Tag Archives: health

Consequences of Inappropriate Antibiotic Use

January 25, 2017General Health and Wellness, Infectious Disease, Respiratory/Lungs844-SMA-TALK, American Academy of Pediatrics, Antibacterial, Antibiotic resistance, Behind the Curtain, CDC, Center For Disease Control and Prevention, Common cold, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Streptococcal pharyngitisJeffrey Sterling, MD

Introduction

This Straight, No Chaser discusses inappropriate antibiotic use.

Whenever physicians attempt to discuss inappropriate antibiotic use with patients, too often fear replaces logic. These days, antibiotic use is treated as a convenience consideration, regardless if there’s actually a disease present that can be treated by antibiotics. Here are some principles your physician is mindful of when deciding if you actually need antibiotics.

We Want to Treat You!

Significant complications exist from missing any disease. If a heart attack is missed, your heart can rupture, and you can die. When a fracture is missed, you can develop necrosis, arthritis and loss of limb. If pneumonia is missed, you can go into respiratory failure and die. Etc., etc. As an emergency physician, my colleagues and I are more in tune than any other specialty of physicians with the risks and consequences of misdiagnosing critical illness; in fact it’s one of the main components of the speciality.

The point is giving medicine is not based on either fear or treating conditions that have a low probability of existing. Any physician is weighing the value of the information you provide to determine what appropriate management will be; that’s the Art of Medicine, and that will always be left to the individual judgment of your treating physician.

That said, the days of such absolute power by physicians are going the way of the dinosaur. Evidence-based medicine and outcomes-based medicine are here to stay. Multiple guidelines for best practices exist across many medical conditions, including when to order ankle x-rays and not, when to order neck x-rays and not, when to treat various infections and not. What’s new here is identifying opportunities to avoid exposing patients to unnecessary, costly medical interventions. What’s also new is you the patient can be better empowered and knowledgeable about the conditions you have and the care you receive.

Antibiotics Come with Risks!

The risk of inappropriate antibiotic use is more real, more present and more important than practicing defensive medicine.

There are classes of antibiotics that we can no longer use. I mentioned previously how Staph is resistant to several of the penicillins we’ve used for decades due to resistance, which occurs from overuse and inappropriate use, most frequently seen in treatment of viral illnesses. Yes readers, MRSA stands for methicillin-resistant Staph Aureus, and that’s why it’s known as a ‘super-bug’. Approximately 80% of those ear, nose and throat infections you’re coming to the emergency room for and asking/receiving antibiotics for are viral illness and would be better on their own in 48-72 hours.

Have you heard about what happened to gonorrhea due to inappropriate antibiotic use?

Similarly, treatment of gonorrhea has recently been revised by the Center for Disease Control and Prevention (CDC) because of the emergence of resistance to the medications used against it. Again, this has resulted from overuse and inappropriate use of these medications, largely in treatment of viral illnesses. One of the more powerful antibiotics we had at our disposal (a member of the fluoroquinolone class) just got pulled back from its 15 different indications for usage due to emerging resistance. This particularly powerful entity, instead of being withheld for serious diseases, was being used for urinary tract infections, minor skin and soft tissue illness and other conditions that eventually led to a loss of effectiveness. Why would such things be done? Profits and defensive medicine are two reasons that rapidly come to mind.

This is a lot more serious than just overusing medications. Sepsis occurs when an infection overwhelms the body and isn’t just limited to the local site where the infection originated. It can be so devastating that your body goes into shock, losing its ability to function and deliver blood throughout your body. Initial treatment of real illness suffers when we’re using medications that are less effective because bacteria have had time to mutate or otherwise become resistant due to non-lethal exposures.

The CDC and the American Academy of Pediatrics have consistently promoted this philosophy. It’s been included in JAMA, the Journal of the American Medical Association. Inappropriate antibiotic use has consequences!

Illnesses that Don’t Need Antibiotics

Consider the following lists of conditions that commonly can be treated without antibiotics.

Common colds and upper respiratory illnesses, including non-strep pharyngitis
Influenza (flu)
Most coughs and bronchitis (chest cold with a cough)
Many ear infections (also called otitis media)
Many skin rashes

To be clear, no one is recommending or promoting inappropriate or less than appropriate treatment of conditions that actually exist. No one is suggesting that anything you read here or anywhere else is more important than the real-time judgement of your physician. Just appreciate that opportunities exist to do the right thing and the wrong thing, and medicine is better with an informed patient.

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Straight, No Chaser: Healthy, Sustainable Weight Loss – Let’s Get Started

January 6, 2017Diet and Nutrition, General Health and Wellness844-SMA-TALK, Behind the Curtain, BMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Weight ManagementJeffrey Sterling, MD

How to Lose Weight, and What is Healthy Weight Loss (AKA, How Much, How Soon and How)?
Let’s start with the How. Commercial voice: “You should contact your physician before starting any weight loss routine”. We ended things on the last post talking about the caloric balance equation, which (simplified) means you need to get off your derriere, and close your mouth. Without getting too technical, to lose weight, 1 pound equals 3,500 calories, so your net caloric intake must be cut by at least 500 calories per day to lose a pound a week. Here are some Quick Tips to cut calories (and I will not be discussing any of the popular diets or medical remedies (with one exception in the next post); you can see your physician or nutritionist about those. Besides, guess what? Most of you don’t need a fad diet. Keep it simple. And…more importantly, you should be more concerned with healthy regimens that help you keep the weight off, not drastic efforts that have proven to have quick short-term but unsustainable long-term outcomes).

1) Work out: If you can sprint, do so. If you can’t, jog. If you can’t jog, walk. I like working out while watching sports, because my heart’s pumping anyway. Weight training at the same time is even better. Once you hit a good exercise regimen, your metabolism will improve, making weight loss that much easier. By the way, the next post is on metabolism; stay tuned.
2) Hungry? Start counting calories. Use this standard to determine what your daily calorie intake should be. Meal plan so you don’t exceed that level. Remember the caloric equation to lose weight: Amount expended minus the amount eaten should be 500 calories a day. In the next post, I’ll give you a Quick Tip for an extra 400 calories a day you can lose.

