Tag Archives: Sterling Medical Advice

Suicide Risks on College Campuses

September 10, 2018General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Bipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideation, Suicide, Suicide prevention, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post looks at suicide risks on college campuses.

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

Suicide Data

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

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

Risks for Suicide at College

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

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

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

It shouldn’t be difficult to appreciate how the lack of social support is one of the most powerful predictors of persistent suicidal thoughts. Appreciate that someone expressing or having feelings of being unappreciated, unloved and uninvolved with family and friends should be considered at risk. Unfortunately, this is true even in the absence of any other risk factors.
Those with a history of clinically diagnosed depression or other psychiatric diagnoses are at significant risk.
Also, risk exist in those with exposure to domestic violence (either witnessing or having been abused) in childhood.
Finally, having a mother with a history of clinical depression also increases the risk of suicide in students.

There are many Straight, No Chaser posts that address suicide prevention, diagnosis and treatment.

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Straight, No Chaser: What is MRSA? Causes, Prevention & Treatments

September 9, 2018Infectious Disease, Skin/Dermatology844-SMA-TALK, Antibiotic resistance, Behind the Curtain, Infection, Methicillin-resistant Staphylococcus aureus, MRSA, Spider bite, Staphylococcus, Staphylococcus aureus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

One of the things that’s changed a lot from when I first started practicing medicine is people show up every day to the emergency room for mosquito and spider bites. The local news has done a number on you, as now everyone is afraid of MRSA.
Methicillin-resistant Staph Aureus (MRSA) is a bacterial infection that’s resistant to the penicillin family of drugs that we used for decades to treat many infections. Staph Aureus itself is a bacteria akin to flipping a light switch. Normally, it resides within us (approximately 30% of us have it in our nostrils but only 2% of us carry the MRSA variety), not causing any problems, but it is also the source of many dangerous and life-threatening illnesses if it enters your bloodstream.
Over the last 50 years of treating Staph infections, resistance to many different antibiotics has occurred, meaning that when a serious infection occurs, it’s potentially very harmful. The emphasis there should be on potentially. Most MRSA infections are community-acquired skin infections that resemble a spider or other insect bite but are still mild and are treatable with different antibiotics than historically used. Regular Staph and MRSA infections are even more likely to occur in those institutionalized (i.e. in hospitals, nursing homes, etc.) and have tubes and wounds. Consider and discuss the risk with your physician when you see someone on a breathing device, a urinary catheter, needing gauze for surgical wounds or on feeding tubes. Amazingly, MRSA causes approximately 60% of hospital-acquired Staph infections now.
My primary goal today is to inform you of what you need to know to prevent obtaining these infections and when to be especially diligent in seeking treatment. It’s really a simple task of maintaining hygiene. Just prevent that ‘light-switch’ from flipping to the on position and most times you’ll be ok.
1. Staph is everywhere. You can best protect yourself by simply practicing good hygiene. Wash your hands early and often.
2. MRSA is spread by contact. Don’t be so quick to feel and squeeze on someone’s (or your own) boil. Wash your hands before and after such contact. Don’t share towels or razors.
3. Keep any cuts, scratches, nicks or scrapes covered until healed.
If you do see or develop signs of a skin infection (redness, warmth, tenderness, pain and possibly discharge from the wound site), it’s worth contacting your physician to see if s/he’d like to start antibiotics or drain a possible abscess.
So… don’t be afraid, be smart. Prevention is key.

Straight, No Chaser: Questions About Abscesses (Boils)

September 8, 2018General Health and Wellness844-SMA-TALK, Abscess, Behind the Curtain, Cellulitis, Folliculitis, Incision and drainage, Methicillin-resistant Staphylococcus aureus, Staph, Staphylococcus aureus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, streptococcus, There are 72 Hours in a DayJeffrey Sterling, MD

Whether you call them boils, pus pockets or abscesses, they hurt. Abscesses are infections that localize and collect pus beneath the skin. Although previous Straight, No Chaser posts have addressed MRSA, this one will highlight your frequently asked questions about abscesses.

