Tag Archives: health

Straight, No Chaser: About That Vomiting and Diarrhea…

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

gastroenteritis.jpg.mid
You’ve all been there and done that. It’s always a bad day when you get the so-called stomach flu… First of all ‘the flu’ is a respiratory disease (affects the lungs, not the stomach and intestines), and the influenza viruses don’t cause that syndrome of vomiting and watery diarrhea. So, what you’re actually getting is gastroenteritis (gastro = stomach, entero = intestines, and itis = inflammation), an inflammation of the stomach and intestines.
Gastroenteritis means inflammation of the stomach and small and large intestines. Most cases of gastroenteritis are infections caused by a variety of viruses that results in vomiting or diarrhea (other symptoms may include belly cramping, fever and headache from all that retching). There are other (bacterial) causes of vomiting and diarrhea, but the overwhelming number of cases is due to viruses. Your physician will know when the other considerations come into play. Here’s a few points you really want to know.
1. Is it serious?

  • In most cases of viral gastroenteritis, the symptoms and condition are rate limited and will come and go without much further ado. Your symptoms will last up to 10 days in most cases.
  • The concern isn’t nearly as much with the vomiting and diarrhea as it is with the dehydration that can result from all those fluid losses. Dehydration can cause all manner of electrolyte abnormalities, leading to serious acute illness and even death. In fact, diarrhea and dehydration have long been the number one cause of death worldwide outside of the United States.

2. Is it contagious?

  • Absolutely. This is one of the main reasons you’re always being told to wash your hands, especially after using the bathroom. Fecal-oral (yes, anus to mouth) transmission of viruses makes gastroenteritis and many other illnesses contagious. Hand shaking and other forms of contact (including eating food poorly handled or undercooked) extend the risk of transmission.

3. How can I avoid gastroenteritis?
There are good options available to you.

  • Avoid food and water that you believe to be contaminated, perhaps because others have had problems with it.
  • Frequent hand washing is very important.
  • Similarly, take steps to wash and disinfect possibly contaminated clothing and surfaces, preventing this before it gets started.
  • A vaccine is available for two of the more common causes of gastroenteritis. Discuss whether it’s appropriate for your child with his/her pediatrician (it needs to be given during your child’s first year of life).

4. How will it be treated?

  • Fluids, fluids and more fluids will be given, and unless you can’t keep anything down at all, the fluids should be given by mouth. It’s interesting to note that the U.S. overuses intravenous (IV) fluids much more in these instances than the rest of the world. Learn about oral rehydration therapy (ORT). It’s how the rest of the world (very successfully) treats most cases of vomiting and diarrhea, and it’s roughly approximated by all those popular rehydration brands. The key is to take in enough fluids to stay ahead of the fluid losses. ORT is available over the counter, and remember that you don’t have to guzzle it. As little as a teaspoon at a time still can keep you hydrated.

It’s important to discuss some other treatment considerations.

  • Antibiotics don’t work against these viruses, so in this example, they won’t be helpful.
  • In select instances, your physician may provide symptomatic treatment for vomiting and diarrhea, but in the absence of this, they should be avoided. There are significant consequences to taking these medications, and a physician should be involved in taking that risk.

In summary, you don’t always have to run to the ER when you get the runs. Stay hydrated, my friends.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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Straight, No Chaser: Depression Quick Tips – How to Avoid It, When to Get Help

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

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

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

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

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

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

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

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

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

Mental Health, Health Prevention, , , , , , ,

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

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

Now consider these most common precipitants for suicide:

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

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

Straight, No Chaser: Suicide Data – Understand the Threat

Mental Health, Public Health, , , , , , , , , , , ,

suicidemap
There are amazing, shocking and saddening facts about suicide.  It is equally amazing that we aren’t discussing this as an epidemic.  Consider the following information provided by the Centers for Disease Control and Prevention:
There were an average of 105 suicides a day in the U.S. (over 38,000 for 2010).
An estimated 8.3 million adults reported having suicidal thoughts in the past year.
Suicide is the third leading cause of death among those aged 15-24, the second among those aged 25-34, the fourth among those aged 35-54, and the eighth among persons aged 55-64.
For those committing suicide:

  • 33.3% tested positive for alcohol.
  • 23% tested positive for antidepressants.
  • 20.8% tested positive for opiates (such as heroin and prescription pain killers).
  • There is one suicide for every 25 attempts.

Females are more likely than males to have had suicidal thoughts, but suicide among males is four times higher than among females (in other words, females think about it and try more often, but males complete the act more often.).
Among Native Americans aged 15-34, suicide is the second leading cause of death, fully 2.5 times higher than the national average.
There are some topics that aren’t amenable to Blogs.  Depression and suicide are among them.  They can’t be done justice.  What I can try to do is break components of the conversation into bite size pieces and give you information to work with.  I’ll do this in three parts.  Above, I’ve shown you the magnitude of suicide.  In the next post, I will help you understand what clinical depression looks like, then finally, I’ll review some Quick Tips to help you prevent falling into the deepest levels of depression and to help you know when immediate attention is required.  Just remember: this isn’t the type of depression that involves having a bad day.  I’m talking about when your downward mood interferes with your activities of daily living.  I’m describing depression that introduces suicide and homicide as an option.  If you don’t read these for yourself, read them for knowledge.  Someone you know may be affected.
I welcome any questions, comments or thoughts.