3) Still hungry? Try brushing your teeth. Don’t laugh. It actually works. And it gives you nice teeth. Otherwise try drinking water or chewing calorie-free gum. All these are nice, simple inexpensive appetite suppressants.
How Soon? It’s natural for anyone trying to lose weight to want to lose it very quickly. But evidence shows that people who lose weight gradually and steadily (about 1-2 pounds per week) are more successful at keeping weight off. Healthy weight loss isn’t just about a “diet” or “program”. It’s about an ongoing lifestyle that includes long-term changes in daily eating and exercise habits. Think health instead of weight, and the weight will improve.

How Much? If you were my patient (but you’re not!), I’d tell you to forget about ideal body weight and BMI – for now. Focus on a modest weight loss, like 5-10% of your current weight. Even this success will improve your blood pressure, cholesterol and blood sugar levels. Once you accomplish that goal, do it again. So even if the overall goal seems large, see it as a journey rather than just a final destination. Seek to learn new eating and physical activity habits that will help you live a healthier lifestyle. These habits may help you maintain your weight loss over time. To that end, I love healthy challenges. Try a 30-day water instead of pop (soda)/coffee, etc. challenge, or even better, give yourself a 30-day ‘fruit for dessert challenge’ or ‘salad of your choice for lunch’ challenge. When that’s done, immediately do it again. Learn to integrate healthy habits into your quest to lose weight, and you’ll increase the odds of having sustainable weight lost. At the end of the day, it’s been well established that those who maintained a significant weight loss report improvements in not only their physical health, but also their energy levels, physical mobility, general mood, and self-confidence. Good luck, and check back for the next post on how to fine-tune your metabolism!

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.
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Straight, No Chaser: Tips on Safe Toys and Gifts

December 24, 2016Pediatrics/Kids Health, Trauma844-SMA-TALK, Disorders, health, Safe Toys and Gifts Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

At Straight, No Chaser, we review the literature and give you the goods. While you’re out and about shopping for toys, print out this list to help you select safe toys, then post it in your home to be reminded of how to keep your kids safe. People tend to think such things aren’t necessary until after something horrible has happened. Be smarter than that; after all, it’s Safe Toys and Gifts Month (of course it is – when else could it possibly be?).
Let’s review shopping tips, adopted from recommendations from the American Academy of Pediatrics, The National Safe Kids Campaign and the National Safety Council. We’ll keep this short and sweet.

Falls and choking cause most toy-related deaths and injuries in children. Choking alone causes one-third of all toy-related deaths – most often from balloons.
Children younger than age 3 are at the greatest risk of choking because they tend to put objects – especially toys – in their mouths.
Children 4 years old and younger account for almost half of all toy-related injuries and almost all deaths.

Remember…the best way to keep your child safe while playing with toys is to BE THERE!
Consider the child’s age, interests and skill level. Actually pay attention to what you’re buying. Look for quality design and construction, and follow age and safety recommendations on labels. They’re not just pulled out of thin air!
Use a small parts tester to determine whether toys may present a choking hazard to children under age 3. Small parts testers can be purchased at toy or baby specialty stores. Here’s a simpler way to decide: use the cardboard core of a toilet paper roll – if a toy can pass through, it is too small for young children and may cause them to choke if swallowed.
Avoid toys with sharp points or edges, toys that produce loud noises, and projectiles (e.g., darts).
Avoid toys with strings, straps or cords longer than 7 inches. These may pose a risk for strangulation for young children.
Avoid electrical toys with heating elements for children under age 8.
Avoid cap guns that use caps that can be ignited by the slightest friction and can cause serious burns.

The selection of gifts and toys you bring into your home should be taken seriously. Let’s keep the holiday season happy!

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.
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Straight, No Chaser: Ruptured Eardrums

December 6, 2016Head/Eyes/Ears/Nose/Throat844-SMA-TALK, Behind the Curtain, Ear, Ear Nose and Throat, Eardrum, health, Otitis media, Perforated eardrum, Sound, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

Most tympanic membrane perforations heal spontaneously. If the injury causing this was penetrating, your physician may refer you to an ear, nose, and throat specialist within 24 hours. If this ever occurs, you must be careful to avoid getting water in the ear. Finally, you won’t typically receive antibiotics for a ruptured eardrum unless the rupture is due to infection or forceful water injury, such as is seen in water skiing.
Just remember: the ears have been cleaning themselves for at least thousands of years prior to cotton swabs. Chasing that itch isn’t worth the consequences of the pain of a ruptured eardrum.
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.
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Straight, No Chaser: About That Vomiting and Diarrhea…

December 1, 2016Gastrointestinal, Infectious Disease, Health Prevention844-SMA-TALK, Behind the Curtain, Coronavirus, Diarrhea, Gastroenteritis, health, Influenza, Intestine, Norovirus, Oral rehydration therapy, Rotavirus, Sterling Medical Advice, SterlingMedicalAdvice.com, Stomach, Straight No Chaser, VomitingJeffrey Sterling, MD

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.
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Straight, No Chaser: Suicide Data 2016 – Understand the Threat

November 28, 2016Mental Health, Public Health844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

There are amazing, shocking and saddening facts about suicide. It is equally amazing that we aren’t discussing this as an epidemic. After a period of nearly consistent decline in suicide rates in the United States from 1986 through 1999, suicide rates have increased almost steadily from 1999 through 2014.
Consider the following information provided by the Centers for Disease Control and Prevention and the National Vital Statistics System.

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.
From 1999 through 2014, the age-adjusted suicide rate in the United States increased 24%, from 10.5 to 13.0 per 100,000 population, with the pace of increase greater after 2006.
Suicide rates increased from 1999 through 2014 for both males and females and for all ages 10–74.
The percent increase in suicide rates for females was greatest for those aged 10–14, and for males, those aged 45–64.

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.
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: End of Life Decision Making

November 25, 2016General Health and Wellness, Medical Treatment, Health Prevention844-SMA-TALK, Behind the Curtain, Blood flow, Brain, Death panel, DecisionMaking, Education, Futile medical care, health, health care provider, Health care proxy, Heart failure, Hypertension, Intubation, Patient Protection and Affordable Care Act, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Terminal illnessJeffrey Sterling, MD

Having this conversation when death is staring you or a loved one in the face is not the most ideal situation. 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. It needs to sink in: at any age your life could be at risk, and at any age you could die. When your life is threatened, if you have specific desires, you’ll need someone comply with decisions. It could happen today. 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 scenario 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 die?
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.
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.
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Straight, No Chaser: Tips to Deal with Depression and The Holiday Blues

November 23, 2016General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Depression, Disorders, health, Major depressive disorder, Mental disorder, Mental health professional, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I don’t mean to bring anyone down during what is supposed to be the ‘most wonderful time of the year,’ but in reality there are many people hurting. For some, life’s tragedies happen this time of year the same as they might any other time. For others, this may have already happened, and this time of year is a permanent reminder of an unfortunate experience. For others still who struggle with depression, anxiety and mental illness all year, the holiday season can exacerbate these feelings and may make holidays especially long, depressing and potentially dangerous times.
Today’s Straight, No Chaser is not meant to drag you into the dumps but to empower you with tips to assist you in the event this is a difficult time for you. By the way, I’m extremely thankful that you’ve chosen to give me moments of your day and life. I take that gift seriously and hope you continue to find it a worthwhile use of your time.

