Tag Archives: Inflammation

Straight, No Chaser: Understanding Asthma – Toothpicks and Snot (Part 2 of 2)

March 25, 2016Respiratory/Lungs, Medical Treatment844-SMA-TALK, Straight No Chaser, SterlingMedicalAdvice.com, Sterling Medical Advice, Respiratory Disorders, Inflammation, health, Emergency department, Conditions and Diseases, Chronic obstructive pulmonary disease, Behind the Curtain, AsthmaJeffrey Sterling, MD

As we move into discussing asthma treatment, remember that asthmatics die at an alarming rate. I mentioned yesterday (and it bears repeating) that death rates have increased over 50% in the last few decades. If you’re an asthmatic, avoid taking care of yourself at your own peril. Your next asthma attack could be your last.
The other thing to remember is that asthma is a reversible disease – until it’s not. At some point (beginning somewhere around age 35 or so), the ongoing inflammation and damage to the lungs will create some irreversible changes, and then the situation’s completely different, possibly predisposing asthmatics to other conditions such as chronic bronchitis, COPD (chronic obstructive pulmonary disease) and lung cancer. This simply reiterates the importance of identifying and removing those triggers.
Given that, let’s talk about asthma control as treatment. Consider the following quick tips you might use to help you reduce or virtually eliminate asthma attacks:

Avoid cigarette smoke (including second hand smoke) like the plague!
Avoid long haired animals, especially cats.
Avoid shaggy carpets, window treatments or other household fixtures that retain dust.
If you’re spraying any kind of aerosol, if it’s allergy season, if you’re handling trash, or if you react to cold weather, wear a mask while you’re doing it. It’s better to not look cool for a few moments than to have to look at an emergency room for a few hours or a hospital room for a few days.
Be careful to avoid colds and the flu. Get that flu shot yearly.

If and when all of this fails, and you’re actually in the midst of an asthma attack, treatment options primarily center around two types of medications.

Short (and quick) acting bronchodilators (e.g. albuterol, ventolin, proventil, xopenex, alupent, maxair) functionally serve as props (‘toothpicks’, no not real ones, and don’t try to use toothpicks at home) to keep the airways open against the onslaught of mucous buildup inside the lungs combined with other inflammatory changes trying to clog the airways. These medications do not treat the underlying condition. They only buy you time and attempt to keep the airways open for…
Steroids (e.g. prednisone, prelone, orapred, solumedrol, decadron – none of which are the muscle building kind) are the mainstay of acute asthma treatment, as they combat the inflammatory reaction and other changes that cause the asthma attack. One can functionally think of steroids as a dump truck moving in to scoop the snot out of the airways. The only issue with the steroids is they take 2-4 hours to start working, so you have to both get them on board as early as possible while continuing to use the bronchodilators to stem the tide until the steroids kick in.

If you are not successful in avoiding those triggers over the long term, you may need to be placed on ‘controller’ medications at home, which include lower doses of long-acting bronchodilators and steroids.
So in summary, the best treatment of asthma is management of its causes. Avoid the triggers, thus reducing your acute attacks. Become educated about signs of an attack. When needed, get help sooner rather than later. And always keep an inhaler on you. It could be the difference between life and death.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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: Appendicitis – When a Little Something Causes a Lot…

March 16, 2016Gastrointestinal, Surgical CareSurgery, Ovarian cyst, Inflammation, health, Conditions and Diseases, Behind the Curtain, Appendicitis, Abdominal pain, AbdomenJeffrey Sterling, MD

Appendicitis is very common, occurring in one of fifteen individuals, usually between ages 10-30. It is more dangerous in the young and old, because they are both less able to describe symptoms and more likely to have abnormal presentations. Both of these scenarios lead to delayed diagnosis and treatment, which as you might imagine, doesn’t give patients the best opportunity for good outcomes.

Symptoms classically involve abdominal pain, followed by nausea, vomiting and fever, although other symptoms involving the digestive and urinary systems may be present. Often, the pain begins near the umbilicus (belly button) and seemingly migrates to the right lower portion of the abdomen. The pain may lead to a ‘board-like’ feel of the abdomen. This is a bad sign when it happens.

The below video is a virtual depiction of appendectomy surgery via a technique known as laparoscopy. Use your discretion in choosing to view.

