect.
  • Thrombosed external hemorrhoids need to have the clot removed.  This is done by the physician with a particular type of incision.

By this point, you should be thinking “I’ll take the prevention!”.  Trust me, that’s the correct choice.
As an emergency physician, I’m even more concerned about the possibility of something else being wrong.  Given that 10 million Americans are walking around with hemorrhoids anyway, that rectal bleeding could be due to something else, such as rectal, anal or colon cancer.  You may receive additional examinations specifically to rule out those considerations (they may involve tubes, probes and/or scoping).  Feel free to ask if you really want details.
Feel free to read this again as motivation during your next bowel movement.
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Straight, No Chaser: Quick Tips on Boosting Your Metabolism

Cardiology/Heart, General Health and Wellness, Health Prevention, , , , , , , , , ,

fat crying
It would be improper for me to have dragged you through the mud for three days and depressed you into thinking you can’t improve your situation. Hopefully, you’re not feeling that way. You should now have a better understanding of how the body works, how to count calories and how to compare yourself to a baseline for health. What left is giving your body a leg up on your efforts. Yep, I’m talking about boosting your metabolism. Any of you that have been with me for a while know that means I’m not promoting something you’ll find in a bottle, although there are many good supplements that can assist in that effort. I’ll refer you to your (or my) favorite personal trainer for those considerations. As always, I want to offer you the tools to be self-empowered. To that end, here’s five Quick Tips to boost your metabolism. Why five? Because five is easier to implement than six. Once you get these five down, let me know, and we can get a bit more intricate.
1. Eat smaller meals, and eat more frequently. It’s true. More meals more often is better, but only if they’re smaller. Calorie counting is still a major part of the equation. The point of more frequent meals is preventing the body from going into starvation mode, which slows your metabolism as the body attempts to conserve energy. If you do this, you’ll discover those meals are smaller and you will get closer to eat more appropriate portions than we typically do. Also, make those in-between meals healthy choices like a handful of fruits or nuts.
2. Prime your pump. Remember, it’s all about your heart’s ability to efficiently move blood around the body anyway. The healthier your heart is, the better your metabolism will be. You need aerobic exercise that increases your heart rate for 20-30 minutes at a time. Learn your target heart rate for your age, and exercise to get into that range. Your metabolism will better approximate that of a fine tuned machine rather than a sputtering old car.
3. Weight train. This is very simple. The more muscular you are, the more calories you will burn, especially relative to someone of the same weight who is obese. Not only will you become a finer calorie-burning machine, in this case you actually will look better! Add weight training to your exercise regimen.
4. Choose the fish (and not the fried variety). Fish oil contains substances called omega-3 fatty acids (EPA, DHA) which increases levels of fat-burning enzymes and decreases levels of fat storing enzymes. Daily ingestion has been shown to help by approximately 400 calories a day.
5. Enlist a personal trainer. Everyone needs help and motivation. Some of us need a lot of help and a lot of motivation. We also need expertise. There’s nothing more frustrating than working hard yet not seeing any results because you’re working incorrectly. A good trainer can put you on the path, supervise your regimen, and hold your hand through the process. The minutia of age, sex and body habitus considerations that also play a role in this can be managed by a good trainer. Your ideal trainer will have knowledge of nutrition, wellness and supplements that are tailored to your specific considerations. This will get your metabolism revved up!
By the way, if you’re into green tea, caffeine or spicy/hot peppers, enjoy them for their other benefits, but don’t expect them to contribute significantly to your efforts to improve your metabolism. At least that’s what the consensus in the medical literature points out.
Finally: yes, it’s true that metabolism naturally slows with age (starting as early as age 25); everyone has heard that fact. However, here’s what you don’t usually hear: that’s not inevitable and is more a result of your becoming less physically active than just aging. That demonstrates the need for you to be even more diligent in your efforts. Good luck, and I welcome your questions and comments.
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Straight, No Chaser: Healthy, Sustainable Weight Loss – Let's Get Started

