Tag Archives: health

Straight, No Chaser: Shingles – Return of the Chickenpox

July 17, 2015Skin/Dermatology844-SMA-TALK, Behind the Curtain, Blisters, Chickenpox, health, herd immunity, Herpes, Herpes zoster, Immunocompromised, Rash, Shingles vaccine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Varicella vaccine, Varicella zoster virus, Vesicles, ZostavaxJeffrey Sterling, MD

It’s another interesting night in the ER. My nurses are hounding me because there’s a patient with a rash, and they don’t know what it is. They’re so good that they rarely get stumped, and they get excited when they are. The patient had a pretty impressive cluster of little blisters called vesicles (see the picture above) under one eye with significant reddening of the skin under the cluster. Unknown to them, their problem with this patient is she’s African-American. Many healthcare professionals have difficulty identifying common rashes in dark-skinned individuals.

I wonder if any of you haven’t had chickenpox. That’s a question that never would have been asked a few decades ago. Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.). Repeat infections or reactivation of the virus that went dormant inside of you causes shingles. When I was younger, no one ever got shingles because no one got chickenpox twice. Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it. The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).

Then an odd thing happened. A chickenpox vaccine came out. Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age. Then shingles started being seen more often.

The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes. Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears. The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks). Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.

Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful. If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half. Please discuss this with your physician. If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.

Quick Tips:

If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from blisters in both conditions is contagious and can cause chickenpox in these groups.
If you have shingles, avoid close contact with people until after the rash blisters heal.
Certain people are at heightened risk from chickenpox and shingles, including anyone pregnant, elderly, ill or with a diminished immune system.

I welcome your questions, comments or stories. For the sports fans out there, this pictorial trivia question shouldn’t be hard to answer. Who’s this famous manager pictured here with shingles?

In the meantime, if you’d like to read Behind the Curtain ahead of its national launch, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com!
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. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: What Should Be in Your Medicine Cabinet

June 15, 2015Detoxification, General Health and Wellness, Health Prevention844-SMA-TALK, American Academy of Pediatrics, Aspirin, Behind the Curtain, Common cold, Emergency department, health, Medical Specialties, medicine, Poison control center, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United StatesJeffrey Sterling, MD

You’ve all done it. I’ve caught a few of you doing it. Why do you rummage through someone’s else’s medicine cabinet? Are newer homes even built with medicine cabinets anymore? Oh well… Today, Straight, No Chaser tackles a simple but important question in an ongoing effort to better empower you. For starters, here’s hoping your cabinet doesn’t resemble any of these pictured, but there is a role for medicines in your medicine cabinet.

1. What should be in your medicine cabinet? Here’s my top five and why.

Aspirin (324 mg).

On the day you’re having a heart attack, you’ll want this available to pop in your mouth on the way to the hospital. Of all the intervention done in treating heart attacks, none is better than simply taking an aspirin. It offers a 23% reduction in mortality (death rates) due to a heart attack all by itself.

Activated charcoal.

This one may surprise you. Talk to your physician or pharmacist about this. If someone in your family ever overdoses on a medicine, odds are this is the first medication you’d be given in the emergency room. The sooner it’s onboard, the sooner it can begin detoxifying whatever you took. That said, there are some medications and circumstances when you shouldn’t take it, so get familiar with it by talking with your physician.

Antiseptics such as triple antibiotic ointment for cuts, scratches and minor burns.

It should be embarrassing for you to spend $1000 going to an emergency room when you could have addressed the problem at home. I guess I should include bandages here as well.

A variety pack for colds, including antihistamines (like diphenhydramine, aka benadryl) and cough preparations.

As a general rule, give yourself 3-5 days of using OTC preparations for a cold to see if it works or goes away. If not, then it’s certainly appropriate to get additional medical care. I guess I can lump a thermometer in this bullet point.

The fifth item would be this number: 800-222-1222, which is number to the national poison control center.

They will address your concerns, route you to your local poison center, advise you on the appropriate use of activated charcoal and help coordinate your care when you go to your emergency department.
Be smart about the items in your home in general and in your medicine cabinet in particular. We’ll continue the theme with the next Straight, No Chaser.
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. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: Your Questions About Human Bites

June 9, 2015Infectious Disease, Medical Treatment, Skin/DermatologyBite, Bite marks, Bites and Stings, Boxer's fracture, cat bite, Conditions and Diseases, Dracula, health, human bite, Infection, laceration repair, metacarpal bone, pinky finger, puncture wound, Snake bite, Wound, Wounds and InjuriesJeffrey Sterling, MD

The votes are in, and it appears that Jaws (from James Bond fame) found the previous post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?

Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…

2) What’s a Boxer’s Fracture?

A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5^th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.

3) Is a human’s mouth really dirtier than a goat’s mouth?

It’s correct to say the bacteria in a human’s mouth cause more disease.

4) Is a bite the same as a puncture wound

The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).

5) I received a bite and didn’t get stitched up. Why?

This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.

6) Why didn’t Dracula ever get Hepatitis or HIV?

Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.

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. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: Human Bites

June 1, 2015General Health and WellnessBite, Bites and Stings, Biting, Cellulitis, Conditions and Diseases, Hangnails, health, human bite, Infection, Mike Tyson, Open wound, Tetanus shot, Wound, Wounds and InjuriesJeffrey Sterling, MD

I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious. However, as an emergency physician, knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first quick tip is to do the same.

