Tag Archives: health

Straight, No Chaser: Our World is Filled with Toxins

August 22, 2016Toxicology/Drugs, Health Prevention844-SMA-TALK, Behind the Curtain, Detoxification, Drinking water, Erin Brockovich, Government, health, High-fructose corn syrup, Kidney, Liver, Lung, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, ToxinJeffrey Sterling, MD

You can’t escape all toxins, but you can certainly minimize your exposure to them. A handy way to classify them involves reminding you of the organ systems that help us detoxify and how, over time, toxins fight and sometimes win the battle against our defenses. In the interest of space, I’m going to give you the names of several chemicals that you may want to know about and should be wary of using, without giving you details on their individual effects. If you have questions about any of them specifically, call me at 1-844-SMA-TALK.
Lungs
The toxins: We are fighting what we breathe and inhale. Air pollution includes levels of carbon monoxide and methane. Exhaust fumes, factory emissions, first and second-hand smoke all contain substances damaging to our lungs. Did someone mention cigarettes? Tobacco smoke has been fascinating to me. The idea that we would introduce smoke into the very area we use to deliver oxygen to our entire body is one of the most curious actions of humans. Look at this diagram of the toxins found in cigarettes.

The effects: The lungs are impressively effective at handling toxins up to a certain point and up to a certain age (approximately 35 years old). At that point what had been reversible airway damage begins to not only change the structure of lung tissue, but it results in lung tissue loss that does not get repaired. It’s as if when you run your hands through your hair, you discover that you’re pulling out large clumps of it. Of course, the problem is that this isn’t your hair, but the lung tissue that you need to breathe. The list of diseases contributed to, exacerbated by or caused by toxins is long, including COPD (emphysema, chronic bronchitis), asthma exacerbations, asbestosis and lung cancer.
Skin:
The toxins: Do you trust your skin products – you know, mascara, styling gel, tanning oil, soaps and body washes, shampoos, hair sprays, shaving creams, cologne and lotions, just to name a few? Toxic chemicals you’re commonly absorbing through your skin include propylene glycol, parabens, glycerin, triethanolamine and sodium lauryl sulfate.
The effects: You thought acne and the occasional allergic reaction were bad? This group’s collective effects includes respiratory, immune system and skin toxicants and known throat carcinogens. I’d suggest you become more conscious of what you’re using and seek organic options when available.
Kidneys
The toxins: The water we drink seems to get worse with time. Does anyone remember when tap water was “just fine?” Now our drinking water is liable to contain ammonia, chlorine, bleach and other toxic substances. An entire movie (Erin Brockovich) was made over the issue of toxins in drinking water. You may recall that the kidneys bear the burden of the actual elimination of urine. They need to maintain excellent health to perform this function.
The effects: The consequences of the kidney’s inability to perform can be so dramatic that dialysis (which is basically manual, external filtering of your blood once the kidneys go into failure) becomes necessary. Prior to that, toxins “gumming up” the kidneys can be left free to create havoc in other parts of the body.
Gastrointestinal system (particularly your liver and intestines)
The toxins: The food you eat is toxic. To be clear, usually I’m asking you to eat healthily. Today, that’s still true, but it’s not the only issue. I’m pointing out that your food contains actual toxins, including food additives and dyes, pesticides on your non-organic fruits, aspartame, MSG, hormones, high fructose corn syrup, sugar, mercury, bisphenols, and alcohol. Did someone mention alcohol? Alcohol is directly toxic to the liver.
The effects: I’m just going to focus on the alcohol. Alcohol produces conditions known as fatty liver, alcoholic hepatitis and cirrhosis. Chronic, excessive alcohol use is the single most important cause of illness and death from liver disease in the U.S. Moderation or abstention is the order of the day, my friends. Liver transplants are very hard to come by.
The purpose of this is not to paralyze you into inactivity but to stimulate you into action. Between now and tomorrow, when you read the fourth post in this toxins series, I’d suggest you review this post about natural detoxification. Compare that to some of the other options I’ll be discussing later. I’d recommend an ounce of prevention.
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 Tips to Detoxify Yourself Naturally

