Tag Archives: health

Straight, No Chaser: Text Neck and Other Smart Phone/Computer Related Difficulties

December 16, 2015General Health and Wellness, Health Prevention, Musculoskeletal System844-SMA-TALK, Behind the Curtain, 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.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Flu Myths and Questions

December 14, 2015General Health and WellnessBehind the Curtain, CDC, 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 who 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, but frankly, that’s accepts a risk that you flies in the face of a reasonable risk/benefit analysis, and you would be 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.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Suicide Data – Understand the Threat

November 30, 2015Mental Health, Public Health844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

There are amazing, shocking and saddening facts about suicide. It is equally amazing that we aren’t discussing this as an epidemic. Consider the following information provided by the Centers for Disease Control and Prevention:
There were an average of 105 suicides a day in the U.S. (over 38,000 for 2010).
An estimated 8.3 million adults reported having suicidal thoughts in the past year.
Suicide is the third leading cause of death among those aged 15-24, the second among those aged 25-34, the fourth among those aged 35-54, and the eighth among persons aged 55-64.
For those committing suicide:

33.3% tested positive for alcohol.
23% tested positive for antidepressants.
20.8% tested positive for opiates (such as heroin and prescription pain killers).
There is one suicide for every 25 attempts.

Females are more likely than males to have had suicidal thoughts, but suicide among males is four times higher than among females (in other words, females think about it and try more often, but males complete the act more often.).
Among Native Americans aged 15-34, suicide is the second leading cause of death, fully 2.5 times higher than the national average.

There are some topics that aren’t amenable to Blogs. Depression and suicide are among them. They can’t be done justice. What I can try to do is break components of the conversation into bite size pieces and give you information to work with. I’ll do this in three parts. Above, I’ve shown you the magnitude of suicide. In the next post, I will help you understand what clinical depression looks like, then finally, I’ll review some Quick Tips to help you prevent falling into the deepest levels of depression and to help you know when immediate attention is required. Just remember: this isn’t the type of depression that involves having a bad day. I’m talking about when your downward mood interferes with your activities of daily living. I’m describing depression that introduces suicide and homicide as an option. If you don’t read these for yourself, read them for knowledge. Someone you know may be affected.
I welcome any questions, comments or thoughts.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Tips to Deal with Depression and The Holiday Blues

November 27, 2015General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Depression, Disorders, health, Major depressive disorder, Mental disorder, Mental health professional, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

Here’s five tips for your holiday mental health:

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

Know when you need professional help. If your support system doesn’t sufficiently address your needs, and you’re feeling severely depressed, can’t function or are suicidal or homicidal, find a physician or mental health professional ASAP. Of course, you can always contact your SterlingMedicalAdvice.com expert. If you type mental health, depression or other keywords into the search bar above, you can access many other Straight, No Chaser blogs on behavioral health concerns that may provide you the support you need. I wish you all the best today and throughout the year, and hopefully the picture above will reflect the only type of blues you’ll have to deal with this year.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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

November 18, 2015General Health and Wellness844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Diabetes, Diet, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

Let’s take a moment to discuss prevention and treatment. There are different types of diabetes, but the risk of one form of diabetes in particular can be reduced by – you guessed it – diet and exercise. In fact, diet, exercise and medications are the three legs of the diabetes treatment stool regardless of type. Some patients require regular insulin injections and others require pills. Still others who are successful with diet and exercise are able to markedly reduce, and in some instances eliminate medications.
If you’re a diabetic, make an investment in your education. It could not only save your legs or eyes, but it may just save your life. I welcome your questions and comments.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Cerebrovascular System (Your Brain)

September 11, 2015General Health and Wellness, Neurology, Health Prevention844-SMA-TALK, Behind the Curtain, Blood vessel, Brain, Cerebrovascular disease, Conditions and Diseases, health, Neurological Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Transient ischemic attackJeffrey Sterling, MD

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

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

Challenges: Unlike many of the other systems I’ve discussed, the effects of these changes on our brain health status can be drastic, ranging from slight discomfort to death, and they involve major physical as well as social components. The social implications of these effects can be just as severe as the physical, as those suffering become less functional both mentally and physically. Unfortunately, in varying degrees stroke survivors become or perceive themselves to be a burden to others. Social interactions are doubly inhibited: internally, the patient is less able to interact; and externally, family, friends, and others may be less interested in interacting with them. This is sad, but true (think about the lives of the stroke survivors you may know…).
Solutions: The alternatives are twofold: after the fact, education is essential by a loved one’s support group and community, otherwise a stroke becomes a different type of life sentence. Physical and occupational therapy save lives and the quality of lives. Continuing to value and show value to your loved ones can make all the difference in the world. Before the fact, again, it’s preventive measures such as diet and exercise that have been shown to decrease or even prevent strokes. I cannot overemphasize how vital diet, exercise and the avoidance of toxins are to your long-term health.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Genital System

September 9, 2015General Health and Wellness, Genital/Urinary, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, health, Human sexual activity, K-Y Jelly, Masturbation, Sex education, Sex organ, Sexual intercourse, Sexuality, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The third part of this Straight, No Chaser series on aging is about your genital system after 40. There’s a lot here both for the ladies and the gentlemen, but everyone should want to know all the information provided on either sex. As before, I’m going to go through changes – challenges – solutions. I welcome any questions or comments.