Maybe it’s where I’m located, but I tend to see way more “fight bites” than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who “won” the fight being the one who has to come in for medical treatment. He cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize, the structures in the hand (tendons, blood vessels, muscles, and bones) are highly concentrated. He also doesn’t know that they are confined to a very limited space and seeding an infection in that tight space makes things really bad really quick. This guy is very dangerous because he tends to deny ever getting into the fight, ascribing the injury to something else (like punching a tree)—at least until I ask him why a tooth is inside his hand.

Then there’s the “Yes, he bit me” variety, where the teeth were the aggressor that engaged the victim instead of the fist engaging the tooth. Think of the Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears, and other unmentionables)! Children, as another example, sometimes bite and need to learn to stop that behavior. Biting is sometimes seen in sexual assault, physical abuse, self-mutilation, or with mentally handicapped individuals.

A third type is the ‘We love too much!’ variety of bites. These may include hickeys that actually break the skin. Other examples of “friendly” bites are folks biting off their hangnails, fingernails, and toenails and create skin infections. Yes, it happens more than you’d think, and no, you don’t have to be a vampire.
The commonality to all of these scenarios is saliva that found its way through the skin. Because of the virulence of the bacteria contained within the saliva, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness, fever, and possible pus from the wound develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, get evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop. In fact, these bites require immunization for tetanus. Bottom line: There’s no reason not to get evaluated if you develop those signs of infection, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.

So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies like peroxide, alcohol, and anything else that burns. Those agents make things worse by damaging the skin more than they “clean” the area.
2) Apply ice—never directly to the wound—but in a towel. Use for 15 minutes on and then 15 minutes off.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
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 © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: When Foreign Bodies are Ingested

May 28, 2015General Health and Wellness844-SMA-TALK, Bag valve mask, Esophagus, Foreign body, Government, health, Nostril, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, SurgeryJeffrey Sterling, MD

Let’s talk about our kids and the things they put inside themselves. Pediatric foreign body ingestion/insertion is a common emergency room presentation. Maybe it’s just part of them exploring their world. In fact, I recall getting a pearl in my ear and a dime in my nostril as a child; maybe I wanted to start saving at a young age…
The bottom line is kids get in trouble. And it’s not always their fault. Families sometimes leave things lying around the house. Children may be fed something they can’t handle. Then there’s always the older sibling putting stuff in them…
More than 100,000 cases of accidental pediatric foreign body ingestion occur each year. I’m going to address the three main orifices where things are placed and let you know the dangers, potential solutions and what to expect if and when you show up in the emergency room. Yep, three different holes, because different types of insertions occur, each with their own risks. I guess they figure if there’s a hole, something needs to go in it.
Ears:

What Happens: Kids will put anything that will fit in their ears, but the problems arise when something either gets stuck or breaks off in an ear. This can include such things as a cotton swab, food, a toy (a bead, something waxy, or something pointy) or whatever else they get their hands on. This poses a significant risk of infection, bleeding and possible rupture of the eardrum, which can lead to an entirely new set of complications.
What You Need to Know: Regardless as to the nature of the item, removal of the item is going to be very dramatic. At home, you should be very conservative in your efforts to get anything out of a child’s ear. Blind efforts may lead to pushing the item further back on the eardrum, possibly rupturing it, or jabbing it into the ear canal, causing damage and potentially setting up an infection. Such efforts usually make it even more difficult for health professionals to get at it once you come to the ER or your doctor’s office.
What happens in the ER: Drama. Depending on the size, shape and depth of the object, tools to flush it out, suck it out, scoop it out or pick it out may be used. There is no guarantee of success, and if the object is unable to be easily retrieved (without an unacceptable risk of further ear damage), the child may either be put to sleep to make the process easier, or you may be referred to an ears, nose and throat specialist.
Nose:

What Happens: Somehow kids think that because of the shape of the nostrils, round things just belong in there. Those smooth pearls, beads, marbles and kernels fit just right.
What You Need to Know: The particular danger with items placed in the nose is they can become dislodged into the airway and choke the child. You should be mindful of this as you try to get that object out yourself. One strategy that you might safely try (assuming no blood or significant pain or other apparent injury exists) is to ‘blow your child a kiss’. Put your mouth around the kids mouth and give a big puff. Sometimes this will pop the object out of the nostril! More easily, if the child is big enough to blow his/her nose, try that while occluding the unaffected nostril.
What Will Happen in the ER: We may try the same things described above. We may also use a piece of equipment called an Ambu-bag to deliver that same type of puff. If that doesn’t work, we have additional means to enter the nose and try to remove the object. The most important consideration is to protect the child’s airway.
Throat to the Stomach or Lower Airway:

What Happens and What You Need to Know: More foreign object ingestions and aspirations (passage down the airway) occur in children younger than 3 years than in other age groups, although they do occur in all ages. Even relatively immobile infants may get something inappropriate in their mouths despite not being able crawl or pick up objects and put them in the mouth. Their relative inability to chew, coupled with faster breathing rates increases the odds of objects entering the windpipe instead of the food pipe. We see simple things such as nuts, raisins, coins, magnets, seeds, foods (e.g. hot dogs and grapes), as well as toys, pins, batteries, balloons, bones and many other items. Your pediatrician has likely advised you to avoid giving certain foods until the child is at least 5 years old.
Objects that have entered or passed through the throat will leave a sensation that something is still in the throat, particularly if it scratched something on the way down. Objects in the airways run the risk of partial or complete obstruction of different parts of the airway. This can be immediately life-threatening if severe enough obstruction has occurred. There’s no guesswork here; the child will be having difficulty breathing, coughing, gasping and likely turning blue.
What Will Happen in the ER:

Management of swallowed or aspirated foreign body depends on the size of both the object and child and the object’s location.
1) If it’s in the stomach or beyond: unless there are multiple sharp objects that suggest something’s been perforated, little will be done, and you’ll be instructed to wait and watch for it in the stool.
2) If it’s in the airway, this is an emergency, and a lung specialist will need to get the object out with a special scope.
3) If it’s in the food pipe but not yet in the stomach or beyond, what’s done will depend on the size and location. Esophageal foreign bodies (that is, those in the food pipe) generally require early removal by a specialist because of their potential to cause respiratory problems (by manual pressure onto the windpipe) and complications to the esophagus itself (scratches, burns or even rupture). Most notably, ingestion of those annoying button batteries, and their lodging in the esophagus require urgent removal even if no symptoms are present because of an unacceptably high risk of complications. Sharp foreign bodies (except for single straight pins) are especially dangerous and prone to complications and most likely will also need to be removed.
So, after all that, is there any wonder why we ask you to child-proof your home? The dangers are real, and the drama of an ER visit for these things is avoidable and worth being diligent at home. Have a great, safe, healthy and happy weekend.
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 © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: When Sex Hurts Her – Vaginismus

May 21, 2015Obstetrics and Gynecology844-SMA-TALK, Disease, health, Human sexual activity, Kegel, Sex therapy, Sexual intercourse, Sexuality, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Support Groups, Vagina, Vaginismus, Women's Health, WordPressJeffrey Sterling, MD

The human body is fascinating and mysterious in so many different ways. Unfortunately, that’s not always a good thing. Not every medical condition has to be life threatening to have a powerful and detrimental impact on one’s life. Vaginismus is an example of that. It’s a condition in which women suffer involuntary contractions of the floor of the vaginal walls. These contractions can be so violent and incapacitating that it renders sex very painful and uncomfortable at best and physically impossible at worst. No, this is not esoterica. Many women suffer through this, not knowing what it is or ascribing the pain to ‘size’.

Here’s three things you need to know:

She’s not faking it.

Vaginismus is horrible for the sufferer, as you’d imagine, and it’s a tremendous stress on relationships. It is the number one cause of unconsummated marriages, and can be complete or situational. It may be complete, impacting ability for a physician to complete a pelvic examination or for a woman to even place a tampon. These contractions can be reflex occurrences such that the symptoms occur when presented with any effort to penetrate the vagina. That said, the reflex is thought to be physiologically learned, and it has been demonstrated that it can be unlearned (Consider your immediate impulse to lift your arm when a fast object comes at you; one episode of vaginismus can prompt a lifetime of similar reactions during efforts at sex.).

Vaginismus can be cured.

It stands to reason that in the many cases in which vaginismus is a learned reflex, the reflex can be overcome. Muscle training and control are the keys to overcoming vaginismus and is a process that can be accomplished over weeks to months. The good news is developing this level of training and control can also have wonderful benefits for couples that do get past the problem. Many women are familiar with Kegel exercises from prenatal classes. Application of these in the correct manner (with systematic progression until penetration is possible) provides success in approximately 90% of patients. If you require details, feel free to ask, or discuss this with your physician.

Vaginismus requires patience (and flexibility) to overcome.

Healthy sex lives are enjoyed by many couples without penetration. This is an important frame of mind to have, less the additional stress can hinder treatment and torpedo the relationship. It may seem like a lot to ask for some, but believe me, many couple maintain happy relationships in the midst of this, either during treatment or throughout a lifetime of suffering through it. Taking this mindset into the period during which treatment is ongoing can lead to a very happy outcome once the vaginismus has been overcome.
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 © 2015 · Sterling Initiatives, LLC

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

May 18, 2015Diet and Nutrition, General Health and Wellness844-SMA-TALK, Alzheimer, Alzheimer's disease, Antioxidant, brain health, Disease, Free radicals, Good health, health, Illnesses, Mother Nature, Oxidative stress, Parkinson's disease, Prostate cancer, Radical (chemistry), Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

People engage in a lot of fads and off the wall activity to pursue health instead of following tried and true principles of basic science. One thing that I wish didn’t fit that trend is use of supplemental antioxidants. Before talking about using antioxidants, this Straight, No Chaser will discuss why they’re necessary.
Free radicals are like the Tasmanian Devil. These molecules are byproducts of many activities that create cell damage. Think about cigarette smoke, trauma (even vigorous exercise), excessive heat and sunlight (and its radiation), to name a few examples. The process of creating and releasing these molecules is called oxidation. The key point is free radicals are unstable and too many of them lead to a process called oxidative stress. This process is implicated in the development of many illnesses, including Alzheimer’s disease, cancer, cataracts and other eye diseases, cardiovascular diseases, diabetes and Parkinson’s disease.

Antioxidants are substances that prevent or delay cell damage caused by free radicals. Antioxidants may be natural or artificial (e.g. man-made). The healthy diets we’re always asking you to eat (e.g. those high in fruits and vegetables) contain lots of antioxidants; in fact this has a lot to do with why we believe they’re good for us. Superfoods are those especially rich sources of antioxidants, as illustrated above.
Of course, now you can get many forms of antioxidants in pills. That’s where things get a little less certain. Logically, you’d think that if some antioxidants are good, a lot would be better, and they would really be effective against free radicals. Furthermore, you’d think a convenient and efficient way of doing this would be putting a lot of antioxidants in a pill. Unfortunately, medical science (including over 100,000 people studied) has shown this not to be as simplistic as our logic would have us believe. I can’t say this any simpler. Antioxidant supplements have not been shown to be helpful in preventing disease. In fact, high-dose supplementation has been shown to have harmful effects, including increasing the risks of lung and prostate cancer. In short, our body doesn’t function in as linear a manner as we would like to think.
Here’s your take home message: We have yet proven that we’re able to cheat Mother Nature. You will not find your health in a bottle. Diet and exercise remain the champions of the battle of pursuing good health. Get your antioxidants the old fashioned way – in your fruits and veggies. Here’s a nice chart for your reference.