August 21, 2016Detoxification, General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, Blood pressure, Cranberry juice, Detoxification, health, Hypertension, Kidney, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Texas, Toxin, Urinary tract infection, Water supply network, Weight lossJeffrey Sterling, MD

Here are 3-4 Quick Tips for each of the organs involved in naturally detoxifying you; I’ve limited what I’m giving you to do in the effort to make this manageable for you. I don’t think you’ll find anything here beyond your ability to implement into your routine. If you incorporate the items listed below, you’ll be well on your way to a healthier life.
Quick tips to naturally detox your skin:

Diet: think fruits and vegetables, and cut back on refined sugar.
Sweat: You know I prefer you exercise, but if you’re healthy enough, the sauna works too. Or you can just move to Texas in the summer.
Exfoliation is a beautiful thing. There are dozens of ways to do it. Find one that works for you.
Hydrate and moisturize. You spend too much time in the sun and lose too much water from your skin not to replenish (You get a bonus tip because your skin is such an important detox organ.).

Quick tips to naturally detox your lungs:

Avoid inhaling cigarette and cigar smoke. Duh.
Exercise makes your respiratory machinery more effective and efficient. Go for it.
Learn to deep breathe. Take it in from your belly. Learn to breathe slowly and deeply. Yoga is a great complement to this.

Quick tips to naturally detox your kidneys:

It’s all about fluids. Remember that your body is over 60% water, and you have to stay hydrated and keep flushing. I’ve discussed this previously but remember to get in at least 64 ounces of fluids a day.
Learn about cranberries. Many of those urinary tract infections are successfully addressed by drinking cranberry juice.
Remember that diabetes and high blood pressure are the most common causes of kidney disease. You want to detox your kidneys? Control your blood pressure and avoid/control diabetes.

Quick Tips to naturally detox your liver and intestines:

Increase your water intake. Water makes your entire body function better but also softens your stools, facilitating transport.
Increase your fiber intake. Fiber bulks your stools and makes it easier to expel.
Decrease your alcohol intake. As everyone knows, alcohol will sufficiently damage your kidneys to the point where your body will be unable to eliminate many toxins. Liver disease is a very unpleasant experience and way to die.

It bears repeating: if all of this sound fundamental, it’s because it is. You have the ability to help yourself if you consistently apply basic health and wellness principles. You can do this.
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: Natural Methods of Detoxification

August 19, 2016Detoxification, General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, Body, Colon cleansing, Detoxification, Detoxification (alternative medicine), Diet, Disease, Government, health, Human gastrointestinal tract, Intestine, Kidney, Liver, Master Cleanse, Shopping, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Support Groups, Texas, Toxin, Weight lossJeffrey Sterling, MD

