Tag Archives: medicine

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

General Health and Wellness, Medical Treatment, Toxicology/Drugs, , , , , , , , , , , , , ,

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

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

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

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

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

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

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

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

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

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

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

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

In my “toxin summary post” tomorrow, I will answer your questions on the entire toxin and detoxification series and add a few final thoughts.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Should NOT Be in Your Medicine Cabinet

General Health and Wellness, , , , , , , , ,

medicine-cabinets
In the previous Straight, No Chaser, we discussed the ideal use of your medicine cabinets to prepare for life’s nagging aches and pain. However, has it ever occurred to you that many people run straight to the medicine cabinet to do harm to themselves or others? I want you to know the harder the effort is to obtain items to hurt oneself, the less likely one is to follow through on the notion. On a related note, there’s a quick not-so-fun-but-interesting fact regarding one of the differences between America and say, certain European countries that has to do with the oversized influence of corporations in the States. Why am I talking about that on a medical blog? Read on. If you can’t tell where I’m going with this, you’ll get it pretty quickly.

Here’s my top five items I want you to take out your medicine cabinets and lock up.

SILO-POISON

1. Any jumbo sized container of any medication. Think about two of the most common over the counter (OTC) medications used for suicide attempts: acetaminophen (Tylenol) and salicylate (aspirin). One thing they have in common is you can buy what amounts to a tub-full of it at your local superstore in the United States. They should call these things ‘suicide quantities’, because often those in the midst of a suicide attempt will grab and swallow whatever is convenient. Many different medications will hurt you if you take enough; Tylenol and aspirin certainly fit that bill. Observing that (and additional considerations after the deaths due to the lacing of Tylenol with cyanide back in 1983), the Brits decided to not only pass a law limiting quantities, but certain medications that are high-frequency and high-risk for suicide use are now mandatorily dispensed in those annoying containers that you have to pop through the plastic container. Needless to say, observed suicide rates by medication rates plummeted as a result. Wonder why that hasn’t been implemented in the good ol’ USA?
2. Have teens in your house? Lock up the Robitussin and NyQuil. Dextromethorphan is the active ingredient in over 100 OTC cold and cough preparations. Teens use these to get high, folks. To make matters worse, they are addictive, and if taken with alcohol or other drugs, they can kill you. Then there’s “purple drank” (yes, that’s how it’s spelled), in which these cough syrups containing codeine and promethazine (Benadryl) are mixed with drinks such as Sprite or Mountain Dew.
3. Have any sexual performance medications? This is part of a category of medicines called ‘medicines that can kill someone with just one pill’. That usually refers to kids or the elderly, but remember that those sexual enhancement drugs are medicines that lower your blood pressure. In the wrong person and in the wrong dose, taking such medicine – whether intentionally or accidentally – could be the last thing someone does.

opioid30p

3. Any narcotic. Need I say more? Remember, you do have people rummaging through your cabinets on occasion!
4. Any sharps. That includes sewing pins, needles, etc.
5. Any medication with an expiration date. The medication date actually is more of a ‘freshness’ consideration than a danger warning. However, in the wrong patient, a medicine that has less than the 100% guarantee of its needed strength that the expiration date represents could be fatal. Play it safe and get a new prescription.
There’s a lot more that could be added to this list, but I like keeping things manageable for you.  Please childproof all your cabinets, and use childproof caps on your medications.
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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

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

Detoxification, General Health and Wellness, Health Prevention, , , , , , , , , , , ,

medicine cabinet sick-care-vs-health-care

You’ve all done it. I’ve caught a few of you doing it. Why do you rummage through someone’s else’s medicine cabinet? Are newer homes even built with medicine cabinets anymore? Oh well… Today, Straight, No Chaser tackles a simple but important question in an ongoing effort to better empower you. For starters, here’s hoping your cabinet doesn’t resemble any of these pictured, but there is a role for medicines in your medicine cabinet.
medicine-cabinet_59x73.5_we
1. What should be in your medicine cabinet? Here’s my top five and why.

  • Aspirin (324 mg).