Here’s five tips for your holiday mental health:

Remove yourself from stressful environments and avoid situations you know will create conflict, mental duress and/or danger. I can not emphasize this enough. If you put yourself in a bad situation, you can not be surprised when bad things happen.’
Find support. Specifically, have ‘go-to’ friends and family that provide you comforting support. There’s a time and place for tough love, but in the midst of depression or suicidal ideation, ‘buck up’ is not good advice. Know where your support lies and be sure (in advance) that it will be accessible if you need it.
Find success and happiness where it is. During the holidays, people tend to lament what isn’t. That’s not a formula for success. Yes, all of your family may not be around, but celebrating happy memories with the ones you can often fills the room with the joyous presence of loved ones not around. Enjoy the pleasures and successes you do have access to, whether big or small. Focusing on the positive keep you positive.
If you’re struggling, admit it. You already know you’re hurting. Often the first step to getting past it is acknowledging it. Once done, then you can put coping mechanisms in place to address your feelings.
Avoid holiday activities that will create post-holiday angst. This applies to eating, drinking, shopping and personal interactions. Some use the holiday as an excuse to overindulge as if the consequences won’t be there afterwards. Reread #1 above.

Know when you need professional help. If your support system doesn’t sufficiently address your needs, and you’re feeling severely depressed, can’t function or are suicidal or homicidal, find a physician or mental health professional ASAP. Of course, you can always contact your SterlingMedicalAdvice.com expert. If you type mental health, depression or other keywords into the search bar above, you can access many other Straight, No Chaser blogs on behavioral health concerns that may provide you the support you need. I wish you all the best today and throughout the year, and hopefully the picture above will reflect the only type of blues you’ll have to deal with this year.
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.
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Straight, No Chaser: Low Blood Sugar (Hypoglycemia)

November 21, 2016Endocrine/MetabolicBehind the Curtain, Blood sugar, Conditions and Diseases, Diabetes, Diabetes mellitus, Endocrine Disorders, Glucose, health, Insulin, PancreasJeffrey Sterling, MD

In a previous post, I provided an overview of diabetes. Everyone knows about diabetes, and most understand how dangerous diabetes is over the long-term. However, as an emergency physician, I’m more concerned with what will kill you immediately, and on that front, low blood glucose (sugar) is usually much more concerning. I want you to know up front that a low enough blood glucose will kill you – now. As we say in the ER, a high glucose level will hurt you and may kill you, but a glucose level that goes to zero means ‘Cancel Christmas’.
Therefore I will start with a simple statement. Any diabetic (or individual known to have low glucose levels) with altered mental status needs to be given juice or if they can handle it, some soft food to chew on. If they’re in the midst of a high sugar reaction, it won’t make much of a difference, but if that glucose level was zero, you’ve just saved a life. Now let’s briefly discuss symptoms and causes.

Low glucose levels can present many different ways including dizziness, jitteriness, numbness, tingling, blackouts, seizures and other symptoms. However, it’s usually the confusion or other change in mental status that’s most predominant and concerning. Just remember, this is not something about which you should wait around to see if it gets better.
Regarding causes, unintentional overdosing of insulin or oral medication (particular the sulfonylureas class of medicines) are especially concerning and common. Sometimes a family member, particularly a child, may take such a medicine to disastrous effects. Beyond that, heavy alcohol consumption on an empty stomach is another common cause due to its effects on the liver (Alcohol locks glucose stores in the liver, preventing release to the blood; as a result you have less to use.).
Other causes are more exotic and fortunately less common; they will be evaluated upon arrival to the hospital when a rapid response isn’t seen with simple administration of glucose. Dysfunction of certain organs (the adrenal and pituitary glands, the liver due to hepatitis, or tumors of the pancreas – the organ that produces the insulin that drives glucose into your cells – can cause problems with regulating either glucose itself or insulin. These conditions can drive your blood glucose dangerously low.
So, the causes are varied, but the message is simple. Be careful with insulin administration, remember to check those blood sugar levels and act promptly in the face of mental status changes. Usually I note that time is tissue, but in this example, you’ll run out of time before your tissues are damaged.
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.
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Straight, No Chaser: Diabetes Basics and the Importance of Education

November 7, 2016Diet and Nutrition, Endocrine/Metabolic, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Diabetes, Diet, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Diabetes is a disease in which education is vital. For a diabetic, knowing the disease well allows him or her to better prevent long-term consequences of the disease. It also allows the diabetic to make real-time adjustments when sick or otherwise in danger acutely. In Straight, No Chaser, we’ve provided a series of posts meant to empower diabetics (and you can review any or all of them via the search box on the right). Remember, it all should start with a basic understanding of the disease.
We eat, and the process of digestion is for the purpose of converting food into glucose (sugar) that’s used by our body for energy. The blood delivers the glucose to different organs of the body where the cells take it up for use. In order for that process to work, an organ that’s part of the digestive tract called the pancreas has to produce a hormone called insulin. Insulin facilitates the glucose getting from the blood to inside the cells. Diabetes is a disease where insulin isn’t being made by the pancreas or isn’t working optimally.
Now think about what happens when you’re not getting sugar into your cells. It’s as if you’re starving (because physiologically, you might as well be). You get symptoms such as weight loss, hunger, fatigue and excessive thirst. Because your cells don’t have energy, they aren’t functioning well. In fact, blood and nerve vessels lose significant function, resulting in significant vision loss and lack of sensitivity in your extremities. Anyone who’s been a diabetic for about 10 years know this because you’re wearing glasses and because you’ve lost a fair amount of sensation, especially in your feet. There are other symptoms that are variations of the same theme, including excessive urination, dry skin, increased infection rate and slower healing from those infections – all due to poor function of your blood vessels.
Sometimes diabetes is a disease that happens to you because of unlucky genetics (or simply a family history). Other times it is a disease that you find. Risk factors for developing diabetes includes obesity, older age, and physical inactivity. Gestational diabetes (i.e. that occurring during pregnancy) is an entirely different conversation.