Straight, No Chaser: Your Questions on When Fainting is Fatal

Neurology, , , , , , ,

fainting
1. So are faints deadly?

  • Potentially. There are three separate sets of considerations. The brain can’t survive very long without adequate oxygen. Whatever caused that faint, if it continues to deny oxygen to the brain, can lead to seizures, strokes and death.
  • The process that caused the faint could be deadly in and of itself. Such things would include heart attacks, strokes, seizures due to bleeding inside the brain.
  • Significant injuries may occur after the faint. Someone who falls may subsequently suffer a head or neck injury, which could be deadly, independent of the cause of the faint. It’s worth mentioning that it’s an especially odd behavior that people seem to travel to the bathroom when they feel dizzy. All things considered, it’s better to faint in your soft bed or surrounding carpeted floor than on the hard tile of a typical bathroom with even harder sinks, toilets and tubs in close proximity.

2. My doctor always warns me about high blood sugars. You mentioned low blood sugars as a cause of faints. Am I putting myself in danger if I’m taking sugar and my sugar level is already high?

  • If you know all of that, yes. More often, you know none of that. Here’s the deal. Both a high and low glucose (blood sugar) count can cause altered mental status, fainting and coma. If your glucose level is especially high, say 900, and you drink some orange juice, it won’t make much of a difference. If your glucose level is 0, and you are given some orange juice, your life just got saved. In other words, it’s medically worth the risk if you don’t know what the glucose level is.

3. Can a loved one really take my breath away?
Yes. Overstimulation can lead to syncope in a variety of ways as mentioned previously.
4. What’s with the goats?
If you’re referring to Tennessee fainting goats, they exist. The goats don’t actually faint. When startled, they become stiff to the point of being unable to move their legs. Subsequently, the terrified goats can’t run and just topple over. Here you go.
faintinggoats

Straight, No Chaser: This is Specifically For the Faint of Heart

Cardiology/Heart, Medical Treatment, Neurology, Health Prevention, , , , , , , , , , , , ,

faint
Don’t faints seem mysterious?  It’s as if your computer crashed and had to reboot.  Although we never seemingly figure out why computers are so crazy, fainting (syncope) is reducible to a common denominator: something causes a decrease in blood flow to your brain.  Recall that oxygen and other needed nutrients are carried in blood, so even a temporary stoppage or shortage of blood flow shuts things down.  Now extrapolate that to strokes and comas, which are often due to serious and prolonged causes of blockage to the blood vessels supplying the brain.  This is a prime example of why good blood flow and good health are so important.  The brain is a highly efficient, oxygen and energy-guzzling organ.  Shut it down for even a few seconds, and bad things start to happen.  Consider fainting a warning sign.
I’m going to start by offering some Quick Tips to help if you find yourself around someone who has fainted.  Then, I will get into the weeds of why these things happen for those interested.  I’m doing this so you can check these and determine where your risks may be.

  • Call 911.  Make sure the person is still breathing and has a pulse.  If not, start CPR.
  • Loosen clothing, especially around the neck.
  • Elevate the legs above the level of the chest.
  • If the fainter vomited, turn him/her to the side to help avoid choking and food going down the airway (aspiration).
  • A diabetic may have been given instructions to eat or drink something if s/he feels as if s/he is going to faint.  If you know this, a faint would be a good time to administer any glucose gel or supplies advised by a physician.  Prompt treatment of low blood sugar reactions is a life-saver.  Discuss and coordinate how you can perform this effort on behalf of your friends and family with their physicians.
  • If it’s possible that the faint is part of some heat emergency (heat exhaustion or heat stroke), follow these steps to save a life (click here).

Actually, faints are caused by all kinds of medical problems.  I list a few notable causes below, but whether the front end difficulty is with the heart pumping, the nerves conducting, or the content of oxygen or energy being delivered, the end result is the same.

  • Decreased nerve tone (vasovagal syncope): This is the most common cause of faints, and contrary to what you might think, it happens more often in kids and young adults than in the elderly.  Understand that your nerves actually regulate blood flow (analogous to a train conductor telling the heart to speed up or pump harder or not).  Changes in nerve tone can result in errant signals being sent, transiently resulting in low flow.
  • Diseases and conditions that affect the nervous system and/or ability to regulate blood pressure: Alcoholism, dehydration, diabetes and malnutrition are conditions that may depress the nervous system.  Alternatively, coughing, having a bowel movement (especially if straining) and urination may abnormally stimulate the system.  In the elderly and those bedridden, simply standing can cause fainting due to difficulty regulating blood pressure.  In this case, standing causes a sharp drop in blood pressure.
  • Anemia: A deficiency in blood cells can lead to a deficiency in oxygen delivery to the brain.
  • Arrhythmias (irregular heart beats): Inefficiency in your heartbeat leads to unstable delivery of blood to the brain.
  • Low blood sugar (hypoglycemia): Low energy states can deplete the body of what it needs to operate effectively, leading to low blood flow.
  • Medications (especially those treating high blood pressure): anything that lowers the heart’s ability to vigorously pump blood around the body can leave the brain inadequately supplied, leading to a blackout.  Let’s include illicit drugs and alcohol in this category.
  • Panic attacks: Hyperventilation caused by anxiety and panic upset the balance between oxygen and carbon dioxide in the brain, which can lead to fainting spells.
  • Seizures: Here’s a chicken and egg scenario.  A prolonged faint can lead to a seizure, and seizures lead to periods of unconsciousness, during and after the seizure.  The lack of oxygen is a common denominator.