Aspirin-tablet-300x300

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

  • Activated charcoal.

activated charcoal

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

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

triple abx

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

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

OTCdrugs

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

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

poisoncontrol

They will address your concerns, route you to your local poison center, advise you on the appropriate use of activated charcoal and help coordinate your care when you go to your emergency department.
Be smart about the items in your home in general and in your medicine cabinet in particular. We’ll continue the theme with the next Straight, No Chaser.
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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

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

Medical Treatment, Toxicology/Drugs, Health Prevention, , , , , , , , , , , , ,

coloniccolonics

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

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

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

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

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

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

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

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

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

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

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

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

In my “toxin summary post” tomorrow, I will answer your questions on the entire toxin and detoxification series and add a few final thoughts.
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.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Should NOT Be in Your Medicine Cabinet

General Health and Wellness, , , , , , , , ,

medicine-cabinets
In the previous Straight, No Chaser, we discussed the ideal use of your medicine cabinets to prepare for life’s nagging aches and pain. However, has it ever occurred to you that many people run straight to the medicine cabinet to do harm to themselves or others? I want you to know the harder the effort is to obtain items to hurt oneself, the less likely one is to follow through on the notion. On a related note, there’s a quick not-so-fun-but-interesting fact regarding one of the differences between America and say, certain European countries that has to do with the oversized influence of corporations in the States. Why am I talking about that on a medical blog? Read on. If you can’t tell where I’m going with this, you’ll get it pretty quickly.

Here’s my top five items I want you to take out your medicine cabinets and lock up.

SILO-POISON

1. Any jumbo sized container of any medication. Think about two of the most common over the counter (OTC) medications used for suicide attempts: acetaminophen (Tylenol) and salicylate (aspirin). One thing they have in common is you can buy what amounts to a tub-full of it at your local superstore in the United States. They should call these things ‘suicide quantities’, because often those in the midst of a suicide attempt will grab and swallow whatever is convenient. Many different medications will hurt you if you take enough; Tylenol and aspirin certainly fit that bill. Observing that (and additional considerations after the deaths due to the lacing of Tylenol with cyanide back in 1983), the Brits decided to not only pass a law limiting quantities, but certain medications that are high-frequency and high-risk for suicide use are now mandatorily dispensed in those annoying containers that you have to pop through the plastic container. Needless to say, observed suicide rates by medication rates plummeted as a result. Wonder why that hasn’t been implemented in the good ol’ USA?
2. Have teens in your house? Lock up the Robitussin and NyQuil. Dextromethorphan is the active ingredient in over 100 OTC cold and cough preparations. Teens use these to get high, folks. To make matters worse, they are addictive, and if taken with alcohol or other drugs, they can kill you. Then there’s “purple drank” (yes, that’s how it’s spelled), in which these cough syrups containing codeine and promethazine (Benadryl) are mixed with drinks such as Sprite or Mountain Dew.
3. Have any sexual performance medications? This is part of a category of medicines called ‘medicines that can kill someone with just one pill’. That usually refers to kids or the elderly, but remember that those sexual enhancement drugs are medicines that lower your blood pressure. In the wrong person and in the wrong dose, taking such medicine – whether intentionally or accidentally – could be the last thing someone does.

opioid30p

3. Any narcotic. Need I say more? Remember, you do have people rummaging through your cabinets on occasion!
4. Any sharps. That includes sewing pins, needles, etc.
5. Any medication with an expiration date. The medication date actually is more of a ‘freshness’ consideration than a danger warning. However, in the wrong patient, a medicine that has less than the 100% guarantee of its needed strength that the expiration date represents could be fatal. Play it safe and get a new prescription.
There’s a lot more that could be added to this list, but I like keeping things manageable for you.  Please childproof all your cabinets, and use childproof caps on your medications.
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: What Should Be in Your Medicine Cabinet

Detoxification, General Health and Wellness, Health Prevention, , , , , , , , , , , ,

medicine cabinet sick-care-vs-health-care

You’ve all done it. I’ve caught a few of you doing it. Why do you rummage through someone’s else’s medicine cabinet? Are newer homes even built with medicine cabinets anymore? Oh well… Today, Straight, No Chaser tackles a simple but important question in an ongoing effort to better empower you. For starters, here’s hoping your cabinet doesn’t resemble any of these pictured, but there is a role for medicines in your medicine cabinet.
medicine-cabinet_59x73.5_we
1. What should be in your medicine cabinet? Here’s my top five and why.

  • Aspirin (324 mg).

Aspirin-tablet-300x300

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

  • Activated charcoal.

activated charcoal

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

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

triple abx

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

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

OTCdrugs

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

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

poisoncontrol

They will address your concerns, route you to your local poison center, advise you on the appropriate use of activated charcoal and help coordinate your care when you go to your emergency department.
Be smart about the items in your home in general and in your medicine cabinet in particular. We’ll continue the theme with the next Straight, No Chaser.