Why do I get an abscess?
Something causes an injury or sufficient irritation to your skin to allow bacteria to enter, and/or your lowered immunity can’t adequately fight back. Examples of circumstances causing skin infections that can develop into abscesses include ingrown hairs (folliculitis), insect bites and IV drug use. You are at increased risk for developing an abscess if you have diabetes, are obese, use IV drugs, have a weakened immune system or have an untreated skin infection (cellulitis).

What causes abscesses?
Bacteria such as Staphylococcus aureus (Staph) and Streptococcus are common causes of abscesses. I’ll remind you that MRSA stands for methicillin-resistant Staph Aureus; this is an indication that traditionally used antibiotics don’t work against this particular strain of bacteria. MRSA should be a reminder of the dangers of inappropriate antibiotic use.

How do I know if I have an abscess?
Trust me. You’ll know. Typically you’ll develop a skin infection first, which could simply include pus-filled bumps that worsen to become red, warm, swollen and tender. You may develop a fever, and you will have a significant amount of pain.
Can I treat these at home?
Generally not unless you’re a physician or have access to one at home… What you can do is prevent them. Stop picking at your skin; in fact, learn to keep your hands off your skin. Use clean equipment (e.g. razors, clippers) if you shave hair from your skin.
In terms of treating abscesses at home, it is not advisable for you to attempt to cut yourself or otherwise deal with these once one has formed. Abscesses often have deep tracks under the skin that need to be explored. Whatever you’re doing to delay getting evaluated is increasing the risk that things will worsen.

So how are abscesses treated?
There are two approaches to treating abscesses: “from the inside out” and “from the outside in.”

From the inside out refers to receiving antibiotics. Most abscess do respond promptly to antibiotics if you don’t wait too long to get them treated.
From the outside in refers to a procedure called incision and drainage (I & D). You’ll recognize this as your physician having to cut open the abscess, clean the area out and place gauze in the wound for a few days. Doing this in most cases eliminates the need to also take antibiotics. Unfortunately, I & Ds often must be done on higher risk abscesses, and in some instances, it’s necessary to have it done by a surgeon.

When should I see a doctor for one of these?
These generally aren’t getting better on their own. In particular, if you have one of the risk factors previously mentioned (diabetes, IV drug use, obesity, decreased immunity), the abscess is on or near your genitalia, is spreading fast or is extremely painful, you should be seen sooner rather than later.

Straight, No Chaser: Recommendations for Early Detection of Prostate Cancer

September 7, 2018General Health and Wellness844-SMA-TALK, American Cancer Society, Behind the Curtain, digital rectal exam, Prostate cancer, prostate cancer screening, Prostate-specific antigen, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Every so often, controversies regarding medical treatment recommendations get in the news and seemingly only serve to confuse the public. Every blog, article or research paper is a single entity that may or may not adjust the body and weight of evidence on a given topic. Even most well-done research articles do not completely change the standard of care for medical practice. Prostate cancer screening is a great example. At the end of it all, controversies aren’t as important as the consensus recommendations that emerge from medical and public health professionals tasked with reviewing such information.
In this Straight, No Chaser, we will review the latest (2016) recommendations from the American Cancer Society (ACS) for early detection of prostate cancer. Remember, when you hear dissenting views, consider the source and balance that against the formal recommendations of ACS.
In an earlier Straight, No Chaser, several questions regarding prostate cancer were addressed. However, there is one additional question that is important to review.
Does Everyone With Prostate Cancer Get Treated?

This is the source of controversies regarding screening of prostate cancer. Most men diagnosed with prostate cancer do not die from the disease. I mentioned previously that 30,000 men with prostate cancer die of the disease every year. However, over 3 million men in the U.S. are currently living with a diagnosis of prostate cancer. Based on these statistics, the question then becomes…

Why Do All Men Need to Be Screened For Prostate Cancer?
A certain stream of logic asks why screening is necessary if most of those who are diagnosed don’t die. Many treatments (e.g. surgery, medications, radiation) have additional risks that could be avoided if interventions were avoided. Similarly, some have taken to asking if any screening program is necessary. The view here is information is empowering. It’s always better to have information regarding the state of your health. Working with your medical team and family, the correct decisions about next steps can be made. This option is only available if you know what’s happening with your health.
How Does Screening Occur?