Straight, No Chaser: When that Eye Problem Could Be an Eye Emergency

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

emergency-eye-injury
Now you may look at the topic and think, “Well, isn’t that obvious?” I’m here to tell you that as many people who come to the emergency room for seemingly minor things, there’s even more that delay coming because of a thought that things will get better. When it comes to your eyes, you only have two, and can’t afford to lose even one. If you have any of these signs or symptoms, come in while you still can see (if indeed you still can).
Sudden vision loss: The problem with sudden vision loss is that it didn’t happen by accident, and it’s not likely to get better without prompt relief. This could represent a stroke involving the eyes’ blood vessels (amaurosis fugax), a blockage of those blood vessels (central retinal artery occlusion), a retinal detachment and a few other critical considerations. The point to be made is that in most of these examples, you should assume that only a limited amount of time exists to repair the damage before the eye injury causes permanent damage.
Eye pain: Yes, there’s a lot of benign things that cause eye pain, but there are some serious considerations, including the following:

  • Burns (seen very commonly in welders and those using chemicals)
  • Conjunctivitis (yep, even this can be serious when caused by gonorrhea or a herpes virus – wash your hands!),
  • Glaucoma,
  • Inflammation of various components of the eye (uveitis, keratitis)
  • Migraines
  • Scratches and ulcers to the eye surface (the cornea – do not sleep in your contacts unless this has been approved by your eye doctor; it just sets you up for bad things to happen),
  • Trauma
  • Tumors

Something is in your eye: Whether a chemical splash, a piece of metal, a branch or other foreign body, there are several concerns you should have. In the example of the chemical splash, something may be burning through the layer of your eye, putting it at risk for rupture. One word – IRRIGATE! If some object is in there that you can remove by blinking, odds are it’s not going away. Don’t cause more damage than is already there by digging around in your eye. Get evaluated.
Visualization of flashing lights and floaters: The most concerning cause of this phenomenon is a retinal detachment, which is a serious eye-threatening emergency. Visualize (no pun intended) wallpaper peeling off a wall. Unfortunately in this analogy, the retina is like the film in your camera, capturing the images of the world you see. If your retina’s gone from its natural position, you’re not seeing anything.
I welcome any questions, comments or thoughts. Otherwise, I’ll see you tomorrow.

Straight, No Chaser: The Week in Review and Your Quick Tips

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

week-in-review-545x210
Another week of knowledge and good health has come and gone at Straight, No Chaser.  Here’s your Week in Review.  Click on any of the underlined topics for links to the original posts.
On Sunday, we started the week reviewing rashes found on the palms and soles.  The entire post was meant to raise awareness that secondary syphilis presents like this, which is an important consideration given how easily primary syphilis can be missed, how devastating tertiary syphilis is and how simple treatment is once diagnosed.  Get it checked, and get it treated.  Sunday also brought a tear jerker of a topic in reviewing the physical signs of child abuse.  We often say knowledge is power, but in this example, knowledge could mean continued life for a victim.  Review those patterns of symptoms, and commit to being involved when needed.
On Monday, we reviewed lactose intolerance, which we tend to think is funny in theory but never is if you’re the one affected.  Remember it’s not the dairy that’s important to your health but the calcium it provides.  There are alternatives.  We also provided Quick Tips for the newborn in your family.  It’s never a bad thing to have a newborn evaluated, but don’t be distraught if the answer to your questions involve a lot of reassurance.  Remember, lots of answers to your questions involve things that happen underneath the diaper.
On Tuesday, we reviewed rabies.  We all knew there was a reason we didn’t like bats, skunks and raccoons, but if you live in the wrong area, your household cat or dog could be just as deadly if they aren’t completely immunized against rabies.  We also looked at injuries that occur from playing golf.  Who’d have thought five hours of swinging a club 100 MPH could cause back problems?  It’s such a peaceful game!
On Wednesday, we discussed ulcers.  Amazingly, peptic ulcer disease is most commonly traceable to a bacterial infection.  This is another condition where smoking and drinking (and overuse of pain medications) will come back to haunt you.  Wednesday also brought a review of allergic reactions and the potential life-threatening nature of them.  Because of this fact, it’s just not a good idea to wait around for things to get better on their own.
On Thursday, we discussed antioxidants and free radicals, which surprised a lot of you.  Although you seemingly can’t go wrong with antioxidants you eat, taking all those expensive supplements has been shown not to provide the same level of benefit and may in fact be harmful.  We also reviewed grief and bereavement.  I hope many of you learned that your suffering and responses are not only normal, but they’re universal.
On Friday, we provided an update on CPR and gave you another reason to remember the BeeGees.  Layperson and bystander CPR has been made so easy that you just have to take the two minutes to learn what to do.  We also reviewed cocaine myths and truths, which is important because cocaine often leads to the need for CPR.  I think I scared some people off with the image of big needles to treat their cocaine erections… Oh well!
On Saturday, we discussed drowning.  Keep your infants at arm’s length, and remember to bring a few life-savers (preservers, ropes, etc.) when you plan on being especially adventurous in the water.  We wrapped the week up discussing bedwetting, which often resolves on its own but sometimes is a symptom of another medical condition.
Thanks for your support and continued feedback.  If you have topics you’d like to see discussed, please feel free to send me an email or comment.
Jeffrey E. Sterling, MD

