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Straight, No Chaser: The Week In Review
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.
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?
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: How I Know If Your Ankle is Broken Without X-Rays – The 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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Your Rebuttals and Questions about Insomnia
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Insomnia – You are Not Getting Sleepy…
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser – The Week In Review
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Quick Tips – You Snore Too Much
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.
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
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.
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?
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.
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
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.
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.
Straight, No Chaser: About That Vomiting and Diarrhea…
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.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress
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.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Depression Quick Tips – How to Avoid It, When to Get Help
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.
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?
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.
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
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.
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
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.
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.
Straight, No Chaser: This is Specifically For the Faint of Heart
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.
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
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.
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
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
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
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.
- 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.
- 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.
- 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.
- 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.
- Is the bedwetting occurring with snoring? This could be a sign of sleep apnea.
- 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.
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.
- 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.
- 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.
- 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.
- 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.
- Is the bedwetting occurring with snoring? This could be a sign of sleep apnea.
- 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.
