Tag Archives: health

Straight, No Chaser: Invisible Health – Developing New Habits

May 23, 2014General Health and Wellness844-SMA-TALK, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Good habits are just as addictive as bad habits, but they’re much more positively rewarding.

The easiest way to change your life is to change your life. But how? When it comes to health, sometimes it can seem like work. For many, the idea of exercise is a big to do. You have to pack. You have to drive. You have to shower. Who has time for all of that? Dieting is just as bad, it seems. Do I need to go find a special store? It always takes time to cook a special meal. It seems like work to count calories! I don’t like the taste of this or that…
Well, at Straight, No Chaser, we want to introduce you to Invisible Health. Today, we offer you a series of ten simple tips (and one admittedly not so easy one) that will promote your health without all the fuss (although we fully endorse the fuss and know that over time, it’s not a fuss). Feel free to expand the list. More importantly, implement the list. You’ll be amazed how just a few minor modifications in regular activities can produce large improvements in your health. Everything is relative. Don’t just sit there. Do something!

One thing you’ll notice about these tips is you’re producing health benefits without the active grind of “working out ” or “dieting.” We just want you to develop some new habits or increase the frequency of some things you may already be doing.

Take a walk. You’re exercising and didn’t know it. Walk the stairs. Take a walk in the park with your loved one. Walk while you talk with your kid. Regular walkers have less heart attacks and strokes, better sex lives and less stress. Walking improves your immune system and reduces all manners of unhealthy cravings. It’s easy. Just do it.
Learn to like to dance. Hear your favorite song? Go for it. Have a child? Teach them and dance with them! I’ll bet while you’re having fun, you’re breaking a sweat, losing calories and getting your heart pumping without the worry of reps or time spent.
Are you hungry and about to shove something unhealthy in your mouth? Drink a glass of water. Your body needs it. The majority of you don’t drink nearly enough water. Learn to appreciate water. Have you heard that you need eight glasses of water a day? You’ll never get there by sipping on a hot beverage. It’s refreshing and replenishing, plus it makes your body function optimally. Besides, if you’re drinking water, you’re not drinking high calorie, sugar-laden soft drinks. Speaking of which…
Stop. Drinking. Sodas. Today. I’d bet the easiest “diet” many of you could go on would be just eliminating soda. Even without doing anything else you’d lower your risk of diabetes and high blood pressure, and you would start losing weight. One can delivers 150 calories. Any amount of water is zero calories.
Still hungry and still looking at that donut? Go brush your teeth. You probably don’t brush enough anyway, and brushing and flossing intermittently throughout the day provide numerous health benefits as well as serve as suppressing your appetite in a simple way.
Wack some weeds. Getting in your yard and doing most any kind of cleaning is going to be beneficial to your health. Stop riding your lawnmower. Walk! Pull some weeds (with both hands), rake some leaves, plant some flowers or sod some grass. You’re burning several hundred calories an hour!
Stand for something. If you think about it, you spend a lot of time sitting during the day. Could you perform a lot of what you’re doing standing or moving? Give it a try. Just develop the habit of getting up and moving around intermittently. For example, learn to pace while you’re on the phone. It’s activity, and you probably need more of it.

Snack healthy. Find a favorite fruit. Eat a handful of nuts. A handful of carrots or almonds, a few slices of an apple or a bowl of grapes is an infinitely better approach to those cravings. Lose the potato chips and the empty calories. This is both addition by subtraction and addition by addition!
Play! Have a kid of any age? Throw the football around. Shag fly balls with each other. Shoot some hoops. You’ll love the benefits to your heart and lungs. Plus, it’ll keep your brain sharp.
Find a healthy friend. Having a companion with whom you share your health aspirations gives you a much better chance of success across the board, as opposed to that friend of yours that you just get together with to eat or drink. It’s true in health as well. You’re probably the average of the five people you most hang around!
Stop smoking. You didn’t really think I would leave smoking off the list, did you? Speaking of invisible health, the more invisible smoking is, the better. I don’t care how you do it, just do it. Every cigarette is costing you about seven minutes of your life. In one fell swoop, eliminating cigarettes from your life will produce as many benefits as most anything else you’ll do.

Give it a try. See how many of these 10 tips you can incorporate into your life. I’d love to get some feedback on your journey.

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.

Straight, No Chaser: Insomnia – You are Not Getting Sleepy…

April 1, 2014Health Prevention844-SMA-TALK, Circadian rhythm, Conditions and Diseases, Edward R. Murrow, health, Insomnia, Night, Sleep apnea, Sleep deprivation, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Talking about insomnia makes me, well, tired. You know what the problem is. You either can’t fall asleep or you can’t stay asleep. You’re tired when you wake and throughout the day. Lack of sleep saps your energy and your productivity.

Insomnia really isn’t very cool to deal with, either as a person or as a physician. Patients are frustrated and sometimes cranky from being tired, or they can be extremely nervous and stressed, which will perpetuate a vicious cycle. There are so many mental factors that can disrupt your ability to sleep.

Medical professionals tend to think of insomnia in two forms for purposes of evaluation. Either the insomnia is the main problem (primary insomnia), or it’s secondary to another condition (secondary insomnia) such as reflux, uncontrolled asthma, arthritis or other pain syndromes. It could be due to medications, depression or just stress. It could be due to some undiagnosed condition, such as cancer, an enlarged prostate (making you have to get up to urinate throughout the night), thyroid disease or sleep apnea. Then there’s the caffeine (coffee/tea), nicotine (cigarettes) and drunk scene (alcohol).

The thing is, whether acute, intermittent or chronic, any type of insomnia really is an inconvenience and can even be incapacitating. Before you subject yourself to a million dollar medical workup, just remember: If it’s secondary insomnia, and you know (for example) that your pain is keeping you awake, try dealing with the primary issue. Alternatively, if it’s primary insomnia, there are a lot of things you might try. In fact, consider this my Top Ten Tips presented in the order you might consider implementing them.