There are two tests commonly used to screen for prostate cancer.

A digital rectal exam (DRE) is when a doctor inserts a gloved, lubricated finger into the rectum and estimates the size of the prostate and assesses it for lumps or other abnormalities.
The prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate, and PSA blood levels can be higher in men who have prostate cancer. Unfortunately the PSA level isn’t specific for prostate cancer, as it can be elevated in other conditions that affect the prostate such as age, race, certain medications or medical procedures, prostate enlargement or infection.

So What Are The Current Recommendations for screening?

The American Cancer Society (ACS) recommends that men get to decide if they want to be screened, based on a recommendation from their physician and having received information about the risks, benefits and uncertainties surrounding screening. In other words, we don’t even talk about screening anymore; now it’s “Who should have a conversation with their physician about getting screened?”

If you’re age 50 and have an average risk of prostate cancer and are expected to live at least 10 more years. Because prostate cancer grows slowly, if your life expectancy is less than 10 years, you wouldn’t benefit from screening or treatment for prostate cancer.
If you’re age 45 for men and are at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
If you’re age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Among these groups, when the decision is made to screen, those men will be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
Assuming no prostate cancer is found as a result of screening, the need for future screenings depends on the results of the PSA blood test:

Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences. Please at least have the conversation with your physician.

Straight, No Chaser: Facts About Prostate Cancer – 2018 Update

September 6, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Prostate cancer, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Men (and those who care for men – meaning everyone) should be knowledgeable about prostate cancer. I don’t mean physician-level knowledgeable, but there are just a few facts that you should know that are meaningful. We’ll cover those in this Straight, No Chaser.
Aside from skin cancer, prostate cancer is the most common cancer among men in the U.S. It is also one of the leading causes of cancer death among men of all races. According to the National Cancer Institute, in 2018, there will be over 164,6900 new cases and well over 29, 430 deaths (13% increase from 2017) from prostate cancer. Approximately 11.2% of men will be diagnosed with prostate cancer at some point during their lifetime. Here are some prostate cancer basics.

What’s the prostate exactly?
The location and function of the prostate was covered in this previous post.
Who’s at risk for prostate cancer?

Age: This is simple. The older you are, the greater your risk of developing prostate cancer.
Race: Prostate cancer is more common in certain racial and ethnic groups.
Genetics: Your risk is increased, which is not the same as saying you’ll develop it if a family member has. This risk is twice to three times more likely if you have a father, brother or son who has had prostate cancer.

What are the symptoms of prostate cancer?
It is of interest that a wide variety of presentations exists in those later diagnosed with prostate cancer. Some men don’t have symptoms (meaning it’s discovered on screening examinations), and other men present with several symptoms, which may include the following.

Blood in the urine or semen
Difficulty completely emptying the bladder
Difficulty starting urination
Frequent urination (especially at night)
Pain in the back, hips, or pelvis that doesn’t go away
Pain or burning during urination
Painful ejaculation
Weak or interrupted flow of urine

How Is Prostate Cancer Treated?
See the above chart for more detailed information. Optimally, treatment for prostate cancer should take into account

Your age and expected life span with and without treatment
Other health conditions you have
The severity (i.e. stage and grade) of your cancer
Your feelings (and your physician’s medical opinion) about the need to treat the cancer
The likelihood that treatment will cure your cancer or provide some other measure of benefit
Possible side effects from treatment

Different types of established treatments are available for prostate cancer, including the following:

Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) and digital rectal exam (DRE) tests regularly, and treating the cancer only if it grows or causes symptoms. This is known as active surveillance.
Surgery to remove the prostate and or surrounding tissue. This surgery is called a prostatectomy.
Radiation therapy with high-energy rays to kill the cancer..
Hormone therapy perhaps could be named “hormone blocking therapy,” because these medicines blocks cancer cells from getting the hormones they need to grow.

The next Straight, No Chaser will provide an update on prostate cancer screening recommendations.