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: What Should NOT Be in Your Medicine Cabinet

General Health and Wellness, , , , , , , , ,

medicine-cabinets
In the previous Straight, No Chaser, we discussed the ideal use of your medicine cabinets to prepare for life’s nagging aches and pain. However, has it ever occurred to you that many people run straight to the medicine cabinet to do harm to themselves or others? I want you to know the harder the effort is to obtain items to hurt oneself, the less likely one is to follow through on the notion. On a related note, there’s a quick not-so-fun-but-interesting fact regarding one of the differences between America and say, certain European countries that has to do with the oversized influence of corporations in the States. Why am I talking about that on a medical blog? Read on. If you can’t tell where I’m going with this, you’ll get it pretty quickly.

Here’s my top five items I want you to take out your medicine cabinets and lock up.

SILO-POISON

1. Any jumbo sized container of any medication. Think about two of the most common over the counter (OTC) medications used for suicide attempts: acetaminophen (Tylenol) and salicylate (aspirin). One thing they have in common is you can buy what amounts to a tub-full of it at your local superstore in the United States. They should call these things ‘suicide quantities’, because often those in the midst of a suicide attempt will grab and swallow whatever is convenient. Many different medications will hurt you if you take enough; Tylenol and aspirin certainly fit that bill. Observing that (and additional considerations after the deaths due to the lacing of Tylenol with cyanide back in 1983), the Brits decided to not only pass a law limiting quantities, but certain medications that are high-frequency and high-risk for suicide use are now mandatorily dispensed in those annoying containers that you have to pop through the plastic container. Needless to say, observed suicide rates by medication rates plummeted as a result. Wonder why that hasn’t been implemented in the good ol’ USA?
2. Have teens in your house? Lock up the Robitussin and NyQuil. Dextromethorphan is the active ingredient in over 100 OTC cold and cough preparations. Teens use these to get high, folks. To make matters worse, they are addictive, and if taken with alcohol or other drugs, they can kill you. Then there’s ‘purple drank’ (yes, that’s how it’s spelled), in which these cough syrups containing codeine and promethazine (Benadryl) are mixed with drinks such as Sprite or Mountain Dew.
3. Have any sexual performance medications? This is part of a category of medicines called ‘medicines that can kill someone with just one pill’. That usually refers to kids or the elderly, but remember that those sexual enhancement drugs are medicines that lower your blood pressure. In the wrong person and in the wrong dose, taking such medicine – whether intentionally or accidentally – could be the last thing someone does.

opioid30p

3. Any narcotic. Need I say more? Remember, you do have people rummaging through your cabinets on occasion!
4. Any sharps. That includes sewing pins, needles, etc.
5. Any medication with an expiration date. The medication date actually is more of a ‘freshness’ consideration than a danger warning. However, in the wrong patient, a medicine that has less than the 100% guarantee of its needed strength that the expiration date represents could be fatal. Play it safe and get a new prescription.
There’s a lot more that could be added to this list, but I like keeping things manageable for you.  Please childproof all your cabinets, and use childproof caps on your medications.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.
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Straight, No Chaser: What Should Be in Your Medicine Cabinet

Detoxification, General Health and Wellness, Health Prevention, , , , , , , , , , , , ,

medicine cabinet sick-care-vs-health-care

You’ve all done it. I’ve caught a few of you doing it. Why do you rummage through someone’s else’s medicine cabinet? Are newer homes even built with medicine cabinets anymore? Oh well… Today, Straight, No Chaser tackles a simple but important question in an ongoing effort to better empower you. For starters, here’s hoping your cabinet doesn’t resemble any of these pictured, but there is a role for medicines in your medicine cabinet.
medicine-cabinet_59x73.5_we
1. What should be in your medicine cabinet? Here’s my top five and why.

  • Aspirin (324 mg).