Adhere to good diet and exercise habits, which make your body perform as it should and which will clean up a lot of potential problems that will affect sleep.
Avoid naps during the day. You want to be good, tired and ready to sleep when night comes.
Develop the habit of only using your bed for sleep or sex. That conditions your body to be ready to sleep when confronted with the stimulus of your bed.
Get your snoring partner some help if s/he is part of what keeps you awake. Check here for tips to deal with snoring.
Try not to eat for several (3-4) hours before you sleep. Nothing says “no sleep” like heartburn all night. (By the way, this is the real reason you shouldn’t eat after a certain hour – not concerns about your weight.)
Avoid nighttime stimulants (e.g., cigarettes, coffee, tea and exercise close to the time you want to sleep, if this proves to be a problem).
Don’t drink and sleep. Although alcohol is a sedative, it’s also on the “don’t do” list, because it can cause restless sleep and interrupt the sleep cycle.
Find a way to relax before sleep. Consider a bath, sex, a book or soothing music … or all of them.
Set the alarm for the morning. Then hide your clock. You don’t need to have a clock to remind you that you aren’t sleeping all night.
Use “white noise” for background if you’re bothered by other sounds.

Here’s a bonus tip: If you fell asleep during the reading of this post, keep it for future reference.
As Edward R. Murrow used to say (well before I was born),

Good night and good luck.

Straight, No Chaser: Toxin and Detoxification Series Summary

March 24, 2014Medical Treatment, Health Prevention844-SMA-TALK, Defecation, Detoxification, health, Intestine, Normal number, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Toxin, Weight lossJeffrey Sterling, MD

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

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

Nothing in a colonic or juice fast will match this level of effectiveness. Spend your efforts keeping your body healthy. Increase your fiber, water, fruit and vegetable intake. Lower or eliminate the intake of red meat, cigarettes and alcohol. There’s your detox program all day long.
2. So what’s the verdict on the detox diets and colon cleansing?
Consult with your physician. I’d imagine that using the diets as a starting point for lifestyle changes would be endorsed. I’d doubt that any fad diet would be endorsed.
3. You said tap water is no longer good? Should I exclusively drink bottled water?
Actually filtered water is even better.
4. Are you suggesting I stop wearing makeup?
You’re beautiful just the way you are.
5. Have you ever had a colonic?
Yes, and it made me feel dirty. (Was that serious, or a joke?)
6. I’d never do that.
Actually, you will. (Well, almost.) Many men over 50 will have a colonoscopy to evaluate for the possibility of colon cancer at some point. If and when you get that, you’ll get your colon cleanse solution one to two days before the procedure and maybe an enema in addition. At least you’ll be under the care of a physician, and you’ll get a sedative first!
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Natural Colon Cleansing (Colonics) as a Means of Detox

March 23, 2014Medical Treatment, Health PreventionColon, Colon cleansing, Detoxification, Food and Drug Administration, health, Intestine, Irrigation, Medical procedure, medicine, ToxinJeffrey Sterling, MD

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

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

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

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

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

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

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

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

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

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

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

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

In my “toxin summary post” tomorrow, I will answer your questions on the entire toxin and detoxification series and add a few final thoughts.
Call us at 1-844-SMA-TALK or login at www.SterlingMedicalAdvice.com to chat with your expert nutritionists about these matters, especially now that we’re in National Nutrition Month.
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: A Look at Detox Diets

March 22, 2014Medical Treatment, Health PreventionDetoxification, Detoxification (alternative medicine), Diet, Disease, health, Master Cleanse, Shopping, Support Groups, Toxin, Weight lossJeffrey Sterling, MD

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

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

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

Weight loss
More energy
Better mental focus

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

Health promotion
Prevention of new diseases
Cure of chronic diseases

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

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

Let’s finish with two pointed questions and answers.
1. Should I go on a detox diet? I encourage almost any activity that motivates you to improve your health and has been shown to improve your health. If you want to naturally detox, apply these principals as the basis for a lifestyle change. As your body recovers, your natural detoxification system will take over and do just fine (assuming you are otherwise healthy).
2. I quick-flush my system with a diet every few months. Is this healthy? It depends on what you’re doing as a “quick-flush” and even more so, what you’re doing in-between. Focus on enhancing your natural detoxification system. I can’t say that a one-time or intermittent initiative to kick things off would be a terrible thing — if you stay with the program. In the best case scenario, it’s like going to get a dental cleaning every six months. You’ll still have decaying teeth and disease if that’s the only thing you’re doing. On the other hand, if you’re brushing and flossing every day, then the six-month check up is quick (and in this case, maybe superfluous). I’m much more concerned with you sustaining a healthy approach toward the desired goal.
Next up, and the last in this series on detoxification will be a look at colonics. Until then, bottoms up!
Call us at 1-844-SMA-TALK or login at www.SterlingMedicalAdvice.com to chat more.
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Our World is Filled with Toxins

March 21, 2014Health PreventionDetoxification, Drinking water, Erin Brockovich, Government, health, High-fructose corn syrup, Kidney, Liver, Lung, Toxin, United StatesJeffrey 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 five-part 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.
Call us at 1-844-SMA-TALK or login at www.SterlingMedicalAdvice.com to chat with your expert nutritionists about these matters, especially now that we’re in National Nutrition Month.
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Quick Tips to Detoxify Yourself Naturally

March 20, 2014General Health and Wellness, Health PreventionBlood pressure, Cranberry juice, Detoxification, health, Hypertension, Kidney, 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.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Horror of Night Terrors

March 18, 2014Pediatrics/Kids Health, Sleep, Health PreventionConditions and Diseases, health, Night terror, Sleep, Sleep deprivation, Sleep disorder, Sleepwalking, StressJeffrey Sterling, MD

I wonder how many of you have been exposed to night terrors. These are different than nightmares, which we all know and experience. In a nightmare, Little Johnny has had a bad dream, maybe thinking there’s a monster under his bed. He wants to be comforted by you, and he is still upset the next morning. That’s not what a night terror looks like.
During a night terror, Little Johnny may be sleep walking, or he seems to wake up in the middle of the night and just starts screaming. He’s really not communicative; he’s just terrified. These episodes generally last about 15 minutes. Then he goes back to sleep. The next morning, the child has no recollection of the event.
The cause of night terrors is unknown but they seem to be triggered by emotional stress and lack of sleep. Febrile illnesses also seem to correlate with the presence of these episodes.
Who gets these? Children less than age seven, more frequently boys. These episodes usually stop by age 10. There often is a family history.
There’s really no testing or treatment for these until they are frequent and prolonged, or unless a secondary injury occurs from all the trashing about.
I bring this to your attention because many parents are aware of this phenomenon and have no idea what to do when it occurs. My best advice is to ensure that the child is safe during the episode for otherwise stress free children. You may want to consider medical or psychological screening if the problem worsens. Sleep well…
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Spotlight on Health Concerns When Traveling – Vaccines and Illnesses

