Tag Archives: health

Straight, No Chaser: Let's Boost Your Metabolism

February 19, 2015Diet and Nutrition, General Health and WellnessBMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, United States, Weight Management, WordPressJeffrey Sterling, MD

It would be improper for me to have dragged you through the mud for three days and depressed you into thinking you can’t improve your situation. Hopefully, you’re not feeling that way. You should now have a better understanding of how the body works, how to count calories and how to compare yourself to a baseline for health. What left is giving your body a leg up on your efforts. Yep, I’m talking about boosting your metabolism. Any of you that have been with me for a while know that means I’m not promoting something you’ll find in a bottle, although there are many good supplements that can assist in that effort. I’ll refer you to your (or my) favorite personal trainer for those considerations. As always, I want to offer you the tools to be self-empowered. To that end, here’s five Quick Tips to boost your metabolism. Why five? Because five is easier to implement than six. Once you get these five down, let me know, and we can get a bit more intricate.

1. Eat smaller meals, and eat more frequently. It’s true. More meals more often is better, but only if they’re smaller. Calorie counting is still a major part of the equation. The point of more frequent meals is preventing the body from going into starvation mode, which slows your metabolism as the body attempts to conserve energy. If you do this, you’ll discover those meals are smaller and you will get closer to eat more appropriate portions than we typically do. Also, make those in-between meals healthy choices like a handful of fruits or nuts.
2. Prime your pump. Remember, it’s all about your heart’s ability to efficiently move blood around the body anyway. The healthier your heart is, the better your metabolism will be. You need aerobic exercise that increases your heart rate for 20-30 minutes at a time. Learn your target heart rate for your age, and exercise to get into that range. Your metabolism will better approximate that of a fine tuned machine rather than a sputtering old car.
3. Weight train. This is very simple. The more muscular you are, the more calories you will burn, especially relative to someone of the same weight who is obese. Not only will you become a finer calorie-burning machine, in this case you actually will look better! Add weight training to your exercise regimen.
4. Choose the fish (and not the fried variety). Fish oil contains substances called omega-3 fatty acids (EPA, DHA) which increases levels of fat-burning enzymes and decreases levels of fat storing enzymes. Daily ingestion has been shown to help by approximately 400 calories a day.
5. Enlist a personal trainer. Everyone needs help and motivation. Some of us need a lot of help and a lot of motivation. We also need expertise. There’s nothing more frustrating than working hard yet not seeing any results because you’re working incorrectly. A good trainer can put you on the path, supervise your regimen, and hold your hand through the process. The minutia of age, sex and body habitus considerations that also play a role in this can be managed by a good trainer. Your ideal trainer will have knowledge of nutrition, wellness and supplements that are tailored to your specific considerations. This will get your metabolism revved up!
By the way, if you’re into green tea, caffeine or spicy/hot peppers, enjoy them for their other benefits, but don’t expect them to contribute significantly to your efforts to improve your metabolism. At least that’s what the consensus in the medical literature points out.

Finally: yes, it’s true that metabolism naturally slows with age (starting as early as age 25); everyone has heard that fact. However, here’s what you don’t usually hear: that’s not inevitable and is more a result of your becoming less physically active than just aging. That demonstrates the need for you to be even more diligent in your efforts. Good luck, and I welcome your questions and comments.

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

February 18, 2015Diet and Nutrition, General Health and WellnessBMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, United States, Weight Management, WordPressJeffrey Sterling, MD