Let’s take a moment to discuss prevention and treatment. There are different types of diabetes, but the risk of one form of diabetes in particular can be reduced by – you guessed it – diet and exercise. In fact, diet, exercise and medications are the three legs of the diabetes treatment stool regardless of type. Some patients require regular insulin injections and others require pills. Still others who are successful with diet and exercise are able to markedly reduce, and in some instances eliminate medications.
If you’re a diabetic, make an investment in your education. It could not only save your legs or eyes, but it may just save your life. I welcome your questions and comments.
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.
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Straight, No Chaser: Quick Tips for The Newborn Addition to Your Family

September 22, 2016General Health and Wellness, Pediatrics/Kids Health, Health PreventionBaby, Behind the Curtain, breastfeed, Breastfeeding, Children, Clothing, Family, Gastroesophageal reflux disease, health, Home, Infant, ShoppingJeffrey Sterling, MD

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

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

I mean no disrespect when I say this, but call your primary doctor before bringing your colicky newborn to the ER during those first 30 days of life. The main reason I say this is for your further protection. The ER is where a lot of bad microorganisms live, and although we never mind seeing you, we want to coordinate when it’s appropriate for you to have to expose your baby to the environment.
Feel free to ask 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.
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Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Cerebrovascular System (Your Brain)

September 9, 2016General Health and Wellness, Mental Health, Neurology, Health Prevention844-SMA-TALK, Behind the Curtain, Blood vessel, Brain, Cerebrovascular disease, Conditions and Diseases, health, Neurological Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Transient ischemic attackJeffrey Sterling, MD

Last but not least, in the first part of this series, let’s talk about your brain. But first a summary comment. Life after 40 poses both opportunity and obstacles. 35 to 40 is either the age when your lifestyle begins to catch up with you, or the work you’ve put in begins to pay off. For those who’ve lived life smartly and healthily, 40 really is the new 30. For those who’ve lived life less diligently, 40 may as well be 60, and your health probably reflects that. It’s really not that difficult. Diet, exercise, don’t smoke and alcohol in moderation keeps a body strong. Now to your brain…

Changes: As you age, cholesterol based blockages (plaque formation) inside the arteries and hardening of the arteries in the blood vessels that supply the brain is called cerebrovascular disease, and it causes strokes. These changes begin in earnest at about age 35. Prior to the complete blockage of the blood vessels, the brain is deprived of adequate blood flow (and oxygen) resulting in less than optimal brain functioning, such as confusion, disorientation, memory loss and ‘mini-strokes’ (TIAs). Strokes may result in paralysis, speech disorder, and sensory deprivation in varying degrees.

Challenges: Unlike many of the other systems I’ve discussed, the effects of these changes on our brain health status can be drastic, ranging from slight discomfort to death, and they involve major physical as well as social components. The social implications of these effects can be just as severe as the physical, as those suffering become less functional both mentally and physically. Unfortunately, in varying degrees stroke survivors become or perceive themselves to be a burden to others. Social interactions are doubly inhibited: internally, the patient is less able to interact; and externally, family, friends, and others may be less interested in interacting with them. This is sad, but true (think about the lives of the stroke survivors you may know…).
Solutions: The alternatives are twofold: after the fact, education is essential by a loved one’s support group and community, otherwise a stroke becomes a different type of life sentence. Physical and occupational therapy save lives and the quality of lives. Continuing to value and show value to your loved ones can make all the difference in the world. Before the fact, again, it’s preventive measures such as diet and exercise that have been shown to decrease or even prevent strokes. I cannot overemphasize how vital diet, exercise and the avoidance of toxins are to your long-term health.
Feel free to ask 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.
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Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Genital System

September 7, 2016General Health and Wellness, Genital/Urinary, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, health, Human sexual activity, K-Y Jelly, Masturbation, Sex education, Sex organ, Sexual intercourse, Sexuality, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The third part of this series is about your genital system after 40. There’s a lot here both for the ladies and the gentlemen, but everyone should want to know all the information provided. As before, I’m going to go through changes – challenges – solutions. I welcome any questions or comments.
Prologue: Sex is good for your long-term genital and mental health. I can’t think of a better, more sexy application of the truism ‘knowledge is power’. Men, feel free to discuss this with your ladies. Ladies, I promise you I’m not being biased here (wink).
Changes: Allow me to start with the most important point: sexuality is not truly an issue of aging as much as it is more an issue of education, psychological response and health. However some changes specific to the genital system do occur with aging. In men, the prostate may enlarge (does so in 50% of men at age 50), potentially causing frequent and urgent needs to urinate and difficultly holding urine. However, more changes occur in women than in men. In women, the uterus shrinks, and several changes occur in the vagina, resulting in decreased lubrication and elasticity being lost.

Challenges: The challenges here are interesting ones. Simple rules to better genital health – Women: Stay sexually active! Men: Be confident in your sexual stamina! It is important to understand that the changes that occur in the genital system are not as related to age as they are to one’s sense of sexuality. The physical changes in the genital system should be non-problematic, especially if sex has been occurring without long periods of abstinence.
Venus Challenges: On the female side, the physical changes all can be dealt with if the woman has maintained some regular level of sexual activity. Yes, genital responses to stimulation slow gradually in both men and women, but you can have normal sexual relations at any age, as long as you are healthy. If after the age of about 40, a woman abstains from intercourse for prolonged periods (such as 3 to 5 years) the ability to secrete lubricating fluids, and much of the elasticity of the vagina are permanently lost.
Mars Challenges: On the male side, a particularly annoying challenge for some men with prostate enlargement is to avoid self-wetting. The even greater challenge is (not believing, but) ‘knowing’ your sexual prowess and stamina are still intact, particularly if dealing with an intimidating female partner (e.g. better conditioned, more adventurous or perhaps younger). For males, premature ejaculation and impotence are dramatically reduced in men when they become legitimately confident in their sexual skills set. Work on that! Women, feed your men confidence! It will come back to you!
Venus Solutions: Masturbation can effectively help to maintain female capabilities to provide lubrication and elasticity, especially if object insertion is included. Since most research shows that less than 50% of women practice object insertion during masturbation, these women who also abstain from intercourse lose some vaginal elasticity, even with regular masturbation. In the event that the woman has been sexually abstinent for a period of 3 to 5 years or more, the use of K-Y Jelly or some other non-alcoholic, non-petroleum lubricant specifically designed for compatibility with the chemistry of the vagina may sufficiently reduce discomfort in sexual intercourse.
Mars Solutions: Remember that most sexual problems are social/psychological problems, and they occur at all ages. Men: work on learning what’s necessary to give you confidence, and better performance will follow. For some it’s a certain partner, for others it’s a pill. Do not underestimate this point: if you’re otherwise healthy, that enhances your ability to perform sexually! It’s all about blood flow anyway.
Solutions Epilogue: The main solution to age-related issues of the genitalia are all within your reach (no pun intended): it’s all about activity, especially continued regular sexual activity, exercise, good nutrition and other healthy habits.
Post-script: Petroleum products such as baby oil and vaseline must never be put in or on the vagina, as they will upset the pH balance of the vagina, making it susceptible to yeast infections and other problems like BV (bacterial vaginosis).
Feel free to ask 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.
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Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Musculoskeletal System

