Tag Archives: Hypertension

Straight, No Chaser: Sleep Apnea

March 7, 2017SleepBehind the Curtain, health, Hypertension, Non-rapid eye movement sleep, Obstructive sleep apnea, Sleep, Sleep apnea, Sleep disorder, Slow-wave sleep, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

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

Sleep apnea is easy and hard to diagnose at the same time. Many of you are suffering with it unsuspectingly as we speak. The person you sleep with may have expressed concern about your snoring or choking while you sleep. If so, get checked.
Sleep apnea once diagnosed is treatable with some combination of lifestyle changes, breathing devices and mouthpieces. Surgery is used in some cases.
We’ve reviewed many components of sleep and sleep disorders. Be mindful that sleep is your body’s time to rest and recover from the day’s activity. Any disruption in its ability to do that does not bode well for you over the long term. If your sleeping habits are problematic for you, you really should get evaluated. Getting this situation addressed can dramatically improve the quality of your life.
Finally, review the attached video for an illustration of what’s happening during sleep apnea. Excuse the scary music!
http://www.youtube.com/watch?v=Wm-TZ-dO_rQ
This discussion has focused on obstructive sleep apnea and not the less common form, central sleep apnea. The symptoms are similar, so if you have the other condition, it would be determined by your physician.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser In The News: The Life Expectancy of Americans Drops for the First Time in 20+ Years

December 9, 2016General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, accidents, Behind the Curtain, Cancer, Diabetes, drug overdose, high blood pressure, Hypertension, life expectancy, National Center for Health Statistics, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, TraumaJeffrey Sterling, MD

This is not a quirk, coincidence or mistake. Accordingly to the National Center for Health Statistics, for the first time in over two decades, life expectancy for Americans declined last year. This information is as shocking as it is rare.

Death rates increased in eight of the top 10 leading causes of death, including the following:

Heart attacks
Strokes
Diabetes
Drug Overdoses
Accidents

Deaths from Alzheimer’s disease represented the largest rate increase for any disease.

Even more concerning, these findings extend across all age groups and follow a five-year trend in which improvement in death rates were among the smallest improvements seen in 40 years. Death rates increased for white men and women and Black men, roughly staying the same for Black women and Hispanics. In case you were wondering, this increase in death rates is not being reproduced in other Western nations. The message here is there is a clear recent reduction in the health of the American citizen.
Many are confused and speculating about the causes for the near global reduction in life expectancy. Instead of guessing when the answers aren’t yet clear, I’d advise you to look for answers in the reporting on the only real positive finding: cancer showed a reduction in the death rate from cancer. The public health community would agree that specific innovation increase better prevention (specifically, fewer people are smoking), earlier detection (self-exams and adherence to screening regimens) and the development of new treatments that work best with good baseline health and early detection.

Straight, No Chaser has previously published a guide on how to live longer. Use these evidence-based pointers to buck the tide. Remember, misinformation and opinions are every bit as bad as bad health habits. Be informed and empowered.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Questions About High Blood Pressure (Hypertension)

December 8, 2016Cardiology/Heart, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, high blood pressure, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

High blood pressure (hypertension) is so prevalent and such a consequence of the way we live that you must already have an understanding of some basic principles if you care at all about your health. Feel free to offer your own questions or comments.

1. How do I know if I have high blood pressure?
You know by the numbers. Consider these defining blood pressure levels.
Normal – Systolic: < 120 mmHg, Diastolic: < 80 mmHg
At risk (pre-hypertension) – Systolic: 120–139 mmHg, Diastolic: 80–89 mmHg
High Systolic – Systolic: 140 mmHg or higher, Diastolic: 90 mmHg or higher
If you don’t already have a diagnosis of hypertension and are anywhere at or above the pre-hypertension stage, get checked by your physician.
2. But when should I get go to the emergency room for high blood pressure?
I’ll always want to see you if your bottom number (diastolic blood pressure) is at or above 110-115, regardless of whether you appropriately take your medication. Don’t look for symptoms to guide you. High blood pressure is called “the silent killer.”
3. If I do have high blood pressure, will I be placed on medication?
I really hope not, but honestly, approximately two-thirds of individuals in the U.S. who have high blood pressure are poorly controlled – even on medication. This means medication will be necessary for most. That said, theoretically, medication should be viewed as necessary only when necessary and only when other measures don’t work. You should discuss this with your individual physician and make every effort to improve your diet and exercise regimens. If and when you’re placed on medication, the choice of medication will be based on your age, sex, ethnicity, mobility, existing health profile and other considerations.
4. You mentioned I could have a heart attack or stroke from this? How would I know if that’s happening?
Check here for Heart Attack Recognition and here for Stroke Recognition where I discuss signs and symptoms. Remember, time is tissue, meaning you must not delay if you develop these symptoms.
5. What else can I do?
Be healthy! Don’t smoke. Limit alcohol intake. Lower your stress level. This is only a broken record if you’ve received the message and have implemented the recommendations.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: High Blood Pressure (Hypertension)

December 7, 2016Cardiology/Heart, General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, Blood, Blood flow, Blood pressure, Heart failure, Hypertension, Kidney, Muscle, Myocardial infarction, Organ, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