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

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

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

How Much? If you were my patient (but you’re not!), I’d tell you to forget about ideal body weight and BMI – for now. Focus on a modest weight loss, like 5-10% of your current weight. Even this success will improve your blood pressure, cholesterol and blood sugar levels. Once you accomplish that goal, do it again. So even if the overall goal seems large, see it as a journey rather than just a final destination. Seek to learn new eating and physical activity habits that will help you live a healthier lifestyle. These habits may help you maintain your weight loss over time. To that end, I love healthy challenges. Try a 30-day water instead of pop (soda)/coffee, etc. challenge, or even better, give yourself a 30-day ‘fruit for dessert challenge’ or ‘salad of your choice for lunch’ challenge. When that’s done, immediately do it again. Learn to integrate healthy habits into your quest to lose weight, and you’ll increase the odds of having sustainable weight lost. At the end of the day, it’s been well established that those who maintained a significant weight loss report improvements in not only their physical health, but also their energy levels, physical mobility, general mood, and self-confidence. Good luck, and check back for the next post on how to fine-tune your metabolism!
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Straight, No Chaser: The Adverse Health Effects of Obesity and Why You Gain Weight

February 17, 2015General Health and Wellness, Health PreventionBMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, United States, Weight Management, WordPressJeffrey Sterling, MD

Earlier, we identified the differences between a ‘normal’ weight and being overweight and/or obese. Today’s goal is to help you understand specific risks of carrying extra weight. We’ll also set the table for losing weight by discussing why weight gain occurs. It bears repeating that none of this has anything to do with the perception of one’s physical attractiveness.
Let’s focus on three considerations.
1. What are the health risks?

As body weight increases, so does the risk for several different medical conditions and illnesses, including the following:
• Arthritis
• Cancers (breast, endometrial, and colon)
• Diabetes
• Gynecological problems (abnormal periods, infertility)
• Heart disease (heart attacks, heart failure, hardening of the arteries)
• High cholesterol
• Liver and gallbladder disease (gallstones)
• Sleep apnea and other respiratory problems
• Stroke
In the event that these risks are just words on a page, learning a little bit about some of them might provide the motivation needed to avoid them.
2. What is a realistic goal for weight loss? What’s the balance between family predisposition and the foods I eat?

No matter what I tell you today, it’s unlikely to turn you into a supermodel. The goal (independent of your consultation with your own health care provider) is to get you to optimize your situation based on the things you can control. Yes, genetic factors do play a role in obesity, but beyond that you are more than able to close your mouth and get off your…couch. You are able to limit your fat and caloric intake and put down the salt shaker. Yes, genetics count, but behavior and environmental (culture, socioeconomic status) consideration play at least as much of a role. These latter considerations can even jumpstart your metabolism beyond your genetic predisposition.
3. Why do I gain weight if I’m still active?

The most simple way to answer this is that weight gain occurs from an energy imbalance. You’re taking in too many calories, and/or you’re not engaging in enough physical activity. It’s an equation, and the weight gain occurs when you’re on the wrong side of the equation. It’s not much more complicated than this. Either do less of the eating, more of the activity, or both. I mentioned in a previous post on caloric counts that you must have an excess of 500 more calories expended than you ingest daily every day for a week just to lose one pound. It takes work. This is the simple answer as to why fad diets don’t work long-term. You can’t cheat the equation. The moment you stop being diligent, you’re headed in the wrong direction. Your weight loss plan must include lifestyle changes for the long-term.
In the next post, we’ll identify some very simple methods to combat obesity based on the information provided to this point. Feel free to ask any questions or submit any comments you have.
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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Straight No Chaser: Examining Obesity – Is It Really a Choice Between Health and Happiness

February 13, 2015General Health and WellnessBMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, United States, Weight Management, WordPressJeffrey Sterling, MD

Obesity in the United States places many at a crossroad between self-esteem and health. Often, larger frames are celebrated as more desirable. Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise. Of course, our culture embraces and contributes to obesity. Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport. I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health. If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed. As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:

Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.

Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.

‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
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Straight, No Chaser: The Treatment of Erectile Dysfunction

February 10, 2015General Health and WellnessAustin Powers, Blood, Erectile dysfunction, health, Limited liability company, Penis, Pharmaceutical drug, Physician, Urology, Viagra, WordPressJeffrey 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.
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Straight, No Chaser: Erectile Dysfunction, Part Two – Causes

February 9, 2015General Health and Wellness, Genital/UrinaryConditions 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.
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Straight, No Chaser: Erectile Dysfunction, Part One

February 6, 2015General Health and WellnessConditions 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.
I welcome any questions or comments you may have.
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Straight, No Chaser: Text Neck and Other Smart Phone/Computer Related Difficulties

December 17, 2014General Health and Wellness, Health Prevention, Musculoskeletal System844-SMA-TALK, carpal tunnel syndrome, Disorders, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Text NeckJeffrey Sterling, MD

It shouldn’t be too much of a chore to be mindful of your future as you unwrap your new technologic gadget this holiday season. You really should think more about your quality of life during your golden years. Arthritis (aka degenerative joint disease) is inevitable if you live longer enough, but that doesn’t mean you need to accelerate the process. Live your life with longevity in mind. There is no reason you can’t maintain a high level of function for years to come. In general the way you’re built represents a position of comfort. Your body best accommodates movements that maintains these positions. With that in mind, this Straight, No Chaser will discuss some simple ergonomic considerations to keep you just a bit safer over the long-term.
Computer use

This is simple. Take ten minutes to set up your workstation so it isn’t damaging your spine.

Place your computer monitor so it is directly in front of you as you type.
Place your monitor at eye level to prevent having to hunch over.
Place your keyboard at elbow level; this aligns your arms and shoulder.
Placing padding in front of your keyboard aligns your wrist and helps prevent carpal tunnel syndrome.
Find an adjustable chair as a means of providing low back support.
Find a footrest to further stabilize your lower back.

An additional consideration for computer use is remembering to take breaks. Your eyes are able to accommodate computer use, but the constant glare causes eyestrain and dryness, which can be irritating and reduce productivity.

Take a break after 45 minutes of computer use. During your break, make a point of staring at something far off in the distance to relax your eye muscles.
If your eyes get easily irritated, consider using clear tears to keep them lubricated.
If you’re a heavy computer user and wear glasses, you can compound your problem if you aren’t getting frequent checks to make sure your prescription is accurate.

Smartphone/Cell phone use
There’s been a lot of chatter lately about “text neck,” which basically points to the dangers of leaning your neck forward over a prolonged period of time. The way your head, neck and shoulders are constructed means you create less stress and strain when your head is centered and your eyes are pointed forward. Consider the following:

When your spine is in a neutral position, the head weighs about 10-12 pounds.
When you lean your head just 15 degrees forward, the neck feels the strain of 27 pounds.
When you lean your head 45 degrees forward, the neck feels the strain of 49 pounds.
When you lean your head 60 degrees forward, the neck feels the strain of 60 pounds.

This level of stress on your neck for hours at a time every day plant the seeds for chronic neck pain, muscle spasms, numbness and tingling in your hands and even misalignment and/or herniated discs.
It’s not just your neck that’s at risk. Have you ever wondered why you have two thumbs and eight fingers? Your thumbs are stabilizers, and really aren’t built for the type of massive work that your smart phones impose on them. Over time such use can cause tendonitis.
The good news is smartphones are accommodating these considerations, but you need to be smart and take advantage of them.

Use earphones and avoid holding the phone up by lodging it between your ear and shoulder.
Use the option that allows you to send texts by speaking instead of typing.
Try to text using your fingers instead of your thumbs.
Use the predictive text functions, which suggest words for you as you type on your phone.
Don’t forget that you could just pick up the phone, and make a call…

So here is a pretty simple consideration for you that works whether you’re on the computer or using a smart phone. Whenever you can, increase the space between your chin and your chest. This action alone optimizes the position of your neck and shoulders, and it avoids any pinching of the nerves in your neck. Additionally, if you find yourself uncomfortable, take a break and stretch. Get a message. Don’t forget to stay hydrated because your bones bathe in fluid.
Remember, technology is meant to work for you, not against you. Use these tips, and enjoy the advantages your technology is offering. Type you later.
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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Straight, No Chaser: Tips on Safe Toys and Gifts