Aspirin-tablet-300x300

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

  • Activated charcoal.

activated charcoal

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

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

triple abx

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

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

OTCdrugs

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

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

poisoncontrol

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

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

Medical Treatment, Health Prevention, , , , , , , , ,

coloniccolonics

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

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

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

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

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

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

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

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

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

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

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

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

In my “toxin summary post” tomorrow, I will answer your questions on the entire toxin and detoxification series and add a few final thoughts.
Call us at 1-844-SMA-TALK or login at www.SterlingMedicalAdvice.com to chat with your expert nutritionists about these matters, especially now that we’re in National Nutrition Month.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what  http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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Straight, No Chaser: When the Patient Knows Better

General Health and Wellness, Public Health, , , , , , , , , ,

drptnt2

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

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

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

Medicine is a science. By that, I mean a real science made of facts—not opinions, educated guesses or perspectives. There are seemingly a million paraprofessionals and incredibly intelligent people on the periphery of healthcare who have what we describe as an “experience base.” That means they “know” it because they’ve seen it or just read it. That is completely different than a knowledge base. Physicians have completed between seven and 10 years after undergrad learning, understanding and mastering the human body. What does that mean to you? Basically, the methodology for practicing medicine is not the linear A+B=C (i.e., “I have this symptom, therefore it must be this disease”).
Yes, this applies to you. Even you, dear “I know my body better than you do” reader. When you tell your physician that you’ve seen or experienced something before, you’re basically suggesting your sample size of one defines the entire universe of medicine. Even as it applies to you, the body is a wondrously complex creation with many, many variables affecting a single breath or heartbeat.
So, when your physician is telling you something different than what you believe or expect to hear about your condition, it’s not that s/he isn’t listening to you. It’s that s/he has listened to you and has come to a different determination. That’s why physicians have the power to write prescriptions, and you (and even pharmacists) don’t.
Of course, none of this is to say that your input isn’t valuable. It is valuable, and that’s why the physician asks you the questions. This is not even to say that physicians don’t make mistakes. This is to challenge you to allow the conversation to occur. Ask your own questions. Demand an explanation from your caregiver. Insist on being part of the care team and a partner in your treatment plan. Learn what to look for, what you can do at home and what should prompt additional measures. If you are stuck on a course of treatment before the conversation occurs, it is just as pointless as if a physician refuses to listen to your concerns.
Cut your physicians some slack. Many of you get so frustrated and outright angry when you don’t get your way. Physician’s offices and emergency rooms are not grocery stores. It’s not as if docs own the pharmaceutical company or the hospital. They’re just trying to care for you as best they can. As much as physicians love to provide satisfaction to patients, caring for you appropriately is of a higher order. Many of you understand this, and as such physicians continue to have among the highest rating of “trust” among professionals. It’s a privilege to take care of patients. The overwhelming majority of us still understand that fact.
Postscript: It was the flu.
PPS: A little advice from a friendly online SMA expert might have saved her the trip to the ER.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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Straight, No Chaser: Do You Take Antidepressants? Learn About the "Black Box" Warning Label.

Medical Treatment, Mental Health, , , , , , ,

antidepressantblackbox

It’s important to note that most recent group of antidepressants known as SSRIs are a marked leap forward in safety from their predecessors. Even still, they retain undesired effects, particularly in adolescents and young adults. The U.S. Food and Drug Administration (FDA) conducted a comprehensive review of controlled clinical research trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4% of those taking antidepressants thought about or attempted suicide, compared to 2% of those receiving placebos (a simulated but medically inactive treatment).
In 2005, this information prompted the FDA  to adopt its most serious level of warning on all prescription antidepressant drugs, known as a “black box” warning. This warning means to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. Specifically, makers of all antidepressant medications must post the warning regarding users up through age 24.
What does this mean for you? Regardless of your age, during the initial treatment period (e.g., the first month), you should have a family member closely follow you and look for any abnormalities or changes in behavior. In particular, worsening depression, suicidal thoughts or action, insomnia, increased agitation or withdrawal should be noted and considered a prompt to receive immediate medical attention.
In the event you’re wondering why such drugs would still be available to the public, it’s basically the risk/benefit ratio. These considerations aren’t taken lightly. It’s a testament to positive benefits of these medications that they remain popular and continually used for children and young adults (in particular) with depression and anxiety. Just be sure to have a detailed conversation with your physician or psychiatrist prior to use. These are not medications that you should just receive a prescription for and walk out of the office.
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.