And now to today’s post.
Prologue: Sex is good for your long-term genital and mental health. I can’t think of a better, more sexy application of the truism ‘knowledge is power’. Men, feel free to discuss this with your ladies. Ladies, I promise you I’m not being biased here (wink).

Changes: Allow me to start with the most important point: sexuality is not truly an issue of aging as much as it is more an issue of education, psychological response and health. However some changes specific to the genital system do occur with aging. In men, the prostate may enlarge (does so in 50% of men at age 50), potentially causing frequent and urgent needs to urinate and difficultly holding urine. However, more changes occur in women than in men. In women, the uterus shrinks, and several changes occur in the vagina, resulting in decreased lubrication and elasticity being lost.
Challenges: The challenges here are interesting ones. Simple rules to better genital health – Women: Stay sexually active! Men: Be confident in your sexual stamina! It is important to understand that the changes that occur in the genital system are not as related to age as they are to one’s sense of sexuality. The physical changes in the genital system should be non-problematic, especially if sex has been occurring without long periods of abstinence.
Venus Challenges: On the female side, the physical changes all can be dealt with if the woman has maintained some regular level of sexual activity. Yes, genital responses to stimulation slow gradually in both men and women, but you can have normal sexual relations at any age, as long as you are healthy. If after the age of about 40, a woman abstains from intercourse for prolonged periods (such as 3 to 5 years) the ability to secrete lubricating fluids, and much of the elasticity of the vagina are permanently lost.

Mars Challenges: On the male side, a particularly annoying challenge for some men with prostate enlargement is to avoid self-wetting. The even greater challenge is (not believing, but) ‘knowing’ your sexual prowess and stamina are still intact, particularly if dealing with an intimidating female partner (e.g. better conditioned, more adventurous or perhaps younger). For males, premature ejaculation and impotence are dramatically reduced in men when they become legitimately confident in their sexual skills set. Work on that! Women, feed your men confidence! It will come back to you!
Venus Solutions: Masturbation can effectively help to maintain female capabilities to provide lubrication and elasticity, especially if object insertion is included. Since most research shows that less than 50% of women practice object insertion during masturbation, these women who also abstain from intercourse lose some vaginal elasticity, even with regular masturbation. In the event that the woman has been sexually abstinent for a period of 3 to 5 years or more, the use of K-Y Jelly or some other non-alcoholic, non-petroleum lubricant specifically designed for compatibility with the chemistry of the vagina may sufficiently reduce discomfort in sexual intercourse.
Mars Solutions: Remember that most sexual problems are social/psychological problems, and they occur at all ages. Men: work on learning what’s necessary to give you confidence, and better performance will follow. For some it’s a certain partner, for others it’s a pill. Do not underestimate this point: if you’re otherwise healthy, that enhances your ability to perform sexually! It’s all about blood flow anyway.
Solutions Epilogue: The main solution to age-related issues of the genitalia are all within your reach (no pun intended): it’s all about activity, especially continued regular sexual activity, exercise, good nutrition and other healthy habits.
Post-script: Petroleum products such as baby oil and vaseline must never be put in or on the vagina, as they will upset the pH balance of the vagina, making it susceptible to yeast infections and other problems like BV (bacterial vaginosis).
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Musculoskeletal System

September 8, 2015General Health and Wellness, Health Prevention, Musculoskeletal System844-SMA-TALK, Adipose tissue, Behind the Curtain, Fitness, health, Muscle, Myocyte, Physical exercise, Skeletal striated muscle, Stem cell, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Weight lossJeffrey Sterling, MD

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

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

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

Young is as young does.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Life Begins (to End) at 40 (Unless It Doesn’t) – The Skin

September 7, 2015General Health and Wellness, Skin/Dermatology, Health Prevention844-SMA-TALK, Beauty, Behind the Curtain, Cosmetics, health, Herpes zoster, Human skin, Skin, Skin Care, Skin neoplasm, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

Part 1/5: Your Skin

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

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Suicide and Suicide Risks in College Students

July 28, 2015General Health and Wellness844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

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

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

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

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

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

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

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

There are many Straight, No Chaser posts that address suicide prevention, diagnosis and treatment. Feel free to use the search box on the right for additional information.If you are a college student or a family member of a college student, you would do well to review your college’s support system and learn about services and support available for those in need of mental/behavioral health services. College should represent the beginning of one’s adult life, not the place where it ends.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Shingles – Return of the Chickenpox

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

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

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

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

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

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

Quick Tips:

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

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

In the meantime, if you’d like to read Behind the Curtain ahead of its national launch, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

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

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

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

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

Aspirin (324 mg).