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 © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: Quick Workouts for the Couch Potato

May 15, 2015General Health and Wellness844-SMA-TALK, 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 enjoying the NBA and NHL playoffs; the ones who have spent the last month 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!

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 © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: Mass Trauma, Community Stress and Post-Traumatic Stress Disorder

May 7, 2015General Health and WellnessCognitive behavioral therapy, health, mental-health, Post-Traumatic Stress Disorder, Posttraumatic stress disorder, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Symptom, TraumaJeffrey Sterling, MD

If you’ve been following the Straight, No Chaser series on post-traumatic stress disorder, it may have occurred to you that episodes that some might be able to handle when taken in isolation can have dramatically different psychological effects on others. It gives one pause and a cause to reflect on recent episodes in the news locally and abroad through a different prism.
This is the fourth in a series on Post-Traumatic Stress Disorder (PTSD).

For an introduction to PTSD, including signs, symptoms and those at risk, click here.
For a discussion of the diagnosis and treatment of PTSD, click here.
For a discussion of the effects of PTSD in children, click here.

When entire communities are affected by a mass trauma such as a natural disaster, a terrorist attack, the effects of war or even a seemingly senseless death within the community, many can develop signs of post-traumatic stress disorder (PTSD). In these instances, symptoms tend to develop in the first few weeks after the episode. This is a normal, expected and shared community response to serious trauma. Fortunately, when communities suffer trauma, resources are more likely to become readily available, which allows many to experience a lessening of symptoms over time.
In the immediate timeframe of the event, vital measures for physical and mental wellbeing should include the following.

Getting medically evaluated and to a safe place
Securing food and water
Contacting loved ones or friends
Learning what is being done to help and either provide or receive help as needed

Unfortunately, some individuals just do not get better on their own. Although most people tend to improve with time after a community disaster, it is not uncommon for some to become more distressed and to exhibit more symptoms of PTSD, depression, and other mental health conditions. There are so many variables in play based on the type of disaster that occurred. Some people are effective at rebuilding their lives if the available resources are appropriate for the type of effect it had on them personally, but others may experience ongoing stress from loss of jobs and schools, trouble paying bills, finding housing, and getting healthcare. These types of stressors compound the effects of the disaster and may delay recovery in those affected by PTSD.
Many in the public health communities are embracing a comprehensive version of mass trauma “psychological first aid.” This complement to medical and financial resources is meant to fill existing voids in post-community disaster care delivery. Otherwise treatment approaches are generally similar to treatment of other forms of PTSD.
At the end of it all, disasters are just that. It would be a good thing for you and your family to be aware of the types of community disasters you may be exposed to and prepare before you ever need help. Having emergency numbers and other resources on your person at all times can be the difference between life and death when seconds count. Here’s hoping you either never need such assistance or you’re prepared enough during a disaster to make it through ok.
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Straight, No Chaser: The Effects of PTSD on Children

May 6, 2015Mental Health, Pediatrics/Kids HealthFacebook, health, mental-health, Posttraumatic stress disorder, Psychological trauma, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, WordPressJeffrey Sterling, MD

This is part of a series on post-traumatic stress disorder (PTSD).

For a review of PTSD signs, symptoms and those at risk, click here.
For a review of PTSD diagnosis and treatment, click here.

Children are exposed to the same stimuli that creates post-traumatic stress disorder (PTSD), including physical abuse, sexual assault and the effects of war, but they may have different responses and symptoms than adults. Symptoms unique to children typically involve developmental regression and may include the following:

Clinginess
Bedwetting
Cessation of speech
Acting out the scary event

Teens may become disruptive, disrespectful, or destructive, and they may express guilt or engage in revenge.
Think about these things when your children have been victims of bullying, abandonment or assault. You have to think about PTSD in order to recognize help may be needed. It is very important to get counseling for children that have experienced a traumatic event. The effects may be subtle but could be devastating and long-lasting.
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Straight, No Chaser: Post-Traumatic Stress Disorder – Signs, Symptoms and Those at Risk

May 4, 2015General Health and Wellness, Mental HealthFacebook, health, Posttraumatic stress disorder, Psychological trauma, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, United StatesJeffrey Sterling, MD

This is Mental Health Awareness Month. Straight, No Chaser has done multiple posts on depression and suicide, the components of health and happiness, and many other mental health topics. It’s important that you appreciate the ways events in your life and even the way you live your life impact you over the long term. I deal with disease and death everyday as an Emergency Physician, and it’s dehumanizing on many levels. Imaging having to pronounce someone dead despite giving your version of a superhuman effort to resuscitate them and then having to deliver the news to a family deep in prayer and holding on to strings of hope. Oh yeah, and then you immediately get to return to a room filled with patients and families oblivious to anything you’re dealing with as an individual, who are completely immersed in their personal situations and often complaining because “you took too long.” Imagine the lives of morticians or cemetery workers, having to stare at and feel the remains of the dead all day everyday. Imagine the lives of those habitually raped or viciously beaten by a loved one as a child. And, of course, there are the soldiers. Over 7.5 million Americans are thought to be suffering from post-traumatic stress disorder (PTSD), approximately one in every 40 individuals.
Traumatic and post-traumatic stress are not only able to affect your reality, but to adjust your reality. The body’s normal “fight-or-flight” response to danger or extremely stressful situations can evolve into abnormalities in your behavior if you are continually immersed in these environments. One such as the emergency physician may become desensitized and/or empowered to address situations that would make otherwise normal individuals recoil, or one may become overly sensitive, hyper-stressed and prone to a fight response to lesser stimuli—or no stimuli at all.
There are three categories of symptoms of PTSD, which are easily remembered by thinking of a hyperactive “fight-or-flight” response: reliving traumatic experiences, avoiding circumstances or situations that remind one of the experience, and reacting out of hyperarousal to stimuli suggestive of the experience.