Treatment involves surgery (an appendectomy) in the overwhelming majority of cases. Your job is to maintain a high level of suspicion and remember a few very important pearls of wisdom. First is seek medical attention without delay. Also, don’t eat, drink or take any medicine if you think this is what’s going on. Surgery requires an empty stomach, and certain medicines may mask the pain (leading to diagnostic difficulties) or facilitate early rupture of the appendix. In case you were wondering, there’s no definitive way to prevent appendicitis, but it is less frequent in those on high fiber diets. Score another point for fruits and vegetables.
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: Appendicitis – A Whole Lot over Quite a Little…

March 10, 2015Surgical Care, GastrointestinalSurgery, Ovarian cyst, Inflammation, health, Conditions and Diseases, Appendicitis, Abdominal pain, AbdomenJeffrey Sterling, MD

The below video is a virtual depiction of appendectomy surgery via a technique known as laparoscopy. Use your discretion in choosing to view.

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

December 28, 2013Musculoskeletal System, Orthopedics/Bones, Geriatrics/Elderly CareStraight No Chaser, WordPress, SterlingMedicalAdvice.com, Sterling Medical Advice, Rheumatoid arthritis, Psoriatic arthritis, Osteoarthritis, Musculoskeletal Disorders, Joint, Inflammation, health, Facebook, Conditions and Diseases, ArthritisJeffrey Sterling, MD

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

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

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

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

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

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

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

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

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

This afternoon, I’ll discuss general treatment of arthritis and tips you can use to help yourself or your loved one with arthritis. I welcome any questions or comments you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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

December 26, 2013Respiratory/LungsCough, WordPress, Tobacco smoking, Straight No Chaser, SterlingMedicalAdvice.com, Sterling Medical Advice, Inflammation, health, Fever, Chronic bronchitis, Bronchus, Bronchitis, Acute bronchitisJeffrey Sterling, MD

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

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

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

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

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

Straight, No Chaser: What's that Rash? Eczema and Psoriasis

September 30, 2013Skin/Dermatology, Medical TreatmentCutaneous condition, Benadryl, Atopic dermatitis, Eczema, WordPress, Skin, Rash, Psoriasis, Inflammation, healthJeffrey Sterling, MD

Rashes are very frustrating for patients. They itch, burn, get infected, aren’t pleasant to look at and never go away rapidly enough. Another problem is no one ever seems to know what they are at first, and that causes a big problem because you’re concerned immediately (as you should be) when the rash appears. Unfortunately, in the early stages, most rashes are indistinguishable. In many cases, in order to diagnose them, you’d have to let them evolve and bloom into whatever they’re trying to become, but who has time for that? I remember in medical school, the prevailing wisdom was “If it’s wet, dry it (powder), if it’s dry, wet it (creams, lotions and ointments), and give everybody steroids.” Well, don’t try that at home without your physician’s direction because it’s not universally true, but it sure does seem like hydrocortisone has a lot to do with treating rashes.
Today, I’d like to review two common chronic conditions defined by rashes, and later I’ll do the same with acute presentations of rashes. The thing about eczema and psoriasis is we should know it when we see it, and so should you. By the way, dermatitis is the general term for skin inflammations, and eczema and psoriasis both fall under this category. As such, they have a lot in common, including basic underlying mechanisms (irritation), treatment considerations and a knack at raising frustration levels.

Eczema (aka atopic dermatitis, which is the most common form of eczema) is a red, dry itchy rash that really is just an inflammatory reaction. If you let it linger, it can become cracked, infected and develop a leather-like consistency. It’s said that you’d develop eczema just by scratching or rubbing your skin long enough, because it’s the damage to the skin that causes the inflammatory reaction that defines eczema. This is why eczema is notoriously called “the itch that rashes”. You’re more likely to have it if you have asthma, have fever or tendencies toward food allergies (or other allergies), but you can get it with pretty much any significant skin irritation. It’s not contagious, but it does run in families.

Psoriasis is another chronic skin condition that is easily recognized. As noted above, that thick scaly, silvery skin (called plaques) results from an overgrowth of skin cells. As with eczema, this condition is a result of inflammation to the skin, in this instance caused by an overreaction of your immune system speeding up the production of skin cells. Psoriatic lesions are most often seen on the elbows, knees and scalp; it can also involve the back, hand and feet (including the nails). Psoriasis tends to flare-up then go into remission, but during those flare-ups, it is very uncomfortable and unsightly.
These are both ‘dry’ rashes, so treatment involves moisturizers, changing habits to include mild soaps, loose fitting clothing, moderate temperature showers (to avoid drying the skin), and when necessary, antihistamines (like Benadryl) and topical steroid creams (like hydrocortisone). Use any medications after consultation with your physician, who may prescribe more exotic treatments such as medications to calm or suppress the body’s immune response or ultraviolet light therapy. Your job is to identify and avoid the irritants that cause the inflammatory reaction (e.g. sweating, scratching, tight-fitting clothing and anything that dries you out). It’s important for you to get these addressed early before the appearance becomes too bothersome for you.
I welcome any questions or comments.
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Straight, No Chaser: Appendicitis – A Whole Lot over Quite a Little…