High blood pressure is called the silent killer. It’s common for me to see someone who thought they were ‘fine’ drop dead from its effects, never knowing it was about to happen and not having been aware of the warning signs and risk factors.
In lay terms, your heart is just a muscular pump pushing blood (containing oxygen and nutrients) around the body keeping stuff alive. The more you poison that pump (by ingesting unhealthy foods and inhaling other toxins) and strain the muscle by adding weight and clogging its vessels so it has to pump against more force (by being obese, not exercising and engaging in other unhealthy behaviors), the more likely that muscle is to strain until it gives out. Once it does, blood isn’t delivering what’s needed to your vital organs, and that’s when bad stuff happens.
The vital organs in question and those bad effects include the following:
• The heart itself (no blood flow and no oxygen = heart attack; when the heart’s not strong enough to pump blood around the body = congestive heart failure)
• The blood vessels, especially the heart’s main offshoot, the aorta (too much strain = aneurysm, an outpouching from the main tubular system, stealing valuable blood from the rest of the body)
• The brain (no blood flow and no oxygen = stroke; aneursyms also occur in the brain)
• The kidneys (not enough blood flow or adequate enough function to clear the toxins from the kidney = renal failure)
• The eyes (poor blood flow and/or diseased eye blood vessels leads to vision loss)

Bottom line: The heart is a muscle best thought of as a machine. Here’s three easy things you can do to reduce your risks.
• Get off your butt. Any exercise helps to get your heart pumping and blood flowing; strive for 20” three times a week at the very least.
• Close your mouth. Everything in moderation is cool, but introduce some fruits and vegetables into your life.
• Lose the salt shaker. At least taste your food first. It’s likely the food was already prepared with salt.
Did I mention stop smoking? Any questions?
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: End of Life Decision Making

November 25, 2016General Health and Wellness, Medical Treatment, Health Prevention844-SMA-TALK, Behind the Curtain, Blood 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, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Terminal illnessJeffrey Sterling, MD

Having this conversation when death is staring you or a loved one in the face is not the most ideal situation. Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.”
I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. It needs to sink in: at any age your life could be at risk, and at any age you could die. When your life is threatened, if you have specific desires, you’ll need someone comply with decisions. It could happen today. You need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.

Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and subsequently with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

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

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Quick Tips to Detoxify Yourself Naturally

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

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

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

Quick tips to naturally detox your lungs:

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

Quick tips to naturally detox your kidneys:

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

Quick Tips to naturally detox your liver and intestines:

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

It bears repeating: if all of this sound fundamental, it’s because it is. You have the ability to help yourself if you consistently apply basic health and wellness principles. You can do this.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Brain Health – Foods and Brain Healthy Habits

July 13, 2016General Health and Wellness, Mental Health, Neurology844-SMA-TALK, Alzheimer's disease, Behind the Curtain, brain health, dementia, Diabetes, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I only get asked about this everyday, so let’s review keeping your brain healthy. Unfortunately too often some of you only ask at the point when early dementia or Alzheimer’s disease has begun to develop, but this is another example of an ounce of prevention being worth a pound of cure. Also, these requests often seem to be related to some internet promise of health based on some fad or miracle cure. Remember the Straight, No Chaser dictum: your health won’t be found in a bottle.
In a previous post about how your brain works, we pointed out that your brain consumes a tremendous proportion of the body’s oxygen supply. So to begin the conversation, just remember that a diet promoting good blood flow throughout the body promotes good blood flow to the brain. I wish I could convince you that a baseline level of brain health is just this simple: consume a diet low in fat and cholesterol. If you’re not clogging the arteries in the rest of your body, you won’t be clogging arteries in your brain. The same things you’re doing to avoid diabetes and hypertension will help you here.
As such let’s provide an overview to five basic principles to keep your brain healthy. If you adhere to these, you can save the money you’re spending on ginkgo biloba.

Reduce your fat and cholesterol intake
It’s as simple as already discussed. High intake of these foods promotes a higher risk of Alzheimer’s disease later in life. Try these specific tips.

Use olive oil instead of other saturated fats.
Bake or grill your food instead of frying it.

Eat foods shown to protect and promote brain health
I want to make this simple. If you’re eating dark-skinned fruits and/or vegetables, you’re being good to your brain. These foods tend to have the highest levels of antioxidants fighting off damage to your brain cells. Here are some specific examples of brain healthy foods. Try working them into your diet.

Fruits – blackberries, blueberries, cherries, oranges, plums, prunes, raisins, raspberries, red grapes and strawberries
Vegetables – alfalfa and Brussels sprouts, beets, broccoli, corn, eggplant, kale, onion, red bell pepper and spinach
Nuts – almonds, pecans and walnuts are a good source of vitamin E, another powerful antioxidant
Fish – halibut, mackerel, salmon, trout and tuna (all contain omega-3 fatty acids, which are brain healthy)

Vitamins
The best way to obtain brain-healthy vitamins is through a brain-healthy diet. Foods strong in vitamins E, C, B12 and folate appear to be important in lowering your risk of developing Alzheimer’s. It should come as no surprise that the foods listed above meet that criteria. You may not know that obtaining vitamins through your food appears to deliver what you need better than taking pills.