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 © 2018 · Sterling Initiatives, LLC · Powered by WordPress
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 © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Questions About the Prostate

September 5, 2018Genital/Urinary844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

This is Prostate Cancer Awareness month, and as such, this Straight, No Chaser explores the prostate (no pun intended). Prostate cancer and screening will be addressed in an additional post. There are generally five questions people ask about the prostate, so let’s take the time to address them. These topics are individually discussed in detail at www.sterlingmedicaladvice.com.

1. What is the prostate?

The prostate is a male-only organ located in front of the rectum and under the bladder. It surrounds the urethra, which is the tube through which urine flows on its way out of the penis. Understanding this anatomy helps one understand the nature of problems that arise related to the prostate. Importantly, the prostate is part of the male reproductive system. It’s a gland that contributes to the fluid (seminal fluid) that carries sperm out of the body (i.e., semen).
2. Doesn’t it get infected?

Prostatitis is either inflammation or infection of the prostate gland. It has many different causes. When an infection with bacteria causes prostatitis, it is called bacterial prostatitis. Bacterial prostatitis can be a particularly long-lasting infection, requiring antibiotics to treat.

Acute bacterial prostatitis is an infection that produces signs and symptoms rapidly.
Chronic bacterial prostatitis is an infection that lasts for at least three months.

3. Why does the prostate get large?

A condition known as benign prostatic hypertrophy (BPH) occurs in men as they age. As a general rule, 50% of men have it by age 50, and 80% have it by age 80. The prostate normally is only the size of a walnut. When BPH occurs, the prostate has enlarged to a point where it may press upon the urethra, disrupting the normal flow of urine, preventing normal emptying. It is important to understand that the growth seen in BPH is not cancer.
4. What’s the relationship between the prostate and sex?
When people ask me this question, they have one of two concerns.

Some medical studies have drawn a relationship between a higher frequency of ejaculations and a lower risk of prostate cancer. This trend is not currently considered definitive; to be clear there is no conclusive evidence that the risk of prostate cancer is reduced by frequent ejaculation.
The male equivalent of a “G-spot” is described as being near the prostate.

5. Is prostate cancer deadly?

Prostate cancer is usually slow-growing, but may occasionally be aggressive. Cancerous prostate cells may break off and spread to other parts of the body, particularly the bones and lymph nodes. Prostate cancer usually is seen in men after 50 and even when discovered often doesn’t require especially aggressive management.

Your bottom line?

You especially need a prostate exam and other considerations yearly after age 50.

Straight, No Chaser: Tips for Treating & Preventing Gas

September 4, 2018Gastrointestinal, General Health and Wellness844-SMA-TALK, alpha-galactosidase, Behind the Curtain, lactase, Simethicone, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

So… you have problems with gas. What are you to do? Well, given that gas production is a natural occurrence, it’s not like you’re going to eliminate having gas (no pun intended). If you read the previous post on what produces belching and flatus, you should have a good idea as to why different things affect you the way they do. Understanding this directly leads into how you can prevent, reduce and treat untoward gas production.

I’ll make this simple. If you want to reduce the amount of gas you produce, think of these three considerations within your reach. If these efforts prove ineffective, your physician may prescribe medicine, but this should not be the initial consideration.
Adjust your diet

If you recall the variety of foods that produce gas or simply remember foods high in carbohydrates produce more gas than foods high in fat or protein, that’s a start. Unfortunately this requires thought and balance. Many healthy foods produce gas (e.g. fruits, vegetables and whole grains). You don’t want to create an unhealthy diet in pursuit of convenience. Be reminded that while fat does not cause gas to the extent that carbohydrates do, limiting high-fat foods can still help reduce bloating and discomfort. Less fat in the diet helps the stomach empty faster. This allows gases to move more quickly through the digestive system.
If you believe or know yourself to be lactose intolerant, simple avoidance of dairy products will improve your situation.

Change how you eat

Your eating habits play a role in this. For example, if you are a fast eater, you’re likely gulping down air. Slow it down, and chew more thoroughly.
Think about how you chew. Do you keep your mouth open? If so, that involves swallowing more air. Now think about those people who habitually chew gum or hard candies with their mouths open. These are habits easily altered.
Keep your dentures or dental plates adjusted so they fit. The constant production of air pockets in those loose spaces can get transmitted down your digestive track as you chew. A little attention in this direction can lead to a lot less gas. Check with your dentist.