It seems that at least once a week I get asked to comment on colonics, detox diets, juice fasts, etc. It seems to me that these are all rather extreme places to start. How about we just talk about the threats that exist, how to avoid them, how to understand the natural detoxification process and how to optimize it?
On some level, our body is at constant war with our surroundings. We are finely tuned machines (until we’re not). We are well designed and equipped to filter the air we breathe and the food we eat, and to repel external poisons from penetrating our bodies. That’s a very good thing, because toxins are everywhere. We eat and drink them. We inhale, absorb and ingest them. Usually we do these things unwittingly, but for various reasons, a good number of us do these things intentionally. By definition, toxins have harmful effects on our bodies. Buildups of these substances can cause damage and eventually death.
In the first part of this five-part review of toxins and how they affect us, I want to point out how the body is equipped to combat and eliminate toxins – until and unless we poison it. In the second part, I’ll offer Quick Tips to enhance your ability to naturally detoxify. In the third part, I’ll discuss what and where the toxins are that we must combat. In the fourth and fifth parts, I’ll discuss some of the exotic (or should that be esoteric?) methods promoted to detoxify the body.
Let’s start not by talking about toxins, but by discussing how the body protects you. There are four areas in particular to review: the skin, the lungs, the kidneys and the gastrointestinal tract (particularly your liver and intestines).
Skin: The skin is actually the body’s largest organ, and it’s the largest organ of elimination. It is in constant contact with the environment and is our primary barrier against disease, keeping out microorganisms, dusts, pollens and other substances with no good intentions. The constant battle leaves your skin’s pores clogged, subject to infection, lacerations, and premature aging.
Lungs: The lungs are the vessels of life, bringing oxygen into the body to supply the needs of all your organs and systems. However, have you looked at the atmosphere lately? Smog’s everywhere, not to mention allergens and cigarette and cigar smoke. If the air you’re breathing is poisoning the lungs themselves, your ability to keep poisons out of you and exhale away carbon dioxide incrementally become diminished to disastrous effect.
Kidneys: Your kidneys are one of the two primary ways you visibly eliminate waste. Consider them the blood’s strainer. You really should learn to watch your urine. It tells a story about your health. If your urine is not clear to light yellow, something’s going on. If you come to me with cloudy, straw-colored, bloody, pink, or brown urine, those all tell me about different medical conditions you could be experiencing.
Your liver and intestines: Now we’re looking at your stools. Consider that if you were ideally healthy, you’d have a bowel movement with the same frequency with which you ate. At the other end of the spectrum (no pun intended), you could be constipated, or your bowels could be obstructed. You have bacteria that live in your intestines that also help naturally detoxify wastes, but that only works as intended if you continue to have stools. The more contact time your body’s intended waste has with your intestinal tract, the more of it that will be absorbed. Fortunately, the intestines have additional barriers in its membranes that fight against toxins reentering the body. Your liver serves a vital function in detoxifying many directly poisonous substances. It uses its natural chemicals to facilitate excretion of toxins by the kidneys.
Most everything you think you know about extrinsic supplemental ways to detoxify are poor substitutes for what a healthy body will achieve. If you focused on your health and fitness, you could rest assured that your body would protect you, and you could also save a ton of money avoiding all those fad diets and other ‘previously secret’ methods of detoxification.
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.

Straight, No Chaser: Contact Dermatitis, Diaper Rash, Poison Ivy and the Like

August 6, 2016Skin/Dermatology, Health Prevention844-SMA-TALK, Allergic contact dermatitis, Allergy, Atopic dermatitis, Behind the Curtain, Citrus, Contact dermatitis, Dermatitis, health, Irritation, Latex, Rash, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Urushiol-induced contact dermatitisJeffrey Sterling, MD

Let’s pick up where we left off. In our discussion of eczema and psoriasis, we described the common theme of underlying inflammation manifesting in rashes of different appearances. The theme continues today, with the difference being overlying inflammation. Contact dermatitis (dermatitis = skin inflammation) results from some external entity becoming a nuisance to your skin and generating a response in the form of a rash. You know this in many different forms (shown in the pictures below) – think about those old nickel coated watches, piercings gone bad (piercings also cause actual infections, which is a different consideration), clothing (below is a picture of contact dermatitis caused by flip-flop slippers), poison ivy and diaper rash. I bet the lead picture, which seems like a brand of a butterfly necklace pendant, as well as the following pictures look familiar to many of you.