Exercise
If you’re keeping your heart strong and pumping blood efficiently throughout your body, your brain is getting its needed supply of oxygen and nutrients. Check this Straight, No Chaser on basic exercise tips.
Be social, Be a lifelong learner
Exercise your brain through social interactions with others, especially those that “stimulate your brain.” The diversity of experience keeps different parts of your brain active, alert, functioning and healthy. Learn a new skill or language. It’s almost as good as starting over!
Another Straight, No Chaser will focus on additional ways for you to engage your brain to keep it working and working well.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Healthcare Disparities

April 17, 2016General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, colorectal cancer, Conditions and Diseases, death rates, Diabetes, healthcare disparities, HIV, Hypertension, immunizations, infant mortality, Influenza, life expectancy, Obesity, periodontitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

In large part, this blog exists to inform individuals of all backgrounds about the risks that lead to abnormal health outcomes. Our hope is that once you discover the risks, you’ll be sufficiently equipped and incentivized to take the simple steps provided to improve your health.
Disparities are abnormal outcomes of a different variety. Disparities in healthcare lead to premature development of disease and death. The culprits are often insufficient access to care, culture barriers, habits and even discriminatory practices. It is critical for all involved, i.e., individuals, healthcare planners and practitioners, to understand these causes so that everyone can adjust habits and apply resources to combat this health hazard affecting both individuals and communities.
For the last 25 years of my career, I’ve had the unfortunate privilege of addressing this topic in national forums, including before the National Urban League, before the National Medical Association, recently, in the NAACP’s The Crisis magazine and in Straight, No Chaser to extent that our service provides you with the information that can make a difference in your lives. Unfortunately for some, it’s almost never that easy.

As a statement of fact, according to the Center for Disease Control and Prevention (CDC) Health Disparities & Inequalities Report  of 2013, African-Americans suffer global health disparities that result in the following outcomes.

Life expectancy: In 2011, the average American could expect to live 78.7 years. The average African-American could only expect to live 75.3 years, compared with 78.8 years for the average White American.
Death rates: In 2009, African-Americans had the highest death rates from homicide among all racial and ethnic populations. Rates among African-American males were the highest for males across all age groups.
Infant mortality rates: In 2008, infants of African-American women had the highest death rate among American infants with a rate more than twice as high as infants of white women.

The following disparities were also reported:

Heart disease and stroke: In 2009, African-Americans had the largest death rates from heart disease and stroke compared with other racial and ethnic populations, with disparities across all age groups younger than 85 years of age.
High blood pressure: From 2007-2010, the prevalence of hypertension was among adults aged 65 years and older, African-American adults, US-born adults, adults with less than a college education, adults who received public health insurance (18-64 years old) and those with diabetes, obesity or a disability compared with their counterparts. The percentages of African-Americans and Hispanics who had control of high blood pressure were lower compared to white adults.
Obesity: From 2007-2010, the prevalence of obesity among adults was highest among African-American women compared with white and Mexican American women and men. Obesity prevalence among African-American adults was the largest compared to other race ethnicity groups.
Diabetes: In 2010, the prevalence of diabetes among African-American adults was nearly twice as large as that for white adults.
Activity limitations caused by chronic conditions: From 1999-2008, the number of years of expected life free of activity limitations caused by chronic conditions is disproportionately higher for African-American adults than whites.
Periodontitis: In 2009-2010, the prevalence of periodontitis (a form of dental disease) was greatest among African-American and Mexican American adults compared with white adults.
HIV: In 2010, African-American adults had the largest HIV infection rate compared with rates among other racial and ethnic populations. Prescribed HIV treatment among African-American adults living with HIV was less than among white adults.
Access to care: In 2010, Hispanic and African-American adults aged 18-64 years had larger percentages without health insurance compared with white and Asian/Pacific Islander counterparts.
Colorectal cancer: In 2008, African-Americans had the largest incidence and death rates from colorectal cancer of all racial and ethnic populations despite similar colorectal screening rates compared to white adults.
Influenza vaccination: During the 2010-11 influenza season, influenza vaccination coverage was similar for African-American and white children aged six months to 17 years but lower among African-American adults compared with white adults.
Socioeconomic factors: In 2011, similar to other minority adults aged 25 years or older, a larger percentage of African-American adults did not complete high school compared with white adults. A larger percentage of African-American adults also lived below the poverty level and were unemployed (adults aged 18-64 years) compared with white adults of the same age.

Identifying disparities is a good start. However, to reduce them it is necessary to identify and implement solutions, both individually and institutionally. To this end, we will explore best practices in future Straight, No Chaser posts. Feel free to ask any questions you have on this topic.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: A Foot Glossary and Introduction to Conditions Affecting Your Feet

March 26, 2016Orthopedics/Bones844-SMA-TALK, Arthritis, athlete's foot, Behind the Curtain, bunions, calcaneal fracture, cardiovascular d, diabetic foot ulcers, diabetic neuropathy, Haglund's deformity, hammer toes, high blood pressure, hyperhidrosis, Hypertension, ingrown toenails, neuroma, orthotics, peripheral artery disease, peripheral neuropathy, Psoriasis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, tendonitisJeffrey Sterling, MD

We talk a lot about health in Straight, No Chaser. We also try to help you recognize potentially troubling signs and symptoms. It’s appropriate to do so from the bottom up because so much weight is placed on your feet (no pun intended). Also, many people take their feet for granted and allow different types of conditions to progress before doing anything about them.
Today’s blog, done in conjunction with the American Podiatric Medical Association, aims to give you a working knowledge of conditions that affect your feet. Over the next few weeks, please use the posts on some of the individual topics mentioned below as a starting point for understanding various entities, conditions and diseases that relate to your feet.