December 16, 2014Pediatrics/Kids Health, Trauma844-SMA-TALK, Disorders, health, Safe Toys and Gifts Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

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

The selection of gifts and toys you bring into your home should be taken seriously. Let’s keep the holiday season happy!
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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Straight, No Chaser: The Holiday Heart Syndrome

December 15, 2014Cardiology/Heart, Toxicology/Drugs844-SMA-TALK, Atrial fibrillation, Disorders, health, Holiday Heart Syndrome, Mental disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There’s something about the holiday season and flickering. We’re all aware that Christmas lights are meant to do so, but did you know that your heart is more inclined to flicker and flutter this time of year (sorry, but I’m not talking about mistletoe)? In a previous Straight, No Chaser, we discussed a mental consideration concerning the holiday season: the increased rate and risks of depression, known as The Holiday Blues. Unfortunately, health issues associated with the holidays don’t stop there. There are defined physical risks associated with the holidays as well. The disturbing aspect of today’s topic is you’re not immune to this even if you’re otherwise healthy.

Holiday heart syndrome is a real condition and has been described as such since the 1970s. It’s the result of eating and drinking alcohol too much (with or without excessive caffeine intake and a lack of sleep), which is exactly what we’re inclined to do this time of year. The combination of these indulgences places an undue level of strain on the heart, which causes the heart to develop an abnormal rhythm, most commonly atrial fibrillation. Interestingly, certain foods, alcohol and caffeine all have direct effects on the heart, and indirectly they can also affect the heart through increase of certain hormones (such as epinephrine) that stimulate the heart.
Curiously, holiday heart syndrome is notable for its occurrence in those without existent heart disease but can be especially concerning in uncovering existing disease or exacerbating disease in those having it. For example, someone with underlying cardiovascular disease featuring microclots can have such clots dislodge during an episode of atrial fibrillation, causing a stroke.
Fortunately, by far the common course of holiday heart syndrome is benign. The abnormal heart rates will slowly resolve as the levels and effects of alcohol and/or other substances decline. That said, the risk is such that you don’t just want to sleep off an occurrence.
The symptoms you’d have are pretty obvious, given that you’d have been eating and drinking to excess. You’d also note that your heart was racing and perhaps pounding, as if it was attempting to jump out of your chest. Heart rates in the 120s are pretty typical for holiday heart syndrome (a normal heart rate is between 70-100 beats per minute). This tidbit is important to know; if your heart rate is higher than this, something more serious could be occurring. Under either circumstance, you need to be evaluated and treated in the emergency room setting with hydration and observation of the heart rhythm and rate.

The lessons here are pretty straightforward:

Holiday heart syndrome suggests that indulgences that occur during the holidays can cause symptoms. By no means does it suggest that these symptoms are restricted to the holidays. Overindulgence in food and drink can cause abnormal heart rhythms at any time, including weekends, spring break, birthday or other celebrations, as well as holidays.
You’d be particularly interested in knowing that the combination of vodka and the energy drink Red Bull have been shown to make these symptoms more likely to occur.

Following alcohol-related abnormal heart rhythms, it is advisable for patients to avoid significant exertion because the excessive stimulation that raises epinephrine levels can precipitate recurrent and possibly more serious episodes. Most patients without underlying heart disease should be able to gradually resume full physical activity over the next few days. Once everything is back to normal, most patients do not require further therapy if they refrain from alcohol use. Patients with underlying heart disease, heart disease that’s discovered during evaluation, or those with severe symptoms on presentation (e.g., blackouts or simultaneous low blood pressure) may be candidates to receive certain heart medications.