These rashes are examples of allergic contact dermatitis. Your immune system is generating a response because it believes it is under attack by whatever has touched you. The way the body defends itself leads to release of various chemicals (most notably histamines) that cause the rash. The reason I picked the illustration of the diaper rash is to remind you that the rash actually is in the distribution of the diaper (not just under it), meaning that it may be the diaper that’s the culprit. In other words, don’t just zone in on feces and urine as the problem. Allergic contact dermatitis can occur from – well, anything you’re allergic to, but it’s commonly associated with latex, fruit peels (especially citrus), lotions, perfumes and other topical substances applied to the skin.
When we discussed eczema earlier, we were describing irritant contact dermatitis, which occurs because something damages the skin (remember eczema is called “the itch that rashes”). Imagine that you’ve sensitized and damaged your eczematous skin by scratching away at it and then place something irritating on it. That’s what this is. The longer the new irritant stays on the already damaged skin, the worse the inflammation is, and the more violent the rash appears.
So let’s get to the bottom line: the name of the game is avoidance (as in poison ivy, latex or other known irritants), prompt recognition and removal of irritants, and symptomatic treatment. If you come in contact with a substance that burns or rashes immediately, remove the object or get away from it, and then wash the affected area with mild soap and moderate water. Consider oral histamines (e.g. benadryl) and a mild OTC hydrocortisone ointment. If the rash isn’t better within a few days, or if you ever feel short of breath or as if your throat is closing, contact your physician or the local emergency room immediately for evaluation. Unless you have an underlying condition like eczema or psoriasis, contact dermatitis should resolve within 2-4 weeks with this approach to management.
So in closing, remember: it’s not just the more you itch, the more you scratch. It’s also the more you scratch, the more you itch. Break the cycle.
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: Your Questions About Human Bites

July 26, 2016Infectious Disease, Medical Treatment, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, 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, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, 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.

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: Human Bites

July 25, 2016Infectious Disease, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bites and Stings, Biting, Cellulitis, Conditions and Diseases, Hangnails, health, human bite, Infection, Mike Tyson, Open wound, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, 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.
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: Stop, The Life You Save May Be Your Own – Snake Bites

July 24, 2016General Health and Wellness844-SMA-TALK, Antivenom, Behind the Curtain, Conditions and Diseases, health, health care provider, postaday, Rattlesnake, Snake, snake bit, snake bites, Snakebite, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, triangular heads, Venomous snake, Wound, wound cleaningJeffrey Sterling, MD

So you’ve been snake bitten. What will you do next?
First things first. Stay calm. Call 911. Realize that most snake bites are non-venomous (A really quick tip regarding the likelihood of a venomous snake: most have triangular heads.). Here’s 10 additional steps to take while waiting for your help to arrive.
5 Things To Do

Protect yourself. Get out of the snake’s striking distance. It should be trying to get away from you as well.
Lie down. Keep the wound below the level of the heart.
Be still. Activity simply facilitates spreading of any venom present.
Cover the wound with a loose, clean dressing. Immobilize the extremity if possible.
Remove all restrictive clothing and jewelry from the area, because the area will swell.

5 Things Not to Do

Try to suck out venom.
Try to cut out the area bitten.
Apply any constrictive dressings.
Apply any cold or ice packs to the wound site.
Run to help.

If you’re lucky enough to have a snake bite kit, you’ll simply follow those instructions, which are a modified version of the instructions I’ve just given.
You will need to be seen by a health care provider for consideration of the following:

Anti-venom may be needed.
Tetanus immunization may be needed.
Appropriate wound cleaning will be needed.
Antibiotics for skin infection may be needed.

Straight, No Chaser: The Treatment of Erectile Dysfunction

June 26, 2016Genital/Urinary, Medical Treatment844-SMA-TALK, Austin Powers, Behind the Curtain, Blood, Erectile dysfunction, health, Limited liability company, Penis, Pharmaceutical drug, Physician, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Urology, ViagraJeffrey Sterling, MD