Straight, No Chaser: Quick Tips on Bedwetting

Genital/Urinary, Neurology, Pediatrics/Kids Health, Health Prevention, , , , , , , , ,

bedwetting
Bedwetting (enuresis) is unintentional urination while asleep.  It could be part of normal bladder development or a cause for concern.  Most kids are toilet trained by 4 years old, and less than 5% of kids are still wetting the bed between ages 8-11.  Here’s some quick tips to help you figure out the difference.

  1. If your child is bedwetting below age 7, and no external cause is in play, you will most likely be reassured if you see a healthcare professional.  Specific treatments for bedwetting aren’t started until at or after age 7.
  2. If bedwetting occurs in conjunction with foul-smelling urine, pain or other discomfort with urine, urinary frequency or enhanced urge to go during the day, your child could have a bladder (urinary tract) infection.  Symptoms may be resolved with antibiotics.
  3. If bedwetting occurs in conjunction with a change in urinary color, this could be a medical issue.  Changes could include urine becoming pink, cloudy, bloody or clear.
  4. Many children who wet the bed also have constipation.  Resolving constipation has been shown to resolve bedwetting in up to 60% of children.  Be on the lookout for this.
  5. Is the bedwetting occurring with snoring?  This could be a sign of sleep apnea.
  6. It is very important for parents to appreciate the behavioral components in play.  Stress can be a significant contributor to bedwetting.  If you reinforce positive behaviors, resolution of bedwetting may occur sooner than otherwise.  If you are relatively unsupportive and critical, symptoms may linger and become more profound.  Techniques such as gold stars and other rewards have proven to be effective.

Despite the topic, this post was intentionally dry.  Good luck.

Straight, No Chaser: Quick Tips for the Drowning Victim

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

Drowning_safety_children_CPSC

  1. If the victim is still conscious, attempt to hand him something that can be used to pull him from the water. If you’re out of handing distance, throw either a floatable object or something he can hold onto and with which he can be pulled to safety.
  2. If the victim has fallen into solid ice, and you have enough individuals, consider forming a human rope, with each individual interconnected and at least two individuals safely connected back on firm land.
  3. The victim should be removed from the water at the earliest opportunity. Forego inclination to perform chest compressions or rescue breathing in the water.
  4. If possible, remove the victim from the water as flat (horizontal) as possible. You want to make every effort to avoid damage to the neck throughout this entire process (This actually would be additional injury to the neck; there’s a fair chance such an injury has already occurred.).
  5. Once victims are out of the water, NEVER assume death unless you’re a qualified medical professional. Begin CPR, as described in yesterday’s post (Click here to review.).
  6. If the victim has an altered mental status, check the airway for foreign material and vomitus. Use your fingers to sweep away any material visible between the mouth and throat.
  7. The Heimlich maneuver (abdominal thrusting) is not effective in removing swallowed water. Don’t waste valuable time with it.
  8. If you’ve successfully saved a drowning victim, don’t bother taking off wet clothes. It’s not worth the possible agitation to the neck, and recent medical thought suggests that cooling after certain likely types of cardiac arrest is especially beneficial in reducing brain injury and death. This consideration is much more important than any benefit to be gained from warming the patient. Sounds weird, but it’s the truth.

Regarding the lead picture, yes it’s true that one can drown in inches of water. Infant safety means keeping them at arm’s length while they’re in the water.

Straight, No Chaser: Cocaine Myth Busters – Facts and Fiction

Medical Treatment, Toxicology/Drugs, Health Prevention, , , , , , , ,

cocaine whitney-houstonbias

Whitney was right. Crack is whack, and coke’s no joke.

There has to be a better way to chase The Glamorous Life.

Debunking myths about cocaine use

1.    “Cocaine isn’t addictive.”

  • This is just wrong.  Cocaine produces an incredibly powerful psychological dependency, and people will chase the experience of that first high to their deathbeds.  As tolerance to the previous doses develops, it takes increasingly high doses to get similar effects as before, and the risk of overdosing becomes incrementally higher.  Let me be clear.  No set number of cocaine doses accurately determines the development of either a physical or psychological addiction.  That first dose could be the one.

2.    “Cocaine is safe if I only use it once or only use it from time to time.”

  • What you’re discounting is that cocaine use is very much a game of Russian Roulette.  A single dose can cause death in many ways, including heart attacks, abnormal heart rhythms and rupture, strokes, sudden kidney failure, and rupture of your nasal passages.  A bad cocaine high could be the last thing you ever do.  Learn the story of Len Bias, pictured above, just to name one example.

3.    “As long as I’m not using crack cocaine, it’s clean and safe.”