Cardiology/Heart, Personal Training, Health Prevention, , , , , , , ,

obesity6obesity5
How to Lose Weight, and What is Healthy Weight Loss (AKA, How Much, How Soon and How)?
Let’s start with the How. Commercial voice: “You should contact your physician before starting any weight loss routine”. We ended things on the last post talking about the caloric balance equation, which (simplified) means you need to get off your derriere, and close your mouth. Without getting too technical, to lose weight, 1 pound equals 3,500 calories, so your net caloric intake must be cut by at least 500 calories per day to lose a pound a week. Here are some Quick Tips to cut calories (and I will not be discussing any of the popular diets or medical remedies (with one exception in the next post); you can see your physician or nutritionist about those. Besides, guess what? Most of you don’t need a fad diet. Keep it simple. And…more importantly, you should be more concerned with healthy regimens that help you keep the weight off, not drastic efforts that have proven to have quick short-term but unsustainable long-term outcomes).
1) Work out: If you can sprint, do so. If you can’t, jog. If you can’t jog, walk. I like working out while watching sports, because my heart’s pumping anyway. Weight training at the same time is even better. Once you hit a good exercise regimen, your metabolism will improve, making weight loss that much easier.  By the way, the next post is on metabolism; stay tuned.
2) Hungry?  Start counting calories.  Use this standard to determine what your daily calorie intake should be.  Meal plan so you don’t exceed that level.  Remember the caloric equation to lose weight: Amount expended minus the amount eaten should be 500 calories a day.  In the next post, I’ll give you a Quick Tip for an extra 400 calories a day you can lose.
3) Still hungry? Try brushing your teeth. Don’t laugh. It actually works. And it gives you nice teeth. Otherwise try drinking water or chewing calorie-free gum. All these are nice, simple inexpensive appetite suppressants.
How Soon? It’s natural for anyone trying to lose weight to want to lose it very quickly. But evidence shows that people who lose weight gradually and steadily (about 1-2 pounds per week) are more successful at keeping weight off. Healthy weight loss isn’t just about a “diet” or “program”. It’s about an ongoing lifestyle that includes long-term changes in daily eating and exercise habits. Think health instead of weight, and the weight will improve.
How Much? If you were my patient (but you’re not!), I’d tell you to forget about ideal body weight and BMI – for now. Focus on a modest weight loss, like 5-10% of your current weight. Even this success will improve your blood pressure, cholesterol and blood sugar levels. Once you accomplish that goal, do it again. So even if the overall goal seems large, see it as a journey rather than just a final destination. Seek to learn new eating and physical activity habits that will help you live a healthier lifestyle. These habits may help you maintain your weight loss over time. To that end, I love healthy challenges. Try a 30-day water instead of pop (soda)/coffee, etc. challenge, or even better, give yourself a 30-day ‘fruit for dessert challenge’ or ‘salad of your choice for lunch’ challenge. When that’s done, immediately do it again.  Learn to integrate healthy habits into your quest to lose weight, and you’ll increase the odds of having sustainable weight lost. At the end of the day, it’s been well established that those who maintained a significant weight loss report improvements in not only their physical health, but also their energy levels, physical mobility, general mood, and self-confidence. Good luck, and check back for the next post on how to fine-tune your metabolism!
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Straight, No Chaser: The Adverse Health Effects of Obesity and Why You Gain Weight

General Health and Wellness, Health Prevention, , , , , , , , ,

obesity1Obesity.jpg
Earlier, we identified the differences between a ‘normal’ weight and being overweight and/or obese. Today’s goal is to help you understand specific risks of carrying extra weight.  We’ll also set the table for losing weight by discussing why weight gain occurs.  It bears repeating that none of this has anything to do with the perception of one’s physical attractiveness.
Let’s focus on three considerations.
1. What are the health risks?
As body weight increases, so does the risk for several different medical conditions and illnesses, including the following:
• Arthritis
• Cancers (breast, endometrial, and colon)
• Diabetes
• Gynecological problems (abnormal periods, infertility)
• Heart disease (heart attacks, heart failure, hardening of the arteries)
• High cholesterol
• Liver and gallbladder disease (gallstones)
• Sleep apnea and other respiratory problems
• Stroke
In the event that these risks are just words on a page, learning a little bit about some of them might provide the motivation needed to avoid them.
2. What is a realistic goal for weight loss?  What’s the balance between family predisposition and the foods I eat?
No matter what I tell you today, it’s unlikely to turn you into a supermodel. The goal (independent of your consultation with your own health care provider) is to get you to optimize your situation based on the things you can control. Yes, genetic factors do play a role in obesity, but beyond that you are more than able to close your mouth and get off your…couch. You are able to limit your fat and caloric intake and put down the salt shaker. Yes, genetics count, but behavior and environmental (culture, socioeconomic status) consideration play at least as much of a role. These latter considerations can even jumpstart your metabolism beyond your genetic predisposition.
3. Why do I gain weight if I’m still active?
The most simple way to answer this is that weight gain occurs from an energy imbalance.  You’re taking in too many calories, and/or you’re not engaging in enough physical activity. It’s an equation, and the weight gain occurs when you’re on the wrong side of the equation. It’s not much more complicated than this. Either do less of the eating, more of the activity, or both.  I mentioned in a previous post on caloric counts that you must have an excess of 500 more calories expended than you ingest daily every day for a week just to lose one pound.  It takes work.  This is the simple answer as to why fad diets don’t work long-term.  You can’t cheat the equation.  The moment you stop being diligent, you’re headed in the wrong direction.  Your weight loss plan must include lifestyle changes for the long-term.
In the next post, we’ll identify some very simple methods to combat obesity based on the information provided to this point. Feel free to ask any questions or submit any comments you have.
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Straight, No Chaser: The United States of Obesity – The Crossroads Between Health and Happiness