Over-the-counter (OTC) treatments
You know certain OTC medicines well. It’s reasonable for you to know what they’re doing.

Beano (alpha-galactosidase) is a digestive aid. It helps the body digest the sugar contained within beans and many vegetables. It doesn’t affect gas production from lactose or fiber.
Mylanta, Maalox or Gas-X (simethicone) also can relieve bloating and abdominal pain or discomfort caused by gas. These products don’t affect gas production but do increase the rate of gas elimination. Thus, even when it seems as if one of these is not producing immediate relief, it’s likely helping.
Lactase tablets or drops can help people with lactose intolerance digest milk and milk products to reduce gas production. Lactose intolerance is discussed in detail in another Straight, No Chaser post.

Here’s a final word of caution. Gas pain may not be due to simple considerations. Those who burp frequently can have gastroesophageal reflux disease (GERD). Cardiac disease can present with gas pain. Irritable bowel syndrome (IBS) can be a reason why you’re more sensitive to gas pain. There are many other examples.
Remember: if these tips aren’t effective in improving your gas discomfort, please consider getting evaluated.

Straight, No Chaser: The Gas You Pass-Eructation (Belching) and Flatus (The Other One)

September 3, 2018Gastrointestinal844-SMA-TALK, Behind the Curtain, belching, carbon dioxide, eructation, flatus, methane gas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

It seems like Straight, No Chaser is unafraid to address any topic! Here’s one of those conversations that everyone wants to have but rarely does. Gas is a natural phenomenon. That’s a given. However, all of us probably want to and would benefit from knowing why it’s happening and what can be done to minimize those odoriferous emanations from above and below. Here are some frequently asked questions on the gas you pass.

What is gas?
Gas is a byproduct of the digestive process or of your swallowing air. It’s some combination of oxygen, carbon dioxide, hydrogen, nitrogen and methane gases. Remember the digestive tract extends from your mouth to your anus, so depending on where the gas is produced, the gas may be expressed from either end of you through burps or flatus.
Why would I swallow air?
Everyone swallows a small amount of air when eating and drinking. The amount of air swallowed increases when people eat or drink too fast, chew gum or suck or hard candy, drink carbonated beverages, smoke or wear loose-fitting dentures.

Why does gas have that smell?
Flatus (gas passed through the anus) may contain small amounts of sulfur. Flatus that contains more sulfur gasses has more odor.

Why do I produce so much gas?

Passing gas is normal. In fact, the average person does so about 15-20 times a day. Many things can cause you to produce more, including eating a lot of carbohydrates (e.g. sugars, starches, fibers). The upper parts of the digestive system (stomach and small intestines) are as effective as the lower intestines as breaking down carbohydrates. When the lower intestines do so, gases including hydrogen, carbon dioxide, methane gas or hydrogen sulfide (a sulfur gas – as mentioned, methane and sulfur as more noticeably smelly gases). This isn’t as much of an issue with fat and protein based diets.
Constipation also results in increased amounts of methane production.
Conditions that disrupt the digestive system can have the same effect. Examples include diabetes and Crohn’s disease.

Can you give examples of foods that are carbohydrates and cause gas?
There’s wide variation between individuals in how foods are digested. As an example, consider the effect of being lactose intolerant. Some foods that may cause gas include

fruits such as pears, apples, and peaches
vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, onions, mushrooms, artichokes, and asparagus
whole grains such as whole wheat and bran
sodas; fruit drinks, especially apple juice and pear juice; and other drinks that contain high-fructose corn syrup, a sweetener made from corn
beans
milk and milk products such as cheese, ice cream, and yogurt
- packaged foods—such as bread, cereal, and salad dressing—that contain small amounts of lactose, a sugar found in milk and foods made with milk
sugar-free candies and gums that contain sugar alcohols such as sorbitol, mannitol, and xylitol

What are the symptoms of gas?
In addition to burping and passing gas, bloating and abdominal discomfort are common.
When should I be seen for gas?
It’s easy to be distracted by what you believe to be simple gas pains. If your symptoms are new or different (especially if you’re above age 40), or if your gas symptoms are accompanied by diarrhea, constipation or weight loss, you should get evaluated. Of course, severe pain seems to be the most common prompt for an evaluation.