February 16, 2014General 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.
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Medical Issues You Encounter While Flying

February 15, 2014General Health and Wellness844-SMA-TALK, Chronic obstructive pulmonary disease, Deep vein thrombosis, health, Limited liability company, Lung, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, ThrombusJeffrey Sterling, MD

I’ve probably been engaged twenty times on airplanes to provide medical assistance. My favorite incident was when four doctors (and a nurse) simultaneously jumped to assistance as if everyone was some type of superhero. Of course, I wouldn’t be telling the story if I didn’t end up being the last man standing (due to my status as the emergency physician among the group – and yes, the patient was ok). Consider this your handy to do and to don’t if and when you’re traveling by air. You never know!
There are four quick considerations I’d like to share:
Blood clots: Flights (and especially the long ones) increase your risk for deep venous thrombosis (DVTs). You can reduce this risk by frequently bending and rotating your ankles, drinking water whenever the opportunity presents and getting up intermittently to walk. Prevention is also important – this is why traveling while in the latter stages of pregnancy is especially problematic and why near-term women aren’t allowed to travel (and you thought it only had to do with early deliveries!).
Headaches and earaches: Air in your body (lungs, intestines, sinuses and eardrums, to name a few) expand when your plane ascends and contracts upon descent. The squeeze on descent is actually more frequent of an issue than gases expanding on ascent, but both situations present problems. In addition to exacerbating migraines, your eardrums can rupture from the squeeze. Of course, adults address this by holding their noses and blowing, thus ‘popping’ their ears (actually this equalizes the pressure on both sides of the eardrum, returning things back to normal). Kids suffer just as much as adults, but the younger ones aren’t able to release the pressure as easily. Thus, it’s true that you should allow them to chew or suck on something during descent. The passenger sitting next to you will thank you.
Fainting: Fainting is a common occurrence on flights for many reasons. Faints and other mental status changes due to hypoglycemia are the most common episodes I’ve personally encountered on flights. My best advice here is to stay hydrated (This will help you prevent faints and problems with DVTs.) and if you’re diabetic, eat during the flight. Low sugar reactions are scary in the air, and the pilots are always wondering if they’ll need to do an emergency landing.
Respiratory disease: This is an important consideration because the potential for bad outcomes are heightened. Those with asthma, blood clots in the lungs (pulmonary emboli) and COPD (chronic obstructive pulmonary disease aka chronic bronchitis and emphysema) need to discuss traveling with their physicians. The high altitude of flights results in thinner air, drier air and increasing viscosity of your blood, which can affect patients suffering from the conditions mentioned. A ruptured lung in a patient with bad COPD is a formula for disaster.
In short, fly smart and fly healthy. An airplane is a horrible place to be in harm’s way. And that doesn’t even include snakes on a plane.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: End of Life Decision Making

January 28, 2014General Health and Wellness, Medical Treatment, Health PreventionBlood flow, Brain, Death panel, DecisionMaking, Education, Futile medical care, health, health care provider, Health care proxy, Heart failure, Hypertension, Intubation, Patient Protection and Affordable Care Act, Straight No Chaser (composition), Terminal illnessJeffrey Sterling, MD

Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.” I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. Please understand that at any age your life could be at risk, you could die, and you could need someone comply with decisions; as such, you need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.
Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and, subsequently, with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That doesn’t have to happen.
Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering or will you want to be allowed to expire?
Will you want the medical staff to feed you if you can’t feed yourself?
Will you want to donate your organs?

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Gall(stones) of Some People

January 2, 2014GastrointestinalBile, Bile duct, Cholesterol, Conditions and Diseases, Gallbladder, Gallstone, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United StatesJeffrey Sterling, MD

Now that we’ve gotten past the twin holidays associated with large meals, it’s a good time to discuss topics related to your New Year’s resolutions of eating less, eating healthier and exercising more. Let’s start with a condition especially associated with eating large meals—gallstones.
To know them is to hate them. If you’re 40ish and in most instances overweight and/or obese, you may have been told you have gallstones. Many of you reading this will have already had their gallbladders removed; some are scheduled to do so. Today’s topic is one that points out how a little maintainence can go a long way in preventing a lot of trouble.
To understand the topic, I’ll provide some basic medical information.

The gallbladder is part of the digestive system, specifically the biliary tract. The biliary tract produces enzymes and the bile in the liver that helps the small intestine digest food. The gallbladder is where the bile gets stored. It releases bile when you eat.
Gallstones are hard particles that develop in the gallbladder as a result of an imbalance in these enzymes, such as occurs when bile contains too much cholesterol.

Your risk for gallstones increases if you’re in the following (independent) risk classes:

Female: Estrogen may increase cholesterol levels in bile. It may also decrease the contractions of the gallbladder that expels the juices from it. That stagnation produces an environment in which gallstones may form.
Obesity and a bad diet: Obesity increases the amount of cholesterol in bile, promoting stone formation. A bad diet (i.e., high in calories/carbohydrates and low in fiber) also increases the presence of gallstones.
Over 40 years old
Family history of gallstones
Mexican American
Native Americans have the highest rate of gallstones in the U.S., with almost 65% of women and 30% of men having them. They have genetic factors that increase the amount of cholesterol in their bile.
Rapid weight loss: Those of you on extremely low-calorie diets and having bariatric surgery increase your risks. As the body breaks down fat during fasting, the liver secretes increased levels of cholesterol into bile.