Cardiology/Heart, General Health and Wellness, , , , , , ,

obesity_trends_20092obesity4

Obesity in the United States places many at a crossroad between self-esteem and health.  Often, larger frames are celebrated as more desirable.  Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise.  Of course, our culture embraces and contributes to obesity.  Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport.  I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health.  If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed.  As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:
Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.
Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.
‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight No Chaser: The United States of Obesity – The Crossroads Between The Pursuit of Health and Happiness

Cardiology/Heart, General Health and Wellness, Health Prevention, , , , , , , , , , , ,

obesity_trends_20092obesity4

Obesity in the United States places many at a crossroad between self-esteem and health.  Often, larger frames are celebrated as more desirable.  Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise.  Of course, our culture embraces and contributes to obesity.  Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport.  I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health.  If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed.  As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:

Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.

Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.

‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Here's How You Stop Smoking – Quick Tips to START Smoking Cessation

General Health and Wellness, Health Prevention, , , , , , ,

smokingcessation1

  • Don’t pick your birthday or NYE to stop. Do it now. Can’t do it now? Do it Monday. In fact, do it every Monday. It’s a fight. If you fall down, start it back up again. It’s the fight of your life (or should I say for your life?).
  • If you decide to quit after your current (last) pack, throw away one cigarette for every one you smoke.
  • Count (figuratively or literally) all the money you’re saving by not smoking.
  • Throw away (not give away) all cigarettes, cigars, matches, lighters, humidors, cigar cutters and anything else you associate with smoking. You’ll realize how sad it is if and when you find yourself rummaging through the garbage to get a fix.
  • Tell everyone (loudly) that you’ve quit. Empower them to help and hold you accountable. Enlist another smoker friend to go through the journey with you.
  • If you do fall off the wagon, smoke a different cigarette brand. Odds are you won’t like it as much, and that will help combat the natural ease you have with smoking.
  • Contact your physician, and ask for help. Here’s a marvelous best-practices schemata of appropriate interplay between a physician and a patient trying to stop smoking.

smoking cessation As

  • If your physician and you decide to place you on a patch or otherwise medicate you, follow instructions carefully and precisely.
  • Practice deep breathing. Part of the euphoria of smoking is nothing more than the physiologic sensations produced by deep inhalations.
  • Keep other things in your mouth. Mints and chewing gum (low-calorie) are great. Brushing your teeth also serves many purposes. Drinking water when you want to smoke will often remove the urge.
  • Make it past the first day. Then make it past the first week.

I personally love the START method, which includes several of the above methods. Let me know if it works for any of you.

S: Set a quit date.

T: Tell your friends, family and associates that you’re quitting, and enlist their help.

A: Anticipate and act on the plan you’ve set and challenges you’ll meet.

R: Remove (trash) cigarettes, cigar and other paraphernalia from your environment.

T: Talk with your physician about options and additional support.

For those of you affected (either first or second-hand), this is huge and important. I really wish you all the best. I welcome any comments or questions.
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Straight, No Chaser: Smoking Cessation

General Health and Wellness, Respiratory/Lungs, Health Prevention, , , , , , , , ,

smoking stop
You’ve all been asked what things you’d take with you on a desert island.  I’ll pose and answer the opposite question, but not on an island but regarding your life.  Getting you to stop smoking is certainly one of the three gifts I’d offer you if it was within my power.  This post won’t be about the dangers of smoking – I’ll continue to hit you over the head with those at every opportunity.  Given that I’m into producing positive outcomes, I’m going to discuss with you effective means of smoking cessation and the benefits of stopping.
The question on your mind is obviously how to stop.  Personally, I’m of the Yoda mindset.  You know, when he was teaching Luke Skywalker, he famously said “Do or Do not. There is no try.”  I can hear you now, “But Doc, I’m addicted…”  Sure you are.  There are many things in medicine about which I’m absolutely sure.  One of these is the most effective way to stop smoking is to quit.  Cold turkey.  The moment you’re motivated.  Not only is this premise supported by the data, which I’ll discuss momentarily, but here’s the benefit of over 20 years in clinical emergency medicine practice and having seen hundreds of people stop, stay stopped, and letting me know months and years later that they stayed stopped.  Despite being addicted, people are amazingly able to quit cold turkey, and they will do it in one of five circumstances.

When they develop the will

After the birth of their first child

After their first heart attack

After their first stroke

When they die

For those of you convinced that you can’t, here’s a fact: today there are more former smokers than current smokers.