September 6, 2016General Health and Wellness, Health Prevention, Musculoskeletal System844-SMA-TALK, Adipose tissue, Behind the Curtain, Fitness, health, Muscle, Myocyte, Physical exercise, Skeletal striated muscle, Stem cell, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Weight lossJeffrey Sterling, MD

The second part of this series on how your body changes with age is about your muscles. This section combined with the previous skin section explains why you wrinkle. As before, I’m going to go through system – changes – challenges – solutions. If you’re keeping score, especially focus on the take home messages within solutions. I welcome any questions or comments.
Changes: Did you know that muscle cells are unable to replace themselves once they are formed? Therefore, muscle cell loss is permanent. Plus, muscular response gradually slows with age. That said, the loss of muscular capabilities over time is by far the result of cell loss due to inactivity. As muscle cells are lost, weakness and slowness increase. Plus, some of you don’t exercise at all, or as much/vigorously as you used to, so you’re not building up anything new.
Challenges: The effects of these changes on our health status are mostly due to the fact that the muscles are the main tools for effecting strong circulation throughout the body (i.e. muscular contraction pushes blood around). As the muscles become smaller, including the muscles in the face, and as fat tissue accumulates, including in the face, the entire appearance changes to that of an older person, with all the ramifications described in the post on the description of skin changes with aging. In addition, as muscle fibers decrease, weaken, and slow, it becomes increasingly difficult to keep up with younger people, who may make allowances, but who may also become avoidant. Your recognition of this creates a vicious cycle, and you eventually settle into ‘being old’.

Solutions: In two words – exercise & activity. A well designed, consistently followed exercise program addressing both strength and response is indispensable for the maintenance of muscle cells, and of good health over time. A personal trainer is a pretty good idea after a certain age. You neither need to under nor overdo your weight lifting regimen. In any event, move those muscles as much as you can, whether via walking, yoga, running or sex. Being a couch potato is never a good thing.
Post-scripts:

Another thing that very few of us do is stretch. Those old muscles are tight, and the tendons/ligaments are short and ready to pop. You really must stretch before your weekend warrior events or most any big exertional activity. That’s a big part of why yoga promotes longevity.
Fortunately, the main muscles of the heart and the diaphragm (your breathing muscle) do not lose muscle fibers with age because they are continually active. Yet, your heart and lungs have their own problems besides the muscles. That topic is forthcoming. All that said, be mindful that through ongoing exercise and training, you can stem the tide on these changes.

Young is as young does.
Feel free to ask 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.
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Straight, No Chaser: Life Begins (to End) at 40 (Unless It Doesn’t) – The Skin

September 5, 2016General Health and Wellness, Skin/Dermatology, Health Prevention844-SMA-TALK, Beauty, Behind the Curtain, Cosmetics, health, Herpes zoster, Human skin, Skin, Skin Care, Skin neoplasm, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We have a natural inclination to think about our mortality as we approach and pass 40 years old. A big part of healthy aging is prior healthy living, particularly as you reach the age at which your unhealthy habits begin to catch up with you or otherwise naturally aging processes begin to demonstrate themselves emphatically. Being on the other side of 40 is an exercise in self-reflection and understanding of limitations previously not existent. I’m still pushing the rock up the mountain, but I’ve seen the challenges of maintaining and continuing to advance. This is a lot to digest, so I’m going to go through five different body systems this week in a simple way: system – changes – challenges – solutions. If you’re keeping score, especially focus on the take home messages within solutions. And don’t be depressed! Forewarned is forearmed. Take action! I welcome any questions or comments.

Part 1/5: Your Skin

Changes: As the skin ages, blood flow to the skin is decreased, and nerve endings are lost or become less sensitive. As a result, the skin loses some of its effectiveness as a protector against bacteria, as an insulator, as a heat/cold regulator, and as a sensory receptor. These losses cause wrinkling, loss of elasticity, freedom of movement, and expression are inhibited. The slowing of circulation results in slower healing. The loss of color is also seen, as the hair becomes gray.
Challenges: The skin generally functions well throughout life though, and most changes in the skin due to aging are not life threatening. Most of the damaging changes in the skin are cosmetic. The drying and thinning result in sagging and wrinkling, the hair becomes sparser and gray or white, and the fingernails become rigid, tend to yellow, and are prone to splitting. Skin disorders more common in the aging skin include enhanced itching, thickening in patches, skin cancer, ulcers/pressure sores, and herpes zoster (shingles). These effects bring social implications based on a significant cultural tendency toward ageism. One’s social life becomes more limited as younger people view elders as “not fun”, “slow”, “grumpy”, less desirable as friends and sexual partners, and so on. These views spill into the workplace or what might be a potential workplace, as one who looks “old” is not considered as having ‘much’ to offer.
Solutions: Two words: hydrate and moisturize. Avoid excessive exposure to the sun, maintain moisture in the skin, provide adequate nutrition so that the skin can be maintained and repaired, and get regular exercise to maintain circulation in the skin. Sounds simple, but we really fail to adhere to this consideration. Many of these changes can be delayed for very long periods of time.
Post-Script: I would be remiss if I didn’t point out that those of you of all races and ethnicities must be diligent in getting rapidly growing or changing moles evaluated. It is an untruth that Blacks and Browns don’t get skin cancer.
Post-Post-Script: Ever imagine what effect holding a cigarette up to your face for decades has? Here’s a depiction.