Well, here’s what many of you’ve been awaiting. Assuming the preventative efforts I mentioned didn’t work for you, there are several different treatment approaches. If there’s an underlying medical cause, then treatment of that cause is not only a good way to relieve erectile dysfunction (ED), but it’s a good way to get healthy and avoid other complications from the primary disease. Today, I’ll review different treatment strategies your primary care physician or urologist may discuss or recommend to you for treatment.
The medications
A first consideration is to be wary of (any) medications via mail order. The same level of testing, scrutiny and quality control just doesn’t exist to the same degree as do medications obtained through a pharmacy. Reports abound of people receiving expired or weak formulations of the pills, as well as fake or hazardous substitutes of the pills they thought they were receiving. Engage at your own risk.
Now, regarding those medications you know all too well by name and brand (e.g. Levitra, Cialis and Viagra), there’s no special ‘magic’ to them. They all are variations of the same theme, physiologically relaxing muscles in the penis, resulting in increased blood flow to it. Unfortunately, that’s not the entire story with these medications. ED medications all lower blood pressure throughout the body, and that increased blood to the penis is coming at the expense of decreased blood flow elsewhere (This is called a ‘steal syndrome’.). If you’re otherwise unhealthy, and your redirecting blood that was needed in the heart or brain, you could end up with a heart attack or stroke while taking these meds. Therefore, this leads to two very important cautions regarding ED meds. You shouldn’t start them without discussing with a physician first (to determine “…if you’re healthy enough to have sex”, as the commercials say), and secondly, don’t keep the fact that you’re taking them a secret (to your significant other, and especially to any physician you come across if you’re sick). These medications could be the cause of whatever medical issue has you in an emergency room. They could also be contributors to life-threatening adverse effects if you’re being treated for something else with a medication that interacts with the ED med you’re taking but didn’t bother to mention to the emergency physician. This is why ED medications generally aren’t given to men also on medications for high blood pressure, an enlarged prostate, blood thinners or certain other heart diseases (e.g. angina).
There are actually even more intricate medications used to treat ED. Taking testosterone injections is an increasing means of addressing low hormone levels. Additional injections directly into the penis or inserting a suppository into the penis itself are additional, effective treatment methods. You’d be given these options by your urologist if necessary.
The counseling
If your ED is due to anxiety, stress or other psychologically generated reasons, psychotherapy (possibly with your partner) may be of incredible assistance. If you pursue this option, you and your partner must be prepared to be patient and to work through a variety of issues and possible approaches.
Surgery and additional methods

If you’ve ever seen an Austin Powers movie, you’re familiar with (well at least the jokes about) penis pumps. These are real things, and involve placing a hollow tube over the penis and creating a vacuum to pull blood to the penis via a pump. A tension ring is placed about the base of the penis to maintain the erection during intercourse.
Actual vascular surgery to repair damaged arteries may be indicated in certain cases.
Penile implants are an additional option. Inflatable rods are placed into the sides of the penis. These rods are simply inflated when needed.

If you think some of this is a bit much, it may or may not be, depending on if you’re the one suffering. As I usually conclude, prevention would have been a much better course of action. Hopefully if that’s not the case, you’ve understood the information provided well enough to have an informed conversation with your physician. Good luck, and I welcome your comments and/or questions.
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: Erectile Dysfunction, Part Two – Causes

June 25, 2016General Health and Wellness, Genital/UrinaryBehind the Curtain, Conditions and Diseases, Erectile dysfunction, health, Hypercholesterolemia, Men's Health, Substance abuse, Western pattern dietJeffrey Sterling, MD

In my last post on erectile dysfunction (ED), I gave a simplistic way to understand and address it. However, the truth of the matter is the overwhelming majority of cases of ED are not related to stress or other psychological issues. First, some sense of ‘reasonable’, expected performance should be established, especially as one ages (as discussed here). Beyond that, you should know that approximately 90% of ED cases involve an underlying medical concern, including, but not limited to, the following:

Diabetes

High blood pressure

Changes/disease to your blood vessels

Low testosterone

Kidney disease

Smoking

Alcohol and Drug abuse

Obesity and High cholesterol

Effects of your medications

Therefore, today’s message is simple and brief, but I’d suggest it’s probably more important than you have previously thought. You should consult your physician if and when you or your partner’s sexual performance becomes an issue. You may actually discover something that will not only save his performance, but his life.
Finally, in the next post we will review the wide variety of treatment options for ED.
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: Erectile Dysfunction, Part One

June 24, 2016General Health and Wellness, Genital/UrinaryBehind the Curtain, Conditions and Diseases, Erectile dysfunction, Erection, health, Heart disease, Impotence, Men's Health, Western pattern dietJeffrey Sterling, MD

It seems appropriate to follow-up a post on age-related changes in your genitourinary system with a discussion on erectile dysfunction (ED). The nature of the topic is such that I’m going to approach this in two different ways. Today, I’ll give you a functional, overly simplistic view of ED and tomorrow, I’ll look at it from more of a clinical orientation, because there really are nuances involved. So keep in mind the lead picture. There are many medical and psychological issues that can lead to problems having erections. I’ll get into that more tomorrow.
In many ways, your health is related to the quality of your blood flow, both in quantity (successful circulation to tissues) and quality (relative absence of toxins we ingest and deliver throughout). This is true for the brain (mental health, absence of strokes), the heart (stamina, absence of heart disease/attacks), and your penis (sexual function, lack of impotence), as well as every other organ.