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Straight, No Chaser: A Solution to the Upcoming Healthcare Crisis and the Affordable Care Act

General Health and Wellness, Public Health, , , , , , , , , ,

logo
Many of you have heard or seen me discuss various aspects of the Patient Protection and Affordable Care Act.  This ambitious effort seeks to maintain the current level of quality that exists (via maintaining the same insurance coverage for those individuals that already have it), while adding approximately 30 million individuals to the insurance rolls while not increasing overall system costs.
Have you noticed that one part of the conversation that doesn’t seem to occur is “Who’s going to take care of these 30 million new individuals? Also, what about the other 20 million that still won’t have insurance?” The twin deterrents of co-pays and deductibles will eventually be stiffened to curtail over- and inappropriate utilization of the emergency room for both the newly insured and the uninsured voucher recipients (Besides, who wants to deal with the long wait times both in your physician’s office and the ER, soon to be even worse with all the newly insured?). Similarly, you would presume that armies of new physicians are being trained to meet this growth in the newly insured, but that simply isn’t the case. Additional options to address this influx will be necessary. Prominent among these options will be those providing better education and greater empowerment of patients to direct their own care.
Sterling Medical Advice (SMA) is a national public health initiative that provides a solution to these issues by the introduction of 24/7 online personal healthcare consulting, featuring physicians and other care professionals covering the entire spectrum of medicine and healthcare. Consultations will be personalized and immediately available to those in need around the clock.
“What’s that, and when might you use it?” Here are a few examples.

  • You need advice regarding an immediate medical concern
  • You need general information about your medical condition
  • You need immediate information about your prescription
  • You are experiencing symptoms and want to know why
  • You want to learn more information about a medical condition that is part of your family history
  • You want additional details on your upcoming medical procedure
  • You need advice regarding the best care option for addressing a medical concern (e.g., emergency room vs. urgent care vs. scheduling an appointment with your primary care physician)
  • You want a second opinion on your new diagnosis
  • You want a second opinion on your new treatment plan
  • You need additional information about what to expect from a newly diagnosed condition

Sterling Medical Advice will improve public health outcomes while reducing healthcare costs for individuals, families and businesses and the healthcare system at large. Personal healthcare consulting will create a better-educated and empowered population and will become an additional component to the American health care system without compromising quality.
To find out more about Sterling Medical Advice, visit www.sterlingmedicaladvice.com, and thanks for following Straight, No Chaser.

Straight, No Chaser: What Should NOT Be in Your Medicine Cabinet

Public Health, Toxicology/Drugs, Health Prevention, , , , , , ,

medicine-cabinets

Ever notice that people run straight to the medicine cabinet to do harm to themselves or others? I want you to know the harder the effort is to obtain items to hurt oneself, the less likely one is to follow through on the notion. On another related note, here’s a quick not-so-fun-but-interesting fact. One of the differences between America and say, certain European countries is the oversized influence of corporations in the States. Why am I talking about that on a medical blog? Read on. If you can’t tell where I’m going with this, you’ll get it pretty quickly.

Here’s my top five items I want you to take out your medicine cabinets and lock up.

1. Any jumbo sized container of any medication. Think about two of the most common over the counter (OTC) medications used for suicide attempts: acetaminophen (Tylenol) and salicylate (aspirin). One thing they have in common is you can buy what amounts to a tub-full of it at your local superstore in the United States. They should call these things ‘suicide quantities’, because often those in the midst of a suicide attempt will grab and swallow whatever is convenient. Many different medications will hurt you if you take enough; Tylenol and aspirin certainly fit that bill. Observing that (and additional considerations after the deaths due to the lacing of Tylenol with cyanide back in 1983), the Brits decided to not only pass a law limiting quantities, but certain medications that are high-frequency and high-risk for suicide use are now mandatorily dispensed in those annoying containers that you have to pop through the plastic container. Needless to say, observed suicide rates by medication rates plummeted as a result. Wonder why that hasn’t been implemented in the good ol’ USA?

2. Have teens in your house? Lock up the Robitussin and NyQuil. Dextromethorphan is the active ingredient in over 100 OTC cold and cough preparations. Teens use these to get high, folks. To make matters worse, they are addictive, and if taken with alcohol or other drugs, they can kill you. Then there’s ‘purple drank’ (yes, that’s how it’s spelled), in which these cough syrups containing codeine and promethazine (Benadryl) are mixed with drinks such as Sprite or Mountain Dew.

3. Have any sexual performance medications? This is part of a category of medicines called ‘medicines that can kill someone with just one pill’. That usually refers to kids or the elderly, but remember that those sexual enhancement drugs are medicines that lower your blood pressure. In the wrong person and in the wrong dose, taking such medicine – whether intentionally or accidentally – could be the last thing someone does.

3. Any narcotic. Need I say more? Remember, you do have people rummaging through your cabinets on occasion!

4. Any sharps. That includes sewing pins, needles, etc.

5. Any medication with an expiration date. The medication date actually is more of a ‘freshness’ consideration than a danger warning. However, in the wrong patient, a medicine that has less than the 100% guarantee of its needed strength that the expiration date represents could be fatal. Play it safe and get a new prescription.