At the end of the day, Holiday Heart Syndrome is yet another example of the virtue of enjoying life in moderation. Failure to do so can turn the holidays into the most dangerous time of the year. Cheers!
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: Tips to Deal with Depression and The Holiday Blues

December 12, 2014Mental Health844-SMA-TALK, Depression, Disorders, health, Major depressive disorder, Mental disorder, Mental health professional, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

Here’s five tips for your holiday mental health:

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

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

November 19, 2014Genital/Urinary, Infectious Disease, Obstetrics and GynecologyConditions 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.
For a historical lesson on what happens with untreated syphilis, review this Straight, No Chaser post on The Tuskegee Experiments.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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Straight, No Chaser: Bacterial Vaginosis – No, That's Not a STD

November 17, 2014Genital/Urinary, Obstetrics and Gynecology, Health PreventionBacteria, Bacterial vaginosis, 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.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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Straight, No Chaser: Pain Awareness Month and Your Chronic Pain

September 29, 2014General Health and Wellness844-SMA-TALK, chronic fatigue syndrome, chronic pain, chronic pain syndrome, Conditions and Diseases, endometriosis, fibromyalgia, health, Inflammatory bowel disease, Interstitial cystitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, TMJ syndrome, VulvodyniaJeffrey Sterling, MD

The notion of a pain awareness month is an odd thing; probably even more so to those suffering from chronic pain. Typically the idea with these periods of recognizing diseases and conditions is to create sensitivity among the general public toward one’s condition. In this and the next Straight, No Chaser, we will not only do that but will build upon that and provide those sufferers of chronic pain some better tools to make those emergency room visits more productive.

I’d begin by asking you to get more in touch with your “you sensitivity” and learn to differentiate between different types of pain. It’s important for you to know the difference.

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Then there’s chronic pain. Remember, sometimes pain happens without injury or disease. Pain is simply a signal communicated from your body to you through your brain. Acute pain is normal and is meant to alert you to somehow protect yourself or get help. Chronic pain is different. Those signals coming from your nervous system can be sporadic or haphazard, and they may be more reflective of dysfunction within the nervous system than a disease or injury. It can even be psychogenic (due to matters of your mind). Regardless of the cause, chronic pain is well, a pain.
There are many established conditions that cause chronic pain, such as the following:

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Maybe the point of this post isn’t to tell those of you who suffer from chronic pain things you don’t already know as much as it is to organize your thoughts and approach to your pain. After all, it’s not like there are cures for chronic pain besides eliminating the underlying condition (which reminds me to remind you not to fall for the many medical scams promising instant and permanent relief to these medical conditions). The first step really is to help you appreciate the need for becoming better sensitized to your condition. Many patients with chronic pain suffer horrible outcomes because they become desensitized to pain, learn to ignore it, and misinterpret a new, unrelated pain condition (maybe with a few similarities), failing to get evaluated before it is too late.
If you suffer from chronic pain, it’s key to know the things you can do to improve your quality of life. Strengthening your mind to reduce stress and avoid fixating on your medical condition is very important. Learning to relax actually is treatment; your body has pain-reducing chemicals, including those that directly treat pain and promote healing, and others that prevent release of internal pain producers. Find someone with whom you can discuss relaxation and stress reduction.

Engage the fight to get better within your physical limitations.

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal trainer or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

Regarding medication, for many people use of medication (especially narcotics) becomes a crutch and a slippery slope. Over the counter medications such as acetaminophen and ibuprofen are quite effective for many causes of pain. Use of narcotics should be measured and part of an overall plan, not a tool for a quick fix or to get you out of your doctor’s face. It is part of reality that even if you are not a drug-seeking patient, with enough exposure to narcotics you will develop tolerance (less effectiveness at the same dose) and become addicted. You should want to avoid this fate.
The pain, mental duress and reduction in quality of life associated with chronic pain can be lessened with you learning how to approach and understand your pain, taking appropriate steps to reduce things you do to exacerbate the pain, increasing the things you do to lessen the pain, and working with your health care team to provide you with appropriate support and treatment. We at http://www.SterlingMedicalAdvice.com and 844-SMA-TALK are here to support your efforts. We welcome your questions.
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: Chronic Pain