  • If you are looking at the relative merits of smoking, inhaling or injecting drugs, you’ve already missed the point.  That said, people tend to confuse ‘clean drug’ with the ‘upscale’ nature of those who snort cocaine, as opposed to the more negative ‘dirty’ stereotypes of the individuals using crack cocaine.  It’s the same drug, folks.  In fact, snorting cocaine leaves you just as sweaty, irritable and prone to hallucinations as crack users.  The subsequent addiction and pursuit of an even higher high will lead to many a rich, ‘clean’ individual eventually resembling the most stereotypically downtrodden crack user.  There’s nothing ‘clean’ about someone walking around with ulcerated, bleeding or perforated nasal passages.

4.    “Cocaine doesn’t produce a hangover or residual effects.”

  • This is frankly ridiculous.  Cocaine acts by producing a massive release of internal substances that rev you up and produce a powerful euphoria.  When you’ve depleted your body of all these hormones, there’s nowhere else to go but down.  Where do you think the term crash came from?  Fatigue, depression and some degree of mental instability, including suicidal tendencies, are not only common but should be expected.  Other residual effects include insomnia, weight loss, paranoia, anxiety, and aggressive behavior.  The downward spiral of a cocaine user is all too predictable.  The lifestyle changes and risky behavior pattern of cocaine users, including enhanced exposure to HIV, hepatitis and other easily transmittable deadly disease must be included as residual effects of cocaine use.

5.    “Cocaine is a great sex drug.”

  • I hold disdain for educational efforts that aren’t truthful, and in this case, too often such efforts make suggestions that any cocaine user knows not to be true.  A large part of the mystique of cocaine is to be found in the fact that users find it an exotic enhancer of sexual activity.  Cocaine opens blood vessels, which in the case of the penis, facilitates the blood flow that produces and sustains an erection.  Recall, however, that I mentioned that cocaine use is playing Russian Roulette.  One big (no pun intended) problem with using cocaine to stimulate erections is you may not be able to finish what you start.  In other words, that “contact your doctor if you have an erection that lasts more than 4 hours” disclaimer should have originated with cocaine, except for the fact that its use is illegal.  And if you ever do get this side effect, when you arrive to see me or my colleagues, we’ll be there with very large needles needing to be inserted into your penis to manually extract the blood.  That’s not a good day for you.

The answer to the naiveté about cocaine is the same.  It is an extremely powerful and dangerous drug with physical and psychological effects that can linger long past the high. If anyone’s reading this that’s a cocaine user, and you’ve never had any of these problems, learn the medical meaning of physiological tolerance.  As you become acclimated to the effects of cocaine, and the propensity to use more drug to get the same effects rise, the more likely these phenomena will happen to you.  Also recall that a single dose, even in the absence of any past such reaction, can produce any of the adverse effects I’ve described.
If you know someone on cocaine, be as aggressive as you can to get them off of it before it’s too late.  Counseling works.

Straight, No Chaser: The Battle of Antioxidants and Free Radicals

Health Prevention, , , , , , , , , , , ,

Antioxidants
We engage in a lot of fads and off the wall activity to pursue health instead of following tried and true principles of basic science. One thing that I wish didn’t fit that trend is use of supplemental antioxidants. Before talking about using antioxidants, allow me to discuss why they’re necessary.
Free radicals are like the Tasmanian Devil. These molecules are byproducts of many activities that create cell damage. Think about cigarette smoke, trauma (even vigorous exercise), excessive heat and sunlight (and its radiation), to name a few examples. The process of creating and releasing these molecules is called oxidation. The key point is free radicals are unstable and too many of them lead to a process called oxidative stress. This process is implicated in the development of many illnesses, including Alzheimer’s disease, cancer, cataracts and other eye diseases, cardiovascular diseases, diabetes and Parkinson’s disease.
Antioxidants are substances that prevent or delay cell damage caused by free radicals. Antioxidants may be natural or artificial (e.g. man-made). The healthy diets we’re always asking you to eat (e.g. those high in fruits and vegetables) contain lots of antioxidants; in fact this has a lot to do with why we believe they’re good for us. Of course, now you can get many forms of antioxidants in pills. That’s where things get a little less certain.
Logically, you’d think that if some antioxidants are good, a lot would be better, and they would really be effective against free radicals. Furthermore, you’d think a convenient and efficient way of doing this would be putting a lot of antioxidants in a pill. Unfortunately, medical science (including over 100,000 people studied) has shown this not to be as simplistic as our logic would have us believe. I can’t say this any simpler. Antioxidant supplements have not been shown to be helpful in preventing disease. In fact, high-dose supplementation has been shown to have harmful effects, including increasing the risks of lung and prostate cancer. In short, our body doesn’t function in as linear a manner as we would like to think.
Here’s your take home message: We have yet proven that we’re able to cheat Mother Nature. You will not find your health in a bottle. Diet and exercise remain the champions of the battle of pursuing good health. Get your antioxidants the old fashioned way – in your fruits and veggies. Here’s a nice chart for your reference.
Top-Antioxidants