I want to point out that I appreciate the difference between cigarette smoking and nicotine dependence.  My particular concern for your health lies in the delivery of smoke (containing over 7000 other toxins, approximately 70 of which can cause various cancers) into the airway system that is supposed to deliver oxygen throughout your body for the maintenance and health of your organ systems.  Still I want you to know I understand and appreciate the difficulty of smoking cessation.

  • Nicotine dependence in the most common chemical dependence in the U.S.
  • Quitting smoking often requires multiple attempts.
  • Nicotine withdrawal produces bothersome symptoms (e.g. irritability, reduced concentration, increased appetite with possible weight gain, and anxiety)

The good news is more than two-thirds of smokers profess a desire to stop smoking, and yearly over half of smokers attempt to stop.  That’s likely a result of knowing that no matter when you stop, you will improve your health outcomes.  Each incremental inhalation of cigarette and cigar smoke produces damage better left unproduced.  Let’s just hope you don’t wait until permanent damage has set in.  Consider a sampling of the following benefits that are sitting there waiting for you.

  • Reduction of the risk for cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix, as well as certain leukemias.
  • Reduction of the risk for heart disease, stroke and peripheral vascular disease.
  • Reduction of the risk for COPD (chronic obstructive pulmonary disease)
  • Reduction of the risk for infertility

In my next post, I’ll review specific methods and tips to help you and/or your loved one stop.  Today’s as good of a day as any.
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Straight, No Chaser: The Week In Review

Medical Treatment, Public Health, Health Prevention, , , , , , , , ,

WeekInReview_thumb2
Based on the response to this week’s posts, I’d say it was an informative week for you.  Remember to click the underlined topics to go to the mentioned post.  Let’s recap the week.
On Sunday, we reviewed night terrors and differentiated them from nightmares.  Remember, if your child develops these, it’s very important to protect them from harm during the episode, and try to identify the source of any increased stress.
On Monday, we reviewed the late Dr. Martin Luther King, Jr.’s comments on healthcare and its relevance today.  Injustice in healthcare is still shocking and inhuman, as health care disparities abound.  Monday also brought a review of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare.  As the time of implementation gets closer, I will revisit implementation of the ACA, particularly health care exchanges, what your options are, and what’s to be done with the 20 million Americans who will still be uninsured.  I will also be discussing how this blog and my national efforts will dovetail into these considerations.  Stay tuned.
On Tuesday, we began our series on toxins and detoxification.  The first post discussed the power our body naturally and normally has to detoxify and to defend us from harm.  The second post offered specific, natural Quick Tips to enhance your body’s capabilities.  Taken together, I strongly recommend you internalize this information (no put intended).  All the other exotic methods typically promoted are, at best, enhancements to what we already do unless disease limits us.  At worst, they can cause damage themselves.
On Wednesday, we looked at some of the environmentally toxic dangers to our bodies, focusing on various toxins affecting our lungs, skin, kidneys, liver and intestines.  If knowledge is power, your brain should be stuffed after reading that post.  Stop smoking (Yes, you.).  Wednesday also brought a review of detox diets.  My advice is simple.  Proceed with caution, and don’t expect any miracle cures.  In fact, the better course of action is to use any such efforts as a launch into a more modest long-term regimen of healthy diet and exercise.
On Thursday, we reviewed colon cleansing, looking at oral solutions and rectal colonics.  These were turbulent topics, to say the least.  Please consult your physician before starting any of these diets or cleansing programs.  They are not without risk and consequence in certain patients.  Thursday also brought a review and wrap-up of the toxin/detoxification series.  I enjoyed your questions, comments and thoughts.
On Friday, we reviewed insomnia.  Do you remember the difference between primary and secondary insomnia?  There are important treatment considerations attached to each, so consider reviewing.  I also gave you 10 Quick Tips to help your difficulty sleeping and answered your questions. 
On Saturday, we peeled back the brains of physicians and taught you how we decide if and when ankle x-rays are needed.  I really do want your feedback when you mention the Ottawa Ankle Rules to your physicians.  I’m sure you’ll have stories about hearing them muttering “Damn internet!” under their breath!  Saturday also brought a review of a normal calorie intake.  I think this is a pretty important topic for several reasons.  I hope you learned the different between sedentary, moderately active and active lifestyles.  Also, many of us have no idea how much we should be eating and how many calories we should have daily.  Also, this will serve as a nice launching pad for my review of obesity next week.
Speaking of the next two weeks, I will be focusing on revisiting some fundamental bread and butter topics (no pun intended).  I continue to hope you enjoy Straight, No Chaser and appreciate your supporting this blog, which has now reached readers in 60 countries around the world in every continent.  I’ll keep bringing the information, and you keep taking advantage of it.

Straight, No Chaser: How Many Calories Do You Need a Day?