Arthritis

Arthritis is inflammation of your joints, which are the spaces where various bones meet. The inflammation typically leads to pain, swelling, warmth and redness. As we age or as disease strikes, we are even more subject to arthritis in our feet, in the same way other joints are affected, because each foot has nearly three-dozen joints (33 to be exact). Straight, No Chaser has previously addressed the treatment of arthritis here.

Bone Spurs

Osteophytes (aka bone spurs) are bony projections that extend along the edges of bones. The main cause of bone spurs is the wear-and-tear damage associated with osteoarthritis (degenerative joint disease).

Cardiovascular Disease

High Blood Pressure Your feet are especially susceptible to the effects of hypertension (aka high blood pressure), because they represent the most distant point from your heart. As your heart’s function worsens–a manifestation of hypertension–your feet suffer from the effects of poor circulation (e.g., receiving suboptimal amounts of the oxygen and nutrients supplied by healthy blood). Check here for the Straight, No Chaser review of high blood pressure.
Peripheral Arterial Disease When fatty deposits (i.e., plaques) partially or completely block our arteries, the blood supply to various organs is compromised. This becomes even worse as the arteries become hardened with prolonged exposure. With the feet’s location being as far from the heart as it is, they are at higher risk.

Diabetes

Diabetic Wound Care

We have described diabetic foot ulcers here in Straight, No Chaser. You must be aware of the risks of losing limbs if you’re diabetic, as this occurs in approximately 15% of diabetics.
Diabetic (Peripheral) Neuropathy  The effects of high blood glucose (sugar) levels include damage of our peripheral nerves, called peripheral neuropathy. This phenomenon is most prevalent in the fingers and toes.

Foot & Ankle Injuries

Sprains, Strains & Fractures  These injuries compromise the ability of the feet to support and move the body.

$calcaneal fracture$

A sprain is an injury to the soft tissue of a structure such as the foot.
A strain (aka a pulled muscle) is an injury that results from excessive stretching and/or tearing of a structure’s supportive muscles.
A fracture is a disruption (e.g., break) in a bone.

Muscle & Tendon Problems

Haglund’s Deformity

 If you’ve ever heard the term “pump bump,” you know what Haglund’s Deformity is. This bony enlargement on the back of the heel often occurs in women who wear pumps.
Heel Pain  The heel bone (the calcaneus) is the largest of the 26 bones in the human foot. Due to size and stress, it is especially susceptible to injury.
Tendinitis  Tendinitis is the inflammation of a tendon prior to its disruption and represents one of the most common causes of foot or ankle pain.
Plantar fasciitis

Plantar fasciitis is inflammation of the tissue that connects the heel bone to the toes and creates the arch of the foot. This occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. Plantar fasciitis is usually quite painful, and that pain makes walking difficult.

Skin Disorders

Athlete’s Foot

 This fungal infection is the result of conditions favorable to fungal growth: dark, warm and humid conditions. It itches and hurts, but treatment is readily available when preventative measures don’t control it.
Corns and Calluses

Irritation to a part of the foot will prompt the body to form thicker skin to prevent irritation and injury. These present as corns and calluses.
Psoriasis

We have discussed  psoriasis here in Straight, No Chaser. It represents abnormally rapid production and replacement of skin cells. This causes a build up of dead cells on the surface that is recognized as scaly, dry and silver patches.
Skin Cancers of the Feet  Although more common on exposed areas of the body, skin cancer can develop anywhere, including on the feet. Skin cancers of the feet tend to present as recurrent cracking, bleeding or ulceration more so than with pain.
Sweaty Feet  Hyperhidrosis is the medical term for excessive sweating. This often presents on the palms of the hands and the soles of the feet.
Warts

When warts present on the feet, they tend to be painful. These are fleshy manifestations of a virus infection.

Toe Joint & Nerve Disorders

Bunions  Bunions occur at the base of the great toe and is an enlargement of the joint that forms when the bone or tissue actually moves out of place.

Hammer Toes  A hammer toe is a bending (contracture) of the toe at its first joint, (i.e., the proximal interphalangeal joint). This produces an appearance of an upside-down V.

Neuromas  A neuroma (aka “pinched nerve”) is a non-cancerous growth of nerve tissue, most commonly located between the 3^rd and 4^th toes (the two next to your pinkie toes). Given that this involves growth of nerve tissue, it shouldn’t surprise you that neuromas are painful.

Toenail Problems

Ingrown Toenails Ingrown toenails represent the most common nail impairment and involve a condition when the corners of the nail dig painfully into your soft tissue, producing signs of infection and inflammation.