Feel free to ask 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.
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Straight, No Chaser: Suicide and Suicide Risks in College Students

August 31, 2016General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

I just had the privilege of spending time at my alma mater addressing issues on behalf of students and mental health services. Among many other things discussed, I was shocked by the extent to which college suicides have become present on college campuses. I wonder when things changed. Isn’t college supposed to be the “best four years of your life?” It really doesn’t take much though to appreciate how this becomes the case.

Suicide is the second leading cause of death among college-age students in the United States and the third leading cause among those aged 15-24. There are approximately 1,100 deaths by suicide occurring in this age group each year. A recent study from Johns Hopkins and the University of Maryland went in-depth in surveying and analyzing why students may have thoughts on suicide. Here is a summary of some of the study’s findings:

12% of those studied admitted that they had thought of committing suicide.
Of this group of 12%, approximately 25% of them said they had those thoughts repeatedly.
Depression and lack of social support appeared to be major factors contributing to thoughts of suicide.

If you actually think about it, college brings together a lot of risks for suicide.

Late adolescence and early adulthood represents the period of highest risk of developing a major psychiatric disorder.
The academic environment can be a stress-producing inferno for some, who may find themselves overwhelmed and feeling lost and as if they have nowhere to turn.
For many, the college experience represents the first time many are away from home and/or completely detached from the family and friends they’ve had their entire lives. Unless and until a sufficient new social network is established, levels of isolation can be overwhelming.
Even among those with social networks, the academic failure and any social rejection that may occur could be perceived by students as having life-long consequences, so much so that hopelessness and thoughts of suicide could set into a young adult’s mind.

Practically, how might you consider the risk in any one individual? The presence of any of these risk factors should prompt implementation of a support system to counter feelings of suicide.

It shouldn’t be difficult to appreciate how the lack of social support is one of the most powerful predictors of persistent suicidal thoughts. Someone who expresses or has feelings of being unappreciated, unloved and uninvolved with family and friends should be considered at risk – even in the absence of any other risk factors.
A history of clinically diagnosed depression or other psychiatric diagnoses
The exposure to domestic violence (either witnessing or having been abused) in childhood
Having a mother with a history of clinical depression

There are many Straight, No Chaser posts that address suicide prevention, diagnosis and treatment. Feel free to use the search box on the right for additional information.If you are a college student or a family member of a college student, you would do well to review your college’s support system and learn about services and support available for those in need of mental/behavioral health services. College should represent the beginning of one’s adult life, not the place where it ends.
Feel free to ask 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.
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Straight, No Chaser: Quick Workouts for the Couch Potato

August 30, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Warning: This post includes adorable animal exercise pictures.

Hey you! Yes, you: the ones about to enjoying the return of the NFL; the ones who have spent the last 3 months on the couch. Let’s turn your couch time into something (relatively) healthy. Now, if you’re reading this, you may be asking “How can anything about being a couch potato be healthy?” Actually it’s not, so if you’re committed to being a couch implant, good luck with that, and I’ll see you in the ER down the road. However, if you are simply spending time on the couch, and you may be interested in multitasking, this read’s for you.

I think I figured this out about 20 years ago. TV commercials are usually very annoying. In many instances, they are a waste of time and just beg you to do something else. Why not get in a workout? That’s right, in our ongoing effort to get you to move, we point your attention to the three minutes between the scenes of your favorite shows. Do something for your benefit (and I don’t mean go grab a beer and chips).

Here is a quick list of activities and exercises that you can do during commercial breaks. Mix and match these into a routine that suits your purposes. If it’s too much for you, consider turning off the TV and reading a book! Of course, be sure you’re healthy enough to engage in exercise before starting any regimen.

Push ups: Drop and do 10 push ups or 10 sit ups for every commercial. Once you’ve done it, break until the commercial starts. Or…
Jumping jacks: After your push ups, do jumping jacks until the start of the next commercial, then go back to the push ups.
Stairs: Rush up and down a flight of stairs.
Knee lifts: You don’t have stairs? Practice knee lifts during the commercials. Stand up and alternate bringing your right elbow down to meet your left knee and switch. Build up to doing this for the length of a commercial.

Windmills: Extend your arms to the side and make circular motions from your shoulders. See if you can build up to doing this for an entire commercial.
Punches: Place your arms in front of you and simulate using a punching bag.

Couch/armchair stands: Sit on the edge of the couch or chair with your feet shoulder-width apart. Fold your arms across your chest or leave them hanging at the side if you need to for balance. Stand while pressing into the floor with your feet, tensing your butt muscles as you rise. Keep your back straight and your abdominal muscles tight. Hold the position for a five count, then slowly lower yourself. Before you touch the couch, stand up again. Build your endurance with this; you should be able to go for a full commercial. These couch/armchair stands will help develop the buttocks and the front portion of your thighs.

Chair dips: Start by sitting on the edge of your couch or chair. Place your hands on either side of you. Move your feet and slide out so that your butt is off the couch, and bend your knees to a 90-degree angle. Bend your elbows so they are pointing behind you. Lower yourself as far as comfortable. Hold the position for a three to five count (build up to five), then slowly press up again. Repeat as you can; build up your stamina. Try to do these for an entire commercial. Armchair dips are great for the backs of your arms.

Leg-up Couch Crunches: Want a quick abdominal workout? While on your couch (or floor if the couch is too soft), lie on your back with your knees bent. Lift your feet up on one end, and keep your hands behind your head. Pressing your lower back into the couch, slowly lift your head, shoulders and upper back off the couch. Hold for a three to five count (build up to five), then slowly lower. Repeat, building up to the length of a commercial.

Don’t forget to work some stretching into your routine!

And if your team doesn’t win, don’t be angry. Just meditate the disappointment away…

I would be remiss if I didn’t point out how important it is for you to avoid to habitual consumption of empty calories that typically occurs during idle TV watching. Remember, your diet is actually about 75% of your issue. Stop poisoning yourself by what you eat!