The symptoms of gallstones (a “gallbladder attack”) are pretty typically pain, nausea and vomiting, although many people with gallstones go without symptoms for a long time. Gallstones become especially problematic when they block the tubes (bile ducts) that transport the “digestive juices,” either through size or location. These attacks usually occur in the right upper portion of the abdomen (right below the chest and liver), which is where the gallbladder is located. Attacks tend to occur after a heavy meal, and they usually produces symptoms in the evening or late into the night.
See your physician ASAP if you develop any of the following symptoms:

Abdominal pain in the right upper portion of your abdomen that lasts more than four hours
Nausea and vomiting
Fever with abdominal pain
Jaundice (a yellowish coloration of the skin and/or the whites of your eyes)
Changes in the color of your stools (lightening) or urine (assume a tea-like color)

After diagnosis, treatment typically involves pain management and prevention of excessive fluid losses and dehydration. Surgery to remove the gallbladder due to excessive stones or symptoms is one of the most common adult operations in the U.S. Patients normally do fine after gallbladder removal, as the digestive tract can redirect the flow of bile and other digestive enzymes. Those that cannot undergo surgery have different treatment options, involving dissolving gallstones.
In summary, if this topic was particularly unappetizing, remember that in most cases, the risk and rate of formation of gallstones can be reduced by a high fiber, lower calorie diet, measured weight loss and exercise. Use this information to your advantage as you pursue those New Year’s resolutions!
Feel free to ask your SMA expert consultant any questions you have on this topic.
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.

Straight, No Chaser: When Good Drugs Do Bad—Drug Interactions

December 30, 2013Toxicology/DrugsAdverse effect, Benadryl, Drug, Drug interaction, Facebook, health, Pharmaceutical drug, Pharmacy, Prescription medication, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Substance abuse, WordPressJeffrey Sterling, MD

“Be sure to let your doctor know if you grow a third foot.”
Ok, well maybe that is about the only side effect you haven’t heard at the end of one of those commercials that seem to spend half of its time describing the side effects. If you pay attention to a pharmaceutical commercial, though, you’ll appreciate that even though medicines do a world of good, sometimes they cause significant problems. Those problems can become sped up or magnified by the effects of taking several drugs at a time. Alternatively, combinations of medications may make one or more of the drugs less effective. Regarding the medicines you’re taking, you should be clear if drug interactions can be minor and insignificant or serious and life-threatening. Let’s review the various types of drug interactions.

Drug/drug interactions: Two or more different drugs taken together may interact and cause an unwanted effect or change how the drug acts in the body. Here are some common examples:

An individual who already takes a sedative (e.g., sleeping pill) to help combat insomnia develops an exacerbation of their seasonal allergies. To treat the allergies, they decide to take an over-the-counter (OTC) antihistamine (like diphenhydramine, branded as Benadryl). Diphenhydramine also may cause drowsiness, so the combination of the medications may pose a danger to the person, especially if s/he is operating heavy machinery, such as driving a car.
Caffeine (which is a drug) in everyday foods—such as coffee and chocolate—also can interact with certain other drugs. In fact, caffeine is known to interact with over 80 different drugs, including about a dozen with which it produces serious effects. These include commonly used medications like aspirin, ciprofloxacin (branded as Cipro), guafenesin (the generic name for your favorite cough medicines) and diazepam (branded as Valium).
Nicotine (another drug) in tobacco products can interact with other medications, especially nicotine-replacement products. So if you’re taking medicine to help with your smoking cessation efforts, and you’re still smoking, you’re making the problem worse!

Drug/food interactions: If you’re a fan of grapefruit or chocolate, then it’s likely that your physician has cautioned you on drug/food interactions. These occur when certain foods or beverages interfere with the metabolism of certain medications. In the example of grapefruit, it’s known to interfere with metabolism of medications used to lower cholesterol levels (called statins). This can lead to adverse drug effects and actual liver damage. Other examples are to be found in the many foods (e.g., red wine, aged cheese) that affect the antidepressant class of drugs known as MAO inhibitors.
Drug/condition interactions: You see these all the time. Many different medication instructions warn you not to take them if you have certain medical conditions, as the medications may make the medical condition worse. Prominent examples include over-the-counter cold, cough and flu remedies that advise you not to take if you have heart disease or high blood pressure. Also if you have kidney or liver disease, any medicine that gets metabolized via one of those routes may have difficulty and delays in getting metabolized and excreted, leading to longer than desired activity of the given drug.
Drug/alcohol interactions: This is actually a subcategory of the drug/drug interaction because alcohol is a drug. It deserves special mention because drinking alcohol while taking certain medications can cause adverse effects related to the additive effects of alcohol and various drugs. Any medication involving the central nervous system or one’s mental state would likely be worsened by alcohol.
The best way to guard against these concerns is to discuss any new medications with your physician or pharmacist prior to taking them. Be smart about medicines you’re putting in your body and don’t be cavalier about them; the wrong combinations can turn a medicine into a toxin.
One final note: don’t be lulled into complacency by herbal preparations as some form of replacement. Herbals are still medicines and work via the same active ingredient as the pharmaceutical drug they’re replacing. As such, they are subject to cause the same types of problems listed above. Even more concerning is that as a class, comparatively less research has been done on herbals. Therefore, the full extent of side effects and drug interactions is not defined. Not knowing the full extend of an herbal medicine’s side effect profile isn’t the same as saying the herbal doesn’t have side effects, and you shouldn’t interpret things that way.
Feel free to contact your SMA expert consultant for any questions you may have on this topic.
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.

Straight, No Chaser: Straight Talk About Vasectomies

December 29, 2013Genital/Urinary, Surgical Carehealth, National Institutes of Health, Pregnancy, Reproductive Health, Semen analysis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Surgery, Vas deferens, VasectomyJeffrey Sterling, MD