Toenail Fungus  When you notice an ongoing change in the color and quality of your toenails, you should suspect toenail fungus. These infections occur under the nail’s surface and require antifungal medications.

Treatment Terms

Shoe Inserts Inserts are simply foot supports that are placed inside your shoes. Shoe inserts don’t require a prescription.
Orthotics  Orthotics are typically custom-designed and prescribed devices designed to support and comfort your feet.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sleep Apnea

March 8, 2016SleepBehind the Curtain, health, Hypertension, Non-rapid eye movement sleep, Obstructive sleep apnea, Sleep, Sleep apnea, Sleep disorder, Slow-wave sleep, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

Sleep apnea is easy and hard to diagnose at the same time. Many of you are suffering with it unsuspectingly as we speak. The person you sleep with may have expressed concern about your snoring or choking while you sleep. If so, get checked.
Sleep apnea once diagnosed is treatable with some combination of lifestyle changes, breathing devices and mouthpieces. Surgery is used in some cases.
We’ve reviewed many components of sleep and sleep disorders. Be mindful that sleep is your body’s time to rest and recover from the day’s activity. Any disruption in its ability to do that does not bode well for you over the long term. If your sleeping habits are problematic for you, you really should get evaluated. Getting this situation addressed can dramatically improve the quality of your life.
Finally, review the attached video for an illustration of what’s happening during sleep apnea. Excuse the scary music!
http://www.youtube.com/watch?v=Wm-TZ-dO_rQ
This discussion has focused on obstructive sleep apnea and not the less common form, central sleep apnea. The symptoms are similar, so if you have the other condition, it would be determined by your physician.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Heart Attack Recognition – Time is Tissue

November 20, 2015Cardiology/Heart, General Health and Wellness, Health PreventionAcute coronary syndrome, Behind the Curtain, Coronary Artery Disease, Heart disease, Hypercholesterolemia, Hypertension, Myocardial infarction, Symptom, Unstable AnginaJeffrey Sterling, MD

Heart Attacks. Myocardial Infarctions. Acute Coronary Syndromes. Coronary Artery Disease. Unstable Angina. There are many names to describe one main phenomenon. Heart attacks are the most common manifestation of heart disease, the #1 cause of death in the United States. Today’s post is to heighten your sensitivity to risk factors and symptoms of a heart attack, because we’ve gotten very good at treating them—especially if you get to us in time.
Risk Factors
Who’s at risk of having a heart attack? If any of the following considerations look or sound like you, you should be especially sensitive to the symptoms I describe below. Please understand these are the rules. I also see the exceptions nearly every day.

Age: especially men over 45 and women over 55
Cocaine or amphetamine (meth) use
Family history of heart attacks: sibling, parents, or grandparents if their heart attacks occurred by age 65
High blood pressure: higher risk with obesity, smoking, diabetes, or high cholesterol.
High cholesterol or triglyceride levels
Obesity/inactivity: especially due to associations with high blood pressure, diabetes, and high cholesterol
Smoking: including prolonged exposure to second-hand smoke

Again, if you have any of the above risk factors, your symptoms are more likely to be attributable to a heart attack. You may still have a heart attack without any of these risks.
Symptoms
How do you know if you’re having a heart attack? There’s no one-answer-fits-all response (like using FAST for strokes, which we’ll discuss in the next post). Heart attack pain comes in many varieties and is usually associated with other symptoms. What you should be aware of are the pain patterns that should prompt you to get evaluated. These may include the following:

Chest discomfort like pressure (something sitting on your chest), squeezing, fullness, indigestion, or just pain
Radiation of chest discomfort or just pain in other areas, such as one or both arms, the back, neck, jaw, or stomach.
Shortness of breath
Nausea or vomiting
Breaking out in a sweat
Racing, fluttering, or forceful beating of the heart
Lightheadedness up to or including blacking out

Again, you may have all of these symptoms or none of these symptoms in the face of a heart attack. We evaluate you based on the combination of your risk factors and your symptoms.
Bottom Line 1: If you have risks, symptoms and/or concerns, I’d much rather give you good news and education than give your family condolences. Get evaluated.
Bottom Line 2: I’m not discussing specific treatment options today (that’s for a future post), but remember two things:

Time is tissue, so the sooner you get to the Emergency Room, the more treatment options we have and the better your outcome is likely to be. This is not the disease to think, “It’ll just go away.” We can do our absolute best for you if you get to us within three hours of the start of your symptoms.
If and when something like this happens to me, the first thing I’m doing on my way the hospital is taking an aspirin.

As per routine, the combination of adequate prevention and prompt symptom recognition are key. I hope you share this with your families, especially those at immediate risk.
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: Questions About High Blood Pressure (Hypertension)

November 19, 2015Cardiology/Heart844-SMA-TALK, Behind the Curtain, Conditions and Diseases, high blood pressure, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

These days everyone is running around getting their blood pressure checked at the local pharmacy. Many times that raises more questions than answers. What are you supposed to do with those numbers? High blood pressure (hypertension) is so prevalent and such a consequence of the way we live that you must already have an understanding of some basic principles if you care at all about your health. Feel free to offer your own questions or comments.