Straight, No Chaser: When Allergies Strike

Medical Treatment, Skin/Dermatology, Health Prevention, , , , , , , , , , ,

allergy
Bee stings.  Medication reactions.  Food allergies.  Latex.  Animals.  Dust.  Cosmetics.  What do these things have in common?  You get allergic to them, and in differing degrees, they make you come to me huffing and puffing and puffy and thinking about not breathing anymore.
The basis of allergies is that your body is trying to defend you from infections.  Sometimes our defense mechanisms are ‘inaccurate’, and the body overreacts to what normally might be harmless substances by producing a system wide reaction (antibodies) to certain triggers (allergens).  This overreaction leads to our bodies fighting a war that isn’t meant to be fought.  That manifests itself clinically by some subset of itchy rashes (wheals, urticaria or angioedema), shortness of breath, nausea, vomiting and other systemic systems.  Again, it’s important to note that this can be both a systemic overreaction or just a local reaction.
One question I commonly get asked is “Why I am allergic to this now?”  In other words, sometimes allergies occur after the initial exposure to seafood or peanuts, or maybe you had been stung by a bee in the past.  That occurs because the first allergic exposure doesn’t always cause a visible reaction.  However, it will sensitize the body such that you’re mobilized for subsequent exposures and will be prepared to ‘unload both barrels’ if it’s needed.  Unfortunately, this reaction can be itself life-threatening.  This life-threatening response is called anaphylaxis, and you’ll know it because more than one organ system of your body (heart palpations, breathing difficulties, gastric upset, itchy skin rashes, dizziness as your body goes into shock, etc.).
Although allergic reactions are more likely to occur in those with conditions like asthma, eczema, allergic rhinitis, seasonal allergies, and sleep apnea, to be clear, the acute allergic reaction is a different animal than seasonal allergies.  If you have any sensation that you’re short of breath, your throat feels like it’s closing, you have any dizziness or altered mental status, palpitations, or if the rash is diffuse and spreading, please get to your closest emergency room.  I wouldn’t be upset if you took the recommended dose of Benadryl along the way.
Final tip: Those of you who’ve suffered any type of allergic reaction to medication, food, animals, etc. should ask your physician about the utility of carrying an epipen, benadryl or steroids in the event of an emergency.  If your risk profile warrants it, any or all of these could prove life saving.  However, these medicines aren’t without risk, so you shouldn’t take any of them unless recommended by your physician.

Straight, No Chaser: Ulcers – I Can’t Believe You Ate the Whole Thing…

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

ulcers
Peptic ulcer disease (PUD) has an increasing incidence in the general population and particularly so in the elderly, due to a liberal use of NSAIDs (non-steroidal anti-inflammatory agents, such as ibuprofen, aspirin, naproxen).  These painful sores in the lining of the stomach or first part of the small intestine make for many a bad day (and night).  That ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum.
What you didn’t know is a bacterial is responsible for most cases.  I’ll come back to that.
You’re predisposed to PUD if you smoke or drink, use NSAIDs or take steroids.
Complications abound.  PUD is actually the #1 cause of abdominal organ rupture.  Other complications include bleeding and obstructions (that you’ll recognize as nausea and vomiting to accompany the pain).
Here we go again with prevention.  If you don’t want an ulcer, or if you want your ulcer to be better, stop the habits that produce it.  I’m talking about smoking, drinking alcohol and taking the pain pills.  Let me be clear: ALL patients with peptic ulcer disease should stop smoking, stop drinking alcohol and avoid NSAIDs.
Severe ulcers are treated with surgery or by endoscopy (which is also the method of diagnosing ulcers – this involves placing a tube down your throat to directly visualize the areas and possibly repairing damage if it’s amenable to that).
Less severe ulcers may be treated with various medications called proton pump inhibitors.  You’ll recognize these acid reducers by names such as aciphex, nexium, prevacid, prilosec and protonix.  If you are discovered to have an infection, antibiotic combinations can be given for one to two weeks for the involved bacteria (Helicobacter pylori) in addition to the proton pump inhibitors.  None of these will address the situation if you don’t make those lifestyle adjustments.
Questions or comments?

Straight, No Chaser: Emergency Room Adventures – The Risk of Rabies

Infectious Disease, Medical Treatment, Health Prevention, , , , , , , , , ,

Rabiesdog
You can’t make this stuff up.   It’s another busy night in the ER, and back-to-back patients come in, not related but dealing with the same issue.  One’s a child bitten over the eye by a family dog with no shots.  The next is a teenager attacked by a possum, which he decided to kick in the mouth, and of course he ends up being bitten.  Both of these situations hold a certain risk of rabies exposure.
Rabies is a viral disease transmitted to humans through the bite (or scratch) of an infected animal.  It infects the central nervous system, initially producing a multitude of symptoms that resemble the flu (fatigue, headaches, fever, malaise) and then progressing to exotic symptoms (including fear of water, increase in saliva, hallucinations, confusion and partial paralysis) culminating in death within days.
There is no cure for rabies once symptoms appear, so prevention is critical.
Animals that are especially likely to transmit rabies include bats (the most common culprit in the U.S.), foxes, raccoons, skunks and most other carnivores.
rabies1

  • Bites from these animals are regarded as rabid unless proven otherwise by lab tests.  These animals must be killed and tested as soon as possible.