Feel free to ask 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.
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Straight, No Chaser: Toxin and Detoxification Series Summary

August 25, 2016Medical Treatment, Health Prevention844-SMA-TALK, Behind the Curtain, Defecation, Detoxification, health, Intestine, Normal number, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Toxin, Weight lossJeffrey Sterling, MD

I want to thank you for all the positive responses to the series of posts on toxins and detoxification. You have shared many personal stories and asked many great questions. I guess I’ll continue to accept your being shy (especially on these topics) about asking personal questions publicly, but keep contacting me here. To that end, I’ll summarize by sharing some of your thoughts and making a few final comments.
You can’t escape toxins, but you can pretty easily reduce your exposure to them. For the things you can control, “everything in moderation” is a pretty good rule of thumb for most, except for cigarette smoke into your lungs. That just needs to stop.
Your body does a great job of detoxification through the lungs, kidneys, liver, intestines and skin. This process is retarded by age and the effects of toxins on these systems.
There are a lot of fad diets and questionable methods of detoxifying. Most have risks that should make you cautious. None are more effective than tuning your body to do its best work. Furthermore, these methods are invariably more effective in the short-term than the long-term.
Now, to some of your questions.
1. So are you saying bowel movements are good enough to detox the intestines?
Until and unless your bad habits catch up with you, yes. Consider the ways the large intestines (the colon) handle toxins.

If healthy, the colon sheds old cells about every three days, preventing a buildup of harmful material. It regenerates new healthy cells in their place. It’s lining includes mucus membranes that can keep toxic substances from reentering the blood and tissues.
You have “natural” bacteria that reside in the colon. They actually detoxify food wastes for you. (One of the potential issues of colon cleansing is the removal of these bacteria.)
The liver’s main function is to neutralize toxins.
Your bowel movements remove waste and toxins from you. Although the number of bowel movements vary between individuals, your body (if healthy) is able to regulate when you defecate based on your needs.
Increasing the number of bowel movements doesn’t improve weight loss. That’s because the body absorbs most calories before they reach the large intestine.

Nothing in a colonic or juice fast will match this level of effectiveness. Spend your efforts keeping your body healthy. Increase your fiber, water, fruit and vegetable intake. Lower or eliminate the intake of red meat, cigarettes and alcohol. There’s your detox program all day long.
2. So what’s the verdict on the detox diets and colon cleansing?
Consult with your physician. I’d imagine that using the diets as a starting point for lifestyle changes would be endorsed. I’d doubt that any fad diet would be endorsed.
3. You said tap water is no longer good? Should I exclusively drink bottled water?
Actually filtered water is even better.
4. Are you suggesting I stop wearing makeup?
You’re beautiful just the way you are.
5. Have you ever had a colonic?
Yes, and it made me feel dirty. (Was that serious, or a joke?)
6. I’d never do that.
Actually, you will. (Well, almost.) Many men over 50 will have a colonoscopy to evaluate for the possibility of colon cancer at some point. If and when you get that, you’ll get your colon cleanse solution one to two days before the procedure and maybe an enema in addition. At least you’ll be under the care of a physician, and you’ll get a sedative first!
Feel free to ask 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: Natural Colon Cleansing (Colonics) as a Means of Detox

August 24, 2016Medical Treatment, Toxicology/Drugs, Health Prevention844-SMA-TALK, Behind the Curtain, Colon, Colon cleansing, Detoxification, Food and Drug Administration, health, Intestine, Irrigation, Medical procedure, medicine, SterlingMedicalAdvice.com, Straight No Chaser, ToxinJeffrey Sterling, MD

C’mon. Be honest. You knew we’d end up here (no pun intended). Isn’t colonic cleansing one of those things that makes you wonder who the Greek guy was who first thought of this centuries ago? Perhaps even more interesting would be talking to the first guy who volunteered for this … I promise to (try to) do (most of) the rest of this post with a straight (no chaser) face.
What Is It? Colon cleansing is done primarily via two methods.

You can take supplements by mouth that will stimulate expulsion of the contents of your intestines.
You can have a tube inserted through your rectum to irrigate your intestines.

Why Do It? Allow me to set the table by explaining the premise for colonic cleansing. It’s actually a pretty simple and linear train of thought.

You have toxins in your intestines from undigested food.
Over time, those toxins can get reabsorbed back into your blood and cause damage to your organs (as previously discussed here).
You’d like to get rid of the toxins by flushing and irrigating them out of your system.

Proponents of colonic cleansing claim potential benefits such as weight loss, improved immunity and mental outlook and reduction of the risk of colon cancer.
The Methods
Oral colon cleansing (through supplements, oral laxatives, or enzymes) and colonic irrigation (through inserting of a tube) are variations of the same theme. Oral cleansing stimulates massive contractions of your intestines with subsequent massive bowel movements. (Think of the effects of Draino – and please don’t try taking any Draino and say I told you to; it’s just an analogy.)
Colonic cleansing involves placement of a tube through the rectum into the colon and irrigating the colon with several gallons of the chosen solution (sometimes including herbs, enzymes, caffeine or probiotics) until the contents are clear, suggesting the stool has been removed (like a high power wash or enema – again please don’t do that at home…).
At the end of either process, all we can say for sure is that you will have a lot less stool in your intestines.
The Risks
I love the phrases “Natural doesn’t necessarily mean safe” and “Safe doesn’t necessarily mean effective.” They especially come to mind when I see the phrase “natural colon cleansing.” Colonic cleanses, even if effective, are risky. Keep in mind the following.

The U.S. Food and Drug Administration (FDA) does not regulate these colonic procedures. Don’t ask me why, but that means that nothing about the procedure has been quality checked in the same way medicines and medical procedures have to be. To be fair, there is a massive case history of these procedures being done safely in the overwhelming number of cases.
If you decided to get a colonic, you may be receiving one from someone who’s not licensed, depending on the state or country. I can’t believe I’m saying this, but ask to see credentials before you allow someone to give you a colonic … and please speak with your primary care physician about options.
Consider the fact that this is a medical procedure. Even in the hands of the best therapists, things go wrong. If and when something happens, will the therapist be able to address the issue? Ask your therapist what will happen if you have an allergic reaction to any solutions being used.
Other risks include dehydration and electrolyte imbalance, infection, rupture of the intestines and depletion of probiotics. (You may recall that in my previous post that I discussed that the intestines have toxin-repellent mechanisms already in place. Probiotics are part of that internal process.)

You should not be undergoing colonics without your physician’s approval under any circumstance and not even then if you suffer from any of the following:

Any lower digestive tract tumor (cancer)
Any recent surgery, especially of the intestines
Specific digestive tract conditions, such as Crohn’s disease, ulcerative colitis, diverticulosis or diverticulitis
Bad hemorrhoids (as opposed to the good ones)
Significant heart, lung or kidney disease (You will be receiving a medical procedure in a place not equipped to deal with emergencies should one occur, and no one can tell you that one won’t happen while you’re on the business end of a rectal tube.)