Reliving can involve flashbacks, scary thoughts and nightmares. Victims have been known to actually re-experience the physical and mental episodes, complete with palpitations, sweating, jitteriness and severe anxiety. Such experiences can become incapacitating.
Avoidance is in many ways the opposite end of the “fight or flight” syndrome. In this example, avoidance isn’t just being proactive and staying away from reminders of the experience, but it can escalate to loss of emotions or even recollection of the event. This isn’t a strategic decision; it’s a defense mechanism gone haywire. As an example, imagine the near-drowning victim who refuses to even sit on the beach.
Hyperarousal leads one to be on edge, sensitive and prone to overreact. In contrast to the other two symptoms listed, hyperarousal tends to be a constant state of being. PTSD victims with hyperarousal describe themselves as easily angered and always stressed.

Many if not most of us will experience traumatic events in our lives sufficient enough to cause tremendous stress. There are circumstances that enhance the risk of developing PTSD.

Childhood trauma is especially dangerous in that the developing brain can respond “appropriately” in coding for abnormal circumstances and exposures. Subsequent trauma can trigger PTSD-quality responses.
Women are more likely to develop PTSD than men.
Mental illness may abnormally shape responses to traumatic events.
There is some evidence that susceptibility to the disorder may run in families. Individual differences in the brain or genes may predispose an individual.
The relative absence of social support and a functional network is a severe risk.

Conversely, if you have strong coping mechanisms, you may be able to lower your risk for developing PTSD after trauma. Consider the following protective factors:

A predisposition toward optimism
The ability and inclination to seek out support from others, ranging from friends, family and/or an active support group
A mental orientation that you “performed well” in the face of the danger
A mental orientation of learning from the experience instead of allowing the experience to define you
Sufficient mental fortitude to be able to carry on in the face of the symptoms (fear, anxiety) that follow the event

The presence of these “resilience factors” does not suggest that those suffering from PTSD are lacking in any way; it suggests the best opportunities for you to avoid succumbing to the enormous pressures that exist.
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Straight, No Chaser: End of Life Decision Making

April 20, 2015General Health and Wellness, Medical Treatment, Health PreventionBlood 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, Straight No Chaser (composition), 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.
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Straight, No Chaser: The Medical Complications and Medication Treatment of Alcoholism

April 8, 2015Gastrointestinal, Toxicology/DrugsAcamprosate, Alcoholic beverage, Alcoholism, Delirium tremens, health, Naltrexone, Neurological disorder, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There are interesting commonalities of certain drugs like alcohol and cigarettes. One is users that really enjoy them are able to do so for a long time while being oblivious to the growing danger those activities pose. Another commonality is even more so than mentally, when things go wrong physiologically, they really go very wrong.
Possible Complications
Alcoholism and alcohol abuse pose threats to many aspects of your health, including the following.

Birth defects (fetal alcohol syndrome)
Bleeding throughout your digestive tract, including the esophagus (up to and including rupture), gastritis (inflammation of the stomach) and ulcer disease.
Brain cell damage
Brain disorder called Wernicke-Korsakoff syndrome (includes dementia, mental status changes)
Cancer of the esophagus, liver, colon, and other areas
Changes in the menstrual cycle (period)
Delirium tremens (DT’s)
Dementia and memory loss
Depression and suicide

Erectile dysfunction
Heart damage
High blood pressure
Increased risks for behavioral disorders including depression and suicide
Increased risks for sexually transmitted infections (STIs)
Increased risks for trauma, including motor vehicle collisions, violence and head injuries with intracranial bleeding
Inflammation of the pancreas (pancreatitis)
Insomnia
Liver disease, including alcoholic hepatitis, cirrhosis and cancer
Nerve damage
Nutritional deficiencies

Treatment

Medical goals and patient goals are often different and seem to depend on the extent of perceptible injury that has occurred at the time of the decision to quit drinking. Often, patients will want to reduce drinking instead of stopping completely. Continued drinking in moderation is only as viable an option as the patient’s level of alcohol-related level of disease and the patient’s ability to stay limited in consumption and focused toward that goal.
Ideally, abstinence (the complete stopping of alcohol intake) is the goal, and it needs to be the goal if and when the desire to stop drinking is coupled with the presence of significant alcohol-related disease.
As everyone knows, the management of alcoholism requires multiple simultaneous approaches, including family and social networks. It is often the family network that helps the alcoholic come to the understanding that alcohol intake has disrupted his or her ability to function normally. It is a most unfortunate occurrence when this has not occurred prior to the development of significant medical disease. Individuals with alcohol problems are more likely to take the steps necessary to successfully withdraw from alcohol use.
Regarding the medical aspects of alcohol cessation, withdrawal is a very important consideration and is best done in a controlled manner. Components of effective withdrawal address the various medical and mental health considerations reviewed earlier and medical avoidance treatment.
Medical avoidance treatment includes medicine that prevent relapse via various methods, and they include the following:

Antabuse (generic name: disulfiram) is a well known and commonly used medicine that works by producing very unpleasant side effects with virtually any alcohol intake within two weeks of taking the medicine.
Naltrexone (brand name: Vivitrol) is an injectable medicine that works to decrease alcohol cravings.
Acamprosate is a drug that has been shown to lower relapse rates in those who are dependent on alcohol.