General Health and Wellness, Health Prevention, , , , , , ,

soda1
Let’s put this post (at least the end of it) under the category of things you do but really don’t think about.
How many calories should you take in per day to function (meaning produce the energy you need for your activities of daily living)?  It actually depends on your gender, your age and your level of activity.  Let me start by defining the types of lifestyles, according to the Institute of Medicine.  If you are in the third category (active), I doubt that you’re worried.
Sedentary means a lifestyle that includes only the light physical activity associated with day-to-day living.
Moderately active means a level of physical activity equivalent to walking about 1.5-3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
Active means a level of physical equivalent to walking more than 3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
That breaks down as follows:

  • For women between 14-50, the number is right about 2000 kcal/day (calories) if you’re moderately active and 1800 if you’re sedentary.
  • For men between 14-50, there’s some greater variance, but the 2500 kcal/day works if you’re moderately active and 2200 if you’re sedentary.

In short, that averages to about 600-800 calories per meal, with the low end being for sedentary females and the high end being for moderately active males.
Now consider, 16% of the calories in the average American diet come from refined sugars.  Fully 50% of that total comes from beverages with added sugar.

Every 12 ounces of non-diet of pop/soda you drink contains about 150 calories.  

Your average dessert ranges from 300-500 calories.  

The most popular one, only one cup of ice cream, contains 270 calories.

I’ll let you take the math forward from there.  However, the take home point is obvious.  Suffice it to say, the link between pop, deserts and obesity has been well established.  Here’s three Quick Tips for you.

  • Try finding a drink with fewer calories if you want to lose calories (and weight).  It’s water, not Coke, that adds life.
  • Try eating your favorite fruits as dessert.
  • Also, consider just walking 3-4 miles a day.  It’s not that hard, if you just do it.

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Straight, No Chaser: How I Know If Your Ankle is Broken Without X-Rays – The Ottawa Ankle Rules

Medical Treatment, Orthopedics/Bones, Health Prevention, Musculoskeletal System, , , , , , , ,

Ottawa-ankle-rules
There are medical secrets, and there are tips.  Then there are initiatives that help the public better understand what’s going on, like the big initiatives on heart attacks and strokes.  I wonder why there’s never been a push to teach the public how to better deal with strains and sprains.  The cumulative radiation exposure and the expense of coming to the emergency room are sufficiently high enough that we should want patients not to expect as many unwarranted x-rays as you end up receiving.  Truthfully, the overwhelming majority of ankle sprains (consistently estimated at 85%) don’t have associated fractures.  The initial research done in developing what are known as the Ottawa Ankle Rules demonstrated a complete absence of ankle fractures in the absence of certain exam findings.
An ankle X-ray is only required if any of the following are present (Doctor version).

  • Inability to bear weight for four steps (both immediately and in the emergency room);
  • Bony tenderness along the posterior edge of the distal 6 cm (almost 3 inches) of either the lateral or medial malleolus;
  • Point tenderness over the proximal base of the 5th metatarsal; or
  • Point tenderness over the navicular bone.

Now that was the medical terminology (I bet you thought I’d lost it for a second!).  Here’s the same information translated for you.

  • Inability to bear weight for four steps (both immediately and in the emergency room);
  • Bony tenderness along the back of those big bones sticking out of either side of your ankle (A and B in the diagram above);
  • Point tenderness right about the middle of your foot down from your pinky toe (C in the diagram); or
  • Point tenderness over top of the middle of your foot (D in the diagram).

These rules aren’t applied to those under 18, intoxicated or otherwise distracted, say from another injury.
What does this mean?

  • More than a third of ankle x-rays can be eliminated by applying these rules, saving you money and radiation exposure.
  • If you find your physician asking you if you’d like to not have an x-ray done, you know this is what s/he’s thinking.  Several major studies showed application of these rules had a 100% sensitivity.  In other words, you don’t need the x-ray.
  • All of you playing with your ankles have made me smile.

What this doesn’t mean for you…

  • You can play doctor at home.

Finally, don’t forget about RICE, remember?  That’s how you treat your ankle sprain.
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Straight, No Chaser: Your Rebuttals and Questions about Insomnia

Medical Treatment, Sleep, Health Prevention, , , , , , , , , , ,

You are certainly an entertaining group behind the scenes. Here are some of your questions on insomnia. Be reminded that should you want to leave me a private question, just go to the Home Page, or type https://jeffreysterlingmd.com into your browser. Here’s five questions from this morning’s post on insomnia.
1. Aw, hell! You’re telling me I can be dying from something causing insomnia?

  • It’s way more likely that level of stress you’re displaying is keeping you awake at night.

2. How is it that sex makes you sleepy?

  • When you do exert yourself vigorously, the greater utilization of muscles will deplete glycogen (energy) stores and make you drowsy. Also, it’s well established that certain hormones (e.g. prolactin, GABA and oxytocin) that promote sleep are released after an orgasm.