Animals that have been reported to transmit rabies include dogs, cats and ferrets.

  • If bitten from these animals, and it appears rabid, treatment must begin immediately.
  • If the biting animal appears healthy and can be observed for 10 days, then do so, but the animal must be euthanized at the first sign of rabies.

Others bites to consider include bites from rodents (woodchucks, beavers and smaller rodents), rabbits and hares, which almost never require post-exposure prophylaxis unless the area is a high rabies exposure area.  In these instances decisions will be made in consultation with local public health officials.
So what should you do if bitten?

  • Remember, there will be no immediate symptoms, so you can’t trust that you’re ok just because you’re feeling ok.
  • Make every effort to secure the animal.
  • Even if the animal isn’t available, go to the nearest emergency room as soon as possible after contact with a suspect animal.

What can you expect?

  • Vigorous wound cleaning
  • Assessment for and possible administration of two different types of vaccinations.  These regimens can prevent the onset of rabies in virtually 100% of cases, one of which needs to be administered in five separate doses over a month’s time.
  • Additional vaccination for tetanus, if appropriate
  • Antibiotics if appropriate.

Remember, rabies is a fatal disease.  It is meant to be avoided, but if you can’t avoid it, you need to get assessed as rapidly as possible.  I hope this information helps you make correct decisions if you’re ever confronted with a rabies prone animal, and for goodness’ sake, please get any house pets all appropriate vaccines.

Straight, No Chaser: Quick Tips for The Newborn Addition to Your Family

Pediatrics/Kids Health, Health Prevention, , , , , , , , , ,

Cute-Newborn-Black-Baby-Girl-Picture
You’re excited. You have a newborn, or maybe you’re a new grandparent caring for the baby for the first time. I get more ‘deer in the headlight’ looks from these folks than perhaps any others. Here’s some Quick Tips for you new parents and family members:

  1. Your child doesn’t have a fully developed immune system yet and won’t until s/he begins receiving immunizations. This is a major reason why breastfeeding is so heavily recommended. Mothers transfer levels of immunity to the baby through this process. It’s not just about bonding.
  2. Your baby is spitting up? Welcome to the club! As long as s/he is gaining weight and is comfortable, there’s not much cause for concern. It’s likely a measure of eating too much and/or too quickly. Acid reflux and or gastroesophageal reflux occurs in about ½ of infants. Again, the baby needs time to have its protective mechanisms fully develop. Speaking of breastfeeding, here’s some more food for thought (no pun intended). Kids who aren’t being breastfed tend to spit up more. Expect it.
  3. I know this is hard and perhaps impractical in many instances, but hold off on multiple family visits for the first month while that immune system is maturing. Exposing them to dozens of relatives is a pretty good way to get a sick baby. Unfortunately, during those first 30 days, babies don’t confine illnesses very well, and even a little cold or ear infection can rapidly spread throughout the body. This could lead to meningitis and someone like me having to perform a lumbar puncture (i.e. spinal tap) on your newborn.
  4. Colic drives parents crazy! Crying newborns obviously are trying to tell you something, and maybe it’s as simple as wanting to be fed, but here’s an important tip for you: check under the diaper. There are multiple issues that present there. Here are three of them:
    1. Anal fissure – hard stools can cause a scratch near the anal opening. Fissures are painful, and whenever stool passes by or anything touches that area, it’s going to hurt! There may be blood associated with this as well; perhaps you’ll notice it on the diaper or streaking along the stool.
    2. Diaper rash – rashes can cause inflammation and infection. They are irritating and painful. New parents must be diligent in getting wet and/or stooled diapers changed with appropriate frequency. After all, wouldn’t you yell if you had to keep that stuff in your undergarments?
    3. Loose hairs – You’d be surprised how often I see loose hairs wrapped around a newborn or infant’s penis, doing it’s best to choke it off. I’m not joking. If the child isn’t circumcised, be sure to retract the foreskin to check and allow look over the testes. This could be dangerous.

I mean no disrespect when I say this, but call your primary doctor before bringing your colicky newborn to the ER during those first 30 days of life. The main reason I say this is for your further protection. The ER is where a lot of bad microorganisms live, and although we never mind seeing you, we want to coordinate when it’s appropriate for you to have to expose your baby to the environment.