Asthma Basics – Control and Treatment

September 2, 2018Medical Treatment, Respiratory/Lungs844-SMA-TALK, Asthma, Behind the Curtain, Chronic obstructive pulmonary disease, Conditions and Diseases, Emergency department, health, Inflammation, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post discussions asthma basics – control and treatment. The previous post discussed asthma triggers and symptoms.

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. At that point, the situation becomes completely different. These changes predisposes asthmatics to other conditions such as chronic bronchitis, COPD (chronic obstructive pulmonary disease) and lung cancer. These points simply reiterate the importance of identifying and removing those triggers.

Asthma Control is the Best Treatment

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:

Eliminate your exposure to cigarette smoke (including second hand smoke)!
Avoid long haired animals, especially cats.
Avoid shaggy carpets, window treatments or other household fixtures that retain dust.
Wear a mask to avoid triggers! 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. The conditions for which you should consider these include the following:
- If you’re spraying any kind of aerosol
- During allergy season
- If you’re handling trash
- If you react to cold weather
Be careful to avoid colds and the flu. Get a flu shot yearly.

Asthma Treatment Options

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.

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Asthma Basics – Triggers and Symptoms

September 1, 2018Respiratory/Lungs, Health Prevention844-SMA-TALK, Asthma, Behind the Curtain, Conditions and Diseases, health, Lung, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post is on asthma basics, including triggers and symptoms.

Asthma concerns me. I’ve had many close friends and family suffer with the disease. In fact, a very good friend died of an attack while in medical school, because he didn’t have his inhaler with him. In other words, this is somewhat personal. I’ve probably given more lectures on asthma than any other topic over the years, and I can say without hesitation that relative to how much we know about its prevention and treatment, I can’t think of another disease where we under perform as much as with asthma management. According to data from the National Institutes of Health, over the last few decades the death rate has increased by over 55%. The prevalence rate has increased by 75%, and among African-Americans the hospitalization rate has increased over 35%. The good news is asthma can be controlled and effectively treated. In this primer, we’ll discuss quick tips to improve the health of the asthmatic in your life.

Asthma Made Simpler

The encouraging thing about asthma is that if you understand what causes it, you understand how to treat it. Here’s what you need to know about what causes asthma. For the purposes of discussion I am simplifying matters for general consumption.

Asthma is a result of certain triggers, causing inflammation to your airways over a long period of time with the occurrence of attacks (intermittent exacerbations). These triggers can be thought of as allergens. Examples of these triggers include cigarette smoke, dust, aerosols, cold air, long-haired animals (especially cats), seasonal pollens, and exercise (in some).
These triggers create a state of inflammation and hyperresponsiveness in the lungs, leading to the excessive production of mucus within the lungs’ various airway branches. If bad enough this will lead to complete obstruction of the airways. In other words you’ll stop breathing, and you will die without assistance and/or reversal.
Exacerbation of asthma include breathlessness, chest tightness, coughing, and wheezing. Basically, because you have the functional equivalent of snot in your lungs, your airways are narrowed, and you’re having difficulty breathing. After all, it’s harder to breathe snot than air. Now imagine how your lungs feel when you’re adding cigarette smoke to that mix.

Asthma Management Considerations

Let’s get logical. Asthma management is theoretically straightforward if you can pull it off. Prevention is treatment. I used to describe this as “Kill the Cat.” (This blog neither supports, advocates, nor is responsible for the harming of any animals resulting from this information.) In short, if you identify the triggers that precipitate your asthma attacks and then remove yourself from that environment, you will dramatically reduce, if not eliminate, your attacks. This is often described (incorrectly) in kids as “growing out of their asthma.” No one grows out of it, and you don’t cure asthma; asthmatics just stop having attacks because they’re not around the triggers.

In Part II, we discuss asthma management. In case you’re wondering, that’s where the toothpicks come in.