Does it work?
I can make the following comments with complete confidence and no equivocation.

There has been very little medical research on the benefit of colonic cleansing. Therefore, any global claims of benefit, include those listed above, are unjustified when placed against the standard by which the medical community judges these things. It is very unlikely that will ever change, as I don’t exactly foresee a sufficient number of research subjects lining up (or backing up) for a randomized, double-blinded study anytime soon … That’s not to say it doesn’t work, and there is a theoretical basis for why it would work. It’s just that sufficient medical evidence that it works hasn’t been put forth.
I know individuals (and not just the colonic hydrotherapists/hygienists who are obviously incentivized to promote the procedure) who swear they feel better getting this done. Of course, this could be attributable to a placebo effect. Alternatively, here’s something that proponents of colonics don’t seem to discuss that is quite reasonable. There are specific medical ailments related to the nervous system (which has several trigger points in the intestines) that are improved by relieving constipation; clearly colonics do that. Perhaps proponents don’t want to see the procedure reduced to a complex way to provide an enema.
I know there are natural methods of cleansing that are at least as effective as colonics. I’ve discussed these here.

So what does all this mean? Given the last bullet point above, the issue can be addressed with either of two analogies.

If you wash a car that already has rust on it, you aren’t really fixing anything.
If you repair a car that still functions as new, you aren’t really improving anything. I’m all for maintenance, but when you’re discussing the body, if you take care of it, it sustains itself rather well.

In my “toxin summary post” tomorrow, I will answer your questions on the entire toxin and detoxification series and add a few final thoughts.
Feel free to ask 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.
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Straight, No Chaser: A Look at Detox Diets

August 23, 2016Medical Treatment, Toxicology/Drugs, Health Prevention844-SMA-TALK, Behind the Curtain, Detoxification, Detoxification (alternative medicine), Diet, Disease, health, Master Cleanse, Shopping, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Support Groups, Toxin, Weight lossJeffrey Sterling, MD

Everyone who talks to me about detox is motivated and sincere about making an improvement in his or her health. Therefore, it’s important that they be shown respect and encouraged. However, some of these same individuals exhibit a level of desperation that is counterproductive and leaves them subject to fads and scams that are doomed to long-term failure. The first question I ask is “Are you trying to improve your health or weight?” These are often separate considerations. Of course, I’m hoping they answer, “Both.” Interestingly, that happens less often than you might think. Next, I’ll ask if they’re engaged in some basic, fundamental activity (click here), which is rarely the case. Once people discover the latest, greatest thing, they tend to lock in on it and just have to go for it. So be it.

So… today and tomorrow, I’m going to discuss two very common “quick-fix” approaches to detoxification. Let’s start with the “detox diet.” For the purposes of this discussion, all detox diets are variations of the same theme. I hope this doesn’t disappoint you or come off as dismissive, but the point of the matter is that from a medical standpoint, these actions are reducible to a set of physiologic actions that either produce biological effects or don’t. Giving a car a new coat of paint doesn’t make it an airplane. Similarly, taking a quick detox diet doesn’t make you healthy if you return to the same conditions that produced your pathology in the first place. Folks, it really should occur to you that given the rates of obesity and disease that exist, if these diets really worked, the pharmaceutical and medical communities would be all over them because of their potential for profit (and of course the potential for good…). Here’s what detox diets do and don’t accomplish.

The Premise: Going on a diet for a few weeks can clear your body of toxins, which will improve your health.
The Short Term Effects: Proponents of detox diets often claim or note the following during the diet:

Weight loss
More energy
Better mental focus

The Long Term Effects: Proponents of detox diets often make the following claims about the benefits of the diets:

Health promotion
Prevention of new diseases
Cure of chronic diseases

What’s Really Happening: Have you ever heard that correlation is not causation? If you engage in any activity involving backing away from fats, drinking more water, taking in less sugar and processed food, eliminating alcohol and caffeine, and taking in more fruits and vegetables, you’ll feel better! In fact, I’m all for it. Refer to this blog post where I give you details on how to naturally, healthily and sustainably do this.
Now, here’s the question. Is your detox diet just a two to four-week “challenge,” or is it the launching pad for a set of lifestyle changes? The problem is that people use these diets with their better principles, but they usually don’t sustain them. In fact, the diets themselves generally are not sustainable because they’re too restrictive. If you tried sustaining some of these diets, you’d end up hospitalized. You’re much better off applying fundamental principles that will slowly and steadily improve your health and also help you lose weight. By the way, those long-term claims have been roundly and routinely debunked by the medical community, which has every incentive to want to discover new ways to treat disease.
Precautions and Risks

Before starting any diet, you need to discuss what you’re trying to accomplish with your physician. I’d venture a bet that most would not approve one of these diets, especially if you suffer from any chronic illness, especially diabetes, mental illness, moderate to severe (and poorly controlled) high blood pressure or cardiac disease. They also won’t approve it if you’re pregnant or at the extremes of age.
Based on the components of these diets, you are introducing certain specific risks. These include vomiting, diarrhea and dehydration, electrolyte loss and imbalance and disruption of the function of your digestive system.

Let’s finish with two pointed questions and answers.
1. Should I go on a detox diet? I encourage almost any activity that motivates you to improve your health and has been shown to improve your health. If you want to naturally detox, apply these principals as the basis for a lifestyle change. As your body recovers, your natural detoxification system will take over and do just fine (assuming you are otherwise healthy).
2. I quick-flush my system with a diet every few months. Is this healthy? It depends on what you’re doing as a “quick-flush” and even more so, what you’re doing in-between. Focus on enhancing your natural detoxification system. I can’t say that a one-time or intermittent initiative to kick things off would be a terrible thing — if you stay with the program. In the best case scenario, it’s like going to get a dental cleaning every six months. You’ll still have decaying teeth and disease if that’s the only thing you’re doing. On the other hand, if you’re brushing and flossing every day, then the six-month check up is quick (and in this case, maybe superfluous). I’m much more concerned with you sustaining a healthy approach toward the desired goal.
Next up, and the last in this series on detoxification will be a look at colonics. Until then, bottoms up!
Feel free to ask 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.
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