September 18, 2013Medical Treatment, GastrointestinalAbdomen, Surgery, Ovarian cyst, Inflammation, health, Conditions and Diseases, Appendicitis, Abdominal painJeffrey Sterling, MD

There’s not much that causes as much legitimate angst in parents as a child with appendicitis. In case you don’t know what the fuss is all about, the appendix is a 3 1/2 inch pouch on the edge of the large intestine near the right lower part of your abdomen. It’s actually like a long, skinny skin tag that (as best as we know) has no purpose other than to seemingly get inflamed, rupture and require surgery. The problem with it is that it’s a pouch (Pouches are bad things in the body. They always seem to twist or otherwise get blocked, leading to problems. This happens with aneurysms and hemorrhoids; twisting otherwise occurs with torsion of ovarian cysts or the testes. These stories don’t end well.). This particular pouch has the misfortune of being filled with stool, so if it gets sufficiently blocked or inflamed to the point where it ruptures, your abdomen will contain loose stool, which as you can imagine will cause a nasty infection rapidly (This is called peritonitis.). Appendicitis is a surgical emergency, because left untreated, the peritonitis caused by rupture will lead to septic shock.
Appendicitis is very common, occurring in one of fifteen individuals, usually between ages 10-30. It is more dangerous in the young and old, because they are both less able to describe symptoms and more likely to have abnormal presentations. Both of these scenarios lead to delayed diagnosis and treatment, which as you might imagine, doesn’t give patients the best opportunity for good outcomes.
Symptoms classically involve abdominal pain, followed by nausea, vomiting and fever, although other symptoms involving the digestive and urinary systems may be present. Often, the pain begins near the umbilicus (belly button) and seemingly migrates to the right lower portion of the abdomen. The pain may lead to a ‘board-like’ feel of the abdomen. This is a bad sign when it happens.
Treatment involves surgery (an appendectomy) in the overwhelming majority of cases. Your job is to maintain a high level of suspicion and remember a few very important pearls of wisdom. First is seek medical attention without delay. Also, don’t eat, drink or take any medicine if you think this is what’s going on. Surgery requires an empty stomach, and certain medicines may mask the pain (leading to diagnostic difficulties) or facilitate early rupture of the appendix. In case you were wondering, there’s no definitive way to prevent appendicitis, but it is less frequent in those on high fiber diets. Score another point for fruits and vegetables.
I welcome any questions or comments you may have.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Understanding Asthma – Toothpicks and Snot (Part 2 of 2)

July 16, 2013Health Prevention, Respiratory/Lungs, Medical TreatmentRespiratory Disorders, Inflammation, health, Emergency department, Conditions and Diseases, Chronic obstructive pulmonary disease, AsthmaJeffrey Sterling, MD

Avoid cigarette smoke (including second hand smoke) like the plague!
Avoid long haired animals, especially cats.
Avoid shaggy carpets, window treatments or other household fixtures that retain dust.
If you’re spraying any kind of aerosol, if it’s allergy season, if you’re handling trash, or if you react to cold weather, wear a mask while you’re doing it. It’s better to not look cool for a few moments than to have to look at an emergency room for a few hours or a hospital room for a few days.
Be careful to avoid colds and the flu. Get that flu shot yearly.

If and when all of this fails, and you’re actually in the midst of an asthma attack, treatment options primarily center around two types of medications.

Short (and quick) acting bronchodilators (e.g. albuterol, ventolin, proventil, xopenex, alupent, maxair) functionally serve as props (‘toothpicks’, no not real ones, and don’t try to use toothpicks at home) to keep the airways open against the onslaught of mucous buildup inside the lungs combined with other inflammatory changes trying to clog the airways. These medications do not treat the underlying condition. They only buy you time and attempt to keep the airways open for…
Steroids (e.g. prednisone, prelone, orapred, solumedrol, decadron – none of which are the muscle building kind) are the mainstay of acute asthma treatment, as they combat the inflammatory reaction and other changes that cause the asthma attack. One can functionally think of steroids as a dump truck moving in to scoop the snot out of the airways. The only issue with the steroids is they take 2-4 hours to start working, so you have to both get them on board as early as possible while continuing to use the bronchodilators to stem the tide until the steroids kick in.