Excluding truly medical considerations, the two surest ways I know to be a sexual stud (without implants or being of a certain age) are to have a legitimately healthy ego (psychologic health) and more importantly, to be in good physical shape and otherwise healthy. However, for now, given that an erection simply results from strong blood flow to the penis, your overall health better enables that process (the first time as well as if you want multiple contiguous encounters). Everything being equal, the best way for a guy to be able to have sex for whatever you define as a ‘sufficient’ period of time (besides being of a certain young age) is to maintain good cardiovascular health by spending that physician-recommended 20-30″ or more at a time on a treadmill, bike, running, etc.

Drugs like Viagra, Cialis, etc. are really nothing more than drugs that lower blood pressure (and resulting demands by other bodily organs on your blood), such that your penis’ call for an erection is otherwise unimpeded. Sounds good? The risk is varying forms of a ‘steal syndrome’, where that blood isn’t being distributed to your heart and brain, which could result in a heart attack or stroke. That’s why you must “ask your doctor if you’re healthy enough for sex” before using…
Bottom line: practice for good sex and stamina during sex by working out. It’s just another benefit to being healthy.
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: Spotlight on Health Concerns When Traveling – Vaccines and Illnesses

June 15, 2016General Health and Wellness, Health Prevention844-SMA-TALK, Chronic obstructive pulmonary disease, Deep vein thrombosis, health, Limited liability company, Lung, Pulmonary embolism, Sterling Medical Advice, Sterling Medical Wellness, SterlingMedicalAdvice.com, Straight No Chaser, ThrombusJeffrey Sterling, MD

Traveling is exciting, but it presents multiple challenges to your health. To best meet these challenges, preparation is everything.

Before you travel and every time you travel, your surest means of protecting yourself is to confirm you are current on routine vaccines.

Your basic vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine and influenza.
Most international travelers will need immunizations to protect you from hepatitis A, polio, and typhoid.
Depending on where you’re international travels take you and the duration of your trip, you may need immunizations to protect you from hepatitis B, malaria, rabies and/or yellow fever.

The plane trip itself can be hazardous to your health. I encourage you to review the risks of flying.

Diseases have different patterns in how they spread and their resistance to medications in different countries. It is important to be aware of prominent diseases affecting the countries you plan to visit, because some may be uncommon in your home country. For Americans traveling abroad, such diseases include the following:

HIV/AIDS
Malaria: an infectious disease caused by a parasite, which invades the blood cells. It is notable for the presence of high fever, shaking chills, low blood count and a flu-like set of symptoms.
Pandemic/avian flu (aka as the bird flu): an infectious disease in birds caused by a virus that can spread to humans
Travelers’ diarrhea – the most common disease acquired by travelers.
Tuberculosis: an infectious disease involving the lungs, able to spread throughout the body

I strongly recommend that you develop a habit of checking the CDC travel site every time you prepare to travel internationally, including those of you coming from abroad into the United States. Detailed information on these diseases is available clicking the links, checking the search engine and at www.sterlingmedicaladvice.com.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
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: Mass Trauma, Community Stress and Post-Traumatic Stress Disorder

June 2, 2016Mental Health, Public HealthBehind the Curtain, Cognitive 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.
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: The Effects of PTSD on Children

June 1, 2016Mental Health, Pediatrics/Kids HealthBehind the Curtain, Facebook, health, mental-health, Posttraumatic stress disorder, Psychological trauma, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey 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.
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: Post-Traumatic Stress Disorder – Signs, Symptoms and Those at Risk