Straight, No Chaser: The Week In Review and Your Take Home Messages

The Week In Review, , , , , , ,

?????
Well, it was a busy week. Let’s look at what you may have missed.
On Sunday, we started with reviewing the important of National Minority Organ Donor Awareness Month. Over 56% of people on the national organ transplant waiting list are minorities. Consider checking in at http://organdonor.gov/becomingdonor/stateregistries.html.
On Monday, we reviewed human bites, which involve any lesion caused by your teeth that breaks the skin. These range from over aggressive hickeys to the Mike Tyson variety to lesions caused by punching someone in the teeth. We posted your FAQs separately here. My bottom line is you need to get evaluated every bite (that breaks the skin) every time.
On Tuesday, we reviewed alcohol intoxication, abuse and dependency and gave you the tools to assess that all important question: Do You Drink Too Much? We included a special Alcohol Facts and Fiction post for your consideration. In case you were wondering, that beer belly isn’t from your beer and is the least of your worries, either from the alcohol or the belly sides of the equation.
On Wednesday, we went Back to the Future in discussing low back pain and identified life-threatening conditions associated with low back pain. Remember to lift with your knees instead of your back, and beware of night-time back pain or loss of motion, sensation, bowel and/or bladder control. You probably heard the word Cauda Equina for the first time.
On Thursday, we discussed spider bites, focusing on the Black Widow and Brown Recluse spiders. Do you remember what a volcano lesion is? We also discussed shingles and answered a lot of questions about the chickenpox and shingles vaccines. The Straight, No Chaser recommendation is to get them (the vaccines, not the diseases)!
On Friday, we busted a few myths about migraine headaches and discussed life-threatening conditions associated with headaches. I want you to remember the association between migraines, heart attacks and strokes. Review the list of ‘headache plus’ symptoms to prompt you to get immediately evaluated.
On Saturday, we taught you how to fall. Do you remember what FOOSH stands for? We also reviewed the causes and treatment of ingrown toenails. Sometimes the simplest advice is the best. Stop biting your toenails!
Thanks to all of you who have filled out the Straight, No Chaser survey. I hope you’re seeing improvements to your satisfaction. The Week in Review post is a direct result of your feedback. We have 500 followers now in a month, which isn’t bad for a blog on a topic that can be a boring as health and medicine. Thanks for your support and continued feedback.
Jeffrey E. Sterling, MD

Straight, No Chaser: Quick Tips – Rashes on Your Palms and Soles – Pay Attention!

Skin/Dermatology, , , , , , , , ,

In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles.  However, there are a few of note, so here’s some Quick Tips to point you in the right direction.
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus.  It’s rather benign.
Hand-Foot-and-Mouth-Disease-3hand-foot-mouth-disease1hand-foot-mouth
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii).  If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.
RMSFRMSFfeet
If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease.  This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.
kawasaki
Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.
Kawasaki2
And yes, secondary syphilis presents with rashes on the palms and soles.  The real take home message is this.  Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed.  Trust me, you want to get treated before tertiary syphilis develops.  Here’s what that rash looks like.
2ndsyphilis2ndarysyphilis
The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.

Straight, No Chaser: Find Something Better to Chew On! Ingrown Toenails

Skin/Dermatology, , , , , , ,

ingrown_toenail

The overwhelming majority of cases of ingrown toenails I see come from people chewing on their toenails.  So the really, really Quick Tip is keep your feet out of your mouth.  If only it was that simple.

Ingrown toenails themselves aren’t the problem.  The resulting skin infection and pain are what bring you in to see me.  Remember that the ingrown toenail is caused by the nail burrowing into the skin of the toe instead of growing out and over it.  I’ve always found it interesting that people wait so long for such things, but in this instance, if you are going to wait, there actually are things you can do to potentially make it better.  You’ll know you need to do this if you have a red, swollen, painful toe and especially short toenails.

  • Soak your feet two-three times a day for 15 minutes at a time.
  • Attempt to lift the nail by placing cotton or dental floss under the toenail after you soak.  The goal is to get that nail corner above the skin.
  • Wear open-toed shoes.  This is not the time when you’d want to have any pressure on your toes.
  • Place a topical antibiotic on the area.

Have you ever seen a bad ingrown toenail get removed?  If you have, you’ll likely agree that it’s a deterrent to having another one.  Treatment usually involves lots of local anesthesia (i.e. needles) and partial manual removal of the toenail.  It’s not a good day when this has to happen.

So, you can avoid this fate.  Just follow a few simple steps to avoid it in the first place.

  • Don’t bite your nails.  As discussed in the human bites blog post, you’ve just added really bad bacterial to the mix for when the infection occurs.
  • Don’t cut your toenail so short that you can’t see some of the white tips.  Be sure to let the corners extend past the skin.
  • Don’t wear excessively tight shoes that literally smash your toes onto themselves.

Here’s a final note: if you’re diabetic or otherwise immunocompromised, these infections can spread rapidly and extend into the bone – these infections are very serious.  In some cases this has led to amputated toes.  If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.

Straight, No Chaser: Orthopedics Quick Tips – Learn How to Fall – The FOOSH injury

Orthopedics/Bones, , , , , , ,

colles1
We use a lot a acronyms in the Emergency Room, many of which can’t be repeated in polite company.  Orthopedics and Trauma seem to lend themselves to a few.  There’s GTSBOOM (got the stuff beat out of me, which is an all too common occurrence) and there’s FOOSH.  FOOSH stands for ‘fell on outstretched hand’.
I bring this up because you need to learn how to fall.  FOOSH injuries predictably cause fractures of the distal radius and ulnar (the two bones of the forearm), usually down by the wrist.  These injuries are incredibly common and avoidable.  The most notable injury is the Colles fracture, which is a distal radius fracture.  You’ll know you have it after a fall when your wrist assumes the typical ‘dinner-fork deformity’.
colles-fracture1
So next time you fall, try to make it a glancing blow and avoid placing the full weight of your body on those wrists.  Try to land and roll when you hit – but be extra careful to avoid bumping your head by doing this.  If you get this right, it could save you 6 weeks in a splint, cast or in some cases a trip to the operating room.

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