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

Activated charcoal.

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

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

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

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

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

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

They will address your concerns, route you to your local poison center, advise you on the appropriate use of activated charcoal and help coordinate your care when you go to your emergency department.
Be smart about the items in your home in general and in your medicine cabinet in particular. We’ll continue the theme with the next Straight, No Chaser.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: Your Questions About Human Bites

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

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

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

2) What’s a Boxer’s Fracture?

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

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

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

4) Is a bite the same as a puncture wound

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

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

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

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

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

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: Human Bites

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

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

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

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

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

So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies like peroxide, alcohol, and anything else that burns. Those agents make things worse by damaging the skin more than they “clean” the area.
2) Apply ice—never directly to the wound—but in a towel. Use for 15 minutes on and then 15 minutes off.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: When Foreign Bodies are Ingested

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

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

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

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

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

Management of swallowed or aspirated foreign body depends on the size of both the object and child and the object’s location.
1) If it’s in the stomach or beyond: unless there are multiple sharp objects that suggest something’s been perforated, little will be done, and you’ll be instructed to wait and watch for it in the stool.
2) If it’s in the airway, this is an emergency, and a lung specialist will need to get the object out with a special scope.
3) If it’s in the food pipe but not yet in the stomach or beyond, what’s done will depend on the size and location. Esophageal foreign bodies (that is, those in the food pipe) generally require early removal by a specialist because of their potential to cause respiratory problems (by manual pressure onto the windpipe) and complications to the esophagus itself (scratches, burns or even rupture). Most notably, ingestion of those annoying button batteries, and their lodging in the esophagus require urgent removal even if no symptoms are present because of an unacceptably high risk of complications. Sharp foreign bodies (except for single straight pins) are especially dangerous and prone to complications and most likely will also need to be removed.
So, after all that, is there any wonder why we ask you to child-proof your home? The dangers are real, and the drama of an ER visit for these things is avoidable and worth being diligent at home. Have a great, safe, healthy and happy weekend.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: When Sex Hurts Her – Vaginismus

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

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

Here’s three things you need to know:

She’s not faking it.

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

Vaginismus can be cured.

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

Vaginismus requires patience (and flexibility) to overcome.

Healthy sex lives are enjoyed by many couples without penetration. This is an important frame of mind to have, less the additional stress can hinder treatment and torpedo the relationship. It may seem like a lot to ask for some, but believe me, many couple maintain happy relationships in the midst of this, either during treatment or throughout a lifetime of suffering through it. Taking this mindset into the period during which treatment is ongoing can lead to a very happy outcome once the vaginismus has been overcome.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

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

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

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

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

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: Quick Workouts for the Couch Potato

May 15, 2015General Health and Wellness844-SMA-TALK, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Warning: This post includes adorable animal exercise pictures.

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

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

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

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

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

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

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

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

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

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

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

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

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

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

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

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

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

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

Unfortunately, some individuals just do not get better on their own. Although most people tend to improve with time after a community disaster, it is not uncommon for some to become more distressed and to exhibit more symptoms of PTSD, depression, and other mental health conditions. There are so many variables in play based on the type of disaster that occurred. Some people are effective at rebuilding their lives if the available resources are appropriate for the type of effect it had on them personally, but others may experience ongoing stress from loss of jobs and schools, trouble paying bills, finding housing, and getting healthcare. These types of stressors compound the effects of the disaster and may delay recovery in those affected by PTSD.
Many in the public health communities are embracing a comprehensive version of mass trauma “psychological first aid.” This complement to medical and financial resources is meant to fill existing voids in post-community disaster care delivery. Otherwise treatment approaches are generally similar to treatment of other forms of PTSD.
At the end of it all, disasters are just that. It would be a good thing for you and your family to be aware of the types of community disasters you may be exposed to and prepare before you ever need help. Having emergency numbers and other resources on your person at all times can be the difference between life and death when seconds count. Here’s hoping you either never need such assistance or you’re prepared enough during a disaster to make it through ok.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: The Effects of PTSD on Children

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

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

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

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

Clinginess
Bedwetting
Cessation of speech
Acting out the scary event

Teens may become disruptive, disrespectful, or destructive, and they may express guilt or engage in revenge.
Think about these things when your children have been victims of bullying, abandonment or assault. You have to think about PTSD in order to recognize help may be needed. It is very important to get counseling for children that have experienced a traumatic event. The effects may be subtle but could be devastating and long-lasting.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

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