1. How do I know if I have high blood pressure?
You know by the numbers. Consider these defining blood pressure levels.
Normal – Systolic: < 120 mmHg, Diastolic: < 80 mmHg
At risk (pre-hypertension) – Systolic: 120–139 mmHg, Diastolic: 80–89 mmHg
High Systolic – Systolic: 140 mmHg or higher, Diastolic: 90 mmHg or higher
If you don’t already have a diagnosis of hypertension and are anywhere at or above the pre-hypertension stage, get checked by your physician.
2. But when should I get go to the emergency room for high blood pressure?
I’ll always want to see you if your bottom number (diastolic blood pressure) is at or above 110-115, regardless of whether you appropriately take your medication. Don’t look for symptoms to guide you. High blood pressure is called “the silent killer.”
3. If I do have high blood pressure, will I be placed on medication?
I really hope not, but honestly, approximately two-thirds of individuals in the U.S. who have high blood pressure are poorly controlled – even on medication. This means medication will be necessary for most. That said, theoretically, medication should be viewed as necessary only when necessary and only when other measures don’t work. You should discuss this with your individual physician and make every effort to improve your diet and exercise regimens. If and when you’re placed on medication, the choice of medication will be based on your age, sex, ethnicity, mobility, existing health profile and other considerations.
4. You mentioned I could have a heart attack or stroke from this? How would I know if that’s happening?
Straight, No Chaser will have upcoming posts on heart attack and stroke recognition. where we will discuss signs and symptoms. Remember, time is tissue, meaning you must not delay if you develop these symptoms.
5. What else can I do?
Be healthy! Don’t smoke. Limit alcohol intake. Lower your stress level. This is only a broken record if you’ve received the message and have implemented the recommendations.
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 Chase: Brain Health – Foods and Brain Healthy Habits

August 12, 2015General Health and Wellness844-SMA-TALK, Alzheimer's disease, Behind the Curtain, brain health, dementia, Diabetes, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I only get asked about this everyday, so let’s review keeping your brain healthy. Unfortunately too often some of you only ask at the point when early dementia or Alzheimer’s disease has begun to develop, but this is another example of an ounce of prevention being worth a pound of cure. Also, these requests often seem to be related to some internet promise of health based on some fad or miracle cure. Remember the Straight, No Chaser dictim: your health won’t be found in a bottle.
In a previous post about how your brain works, we pointed out that your brain consumes a tremendous proportion of the body’s oxygen supply. So to begin the conversation, just remember that a diet promoting good blood flow throughout the body promotes good blood flow to the brain. I wish I could convince you that a baseline level of brain health is just this simple: consume a diet low in fat and cholesterol. If you’re not clogging the arteries in the rest of your body, you won’t be clogging arteries in your brain. The same things you’re doing to avoid diabetes and hypertension will help you here.
As such let’s provide an overview to five basic principles to keep your brain healthy. If you adhere to these, you can save the money you’re spending on ginkgo biloba.

Reduce your fat and cholesterol intake
It’s as simple as already discussed. High intake of these foods promotes a higher risk of Alzheimer’s disease later in life. Try these specific tips.

Use olive oil instead of other saturated fats.
Bake or grill your food instead of frying it.

Eat foods shown to protect and promote brain health
I want to make this simple. If you’re eating dark-skinned fruits and/or vegetables, you’re doing good by your brain. These foods tend to have the highest levels of antioxidants fighting off damage to your brain cells. Here are some specific examples of brain healthy foods. Try working them into your diet.

Fruits – blackberries, blueberries, cherries, oranges, plums, prunes, raisins, raspberries, red grapes and strawberries
Vegetables – alfalfa and Brussels sprouts, beets, broccoli, corn, eggplant, kale, onion, red bell pepper and spinach
Nuts – almonds, pecans and walnuts are a good source of vitamin E, another powerful antioxidant
Fish – halibut, mackerel, salmon, trout and tuna (all contain omega-3 fatty acids, which are brain healthy)

Exercise
If you’re keeping your heart strong and pumping blood efficiently throughout your body, your brain is getting its needed supply of oxygen and nutrients. Check this Straight, No Chaser on basic exercise tips.
Be social, Be a lifelong learner
Exercise your brain through social interactions with others, especially those that “stimulate your brain.” The diversity of experience keeps different parts of your brain active, alert, functioning and healthy. Learn a new skill or language. It’s almost as good as starting over!
Another Straight, No Chaser will focus on additional ways for you to engage your brain to keep it working and working well.
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: Healthcare Disparities

April 24, 2015General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, colorectal cancer, Conditions and Diseases, death rates, Diabetes, healthcare disparities, HIV, Hypertension, immunizations, infant mortality, Influenza, life expectancy, Obesity, periodontitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Life expectancy: In 2011, the average American could expect to live 78.7 years. The average African-American could only expect to live 75.3 years, compared with 78.8 years for the average White American.
Death rates: In 2009, African-Americans had the highest death rates from homicide among all racial and ethnic populations. Rates among African-American males were the highest for males across all age groups.
Infant mortality rates: In 2008, infants of African-American women had the highest death rate among American infants with a rate more than twice as high as infants of white women.