July 2, 2014General Health and Wellness, Neurology, Musculoskeletal System844-SMA-TALK, chronic fatigue syndrome, chronic pain, chronic pain syndrome, Conditions and Diseases, endometriosis, fibromyalgia, health, Inflammatory bowel disease, Interstitial cystitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, TMJ syndrome, VulvodyniaJeffrey Sterling, MD

If I could talk to you about pain (oh wait, I can), I’d begin by asking you to get more in touch with your “you sensitivity” and learn to differentiate between different types of pain. It’s important for you to know the difference.

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Engage the fight to get better within your physical limitations.

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal training or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

Regarding medication, for many people use of medication (especially narcotics) becomes a crutch and a slippery slope. Over the counter medications such as acetaminophen and ibuprofen are quite effective for many causes of pain. Use of narcotics should be measured and part of an overall plan, not a tool for a quick fix or to get you out of your doctor’s face. It is part of reality that even if you are not a drug-seeking patient, with enough exposure to narcotics you will develop tolerance (less effectiveness at the same dose) and become addicted. You should want to avoid this fate.
The pain, mental duress and reduction in quality of life associated with chronic pain can be lessened with you learning how to approach and understand your pain, taking appropriate steps to reduce things you do to exacerbate the pain, increasing the things you do to lessen the pain, and working with your health care team to provide you with appropriate support and treatment. We at www.SterlingMedicalAdvice.com and 844-SMA-TALK are here to support your efforts. We welcome your questions.
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 In The News: Your Teens Have Healthier Habits Than You

June 14, 2014General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, CDC, Centers for Disease Control and Prevention, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, TraumaJeffrey Sterling, MD

Your teens are healthier than you. From the department of good health news – on some very important measures, somehow it seems as if our youth have actually received and read the memo on health. According a recent survey from the Centers for Disease Control and Prevention (CDC), several measures of health have improved significantly in the teen population – with a few important exceptions.

These improvements include the following.

Cigarette smoking. Cigarette smoking among U.S. high school students has reached an all time low. Teen smoking is down to 15.7%. It was just over 15 years ago (in 1997) that the rate was 36.4%. Unfortunately, this still translates to 2.7 million high school students who smoke.
Armed trauma. The proportion of students threatened or injured with a gun, knife or other weapon on school property has dropped to 6.9%, from a peak of 9.2% in 2003. In the presence of so many school shootings, a ray of hope exists.
Fist fights. The proportion of students involved in fist fights was reported at 25%, which is down from 42% in 1991. The number of students having had a fight at school within the last year sits at 8%, which is down from 16%.
Soda consumption. 27% of teens had at least one soda daily, down from 34% in 2007.
TV viewing. 32% watched three daily hours of TV, down from 43% in 1999.
Other: Overall, teens are drinking less alcohol and are having less sex with more birth control use by females.

And now, the not so good news…

Condom use: Condom use is declining among the sexually active, being reported at 59%, down from a peak of 63% in 2003. Remember, HIV and other sexually transmitted diseases/infections haven’t gone away at all; we’ve just gotten better in controlling them. Now is not the time to get comfortable.
Texting and driving: 41% of those who drove admitted to texting or e-mailing while driving. This is bad anyway you look at it.
Cigar and other forms of smoking: Cigars are now as popular as cigarettes with high school boys. Cigars were smoked by 23% of 12th grade boys in the month before the survey. Smokeless tobacco use hasn’t changed since 1999, holding at about 8%. Other surveys have shown increases in e-cigarette and hookah use.
Computer time: 41% of teens report using a computer for non-school reasons at least three hours a day, up from 22% in 2003. Apparently this is where the TV time has gone.