There’s a lot more that could be added to this list, but I like keeping things manageable for you.  Please childproof all your cabinets, and use childproof caps on your medications. I welcome your questions or comments.

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

Toxicology/Drugs, , , , , , , ,

medicine-cabinet_59x73.5_we
You’ve all done it. I’ve caught a few of you doing it. Why do you rummage through someone’s else’s medicine cabinet? Are newer homes even built with medicine cabinets anymore? Oh well… Today, I’m tackling a simple but important question in an ongoing effort to better empower you.
1. What should be in my medicine cabinet? Here’s my top five and why.

  • Aspirin (324 mg). On the day you’re having a heart attack, you’ll want this available to pop in your mouth on the way to the hospital. Of all the intervention done in treating heart attacks, none is better than simply taking an aspirin. It offers a 23% reduction in mortality due to a heart attack by itself.
  • Activated charcoal. This one may surprise you. Talk to your physician or pharmacist about this. If someone in your family ever overdoses on a medicine, odds are this is the first medication you’d be given in the emergency room. The sooner it’s onboard, the sooner it can begin detoxifying whatever you took. That said, there are some medications and circumstances when you shouldn’t take it, so get familiar with it by talking with your physician.
  • Antiseptics such as triple antibiotic ointment for cuts, scratches and minor burns. It should be embarrassing for you to spend $1000 going to an emergency room when you could have addressed the problem at home. I guess I should include bandages here as well.
  • A variety pack for colds, including antihistamines (like diphenhydramine, aka benadryl) and cough preparations. As a general rule, give yourself 3-5 days of using OTC preparations for a cold to see if it works or goes away. If not, then it’s certainly appropriate to get additional medical care. I guess I can lump a thermometer in this bullet point.
  • The fifth item would be this number: 800-222-1222, which is number to the national poison control center. They will address your concerns, route you to your local poison center and help coordinate your care when you go to your emergency department.

Straight, No Chaser Editorial: The Future of Medicine – Nurses are Stepping Up to the Plate

Public Health, , , , , , , ,

Nursing1
I doubt you’ll hear this perspective anywhere else anytime soon, but there are some very interesting developments in health care underway. By way of introduction, a few decades ago, physicians abdicated the ownership and preeminent leadership role in healthcare, leaving the industry to the business minds of HMOs. During these early days, non-physician corporations actually owning medical practices and developing practice parameters were outlawed as to ensure that sufficient protections would remain in place for autonomous (and presumably honorable) medical practice. 
The combination of for profit hospitals and the advent of contract medical practice management groups (particularly in emergency medicine, hospitalist medicine and radiology) combined to erode away at the corporate practice of medicine laws to where even though the laws are still on the books, suits to enforce it are now routinely defeated. Today, in addition to emergency room physicians, radiologists, surgeons, hospitalists, and anesthesiologists are more likely to be employees than owners of a practice.
In recent times, health care costs have skyrocketed to 17% of our economy, while 50 million Americans went without insurance. Meanwhile, the combination of a shortage of primary care physicians and for-profit entities’ desire to cut costs has led to the development and proliferation of alternative, less costly methods of paying individuals to provide health care. Most notably, this has included the development of advance practice nurses (e.g. nurse practitioners and nurse anesthetists – instead of family doctors and anesthesiologists). Similar interest in cost savings has led to nurses assuming senior managerial positions in hospitals instead of MBA-type executives.
It is against this backdrop that the Patient Protection and Affordable Care Act (aka ‘Obamacare’) passed, seeking to infuse 30 million more paying patients into the primary care arena. With ongoing physician shortages unable to meet this demand, and with there being downward cost pressure on salaries due to the goals of the ACA and desires of corporations, it’s reasonable to predict that we will see a dramatic increase in primary care nurse practitioners (NPs) and physician assistants (PAs), which will lead to further abandonment of primary care as a physician specialty.
Meanwhile, nurses have stepped up to fill the void.  In addition to the ongoing advancement of Nurse Practitioners, nurses have successfully lobbied for and created a new provider entity: ‘The Doctorate in Nursing Practice’. It is important to note that NPs and PAs can successfully treat about 85% of the things physicians routinely see. Quality concerns aside, it is an important public health consideration that additional healthcare professionals and health options are being established to fill the need of care for tens of millions of individuals more likely to use the healthcare system.
Meanwhile, regarding your doctors, a conceivable end result is physicians are being marginalized in virtually every aspect of health care. It is easy to see a future in health care 25 years from now where cost concerns have been addressed by nurses having replaced physicians in more specialties than just primary care and anesthesia, and nurses have more control of the hospital apparatus than physicians. Physicians remain oblivious to what’s happening under their noses and an insufficient interest in contributing to healthcare solutions in the ways nurses have. The Straight, No Chaser perspective is given the large segments of society that continue not to have access to care (even with implementation of the Affordable Care Act, it is estimated that 20 million American still won’t have insurance), new innovative options to address these needs are welcome and have a place in the system. What’s next is for society to ensure that this transition occurs with appropriate quality controls and public education.
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Straight, No Chaser: Circumcision – To Do or Not to Do?