A couple’s conversation about having a vasectomy can either be a tense one or it can be a display of trust and cohesion. The decision by a man to have a vasectomy can be a soul-searching “moment of truth.” In this Straight, No Chaser, let’s look at seven of the issues surrounding vasectomies. At the end there’s an illustration of the procedure. Yes, it involves a clip.
A vasectomy is a surgical procedure that involves cutting the tube (the vas deferens) that carries sperm from the scrotum to the testes. The vasectomy prevents sperm from leaving the testes so that the man can’t impregnate a woman.
Issue 1: Why would you want it?
The answer to this is relatively straightforward. You’d want a vasectomy if you don’t want any, or any more, children. This is a form of sterilization.
Issue 2: When would it be a good option?
If you’re in a relationship and both partners agree that you’ve either had all the children you want or don’t want the risk of having any children, a vasectomy would be a reasonable option. Other considerations may include if you can’t use other forms of birth control, if pregnancy would be medically unsafe, or if the risk of genetic disease or a birth defect in your offspring is greater than you’re willing to accept.
Issue 3: When wouldn’t it be a good option?
This gets a little dicey and relates to levels of instability, either in your relationship or other personal situations. A decision to have a vasectomy to please your partner or salvage a relationship may not be the best choice. If you’re young or unmarried, you are subject to many life changes that may prompt reevaluating whether you really want a child. For example, if you marry/remarry, children may become more important than they currently are. A vasectomy is a surgical procedure with risks. A decision to have it done as a convenience (e.g., because you are unreliable or don’t want to use other forms of birth control) is irresponsible.
Issue 4: How successful is the procedure?
Vasectomies are very successful and have a failure rate of approximately 1 in 2,000. Comparatively speaking, the analogous procedure in females (tubal ligation) has a failure rate of 1 in 200-300. Typical failure rates are due to having sex too soon after the procedure. It takes time for existing sperm to be cleared from both ends of the vas deferens; that existing sperm can still impregnate a woman. This is a major reason why men should wait a week after the surgery and until the sperm count has been documented to be zero in the seminal fluid. To a much lesser extent, rare spontaneous reconnection of the clipped portions of the vas deferens may produce failures.
Issue 5: What complications exist?
Vasectomies are generally very safe, and the complications associated with it are those seen with any surgery. These include pain, swelling and infection. Remember, as we just discussed, the circumstances under which post-vasectomy pregnancies can occur.
Issue 6: What happens should I choose to have it reversed?
It is important for men considering a vasectomy to read and fully understand the next sentence. If you have a vasectomy, you should not consider it reversible. That said, you can spend a lot of money for a microsurgical reversal procedure that is successful about 50% of the time if done within 10 years of the vasectomy and approximately 25% of the time if done after 10 years. Be advised that such reversals are associated with a higher level of birth defects.
Issue 7: About what other considerations should I be concerned?

Men seemingly are most often concerned about post-vasectomy ability to have an erection or orgasm. Vasectomies do not diminish a man’s ability to have either.
You should be concerned about the spread of sexually transmitted infections (STIs), which a vasectomy does not prevent. A false sense of confidence may exist after a vasectomy knowing that pregnancy is extremely unlikely, but that has nothing to do with STIs. In fact the greater inclination to have unprotected sex after a vasectomy may put men at greater risk for transmitting or receiving STIs.
Vasectomies do not increase the risk of testicular or prostate cancer.

Most men are satisfied with vasectomies, because most men who have vasectomies do so in the context of a stable and healthy relationship. Men who are most likely to seek reversals do so in the context of unexpected life events (e.g., new partner/marriage with a desire for kids). Sometimes their reconsideration is in response to a tragedy. If you are considering a vasectomy, please only do so after a solemn view of the rest of your life. If you believe it to be stable, you will likely be satisfied with the outcome.
The following clip (click the link) is courtesy of the National Institutes of Health and demonstrates the logistics of the various approaches to the procedure. Feel free to leave any comments or ask any questions you may have.
Vasectomy
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.

Straight, No Chaser: The Treatment of Arthritis

December 28, 2013Geriatrics/Elderly Care, Medical Treatment, Orthopedics/Bones, Musculoskeletal SystemArthritis, Conditions and Diseases, Disease-modifying antirheumatic drug, health, Non-steroidal anti-inflammatory drug, Omega-3 fatty acid, Pain, Pharmaceutical drug, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The thing about treating arthritis is you’d better do it. If you’re not lucky enough to have a form that readily responds to treatment or if you didn’t get early treatment, your arthritis will progress and create an incrementally worse situation for you. Given that we’re discussing arthritis, we’re talking loss of mobility somewhere, maybe in your legs or hands, and pain.
The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause often cannot be cured.
Treatment considerations for arthritis fall into three general categories: lifestyle changes, medication and surgery. Let’s review each.
Lifestyle
The best time to enact lifestyle changes is before you’re struggling to return to normalcy. Exercise is a lifelong habit that will improve the quality and extend the quantity of your life. For starters, exercise maintains and improves muscle tone. It also strengths your bones and cartilage. This will reduce pain, fatigue and stiffness over the long term.
Exercise should include a tolerable level of aerobic activity, flexibility exercises to sustain your range of motion and strength training to maintain and improve your muscle tone. Physical therapy is another component; massage, heat and ice application, splints and other treatments are important in maintaining blood flow, mobility and positioning as stiffness and deformity increase over time.
Medication
Using medication for arthritis is a very delicate act. Many if not most arthritics are aging and may have other medical issues. Medications in these settings have risks for side effects and drug interactions, including kidney, liver and heart damage, stroke, ulcers and bleeding. Any medications should be coordinated with your physician. Typical over-the-counter (OTC) medical regimens begin with acetaminophen, then move to NSAIDs (non-steroidal anti-inflammatory agents such as ibuprofen, aspirin or naproxen).
When OTCs don’t work, your doctor may prescribe medicines, including steroids and other medications called biologics, immunosuppressants and DMARDs (disease-modifying anti-rheumatic drugs). These drugs all are effective in certain patients but can have serious side effects.
Surgery
Surgery is an option if and when other therapies haven’t worked and if the patient is healthy enough to have it. There are two primary options. Arthroplasty rebuilds the joint, and joint replacement starts from scratch.
Let’s start back where I’ll always hope you start: prevention. Here are some lifestyle change tips for holding off the onset of arthritis or slowing down its advance.

If you are overweight, do what you can to slim down. Weight loss significantly reduces joint pain in the legs and feet.
Eat a healthy diet full of fruits and vegetables. Among other things, a rich supply of vitamin E yields benefits you’ll need. Also eat foods rich in omega-3 fatty acids (e.g., salmon, mackerel, herring, flaxseed, canola oil, soybeans and soybean oil, pumpkin seeds, and walnuts).
Sleeping eight to 10 hours a night and taking naps during the day can help you both prevent and recover from flare-ups more quickly.
Avoid staying in one position for too long.
Try stress-reducing activities, such as meditation, yoga or tai chi.
Avoid positions or movements that place extra stress on your sore joints.
Change your home to make activities easier (e.g., grab bars in the shower, the tub, and near the toilet).
Consider capsaicin cream over your painful joints. Typically expect improvement after three to seven days if it’s going to help.

If and when you develop arthritis, it’s going to be a tough time. Get ahead of the challenge and take care of yourself in advance. Feel free to ask questions or leave 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.