What this really means is (wait for it!) your teens are educable. Discuss these topics with them and why it’s important to make healthy decisions. Of course it helps if you model the behavior.
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: New Findings and Other Vaccine News

June 11, 2014Infectious Disease, Public Health, Health Prevention844-SMA-TALK, chicken pox, health, immunizations, measles, mumps, Rotavirus, rubella, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vaccines, varicellaJeffrey Sterling, MD

Introduction

This Straight, No Chaser provides vaccine news of interest.

If this doesn’t convince you, nothing will. You’ll want to read until the end.

The most recent edition of the medical journal Pediatrics this week publishes the results of three new studies that individually are convincing and together are definitive. This really isn’t news; the public health and medical communities have been speaking with one voice on this for nearly a century. However, given all the recent misinformation disseminated, it’s important to continue to drive home the point that vaccines save lives.
Let’s summarize the three studies.

Rotavirus

Rotavirus was once an extremely common cause of infant diarrhea, causing hospitalization and even death due to diarrhea and dehydration. A rotavirus vaccine was developed. According to a study conducted by the U.S. Centers for Disease Control and Prevention (CDC), based on previous usage rates, during the first four years of vaccine use, more than 176,000 hospitalizations, 242,000 emergency department visits, and 1.1 million doctor’s visits among children under 5 were prevented, saving approximately $925 million in the U.S.

Chickenpox

Chickenpox actually kills, especially adults and those with compromised immune systems. Prior to development of the chicken pox vaccine, approximately 11,000 people were hospitalized a year in the United States from chickenpox. According to a study performed by the Kaiser Permanente Vaccine Study Center, in the fifteen year period between 1994 and 2009, the chickenpox vaccine slashed the number of hospitalizations by 90%, across all age groups.

Measles

The recent measles outbreak has previously been discussed in Straight, No Chaser, but a 2011 outbreak was highlighted in detail in Pediatrics, and yes, the study speaks to the consequences of going without immunization. The CDC is clear that current measles outbreaks are due to parents withholding vaccines from their children, and this review could be the proverbial Exhibit A. The Minnesota Department of Health identified an outbreak infecting 21 people, with an average age of 1-year-old and whose parents in the community had largely withheld the measles vaccine. About 67% of those infected were hospitalized, mostly due to breathing complications and dehydration.

An interesting post-script to the findings in Minnesota directly involves the source of widespread misinformation about the measles vaccine (actually the measles-mumps-rubella vaccine; they’re all given together). The author of a discredited 1998 research paper that is the source of the alleged link between vaccines and autism had visited this community approximately four times, convincing many residents to go without the measles vaccine. This author, Andrew Wakefield, actually lost his right to practice medicine in England, and the journal that published his study retracted the paper linking autism and vaccines. However, you probably hadn’t heard that part of the story, and the autism-vaccine link continues in mythology via the internet and ill-informed “advocates.”

Diseases and Vaccines

The story of diseases and vaccines is actually pretty linear and historically consistent.

There were a series of infectious diseases that once wreaked havoc on society, often killing mass numbers of humans.
Vaccines were developed to prevent infections (and their complications) from these microorganisms.
Mass vaccinations markedly reduced (and actually eliminated in some examples) the rate of contracting these diseases to where we take for granted the danger of the actual disease (discussing what it was like in the US when polio was a common disease would be an interesting conversation to have with your grandparents if you can).
Certain segments of society opt out of getting immunized over fear of the vaccine.
At some point when the vaccination rate drops below a certain percentage, the diseases return in those not immunized.

I welcome your questions. Discuss your legitimate concerns with your physician or experts personal healthcare consultants such as we offer at 844-SMA-TALK and www.sterlingmedicaladvice.com. Protect your families. Without exception, if a vaccine exists, you should fear the disease more than the vaccine.

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Straight, No Chaser: Your Questions About Measles (Rubeola)

May 31, 2014General Health and Wellness, Infectious Disease, Pediatrics/Kids Health844-SMA-TALK, Conditions and Diseases, enchephalitis, health, immunization, measles, MMRV, pneumonia, rubeola, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vaccination MMR, Vitamin AJeffrey Sterling, MD

In discussing the recent measles outbreak, the most common response I received was “So? What’s measles anyway?” It has been that long since measles has been a problem in the United States. Let’s talk about common questions related to measles.
What causes measles? The medical term for measles is rubeola, and it’s caused by a virus.