Genital/Urinary, Medical Treatment, Pediatrics/Kids Health, Public Health, , , , , , , , ,

screamingbaby
As a medical professional, circumcision has long been one of those things that’s made me go hmmm…. If your religious beliefs include this as a ritual or ceremony, fine.  I get it, and I have no criticism at all.  No disrespect is intended.  Otherwise, circumcision is largely a procedure looking for an indication.  Quick, tell me what other elective surgical procedure or harmful activity of any type is allowed on children, much less newborns?  While I’m waiting for you to think about an answer that doesn’t exist, let’s recap the procedure and the medical logic behind it.
As you know (and men are painfully aware – pun intended), circumcision is the surgical removal of the skin over the glans (tip) of the penis.  Over the last 30 years, the rate of males receiving the procedure has dropped from 64.5% to 58.3%, according to the National Center for Health Statistics.  Worldwide about 30% of males are circumcised, and of those receiving it, the religious influence is largely present. 69% of those being circumcised are Muslim and 1% are Jewish (Circumcision is part of religious rituals in both religions.).
Let’s cut to the chase (no pun intended): Here are the best arguments for circumcision.

  • It helps prevent certain infections (e.g. yeast and UTIs – which most males aren’t especially prone to anyway).
  • The cells of the inner surface of the foreskin may provide an optimal target for the HIV virus (This is theoretical and not conclusively decided in the medical literature.  In any event, this is NOT the same as saying uncircumcised males do or are more likely to contract HIV.).
  • Circumcised males have a lower rate of penile cancer (which is very low under any circumstances).
  • Now, there are emergency indications for circumcision; the one I’ve had to address (once in twenty years) is an inability to readjust a foreskin that too tightly adhered to the shaft of the penis (paraphimosis).  Obviously, that’s a medical emergency and not something frequently seen enough to justify universal circumcision any more than a much higher rate of appendicitis would warrant universal and elective removal of everyone’s appendix.

Here are criticisms of the decision to have circumcision.

  • Any surgical procedure has complications, and that should be taken seriously.  That said, the complication rate for circumcision is very small and includes bleeding infection and pain.
  • Circumcision is a violation of a child’s body and is unnecessary and disfiguring.  The foreskin might not be cut the appropriate length, might not heal properly and may require addition surgery because the remaining foreskin incorrectly attaches to the end of the penile shaft.

Honestly, both the risks and benefits are quite overstated.  Circumcision doesn’t appear to be a medically necessary procedure, but it isn’t an especially dangerous one.  Interestingly, the American Academy of Pediatrics’ latest comment on circumcision is that the benefits of circumcision outweigh the risks, which stops short of recommending routine circumcision for all.  Even that equivocal smacks of conflict of interest, given who’s performing the procedure at a significant cost to the consumer.  Again, this appears to be a procedure looking for an indication…
If I was having this conversation in Africa, where the sexually transmitted infection rate is substantially higher and can be significantly reduced by circumcision, we’d be having a different conversation.  If my Jewish or Muslim friends and colleagues were asking my medical advice on the safety of getting the procedure done as part of their religious ceremonies, we’d be having a different conversation.  However, we’re not, and for the population in general, it’s safe to say that – various preferences (for various reasons) aside – there’s no compelling reason to recommend circumcision on all newborn males.  Make your judgment based on facts, not a whim.  And that’s medical straight talk.  Oh, and guys – sorry about the picture.  That wasn’t a good day.