Feel free to contact your SMA expert consultant if you have any questions on this topic.
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. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: In the News – NFL Star Retires Over Concussion Concerns

March 19, 2015Neurology, Trauma844-SMA-TALK, Chris Borland, chronic traumatic encephalopathy, Concussion, CTE, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, TBI, Traumatic brain injuryJeffrey Sterling, MD

Chris Borland, a 24 year old linebacker with the San Francisco 49ers, has made the decision to retire from the National Football League because of fears of concussions and the consequences playing football could have on the rest of his life. He made this decision prior to the onset of any chronic symptoms and after presuming that he may have suffered from a concussion at some point in the past (when attempting to make the team).
Straight, No Chaser has discussed concussions in previous posts, including the following (click the links to review):

In this space we talk a lot about health as currency and how our choices spend that currency. It wouldn’t be very Straight, No Chaser not to call this what it is: a very smart decision, which Mr. Borland is very fortunate to be able to make. His background and personal circumstances allow him to place a different value judgment on the risk/benefit ratio that playing professional football offers. To some degree many of us place ourselves in dangerous work environments: healthcare workers are exposed to diseases, police officers and firemen are exposed to danger, construction workers face multiple occupational hazards and on and on.

It becomes an additional concern when health risks are minimized or denied. It has only been in the last few years that the extent of the dangers of pro football have been analyzed, ranging from concussions to chronic traumatic encephalopathy (CTE), a condition that results from multiple head injuries and can include multiple neurologic symptoms including memory loss, confusion, aggression, depression and suicide. Several notable former NFL players have committed suicide and on autopsy were found to be suffering from CTE.

It’s not that playing football will cause these conditions; it’s that it clearly increases the risks. We are past the point of pretending it’s a debate. Folks, head trauma causes brain injury, and repeated head injuries are incredibly likely to cause chronic brain injury and damage. This is especially true in children who are physically abused in ways that affect the still-developing brain, and it is especially true is sports that cause violent, repeated trauma to the head.
Yes, it’s somewhat tragic that those of a certain social standing disproportionately feel like they have to make the choice to risk their health to pursue certain careers. However, there does come a time when as long as these choices are educated, informed choices, you have to accept that whether we’re discussing smoking, drinking, working in a hospital, boxing or playing professional football, in the U.S., freedom of choice doesn’t equate to absence of risk. When it comes to those whose careers are spent in harm’s way, we hope accurate information, advice and education continue to be offered instead of opinions, obstruction and half-truths.
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Straight, No Chaser: Hernias Are Why Your Doctor Asks You to Turn Your Head and Cough!

March 11, 2015Gastrointestinal, Surgical Care, Musculoskeletal System844-SMA-TALK, Abdomen, Groin, health, Hernia, Intestine, Muscle, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Surgery, Umbilical herniaJeffrey Sterling, MD

Hernias are an uncomfortable topic (no pun intended, for many reasons). Hernias are yet another example of body parts not being in their proper place. They are caused by weak muscles or tissue allowing other tissue to push through in the face of pressure. Hernias can be found in many places and can be caused by many things.
Here are some examples of places hernias occur:

In your groin, different types of hernias occur when either the intestine or bladder pushes through groin (inguinal canal) or the abdominal wall. The most common type of hernias here are called inguinal hernias.
In the upper thigh, the intestine can push through a different space where arteries are normally carried. These are called femoral hernias.
In your abdomen, your intestine may protrude through an area where you’ve had surgery (rendering that area relatively weak). These are called incisional hernias.
The small intestine can protrude through the area immediately at or near your belly button. These are called umbilical hernias.
Part of your stomach can push through an opening in your diaphragm near the end of the feeding tube (your esophagus). These is called hiatal hernias.

The ‘so-what’ of hernias is similar to other outpoutchings throughout the body. Prolapsed intestines (to use one example) can become unable to be relocated into the proper area (an irreducible or incarcerated hernia) or once trapped, it may have blood flow cut off from that part of your intestine (a strangulated hernia). This could lead to death of that tissue. Given the contents of your intestines, any such situations could lead to rupture and infection throughout your body (sepsis). Such complications are life-threatening and require immediate surgery.
Here are causes and risk factors (remember the common denominators are pressure and weakness of the affected area):

Lifting heavy objects is a particular risk if your abdominal muscles are weak. Men are structurally weaker in the groin anyway.
Pregnancy and obesity lead to femoral hernias and umbilical hernias (although this type is most common in newborns).
Surgery obviously places you at risk for an incisional hernia, particularly if you’re inactive.
Pressure within the abdomen is also increased by sneezing, coughing, diarrhea and constipation (Don’t strain!).
Smoking, obesity and poor dietary habits also increase the risk by lessening muscle strength.

Don’t let this happen to you! I welcome any questions. Hold the comments!