Straight, No Chaser: The Inevitable Disease (Assuming You Live Long Enough)

December 28, 2013Geriatrics/Elderly Care, Orthopedics/Bones, Musculoskeletal SystemArthritis, Conditions and Diseases, Facebook, health, Inflammation, Joint, Musculoskeletal Disorders, Osteoarthritis, Psoriatic arthritis, Rheumatoid arthritis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Actually, humans have a few different “inevitable” diseases, but today we’re discussing arthritis, specifically degenerative joint disease (osteoarthritis). For this conversation, the inevitability of arthritis is based in the gradual wear and tear on your joints. It seems our design includes an expiration date on our joints. By now, you’re likely wondering why. The answer is in the definition.
Arthritis is inflammation of one or more of your joints.

Inflammation is a process of some form of attack to an area, producing symptoms that usually include redness, swelling, warmth and pain.
A joint is the area where two bones meet.

It stands to reason that when regular use becomes wear and tear, ongoing inflammation ensues, the structure of your bones and joints changes and function decreases. This is why you see decreased movement and deformities in the involved joints of arthritics.
What I just described was a reasonable description of osteoarthritis, the most common form of arthritis, but in fact there are over 100 different types of arthritis. Given its importance in helping you understand and treat yourself and/or your loved one with arthritis, let’s review the common and distinguishing mechanisms.

Arthritis involves the breakdown of cartilage, which is the tissue coating the ends of two bones at a joint. Its purpose is to keep the bones in place and moving smoothly. When cartilage is damaged, the bones rub together. This damage results in pain, swelling, stiffness, warmth and redness—inflammation.
The causes of this inflammation are broad but typically center on four mechanisms:

The aging process itself causes sufficient wear and tear on the body, including bones and cartilage, such that the joints will suffer. This represents the most common form of arthritis: degenerative joint disease, aka osteoarthritis.
When you break bones, especially near a joint, the resulting damage and/or insufficient healing will expedite the development of arthritis.
When you develop certain infections, they can occur in the bones/joints or target those areas. This also can lead to arthritis.
The body’s immune system sometimes mistakenly views certain parts of the body as foreign. When this occurs, it will attack healthy tissue, including bones and cartilage. These conditions are known as autoimmune disorders, and they cause inflammation and can lead to acute and chronic arthritis.

You’ve heard of many different forms of arthritis. If you know anyone with any of the following diseases, they likely have arthritis as part of (if not the predominant feature of) the disease.

Ankylosing spondylitis
Gonococcal (i.e., due to gonorrhea) arthritis and other arthritis due to other bacterial infections
Gout
Juvenile rheumatoid arthritis (in children) and rheumatoid arthritis (in adults)
Psoriatic arthritis
Reactive arthritis (Reiter syndrome)
Scleroderma
Systemic lupus erythematosus (SLE)

The inflammation and other symptoms usually go away if you can find and treat the cause. If it doesn’t go away, or if it goes untreated, chronic arthritis will develop.
Here are the various conversations you should have with your physicians regarding arthritis:

“I have a family history of arthritis. Should I be concerned?”
“I have a newly swollen joint but didn’t strain or sprain anything.”
“All of a sudden my joint (or joints) have really started hurting.”
“My skin in my (knee, elbow or other joint) is very hot and very red.”
“I have arthritis, and now I’m having problems moving my joint.”
“I have arthritis, and the swelling is much worse.”
“I have arthritis, and my pain has lasted more than three days.”
“I have arthritis, and I have developed a fever plus my joints are really aching.”
“I have arthritis, and I seem to be losing weight.”

This afternoon, I’ll discuss general treatment of arthritis and tips you can use to help yourself or your loved one with arthritis. I welcome any questions or comments you may have on this topic.
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.

Straight, No Chaser: When the Patient Knows Better

December 27, 2013General Health and Wellness, Public HealthAsthma, Conditions and Diseases, Cough, health, Influenza vaccine, medicine, Physician, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

So … your friendly neighborhood ER physician chats with a patient.

Client: “Doc, I’m sick. I need my asthma medicine. I need steroids, an inhaler and some antibiotics.”
Expert: “Oh really. How do you know that?”
Client: “Oh, I get the same thing this time every year.”
Expert: “Hmm. Same time every year, huh? Would you mind telling me your symptoms first?”
Client: “Cough, chest tightness, wheezing. I’m telling you. Same thing every year.”
Expert: “Have you gotten your flu shot this year?”
Client: “I haven’t had the flu shot since 2005, but I’m going to get it in January. But this is my asthma! C’mon, Doc. I just need my antibiotics and my asthma medicine.”
Expert: “There’s an adage in medicine that has been proven true a million times over. A physician that treats himself has a fool for a patient. Now, if physicians won’t treat themselves …”
If I’ve heard it once, I’ve heard it a million times.

“I know my body.”
“I’ve had the exact thing before.”
“I read it on the Internet.”
“I had a friend with the same thing.”
“I just want to make sure.”
“Well you have to do something, don’t you?”

Medicine is a science. By that, I mean a real science made of facts—not opinions, educated guesses or perspectives. There are seemingly a million paraprofessionals and incredibly intelligent people on the periphery of healthcare who have what we describe as an “experience base.” That means they “know” it because they’ve seen it or just read it. That is completely different than a knowledge base. Physicians have completed between seven and 10 years after undergrad learning, understanding and mastering the human body. What does that mean to you? Basically, the methodology for practicing medicine is not the linear A+B=C (i.e., “I have this symptom, therefore it must be this disease”).
Yes, this applies to you. Even you, dear “I know my body better than you do” reader. When you tell your physician that you’ve seen or experienced something before, you’re basically suggesting your sample size of one defines the entire universe of medicine. Even as it applies to you, the body is a wondrously complex creation with many, many variables affecting a single breath or heartbeat.
So, when your physician is telling you something different than what you believe or expect to hear about your condition, it’s not that s/he isn’t listening to you. It’s that s/he has listened to you and has come to a different determination. That’s why physicians have the power to write prescriptions, and you (and even pharmacists) don’t.
Of course, none of this is to say that your input isn’t valuable. It is valuable, and that’s why the physician asks you the questions. This is not even to say that physicians don’t make mistakes. This is to challenge you to allow the conversation to occur. Ask your own questions. Demand an explanation from your caregiver. Insist on being part of the care team and a partner in your treatment plan. Learn what to look for, what you can do at home and what should prompt additional measures. If you are stuck on a course of treatment before the conversation occurs, it is just as pointless as if a physician refuses to listen to your concerns.
Cut your physicians some slack. Many of you get so frustrated and outright angry when you don’t get your way. Physician’s offices and emergency rooms are not grocery stores. It’s not as if docs own the pharmaceutical company or the hospital. They’re just trying to care for you as best they can. As much as physicians love to provide satisfaction to patients, caring for you appropriately is of a higher order. Many of you understand this, and as such physicians continue to have among the highest rating of “trust” among professionals. It’s a privilege to take care of patients. The overwhelming majority of us still understand that fact.
Postscript: It was the flu.
PPS: A little advice from a friendly online SMA expert might have saved her the trip to the ER.
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.