Straight, No Chaser: When (Not) to Visit the ER

Public Health, , , , , , ,
copay I’ve spent a lot of time discussing the life threats that should prompt you to rush to the Emergency Room.  Today, I’m going to give you some factual information that could save you some time and a lot of money and keep you out of the ER.  There are so many misconceptions about the appropriate use of an ER.  Let’s address five points you should consider before you come to see me or my colleagues.  The message is not meant to be disrespectful to you and your families, but it’s just straight talk, and remember, the most important consideration is if you ever feel yourself (or your family) to be in harm’s way, don’t even think about it, get to the ER, and we’ll sort it out for you. 1)   Your expectations are sometimes completely unrealistic about the appropriate use of the ER.  One of the most expensive and inefficient healthcare laws on the books is the Prudent Layperson, which places in the hands of the public the right to go to an ER if one ‘believes’ an emergency exists.  Of course, the result of this is 80% of ER presentations represent things that could have been seen elsewhere for a fraction of the cost (mostly strains and sprains, bumps and bruises, sniffles and coughs – none of which usually requires an ER visit).  Admit it.  Your family sometimes uses the ER as a convenience because we’ll see you quicker than your doctor and can do certain tests quicker.  That doesn’t make it right and certainly doesn’t make it cheap.  But it sure makes for good business. 2)   The ER is not a clinic or a take out restaurant, regardless of what you think or need.  The ER’s notoriety as the ‘facility of last resort’ doesn’t mean we’re a substitute for seeing your doctor.  We rule out life-threats.  We’re not necessarily trying to diagnose the issues you’ve had for 3 years.  We don’t have the equipment or inclination to diagnose chronic disease.  It’s called an emergency department and is a specialty just as much as Surgery, Obstetrics or anything else.  We understand if you leave with some degree of dissatisfaction when we don’t address the reasons you came that were not life-threatening and/or emergent, and your complaining doesn’t impose a different standard of care onto us.   All to which you are entitled on an ER visit (as spelled out in the EMTALA law) is a medical screening exam, which is still going to be expensive.  All this accomplishes is the ER doc determining that you really aren’t trying to die at this moment.  Just because you think you need an x-ray doesn’t mean we’re going to order one.  We’re practicing medicine, not taking orders.  I’m not doing a spinal tap on your child because you saw a news report on encephalitis when you don’t have the symptoms (and as a rule, that analogy fits whenever you say the words “Can you do…xxx…just to be sure?” to an ER physician).  We do care.  We will go the extra mile for you and accommodate you – within reason. 3)   The ER is the most expensive portal of entry into the healthcare system by design.  Controlled for the same typical presentations, the average cost for an ER visit is $1020, and the average cost for the same in an office setting is $140.  The government sets prices, not hospitals or physicians.  Hospitals are able to charge more for any presentation because the infrastructure and operating costs of hospitals are massive compared with your doctor’s office.  In fact, hospitals charge a facility fee of several hundred dollars just for you walking through the door, in addition to everything else.  Insurance companies also attempt to discourage this by charging you higher co-pays for your ‘bad behavior’ ($50-150 upfront) to be seen in the ER instead of your doctor’s office, and in some instances, they require pre-authorization. 4)   The ER, hospital and the medical care system in general in this country is not about charity (or health care for that matter).  The US system is capitalistic by design, and has been very successful at that, capturing 1/6th of the US Gross Domestic Product.  We spend $2 trillion a year on medical care, fully one out of every six dollars spent in this country.  It’s probably the very best place to conduct business in this country.  Your occasionally irrational fears are costing you money.  And this is how hospital bills have been the #1 cause of personal bankruptcy in the US.  Just because you’re not paying upfront doesn’t mean the hospital won’t be tenaciously coming after you for payment. 5)   About 80% of disease takes care of itself if you’re patient.  The body is able to fight off most disease.  Nearly all of your creature comfort symptoms can be addressed by over the counter preparations.  Stop letting your fears be played upon.  Use the internet and other resources available to you, and smartly (i.e. selectively) decide when you need to come to the ER.   And please call your primary physician first. Doctors, nurses and pharmacists are still the best advocates you have left in the system, and we love taking care of you.  Virtually every survey this century shows that the aforementioned medical professionals are the most trusted in the United States, with teachers occasionally in the mix.  The ethics of healthcare providers offer a nice cover for the sometimes questionable (but legally permissible) behavior of insurance companies, pharmaceutical companies and for-profit hospitals, who all too often are all about the profit margin.  The business of American medicine in the 21st century is business first and medical care second.  I’ve told you time and again that diet, exercise, moderation and ounces of prevention preclude all manners of disease.  Take care of yourself, lest you’ll become one of the many for whom medical care expenses destroy personal finances. If you have any questions, comments or financial horror stories to share, I’m all ears.

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