May 30, 2016Mental HealthBehind the Curtain, Facebook, health, Posttraumatic stress disorder, Psychological trauma, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, United StatesJeffrey Sterling, MD

Memorial Day serves to honor our fallen heroes. Part of that involves caring for our soldiers still with us. Understanding and acknowledging the mental components of their suffering remains a vital and underachieved need. Our soldiers disproportionately suffer from several mental disorders, notably, post-traumatic stress disorder. Today’s post begins a review of post-traumatic stress disorder (PTSD). We thank all of our veterans for their service.
I’ve dealt with disease and death everyday as an Emergency Physician, and it has been 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.
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: When Sex Hurts Her – Vaginismus

May 26, 2016Obstetrics and Gynecology844-SMA-TALK, Behind the Curtain, 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 HealthJeffrey 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.
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: Bell’s Palsy

May 19, 2016Head/Eyes/Ears/Nose/Throat, Neurology844-SMA-TALK, Behind the Curtain, Bell's palsy, Facial nerve, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We’ve spent a few days focusing on stroke recognition, but today we focus on a condition that often gets confused with a stroke. Bell’s palsy is a paralysis of the facial nerve, caused by inflammation or other irritation to the nerve. This paralysis causes muscle weakness in one side of the face.
Patients often find themselves unable to close one of the eyelids or wrinkle one side of the forehead/face. The eyes may become dry due to inability to blink. One side of the mouth may drool and droop. The sense of taste may change. Sounds may become louder, and headache may develop.

Bell’s palsy is treated with steroids and artificial tears.

The prognosis for individuals with Bell’s palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of symptoms and most recover completely, returning to normal inside of 3-6 months. For some, the symptoms may last longer, and in a few cases, the symptoms may never completely disappear.

By the way, in case you’re wondering about the picture, the right side of the picture (the left side of the patient’s face) is the side affected. He can neither wrinkle his forehead nor close his eye, both of which are functions of the cranial nerve. And no, this is not a stroke.
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: Bacterial Vaginosis – No, That’s Not a STD

May 3, 2016Genital/Urinary, Obstetrics and GynecologyBacteria, Bacterial vaginosis, Behind the Curtain, Centers for Disease Control and Prevention, Conditions and Diseases, health, Human sexual activity, Infection, Microorganism, PH, Sexual partner, Sexuality, Sexually transmitted disease, Vagina, Vaginitis, Women's HealthJeffrey Sterling, MD

I try to give you straight talk but never crudely. As I’ve discussed conditions involving the genitalia, I’ve been mindful of the reality that large numbers of you have been affected by sexual transmitted diseases/infections (aka STDs/STIs), and I will always respectful of that consideration. That doesn’t mean I’m sugar-coating your information, it just means I am aware that you’re suffering and concerned by different scenarios.

One of those is bacterial vaginosis. There is an age after which women invariably start discovering that various things they do can disrupt the appearance, smell and content of their vaginal fluid. It’s certainly human nature to wonder if something has gone terribly wrong. Let’s pick up our Doctor-Couple conversation from earlier…
Patient: Yep! I have this grayish/whitish discharge that only happens after sex. And sometimes it itches around there. And it burns when I pee! No rashes or that other stuff, though.
Doctor: Ok. Let’s examine you…

All humans have various microorganisms that normally reside inside us at relatively low levels; different microorganisms inhabit different part of the body. They’ve set up a delicate balance (like an ecosystem, if you will) that, once settled doesn’t disturb us (their hosts) at all. If external or internal circumstances disturb that balance such that one set of organisms is disproportionately affected, overgrowth of the other organisms may occur. Many of you will recognize this as happening when you get a ‘yeast’ infection. It’s also what occurs when you develop bacterial vaginosis (BV). BV is the most common vaginal infection in the U.S. It’s more likely to be seen when you start having unprotected sex with a new partner, have multiple sex partners, are pregnant or douche (therefore, women who are not sexually active can have BV also). By the way, you don’t get BV from toilet seats or swimming pools.