Straight, No Chaser: The Challenges and Frustration of Acute Bronchitis

December 26, 2013Respiratory/LungsAcute bronchitis, Bronchitis, Bronchus, Chronic bronchitis, Cough, Fever, health, Inflammation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Tobacco smoking, WordPressJeffrey Sterling, MD

Imagine what it looks like when someone gets hit in the jaw. There’s the redness, swelling from excess fluid in the area, warmth and pain. Those are the components of inflammation. Now imagine those symptoms in your lungs as you’re trying to breath and deliver oxygen to the rest of your body. Off the top of my head, I can’t think of a more frustrating diagnosis than bronchitis for both patients and physicians alike. I’ll get into the reasons for that soon enough, but a bit of explanation is definitely in order.
Bronchitis is inflammation of a portion of the airways (the bronchi). Far and away, bronchitis is seen in smokers and after a viral, upper airway infection (e.g., a cold, the flu). In that last statement I slipped in two words that create the frustration regarding this condition: viral and smokers. There’s still more to come on what that means for you.
Everyone reading this has suffered from bronchitis at some point, and, based on what’s already been said, it’s easy to figure out what the symptoms would be. The inflammation of your airways leads to a cough, shortness of breath, chest discomfort, a mild fever and fatigue. If you have asthma, you’re likely to start wheezing. Another major source of frustration is even after the bronchitis has gone away or been treated, the cough stays around for up to an additional four weeks. This gives many the impression that they’re still sick, and leads them to demand that the doctor do something to “fix it.”
There are a few more problems dealing with or treating acute bronchitis.

Bronchitis is actually the most common cause of coughing up blood. Coughing up blood or producing blood-tinged mucus tends to make people anxious, and they often start thinking of things like cancer. That train of thought makes some people want to take every test possible to rule out cancer, “just to be sure.” Now your physician knows better and isn’t going to do that unless you have additional symptoms or tell a story more consistent with cancer. That often leads to a lot of frustration and sometimes anger.
Bronchitis is most often caused by smokers who don’t stop smoking even while they’re suffering. It is a very tense conversation (from both sides) when you return to the ER five days after being seen and diagnosed with bronchitis, and you’re complaining because you’re not better. Folks, even if your physician puts out the fire, if you continue to relight the match, it’ll continue to blaze.
Bronchitis is not pneumonia, which is an infection of the lungs. In most cases where bronchitis has an infectious cause, that cause is a virus. Viruses do not respond to antibiotics. You physician understands that you’re sick. Just because you’re sick and coughing, that doesn’t mean you need antibiotics or that antibiotics will cure you. Inappropriate antibiotic use is not without long-term complications that you should want to avoid. (Click here for a discussion on inappropriate antibiotic use.) In most cases, assuming you remove the source of inflammation (e.g., cigarette or cigar smoke, dust, allergens), your symptoms will improve on their own within a week, and all you need is supportive therapy such as cough, fever and pain medicines along with fluids and rest. You must also practice good hygiene to avoid spreading any viruses that may be causing the bronchitis.
What complicates this is when your weakened state and continued exposure to whatever is causing the inflammation allows a bacterial infection to land on top of your bronchitis. Ask your physician if it’s possible that this is what is going on. S/he will know how to proceed, including potentially using antibiotics.
In a majority of cases, a diagnosis of bronchitis will be a big source of frustration for patients because, from the physician’s standpoint, bronchitis is an easily diagnosed condition due to an obvious cause (such as a cold or cigarette smoking). As such, your physician is likely not to order a lot—or any—tests. Now from the patient’s standpoint, don’t you just hate going to the physician’s office or ER when you’re sick and “nothing” gets done? Well, especially in an ER setting, tests are not used to make diagnoses. They’re meant to be ordered if the results will change the management of the condition or might lead to a change in what is done with you (e.g., admit you to the hospital). Most often, that’s just not going to be the case with bronchitis. Now if after 3–5 days symptoms haven’t improved, you’ve stopped smoking and the mucus you’re coughing up looks a certain way, there’s plenty that will be done differently in most cases.

Please don’t take any of this to mean that you shouldn’t be seen for bronchitis. My effort today is to temper your expectations and help you appreciate what your physician is looking for and thinking. Here are some specific signs and symptoms to look for when you’re suffering from acute bronchitis that indicates a level of seriousness warranting prompt attention:

You have a documented high fever or have had a documented fever for more than three days.
You have greenish or bloody mucus, or you are coughing up only blood.
You have shaking chills.
You have chest pain or shortness of breath.
You have heart or lung disease (such as asthma or COPD/emphysema).

Over time, bronchitis can become chronic if the source of the inflammation isn’t removed. If you find yourself with ongoing symptoms for over three months, you will fall into a different category known as chronic bronchitis. Your physician will need to address additional considerations for you.
So often patients with bronchitis are looking for a “quick fix.” As is often the case, that fix is to be found in prevention. In this case, good hygiene and avoidance of smoke and other lung irritants can save you a lot of the shortness of breath and chest pain associated with bronchitis (pun intended).
Feel free to contact your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) 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: The Intersection of Health and Happiness, aka Merry Christmas!

December 25, 2013Mental HealthChristmas, Facebook, Hanukkah, Happiness, Harvard School of Public Health, health, mental-health, Merry Christmas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Today is Christmas, and we want to celebrate the best parts of you! Even better, do that for yourself and allow that to translate into better health. We have previously discussed your bad habits and how they negatively impact your health. Click here for that discussion. The literature on negative energy and health is well documented and robust. In short, avoid negativity and those that bring it to you! That said, we’re following our own advice and going positive today. That’s the other half of the “health and emotions” equation:

STATE OF MIND = STATE OF BODY.