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Straight, No Chaser: Appendicitis – A Whole Lot over Quite a Little…

March 10, 2015Gastrointestinal, Surgical CareAbdomen, Abdominal pain, Appendicitis, Conditions and Diseases, health, Inflammation, Ovarian cyst, SurgeryJeffrey Sterling, MD

There’s not much that causes as much legitimate angst in parents as a child with appendicitis. In case you don’t know what the fuss is all about, the appendix is a 3 1/2 inch pouch on the edge of the large intestine near the right lower part of your abdomen. It’s actually like a long, skinny skin tag that (as best as we know) has no purpose other than to seemingly get inflamed, rupture and require surgery. The problem with it is that it’s a pouch (Pouches are bad things in the body. They always seem to twist or otherwise get blocked, leading to problems. This happens with aneurysms and hemorrhoids; twisting otherwise occurs with torsion of ovarian cysts or the testes. These stories don’t end well.). This particular pouch has the misfortune of being filled with stool, so if it gets sufficiently blocked or inflamed to the point where it ruptures, your abdomen will contain loose stool, which as you can imagine will cause a nasty infection rapidly (This is called peritonitis.). Appendicitis is a surgical emergency, because left untreated, the peritonitis caused by rupture will lead to septic shock.

Appendicitis is very common, occurring in one of fifteen individuals, usually between ages 10-30. It is more dangerous in the young and old, because they are both less able to describe symptoms and more likely to have abnormal presentations. Both of these scenarios lead to delayed diagnosis and treatment, which as you might imagine, doesn’t give patients the best opportunity for good outcomes.

Symptoms classically involve abdominal pain, followed by nausea, vomiting and fever, although other symptoms involving the digestive and urinary systems may be present. Often, the pain begins near the umbilicus (belly button) and seemingly migrates to the right lower portion of the abdomen. The pain may lead to a ‘board-like’ feel of the abdomen. This is a bad sign when it happens.

The below video is a virtual depiction of appendectomy surgery via a technique known as laparoscopy. Use your discretion in choosing to view.

Treatment involves surgery (an appendectomy) in the overwhelming majority of cases. Your job is to maintain a high level of suspicion and remember a few very important pearls of wisdom. First is seek medical attention without delay. Also, don’t eat, drink or take any medicine if you think this is what’s going on. Surgery requires an empty stomach, and certain medicines may mask the pain (leading to diagnostic difficulties) or facilitate early rupture of the appendix. In case you were wondering, there’s no definitive way to prevent appendicitis, but it is less frequent in those on high fiber diets. Score another point for fruits and vegetables.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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Straight, No Chaser: Got Hemorrhoids?

March 9, 2015Gastrointestinal, Genital/UrinaryAl Bundy, Anal canal, Analgesic, Conditions and Diseases, Constipation, Defecation, Dietary fiber, Digestive Disorders, health, Hemorrhoid, Pain, The CureJeffrey Sterling, MD

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

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

5. How will your physician treat them?

hemorrhoid

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

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

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

March 5, 2015General Health and Wellness, Sleephealth, Hypertension, Non-rapid eye movement sleep, Obstructive sleep apnea, Sleep, Sleep apnea, Sleep disorder, Slow-wave sleep, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

We’ve discussed many components of sleep and sleep disorders. Sleep apnea is a very common condition that many of you are walking around with undiagnosed. Sleep apnea is a common, recurring sleeping disorder in which your breathing temporarily pauses during your sleep. Have you ever awakened and felt as if you were choking or coughing? We may be talking to you.
The pauses of sleep apnea range in frequency and severity. They can last seconds or minutes. They may occur about 30 times in an hour.
apnea111
Let’s pause there. I just told you that many of you are suffering from a disorder in which you stop breathing while asleep. Think about what that means.
Physiologically, if you’re not breathing while you’re asleep, your body will adjust. If you are in a stage of deep sleep, you’ll be kicked into light sleep, which is a lesser quality of sleep, and your body won’t be as replenished as it would be otherwise. Your body will be less rested as a result, and you will suffer throughout the day.
Sleep apnea is most commonly due to some level of obstruction within the airway—obstructive sleep apnea. Do you have a large tongue or big tonsils? Are you overweight? Are you a big snorer? We may be talking to you. That snoring may be the sound of air moving past some obstruction. By the way, obstructive sleep apnea occurs more often in overweight people, but it can occur in anyone.

Now to the “So What?” of the conversation. This is about the quality of your life. Sleep apnea is about insufficient quantity and quality of sleep. It’s about excessive daytime sleepiness. It’s about recurring episodes of inadequate levels of air resulting from the breathing difficulty, which can lead to inadequate levels of oxygen getting into your bloodstream and circulating throughout your body. These facts have consequences. Refer to the lead picture above for an illustration of the various types of symptoms and problems that are associated with sleep apnea. Sleep apnea also brings risks for the following conditions and diseases if left untreated.

Diabetes
Heart attacks
Heart failure
High blood pressure
Irregular heartbeats (arrhythmias)
Obesity
Strokes

Sleep apnea is easy and hard to diagnose at the same time. Many of you are suffering with it unsuspectingly as we speak. The person you sleep with may have expressed concern about your snoring or choking while you sleep. If so, get checked.

Sleep apnea once diagnosed is treatable with some combination of lifestyle changes, breathing devices and mouthpieces. Surgery is used in some cases.
Straight, No Chaser has reviewed many components of sleep and sleep disorders. Be mindful that sleep is your body’s time to rest and recover from the day’s activity. Any disruption in its ability to do that does not bode well for you over the long term. If your sleeping habits are problematic for you, you really should get evaluated. Getting this situation addressed can dramatically improve the quality of your life.
Finally, review the attached video for an illustration of what’s happening during sleep apnea. Excuse the scary music!