What are the symptoms I’d see? To the layperson, measles most often presents as a full body rash with cold/flu-like symptoms, such as a fever, cough and runny nose. Your doctor is also looking for red eyes (conjunctivitis) and small reddish spots inside the mouth (known as Koplik’s spots).
Is measles contagious? It’s highly contagious to those not immunized. According to the Center for Disease Control and Prevention, 90% of those not immunized will contract measles if exposed to someone with it.
How is it spread? It’s spread through the air. This means sneezing, coughing and kissing.

Why don’t I ever see measles? Measles has been contained in the U.S. since the introduction of the measles vaccine over 50 years ago. It is amazing to think that there are still 20 million cases still occurring around the world annually.
How is measles prevented? Immunization! Infants are generally protected from measles for 6 months after birth due to immunity passed on from their immunized mothers. For most others, the measles vaccine is part of the measles-mumps-rubella immunization (MMR) or measles-mumps-rubella-varicella immunization (MMRV) given at 12 to 15 months of age and again at 4 to 6 years of age. Additional considerations exist in the face of an outbreak.

What are the side effects of the vaccine? Unless you have an underlying health condition and/or have a reduced immunity, the most common reactions include the following:

fever 6-12 days after vaccination (in about 5%-15% of those vaccinated)
an incidental (and non-allergic, non-contagious) rash. This goes away on its own and occurs in about 5% of vaccine recipients.

What’s the treatment of measles? Given that measles is a virus, there is no specific medical treatment (as is almost always the case with viruses). Supportive treatment is important and involves fluids and rest for what is expected to be a two-week period. Something like Tylenol or children’s ibuprofen can be given for fever or pain (but never give aspirin to a child).

What are the common complications? 30% of cases of measles involve complications. Complications include simpler conditions such as otitis media (those pesky ear infections), croup and diarrhea.
This all sounds pretty benign. Why not just get the disease and avoid the vaccination? Because children can die from measles. Unfortunately, measles also has more serious considerations such as pneumonia (which occurs in approximately 1 of 20 cases) and a serious brain infection called encephalitis (which occurs in approximately 1 of 1000) cases. Measles also causes pregnant women to have miscarriages, premature births or low-birth-weight babies.
How do people die from measles? Pneumonia is the complication most often causing death. For every 1,000 children who acquire measles, 1 or 2 will die.
What’s the Vitamin A connection with measles? Vitamin A has been found to decrease complications and death in those infected with measles. It should be considered, especially in those hospitalized with complications of measles or those who have compromised immune systems and acquire measles.
If I had measles as a child and get exposed to the disease again, am I in danger? No. Surviving a measles infection provides one with life-long immunity. Of course, your take home message is most of this isn’t a consideration if you simply get immunized.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 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. Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Diabetes Basics and the Importance of Education

May 28, 2014General Health and Wellness844-SMA-TALK, Conditions and Diseases, Diabetes, Diet, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

Let’s take a moment to discuss prevention and treatment. There are different types of diabetes, but the risk of one form of diabetes in particular can be reduced by – you guessed it – diet and exercise. In fact, diet, exercise and medications are the three legs of the diabetes treatment stool regardless of type. Some patients require regular insulin injections and others require pills. Still others who are successful with diet and exercise are able to markedly reduce, and in some instances eliminate medications.
If you’re a diabetic, make an investment in your education. It could not only save your legs or eyes, but it may just save your life. I welcome your questions and comments.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 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.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Quick Workouts for the Couch Potato

May 25, 2014General Health and Wellness844-SMA-TALK, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Warning: This post includes adorable animal exercise pictures.

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!

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 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

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