So here we go.

Research from the Harvard School of Public Health (Go, Crimson!) led by Laura Kubzansky, Associate Profession of Society, Human Development and Health, identified personal attributes that actually do translate into better health. Specifically these personality traits have been shown to help avoid or healthfully manage depression, diabetes, heart attacks, strokes and other diseases.
Her landmark 2007 study followed over 6,000 men and women for over 20 years, discovering that a sense of enthusiasm, hopefulness, engagement in life and the ability to face life’s stresses with emotional balance appears to reduce the risk of coronary heart disease. Her studies have also demonstrated that children with a positive outlook and ability to focus on a task at age seven are in better health with fewer illnesses 30 years later. An additional finding of hers is that optimism cuts the risk of coronary heart disease in half.
This isn’t that hard. It just requires a rewiring of some of our outlook on life. Make a change today. Become a more positive person; become a healthier person! Incorporate these mental lifestyle changes and reap the benefits.

Emotional vitality: a sense of enthusiasm, hopefulness, engagement
Optimism: the perspective that good things will happen and that one’s actions account for the good things that occur in life
Supportive networks of family and friends
Good “self-regulation,” i.e., bouncing back from stressful challenges and knowing that things will eventually look up again
Healthy behaviors such as physical activity and eating well
Avoidance of risky behaviors such as unsafe sex, drinking alcohol to excess, and regular overeating

Speaking of Christmas, the Straight, No Chaser team greatly appreciates your readership, support and feedback. In a matter of a few months, over 3,000 of you both follow us and like us on Facebook. We’ve had readers in over 105 countries around the world. Most of all you’ve helped us successfully launch www.SterlingMedicalAdvice.com (SMA). We’ll continue to give you information to make a difference in your lives. Please continue to share your stories. It is very fulfilling and fascinating to hear how these efforts have made a difference in your lives. Feel free to continue to send us topic requests. We generally find a way to work them into the schedule.

Thank you so much, Merry Christmas, Happy Hanukkah, Happy Kwanzaa, peace and blessings throughout the holiday season.

Feel free to ask your SMA expert consultant if you have any questions on this post.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com 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: Flu Myths and Questions

December 24, 2013Infectious DiseaseCDC, Center For Disease Control and Prevention, Centers for Disease Control and Prevention, Disease, health, Influenza, Influenza vaccine, Influenza-like illness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Vaccination, Vaccine, WordPressJeffrey Sterling, MD

Every year 36,000 people die and over 200,000 are hospitalized each year due to the flu—in the U.S. alone. If you’re not getting a vaccine every year, you are subjecting yourself to a significantly higher risk and allowing fears and myths to get the better of you. Knowledge is power. Learn the facts.
Does the flu shot give you the flu?
No, no, no. The influenza vaccine cannot cause flu illness. There are vaccines that involve the delivery of live virus, including mumps, measles, rubella, chicken pox and polio. Influenza is not in that category. Flu shots are made either with ‘inactivated’ vaccine viruses that are not infectious or they contain no flu vaccine viruses at all (and instead have recombinant particles that serve to stimulate your immune system).
The most common side effects from the influenza shot are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. These symptoms are among the same symptoms you see with influenza, so it’s easy to confuse them as flu symptoms. They are not.
Controlled medical studies have been performed on humans in which some people received flu shots and others received shots containing salt water. There were no differences in symptoms other than increased redness and soreness at the injection site for those receiving influenza vaccine. The flu shot does not give you the flu.
I swear I’ve gotten the flu right after getting the flu shot! How is that possible if I can’t get the flu from the flu shot?
I always remind people that the flu vaccine does an even better job of preventing you from dying from the flu than it does in preventing you from catching the flu (and it does that at a 70–90% rate). It primes your immune system to better fight off the influenza virus when you’re exposed to it.
There are several reasons why someone still might get a flu-like illness after being vaccinated against the flu:

Influenza is just one group of respiratory viruses. There are many other viruses that cause similar symptoms including the common cold, which is also most commonly seen during “flu season.” The flu vaccine only protects against influenza, so any other infection timed correctly can give you similar symptoms.
When you get immunized against influenza, it takes the body up to two weeks to obtain the desired level of protection. There is nothing preventing you from having been infected before or during the period immediately before immunity sets in. Such an occurrence will result in your obtaining the flu despite being vaccinated.
An additional reason why some people may experience flu-like symptoms despite getting vaccinated is that they may have been exposed to a strain of influenza that is different from the viruses against which the vaccine is designed to protect. The ability of a flu vaccine to protect a person depends largely on the match between the viruses selected to make the vaccine and those causing illness among the population that same year.
It is also the case that the flu vaccine doesn’t always provide adequate protection against the flu. This is more likely to occur among people that have weakened immune systems or people age 65 and older. Even if the vaccine is 90% effect, some individuals will contact the flu despite having been vaccinated.

Please don’t get the wrong message from this section. These explanations are the exceptions, not the rule. In the overwhelming number of cases, the influenza vaccine does an excellent job of protecting against and prevent disease from the influenza virus.
Is it better to get the flu than the flu vaccine?
No. Influenza causes tens of thousands of deaths every year. If you have asthma, diabetes, heart disease or are especially young or old, you are placing yourself at significant risk by not getting vaccinated. Even if you aren’t in one of the above categories and are otherwise healthy, a flu infection can cause serious complications, including hospitalization or death.
Why do I need a flu vaccine every year?
The Center for Disease Control and Prevention (CDC) recommends a yearly flu vaccine for just about everyone six months and older. Once vaccinated, your immune protection decreases over time. These boosters are scheduled and dosed to help you maintain the best level of protection against influenza. Additionally, the virus mutates (changes) every year, so what you were covered for this year may not apply next year.
You can make a decision not to get vaccinated, and Straight, No Chaser has posted tips for you to protect yourself in the event you choose not to. (Click here to review.) However, you’re doing so in the face of the solid consensus of medical evidence and research. You should seriously question the motives or knowledge of someone who suggests that you should not get vaccinate for influenza, particularly if they profess to be involved in healthcare. Get vaccinated.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Page 7 of 15

« Previous 1 … 5 6 7 8 9 … 15 Next »