This discussion has focused on obstructive sleep apnea and not the less common form, central sleep apnea. The symptoms are similar, so if you have the other condition, it would be determined by your physician.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Narcolepsy – The Sleep Attack

March 4, 2015General Health and Wellness, SleepCataplexy, Conditions and Diseases, Excessive daytime sleepiness, health, Narcolepsy, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

When you hear about narcolepsy, it’s usually in the context of some joke, but it’s a horrifying condition. Looking at the lead picture, imagining blacking out while driving a car. A diagnosis of narcolepsy should prompt certain lifestyle changes. Narcolepsy is a chronic sleep disorder that causes overwhelming daytime drowsiness and is characterized by an extreme tendency to fall asleep whenever in relaxing surroundings.

To better understand this condition, let’s look at certain truths of narcolepsy.

Narcolepsy doesn’t happen just because you’re tired.

Narcolepsy is a brain disorder. The part of your brain that regulates your cycle of being awake vs. being asleep is disturbed. The drop attack is not fading into sleep. It is an irresistible shut down. Now, narcoleptics do suffer from severe sleepiness throughout the day, but the sleep attacks aren’t predictable based on how tired one is.

Narcoleptics have severe disruptions of the activities of daily living.

Just remembering that this is a drop attack will help you appreciate the danger of narcolepsy. It can occur at any time during any activity. The unpredictability of the condition renders it very dangerous to the sufferer, and it makes performing at work, at school, in social and in many other settings very difficult.

Narcoleptics are likely suffering from other sleep disorders.

Understand that narcolepsy is a disruption of the sleep/wake cycle. That disturbance can manifest in other ways, including poor sleep quality and frequent nighttime waking. However, narcoleptics do not tend to spend more total time asleep during the day than unaffected individuals.

In addition to the sleep attacks, the main symptoms are excessive daytime sleepiness and cataplexy.

Cataplexy is a sudden voluntary muscle loss while one is still awake—the horror before the horror, if you will. Individuals feel limp and/or unable to move. Other symptoms may include hallucinations and an extension of the cataplexy to outright paralysis before and after the episode. Now the drop attacks themselves typically last seconds to minutes and result in a temporary feeling of refreshment before the sleepiness phenomenon reoccurs.

There’s no special rhyme or reason to who suffers from narcolepsy.

Narcolepsy occurs the world around and in men and women at a roughly equal rate. It typically occurs in children through young adulthood, but it can occur at any age. Surprisingly, it often is underdiagnosed. Don’t let that happen to you. With any form of a blackout or sleep attack, please get evaluated and be sure to ask if the episode could have been narcolepsy.

Straight, No Chaser: When Eating Goes Wrong, Part I – Anorexia

February 27, 2015Diet and Nutrition, Mental HealthAnorexia nervosa, Diet, Disease, Disorders, Eating, Eating disorder, health, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Simply put, our society doesn’t do the job it should in promoting a normal image of health at either end of the spectrum. The typically promoted American ideal of beauty sets standards that lead many to pursue unrealistic means of meeting that ideal. In the setting of an actual American population that is disproportionately obese by medical standards, this becomes even more of a problem, as individuals give up on realistic goals and settle into unhealthy eating habits that lead to disease due to obesity.
Most people are aware of two eating disorders (on the low side that is; obesity is another conversation): anorexia and bulimia. It is important to note that eating disorders are real medical and mental diseases. It is equally important to understand that they can be treated. It is vitally important to understand that when left untreated these disorders lead to a much higher incidence of death than in those without these conditions. These diseases cause severe disturbances in one’s diet, so much so that individuals spiral out of control toward severe disease and death in many instances. Sufferers of eating disorders often have a distorted self-image and ongoing concerns about weight and appearance. (This is as true for those pathologically overweight and in denial as it is for those pathologically underweight.)

Today’s Straight, No Chaser discusses anorexia. Anorexia nervosa is an eating disorder with nearly a 20 times greater likelihood of death that those in the general population of a similar age. Why, you ask? Simply put, anorexics are suffering the consequences of starving themselves. Anorexics have a maniacal and relentless pursuit of thinness, even in the face of being extremely thin. They couple an unwillingness to maintain a healthy weight with an intense fear of gaining weight. They possess a distorted view of their bodies and severely restrict their eating in response. They are obsessed.
Other symptoms and habits of anorexics include a lack of menstruation (among females, though men suffer from anorexia, too), binge-eating followed by extreme dieting and excessive exercise, misuse of diuretics, laxatives, enema and diet medications. The medical manifestations of anorexia are serious and can include osteoporosis or osteopenia (bone thinning), anemia, brittle hair and nails, dry skin, infertility, chronically low blood pressure, lethargy and fatigue, and heart and brain damage. It’s worth noting again that people die from anorexia. It is a disorder to be taken seriously.
The key components of treating eating disorders in general are stopping the behavior, reducing excessive exercise and maintaining or establishing adequate nutrition. The pursuit of adequate nutrition is vital enough that when patients develop dehydration and chemical imbalances (i.e., electrolyte abnormalities), they need hospitalization to correct deficiencies.
Specific management of anorexia involves addressing the psychological issues related to the eating disorder, obtaining a healthy weight, and consuming sufficient nutrition. This may involve various forms of behavioral therapy and medication. Regarding medication use, although some (such as antipsychotics or antidepressants) have been effective in addressing issues related to anorexia such as depression and anxiety, no medication has been proven effective in reversing weight loss and promoting weight gain back to a healthy/normal level. Similarly, behavioral therapy has been shown to assist in addressing the roots causes of anorexia but insufficient in addressing the medical issues that the disease contributed to or caused. Ultimately, it appears that a combination of medications, other medical interventions and behavioral therapy is the most effective course. As is the case with most illnesses, the earlier treatment is initiated, the better the outcome tends to be.
Please maintain a sufficient sensitivity toward those with anorexia. It’s a life-threatening condition, not the punch line of a joke about someone’s appearance.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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