3. You mentioned tea. A good cup of tea at bedtime helps me sleep.

  • If that works for you, go for it. Some people have paradoxical effects to stimulants (In fact, stimulants are the most common treatment for ADHD – a topic for another day.)

4. What about giving my baby Benadryl?
I’m giving information here, not practicing medicine, so that’s a question for your physician. I will say there are many drugs (most notably those in the anticholingeric class) that have drowsiness as a side effect, and many emergency departments will give Benadryl to adults for that purpose. That said, these medications are not primarily used for drowsiness, and you’ll have to deal with other drug effects (such as the intended purpose for the medication) in addition to any possible drowsiness that occurs.
5. Sex at night keeps me wide awake.
That’s why a lot of you are shy about putting comments in the inbox… Sorry, but the answer to that question was not meant for public consumption.
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Straight, No Chaser: Insomnia – You are Not Getting Sleepy…

Medical Treatment, Sleep, Health Prevention, , , , , , , ,

insomniahypnosis

Talking about insomnia makes me well, tired. You know what the problem is. You either can’t fall asleep, or you can’t stay asleep. You’re tired when you wake and all throughout the day. Lack of sleep saps your energy and your productivity.
Insomnia really isn’t very cool to deal with, either as a person or as a physician. Patients are frustrated and sometimes cranky from being tired, or they can be extremely nervous and stressed, which will perpetuate a vicious cycle. There are so many mental factors that can disrupt your ability to sleep.
Medical professionals tend to think of insomnia in two forms for purposes of evaluation. Either the insomnia is the main problem (primary insomnia), or it’s secondary to another condition (secondary insomnia) such as reflux, uncontrolled asthma, arthritis or other pain syndromes. It could be due to medications, depression or just stress. It could be due to some undiagnosed condition, such as cancer, an enlarged prostate (making you have to get up to urinate throughout the night), thyroid disease or sleep apnea. Then there’s the caffeine (coffee/tea), nicotine (cigarettes) and drunk scene (alcohol).
The thing is, whether acute, intermittent or chronic, any insomnia really is an inconvenience and can even be incapacitating. Before you subject yourself to a million dollar medical workup, just remember, if it’s secondary insomnia, and you know (for example) that your pain is keeping you awake, try dealing with the primary issue. Alternatively, if it’s primary insomnia, there are a lot of things you might consider trying. In fact, consider this my Top Ten Tips, presented in the order you might consider implementing them.

  • Good diet and exercise habits make your body perform as they should and will clean up a lot of potential problems that will affect sleep.
  • Avoid naps during the day. You want to be good, tired and ready to sleep when night comes.
  • Develop the habit of only using your bed for sleep or sex. That conditions your body to be ready to sleep when confronted with the stimulus of your bed.
  • Get your snoring partner some help if s/he is part of what keeps you awake. Check here for tips to deal with snoring.
  • Try not to eat for several (3-4) hours before you sleep. Nothing says ‘no sleep’ like heartburn all night (By the way, this is the real reason you shouldn’t eat after a certain hour – not concerns about your weight.).
  • Similarly, avoid nighttime stimulants (e.g. cigarettes, coffee, tea and exercise close to the time you want to sleep, if this proves to be a problem).
  • Although alcohol is a sedative, it’s also on the don’t-do list because it can cause restless sleep and interrupt the sleep cycle.
  • Find a way to relax before sleep. Consider a bath, sex, a book or soothing music. Or all of them.
  • Set the alarm for the morning, then hide your clock. You don’t need to have a clock to remind you that you aren’t sleeping all night.
  • Use ‘white noise’ for background if you’re bothered by other sounds.

Here’s a bonus tip: If you fell asleep during the reading of this post, keep it for future reference.
As Edward R. Murrow used to say (well before I was born): Good night, and good luck.
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Straight, No Chaser – The Week In Review