The following disparities were also reported:

Heart disease and stroke: In 2009, African-Americans had the largest death rates from heart disease and stroke compared with other racial and ethnic populations, with disparities across all age groups younger than 85 years of age.
High blood pressure: From 2007-2010, the prevalence of hypertension was among adults aged 65 years and older, African-American adults, US-born adults, adults with less than a college education, adults who received public health insurance (18-64 years old) and those with diabetes, obesity or a disability compared with their counterparts. The percentages of African-Americans and Hispanics who had control of high blood pressure were lower compared to white adults.
Obesity: From 2007-2010, the prevalence of obesity among adults was highest among African-American women compared with white and Mexican American women and men. Obesity prevalence among African-American adults was the largest compared to other race ethnicity groups.
Diabetes: In 2010, the prevalence of diabetes among African-American adults was nearly twice as large as that for white adults.
Activity limitations caused by chronic conditions: From 1999-2008, the number of years of expected life free of activity limitations caused by chronic conditions is disproportionately higher for African-American adults than whites.
Periodontitis: In 2009-2010, the prevalence of periodontitis (a form of dental disease) was greatest among African-American and Mexican American adults compared with white adults.
HIV: In 2010, African-American adults had the largest HIV infection rate compared with rates among other racial and ethnic populations. Prescribed HIV treatment among African-American adults living with HIV was less than among white adults.
Access to care: In 2010, Hispanic and African-American adults aged 18-64 years had larger percentages without health insurance compared with white and Asian/Pacific Islander counterparts.
Colorectal cancer: In 2008, African Americans had the largest incidence and death rates from colorectal cancer of all racial and ethnic populations despite similar colorectal screening rates compared to white adults.
Influenza vaccination: During the 2010-11 influenza season, influenza vaccination coverage was similar for African-American and white children aged six months to 17 years but lower among African-American adults compared with white adults.
Socioeconomic factors: In 2011, similar to other minority adults aged 25 years or older, a larger percentage of African-American adults did not complete high school compared with white adults. A larger percentage of African American adults also lived below the poverty level and were unemployed (adults aged 18-64 years) compared with white adults of the same age.

This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK (844-762-8255) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd. Please like and share our blog with your family and friends. We’re here for you 24/7 with immediate, personalized information and advice. Contact your Personal Healthcare Consultant at http://www.SterlingMedicalAdvice.com or 1-844-SMA-TALK.

Straight, No Chaser: End of Life Decision Making

April 20, 2015General Health and Wellness, Medical Treatment, Health PreventionBlood flow, Brain, Death panel, DecisionMaking, Education, Futile medical care, health, health care provider, Health care proxy, Heart failure, Hypertension, Intubation, Patient Protection and Affordable Care Act, Straight No Chaser (composition), Terminal illnessJeffrey Sterling, MD

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

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: A Foot Glossary and Introduction to Conditions Affecting Your Feet

March 30, 2015Orthopedics/Bones844-SMA-TALK, Arthritis, athlete's foot, bunions, calcaneal fracture, cardiovascular d, diabetic foot ulcers, diabetic neuropathy, Haglund's deformity, hammer toes, high blood pressure, hyperhidrosis, Hypertension, ingrown toenails, neuroma, orthotics, peripheral artery disease, peripheral neuropathy, Psoriasis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, tendinitisJeffrey Sterling, MD

Arthritis

Bone Spurs

heel-bone-spur

Cardiovascular Disease

Diabetes

Diabetic Wound Care

DM foot ulcer

Foot & Ankle Injuries

Sprains, Strains & Fractures  These injuries compromise the ability of the feet to support and move the body.

$calcaneal fracture$

A sprain is an injury to the soft tissue of a structure such as the foot.
A strain (aka a pulled muscle) is an injury that results from excessive stretching and/or tearing of a structure’s supportive muscles.
A fracture is a disruption (e.g., break) in a bone.

Muscle & Tendon Problems

Haglund’s Deformity

HaglundsDeformity

Plantar_Fasciitis1

Skin Disorders

Athlete’s Foot

toes+athletes+foot

cornscalluses

Irritation to a part of the foot will prompt the body to form thicker skin to prevent irritation and injury. These present as corns and calluses.

Psoriasis

We have discussed  psoriasis here in Straight, No Chaser. It represents abnormally rapid production and replacement of skin cells. This causes a build up of dead cells on the surface that is recognized as scaly, dry and silver patches.
Skin Cancers of the Feet  Although more common on exposed areas of the body, skin cancer can develop anywhere, including on the feet. Skin cancers of the feet tend to present as recurrent cracking, bleeding or ulceration more so than with pain.
Sweaty Feet  Hyperhidrosis is the medical term for excessive sweating. This often presents on the palms of the hands and the soles of the feet.
Warts
Planters Warts
When warts present on the feet, they tend to be painful. These are fleshy manifestations of a virus infection.

Toe Joint & Nerve Disorders

Bunions  Bunions occur at the base of the great toe and is an enlargement of the joint that forms when the bone or tissue actually moves out of place.

Hammer Toes  A hammer toe is a bending (contracture) of the toe at its first joint, (i.e., the proximal interphalangeal joint). This produces an appearance of an upside-down V.