The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Next we will focus on the risks of various sexual activities. Stay tuned.
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: Syphilis Prevention, Treatment and the Tuskegee Experience

April 30, 2016Infectious Disease, Medical Treatment, Public HealthAfrican American, Behind the Curtain, health, Human papillomavirus, Limited liability company, Monogamy, Penicillin, Powered, Sexual partner, Sexuality, Sexually transmitted disease, Sterling, Straight No Chaser (composition), Syphilis, Tuskegee, United States, United States Public Health ServiceJeffrey Sterling, MD

Introduction

Syphilis should be a word derived from something meaning horrible. In an earlier post, we reviewed the rather horrific progression of the symptoms of syphilis. An additionally horrible consideration is that treatment is so very easy once identified. Of course, that’s not the most horrific aspect of the disease. Read on.

Looking back retrospectively, advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. However, as discussed in the post discussing the symptoms of syphilis, remember that treating syphilis at any point can prevent the most severe complications that lead to death. Which brings us to Tuskegee – and keep in mind this is Straight, No Chaser.

The Tuskegee Experiments

In the early 1930s, the US Public Health Service working with the Tuskegee Institute in Alabama began a study to evaluate the effectiveness of current treatments for syphilis, which at the time, were thought to be at least as bad as the disease. The study was conducted on 600 Black men, who were convinced to participate in the study with the promise of free medical exams, meals and money for burial, ‘if’ it was necessary.

The study was initially meant to last 6 months, but at some point a governmental decision was made to continue the study and observe the natural progression of syphilis until all subjects died of the disease, with a commitment obtained from the subjects that they would be autopsied ‘if’ they died. There were several problems with this decision.

None of the patients participated under informed consent. They believed they were being treated as opposed to being observed and having medicine withheld while they were being allowed to die. In other words, the subjects were not aware of the purpose of the study.
Penicillin was established as a true, rapidly effective treatment for syphilis and the standard of care by 1947. The study continued 25 years beyond this treatment option being available.
Efforts by concerned individuals failed to end the study for 5 years prior to a whistleblower going to the press in 1972. The study was ended in a day.

Aftermath

The aftermath of the study includes the following:

Reparations averaging a mere $15,000 per individual were given ($9M total) as well as a formal apology, delivered by President Clinton. Yep, the victims received the equivalent of $15,000 per person on average for 40 years of carrying syphilis 25 years after there was a known cure, after infecting wives and unborn children in several documented cases.
Strict requirements for protocols for human study (i.e. Institutional Review Boards) were implemented for the first time.

It shouldn’t surprise anyone that many African-Americans remain distrustful of governmental public health efforts to this day; for many, this study continues to be the reason while vaccination isn’t optimally taken advantage of (e.g. HPV) and why organ donation rates are so relatively low in the African-American community. Even though this posture contributes to the adverse health outcomes that exist in the African-American community, it isn’t hard to see why the fear and distrust exists.

Let’s bring this full circle. When it comes to syphilis, prevention is best, and full treatment is available. At the very least, I certainly can say you’ve been warned. Folks have given their lives to make your warning possible. I welcome your questions and comments.

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Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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Straight, No Chaser: STDs – Syphilis, The Great Mimicker

April 30, 2016Genital/Urinary, Infectious Disease, Obstetrics and GynecologyBehind the Curtain, Conditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, Syphilis, TuskegeeJeffrey Sterling, MD

Today, Straight, No Chaser will present two phrases that you may not have previously heard: The Great Mimicker and MSM, and that means we’re discussing what has historically been a devastating disease: syphilis. Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease between the Americas and Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The microorganism causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
Prevention and Treatment Considerations: Advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. Remember that treating syphilis at any point can prevent the most severe complications that lead to death.
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: The Medical Complications and Medication Treatment of Alcoholism

April 4, 2016Gastrointestinal, Toxicology/DrugsAcamprosate, Alcoholic beverage, Alcoholism, Behind the Curtain, 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.

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