Medical Treatment, Public Health, Health Prevention, , , , , , , , , ,

weekinreview
I hope this was another week of good health for you.  Let’s review how Straight, No Chaser tried to contribute to your health and wellness.  Don’t forget to click on any of the underlined topics for links to the original posts.
On Sunday, we reviewed eye emergencies.  Don’t forget that even transient vision loss could be a stroke in progress, and certain causes of vision loss have a limited window of time in which treatment must occur.  Act quickly!  By the way, I didn’t mention this information that occurs more commonly than you’d think: If you ever have eye discharge so copious that it seems like you’re tearing pus, this is probably gonorrhea.  Get it treated, lest you could lose an eye.  Now that I have your attention…
On Monday, we reviewed syncope (aka fainting) in two parts, talking about the entity (click here) and the life-threatening conditions associated with faints.  You’re way too cavalier with faints; please get them evaluated.  Faints can either be the result of significant disease or can secondarily produce significant head and neck injuries from the falls.  Stop going to the bathroom (with all the hard stuff in there) when you’re feeling dizzy.  That’s not a good place to black out!
On Tuesday, we discussed suicide and depression in-depth, reviewing demographic information, information for your self-assessment, and tips on how to recognize when help is needed (and how you can avoid depression).  I’m pleased that you’ve made these topics the most read topics yet, and I sincerely hope this information helps some of you.
On Wednesday, we reviewed the overuse of the emergency room, which will become a major theme of this blog.  Those creature comfort visits are 8 times more expensive than the same visits done at a primary care physician’s office.  In Texas, the average ER cost is $1020.  Just because you’re not necessarily paying up front doesn’t mean the hospital won’t ensure you’ll pay eventually.  Remember, hospital bills are the #1 cause of personal bankruptcy in the U.S.  Straight, No Chaser was created to point you toward better options.  Stick around, and we’ll get you there.  Wednesday also brought a review of vomiting and diarrhea (viral gastroenteritis).  Learn about oral rehydration therapy.  Viral gastroenteritis is a good example of something that feels really… bad but is usually self-limited and will go away on its own, as long as you stay hydrated.
On Thursday, we reviewed end of life decision-making.  I know this struck home for a lot of you, bringing back not so fond memories.  That said, you must begin to think about how you want to be treated in your last days.  There are many tragedies during this time that tear families apart.  Use the tools discussed on the post on living wills, power of attorney designations and DNR considerations to make sure your interests are the only consideration being addressed when the time comes.
On Friday, we seemed to prick a nerve or two (no pun intended) discussing circumcision.  If nothing else, be an educated consumer.  Even now, considerations are perhaps best summed up by the posture of the American Academy of Pediatrics, which declines to recommend routine circumcisions for all newborns but notes that if you are inclined to get the procedure (which should be a big if), the benefits outweigh the risks.  Friday afternoon, we reviewed hearing loss and the damage the activities of daily living produce.  This is a pretty good example of how we take our health for granted.  Just a little bit of protection and prevention over the first 40 years of your life will make a big difference later on.
Saturday, we discussed two different types of sounds that come out of you.  First, we discussed snoring (which is always annoying but never boring) and gave you some Quick Tips to overcome it.  We also discussed hiccups, which everyone gets at some point, but no one ever wants.  We also gave you Quick Tips on hiccup cures here.  Remember those ABCDEs!
We continue to listen to your comments and feedback, and over the next few months, some major changes will be occurring.  Please continue to forward your topic requests.  I promise I’ll get to them all eventually.  Maybe I’ll start doing reader submission posts.  As we continue to grow, your support, referrals and follows are much appreciated.  Have a happy and healthy week.
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Straight, No Chaser: Quick Tips – You Snore Too Much

Neurology, Sleep, Health Prevention, , , , , , ,

snoring
You snore too much.  What this means is your breathing is intermittently partially obstructed while you’re sleeping.  Snoring is the sound of air moving past that obstruction.  Whether serious or not, first you should know it’s common, occurring in about 50% of adults.    It could be serious or just positional.  Here are some Quick Tips for you.

  • Sleep on your side.  This should remove the tongue as a cause of a partial obstruction.
  • Avoid sedatives if possible.  Sedatives cause significant enough relaxation to the tissues in your throat to cause that partial obstruction.
  • Limit alcohol before sleeping (by about two hours).  Alcohol is a sedative.
  • Elevate the head of your bed or prop your head up by about 4-6 inches.  This should manually move partially obstructing tissue out of the way.
  • Fix what ails your nose.  If you have chronic problems with nasal obstruction or a deviated nasal septum, you’re more inclined to breathe through your mouth.  This will increase the chances that you snore.  Similarly, those nasal strips you may have seen work (when they do) by increase the area in the nose through which they can breathe.
  • Finally, losing weight (if you have it to lose) works by reducing the tissues in and around your throat that cause snoring.

It’s time to see your physician if you find yourself awakening from sleep choking, gasping or otherwise short of breath.  This could be an indicator of a serious condition, including sleep apnea.  Additionally, you may want to seek care if your sleeping causes functional problems (e.g. you or your partner have difficulty sleeping as a result of your snoring).
This is a significant enough issue that I will revisit it in the future.  In the meantime, sleep well.

Straight, No Chaser: Can You Hear Me Now? Checking Hearing Loss

Head/Eyes/Ears/Nose/Throat, Health Prevention, , , , , , ,

noise_thermometer
We live in a loud world. Take a listen around. You’re likely in the midst of multiple simultaneous noises, many of which (if you actually think about it) sound harsh and annoying. However, we’re pretty good at consciously ignoring background noise, even though the sounds are affecting our hearing apparatus. After years of traffic, screaming, loud music and other assorted sounds, our hearing invariably starts to suffer.
I’ll discuss the causes, mechanisms and prevention of hearing loss another day, but for now, I want to point you toward getting your hearing checked before you find yourself needing a hearing aid. Being cognizant of where your hearing stands may prompt you to make some early alterations that can save your hearing over the longer term.
Signs and symptoms of hearing loss may include the following:

  • Previously normal sounds, including speech, become muffled.
  • The ability to distinguish sounds in the midst of background noise becomes harder.
  • You need others to speak more slowly, clearly and loudly
  • You need to turn up the volume of the television, radio and other devices to which you’re listening.
  • You avoid socializing and find yourself withdrawing from conversations.