Toenail Problems

Treatment Terms

Shoe Inserts Inserts are simply foot supports that are placed inside your shoes. Shoe inserts don’t require a prescription.
Orthotics  Orthotics are typically custom-designed and prescribed devices designed to support and comfort your feet.
Feel free to ask your SMA personal healthcare 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) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: Sleep Apnea

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

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

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

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

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

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

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

Straight, No Chaser: Questions About High Blood Pressure (Hypertension)

May 27, 2014General Health and Wellness844-SMA-TALK, Conditions and Diseases, high blood pressure, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

1. How do I know if I have high blood pressure?
You know by the numbers. Consider these defining blood pressure levels.
Normal – Systolic: < 120 mmHg, Diastolic: < 80 mmHg
At risk (pre-hypertension) – Systolic: 120–139 mmHg, Diastolic: 80–89 mmHg
High Systolic – Systolic: 140 mmHg or higher, Diastolic: 90 mmHg or higher
If you don’t already have a diagnosis of hypertension and are anywhere at or above the pre-hypertension stage, get checked by your physician.
2. But when should I get go to the emergency room for high blood pressure?
I’ll always want to see you if your bottom number (diastolic blood pressure) is at or above 110-115, regardless of whether you appropriately take your medication. Don’t look for symptoms to guide you. High blood pressure is called “the silent killer.”
3. If I do have high blood pressure, will I be placed on medication?
I really hope not, but honestly, approximately two-thirds of individuals in the U.S. who have high blood pressure are poorly controlled – even on medication. This means medication will be necessary for most. That said, theoretically, medication should be viewed as necessary only when necessary and only when other measures don’t work. You should discuss this with your individual physician and make every effort to improve your diet and exercise regimens. If and when you’re placed on medication, the choice of medication will be based on your age, sex, ethnicity, mobility, existing health profile and other considerations.
4. You mentioned I could have a heart attack or stroke from this? How would I know if that’s happening?
Check here for Heart Attack Recognition and here for Stroke Recognition where I discuss signs and symptoms. Remember, time is tissue, meaning you must not delay if you develop these symptoms.
5. What else can I do?
Be healthy! Don’t smoke. Limit alcohol intake. Lower your stress level. This is only a broken record if you’ve received the message and have implemented the recommendations.
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: Health Disparities

April 14, 2014General Health and Wellness, Public Health844-SMA-TALK, colorectal cancer, Conditions and Diseases, death rates, Diabetes, healthcare disparities, HIV, Hypertension, immunizations, infant mortality, Influenza, life expectancy, Obesity, periodontitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Life expectancy: In 2011, the average American could expect to live 78.7 years. The average African-American could only expect to live 75.3 years, compared with 78.8 years for the average White American.
Death rates: In 2009, African-Americans had the highest death rates from homicide among all racial and ethnic populations. Rates among African-American males were the highest for males across all age groups.
Infant mortality rates: In 2008, infants of African-American women had the highest death rate among American infants with a rate more than twice as high as infants of white women.

The following disparities were also reported:

Heart disease and stroke: In 2009, African-Americans had the largest death rates from heart disease and stroke compared with other racial and ethnic populations, with disparities across all age groups younger than 85 years of age.
High blood pressure: From 2007-2010, the prevalence of hypertension was among adults aged 65 years and older, African-American adults, US-born adults, adults with less than a college education, adults who received public health insurance (18-64 years old) and those with diabetes, obesity or a disability compared with their counterparts. The percentages of African-Americans and Hispanics who had control of high blood pressure were lower compared to white adults.
Obesity: From 2007-2010, the prevalence of obesity among adults was highest among African-American women compared with white and Mexican American women and men. Obesity prevalence among African-American adults was the largest compared to other race ethnicity groups.
Diabetes: In 2010, the prevalence of diabetes among African-American adults was nearly twice as large as that for white adults.
Activity limitations caused by chronic conditions: From 1999-2008, the number of years of expected life free of activity limitations caused by chronic conditions is disproportionately higher for African-American adults than whites.
Periodontitis: In 2009-2010, the prevalence of periodontitis (a form of dental disease) was greatest among African-American and Mexican American adults compared with white adults.
HIV: In 2010, African-American adults had the largest HIV infection rate compared with rates among other racial and ethnic populations. Prescribed HIV treatment among African-American adults living with HIV was less than among white adults.
Access to care: In 2010, Hispanic and African-American adults aged 18-64 years had larger percentages without health insurance compared with white and Asian/Pacific Islander counterparts.
Colorectal cancer: In 2008, African Americans had the largest incidence and death rates from colorectal cancer of all racial and ethnic populations despite similar colorectal screening rates compared to white adults.
Influenza vaccination: During the 2010-11 influenza season, influenza vaccination coverage was similar for African-American and white children aged six months to 17 years but lower among African-American adults compared with white adults.
Socioeconomic factors: In 2011, similar to other minority adults aged 25 years or older, a larger percentage of African-American adults did not complete high school compared with white adults. A larger percentage of African American adults also lived below the poverty level and were unemployed (adults aged 18-64 years) compared with white adults of the same age.

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

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.

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