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From the SterlingMedicalAdvice.com Health Library: “My Doctor Said I Was a High-Risk Asthmatic. What Does That Mean?”

August 31, 2018General Health and Wellness, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Bispebjerg, Conditions and Diseases, health, Pregnancy, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you have an asthmatic in your life, it’s important to know that asthmatics die. The risk of death is higher in certain asthmatics. If you or your loved one is in this subset of asthmatics, you really must be diligent in avoiding those triggers that cause asthma attacks. You must also be attentive and consistent in taking your ‘controller’ medicines.
These circumstances define a high risk asthmatic:

A history of sudden severe asthma attacks
Prior need to be intubated (placed on a respiratory aka breathing machine)
Prior admission to a hospital ICU (intensive care unit)
Greater than one admission or two ER visits in the past year
An ER visit within the last month
Needing to use two or more inhalers per month
Current or recent oral steroid use
Illicit drug use
Concomitant cardiopulmonary or psychosocial disease

Feel free to ask your SMA expert consultant any questions you may have on this topic.

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Straight, No Chaser: Five Frequently Asked Questions on Lupus

August 30, 2018Cardiology/Heart, Endocrine/Metabolic, Genital/Urinary, Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs, Skin/Dermatology844-SMA-TALK, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, LupusJeffrey Sterling, MD

What is lupus? What causes it?

In general terms, lupus is a disease in which your immune system malfunctions and attacks your healthy tissue. This is known as an autoimmune disease. The consequences of lupus are pretty profound because the body’s immune response can be pretty indiscriminate. Lupus can damage your heart, brain, skin, kidneys, lungs, blood vessels, joints and other tissues, meaning it can present in a multitude of ways. This occurs most often in the type known as systemic lupus erythematosus (SLE). The cause is unknown.

Can anyone get lupus? Who is most at risk?

Anyone can get lupus, but certain groups are more at risk, including the following.

Women are most at risk.
African American women are affected by lupus two to three times more often than Caucasian women.
Lupus is also more common in Hispanic, Asian, and Native American women.
Black and Hispanic women are more likely to have severe forms of lupus.

What are the symptoms of lupus?

Because of the variety of locations that can be affected, lupus can have a wide variety of symptoms in different people. The most common symptoms include joint pain or swelling, muscle pain, fatigue, fever, a red facial rash (aka “butterfly rash”), chest pain with breathing, sun sensitivity, hair loss, eye, leg and gland swelling, and mouth ulcers. The fingers and toes also may tend to become pale or purplish.

Symptoms tend to flare (come and go) and can change in severity and type between attacks, with new symptoms occurring at any time.

How is lupus diagnosed?

The diagnosis of lupus really is often a source of frustration. There’s not a defining diagnostic test, and because it mimics so many other conditions, it can take years for a correct diagnosis to be made. Tests can range to routine blood tests to samples of tissue that looks at suggestive changes under a microscope.

What are the treatments for lupus?

Lupus has no definitive cure. Management focuses on control of the various parts of your body separately affected by the disease. The approach to care involves prevention, prompt treatment and reduction/elimination of long-term damage to the parts of your body (organs) being affected.

Along those lines, treatments also involve two components. The first is to attempt to normalize the immune system, prevent and reduce flare-ups and minimize the pain and other symptoms when flares occur. The second component involves treating the consequences of the organs affected by lupus (e.g. high blood pressure, high cholesterol, infections). In case you were wondering, alternative medicines have not been shown to be effective in treating lupus beyond stress reduction. Given the impact of medications on your immune system, it’s not advisable to add additional medicines to your treatment regimen without coordination with your primary care physician.

As much as anything, those with lupus need to become empowered and active in their management. Routine health activities (diet and exercise) that produce global health benefits, along with stress reduction have often proven to be as important as other components of the care plan. It the best cases, management of lupus is a group activity. Make sure your team is assembled and working in the same direction.