Our hearing anatomy is actually quite fascinating and complex, and there’s a lot that could be going on. It’s time to get an evaluation if you’re suffering from the above, or your daily activities are being interfered with by hearing difficulties. While you’re at it, check out the noise thermometer, and see how easy it is for a few common sounds to cause some real damage.

Straight, No Chaser: Circumcision – To Do or Not to Do?

Genital/Urinary, Medical Treatment, Pediatrics/Kids Health, Public Health, , , , , , , , ,

screamingbaby
As a medical professional, circumcision has long been one of those things that’s made me go hmmm…. If your religious beliefs include this as a ritual or ceremony, fine.  I get it, and I have no criticism at all.  No disrespect is intended.  Otherwise, circumcision is largely a procedure looking for an indication.  Quick, tell me what other elective surgical procedure or harmful activity of any type is allowed on children, much less newborns?  While I’m waiting for you to think about an answer that doesn’t exist, let’s recap the procedure and the medical logic behind it.
As you know (and men are painfully aware – pun intended), circumcision is the surgical removal of the skin over the glans (tip) of the penis.  Over the last 30 years, the rate of males receiving the procedure has dropped from 64.5% to 58.3%, according to the National Center for Health Statistics.  Worldwide about 30% of males are circumcised, and of those receiving it, the religious influence is largely present. 69% of those being circumcised are Muslim and 1% are Jewish (Circumcision is part of religious rituals in both religions.).
Let’s cut to the chase (no pun intended): Here are the best arguments for circumcision.

  • It helps prevent certain infections (e.g. yeast and UTIs – which most males aren’t especially prone to anyway).
  • The cells of the inner surface of the foreskin may provide an optimal target for the HIV virus (This is theoretical and not conclusively decided in the medical literature.  In any event, this is NOT the same as saying uncircumcised males do or are more likely to contract HIV.).
  • Circumcised males have a lower rate of penile cancer (which is very low under any circumstances).
  • Now, there are emergency indications for circumcision; the one I’ve had to address (once in twenty years) is an inability to readjust a foreskin that too tightly adhered to the shaft of the penis (paraphimosis).  Obviously, that’s a medical emergency and not something frequently seen enough to justify universal circumcision any more than a much higher rate of appendicitis would warrant universal and elective removal of everyone’s appendix.

Here are criticisms of the decision to have circumcision.

  • Any surgical procedure has complications, and that should be taken seriously.  That said, the complication rate for circumcision is very small and includes bleeding infection and pain.
  • Circumcision is a violation of a child’s body and is unnecessary and disfiguring.  The foreskin might not be cut the appropriate length, might not heal properly and may require addition surgery because the remaining foreskin incorrectly attaches to the end of the penile shaft.

Honestly, both the risks and benefits are quite overstated.  Circumcision doesn’t appear to be a medically necessary procedure, but it isn’t an especially dangerous one.  Interestingly, the American Academy of Pediatrics’ latest comment on circumcision is that the benefits of circumcision outweigh the risks, which stops short of recommending routine circumcision for all.  Even that equivocal smacks of conflict of interest, given who’s performing the procedure at a significant cost to the consumer.  Again, this appears to be a procedure looking for an indication…
If I was having this conversation in Africa, where the sexually transmitted infection rate is substantially higher and can be significantly reduced by circumcision, we’d be having a different conversation.  If my Jewish or Muslim friends and colleagues were asking my medical advice on the safety of getting the procedure done as part of their religious ceremonies, we’d be having a different conversation.  However, we’re not, and for the population in general, it’s safe to say that – various preferences (for various reasons) aside – there’s no compelling reason to recommend circumcision on all newborn males.  Make your judgment based on facts, not a whim.  And that’s medical straight talk.  Oh, and guys – sorry about the picture.  That wasn’t a good day.

Straight, No Chaser: End of Life Decision Making

Medical Treatment, Health Prevention, , , , , , , , , , , , , ,

AdvanceDirective
Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.” I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. Please understand that at any age your life could be at risk, you could die, and you could need someone comply with decisions; as such, you need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.
Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and, subsequently, with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

  • Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
  • Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
  • Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That doesn’t have to happen.
  • Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
  • If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering or will you want to be allowed to expire?
  • Will you want the medical staff to feed you if you can’t feed yourself?
  • Will you want to donate your organs?

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.

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