Straight, No Chaser: The Health Risks of Urban vs. Rural Living

August 29, 2018General Health and Wellness, Public Health844-SMA-TALK, Behind the Curtain, Public Health, Rural health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Urban healthJeffrey Sterling, MD

What’s your flavor, city vs country living? Regardless as to wear you live your life, each decision comes with defined risks to your health, and yes, these effects go beyond the risks of different forms of trauma in each location. To extend the scenario globally, it is an amazing fact that for the first time in human history, it is estimated that more people worldwide live in urban areas than in rural ones. In today’s Straight, No Chaser, we evaluate a few health facts that speak to the relative value of city vs. country living.
It is important to understand that some considerations are more reflective of socioeconomic status than urban vs. rural dwelling. Notably, poverty is a cause of poor health and limits access to health prevention and medical care, regardless of the location of one’s home. There are strong correlations between lower income and higher death rates (mortality) across the board. Poverty, not urban living per se, increases the likelihood of encountering violence, increases the likelihood of experiencing violence and child abuse.

More specific to inner-city urban living, in 1997 the American College of Physicians identified specific health problems most commonly associated with US inner cities, labeling this disadvantage as an “urban health penalty.” They included the following:

Drug abuse
HIV infection
Teenage pregnancy
Violence

Simply put, addressing this set of issues requires addressing the root causes of poverty. It is also of note that access to care presents as significant problems in both urban and rural communities, but for different reasons. Rural communities are likely to have access considerations due to geographic and physician shortages, and urban communities are more likely to have barriers prevent accessing available resources.

There are defined differences in health and health risks, based on living in the city vs. a rural location. For example, those that live in cities:

Actually have less of a risk of becoming obese;
Are less likely to die of an accident;
Are more likely to be lactose tolerant.
Are more likely to develop asthma, have allergies and suffer from dry eyes;
Are more likely to have better TB resistance;
Have a much lower risk of suicide;
Have troubled circadian rhythms and disturbed sleep; and
Report a more pleasant and healthy old age.

Finally it is worth noting that inner city environments produce specific public health threats. These include the following:

Homelessness,
Increased availability of illicit drugs,
Increased spread of HIV infection and treatment-resistant tuberculosis
Presence of higher concentration of certain types of pollutants, such as carbon monoxide and molds.

At the end of the day, these risks may or may not result in health problems for you individually. It is important for you to be aware of the risks in order to limit your exposure. Be empowered, not crippled, by this information, and enjoy the rest of this wonderful time of the year, regardless of your environment.

Straight, No Chaser: The Roof Is On Fire – The Trauma of Residential Fires

August 27, 2018Trauma, Health Prevention844-SMA-TALK, Behind the Curtain, Burns, Carbon Monoxide, Cyanide, Fires, health, Home Fires, Hypertension, Residential area, Residential Fires, Smoke detector, Smoke Inhalation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, United StatesJeffrey Sterling, MD

As Trauma Week winds down on Straight, No Chaser, we work our way back home, which sadly is the site of most traumatic injuries. In fact, about 85% of all U.S. fire deaths occur in homes.
The good news is the number of residential fire-related deaths and associated injuries is going down, but that won’t help you if you aren’t aware of how to prevent them and get to safety and cared for in the event a fire occurs in your home. Let’s address this right off the bat. You’re most likely to die or be injured from a fire if you’re in one of the following groups, according to the Center for Disease Control (but of course, the fire doesn’t check who’s being burnt):

Poor
Rural
African-American
Native American
Ages less than 4 or over 65

Based on new injury statistics (2016), an American is accidentally injured every second and killed every three minutes by a preventable event. Interestingly, victims aren’t burning to death as much as they are dying from inhalation injuries from smoke and gases (estimated to be the cause of death in between 50-80% of cases). Speaking of smoke, although cooking is the #1 cause of fires, smoking is the leading cause of fire-related deaths. Alcohol consumption is a contributing factor in 40% of residential fire deaths. Most fires occur in the winter.
So What To Do?

Install a smoke alarm. They work. Over one-third of residential fire deaths occur in homes without alarms.
Plan your escape in advance. Have an exit strategy based on where a fire might break out in your home.
Don’t fight the fire. Nearly ½ of fire related injuries occur from efforts to fight the fire. Get out of the house. Of course if you have easy access to an extinguisher, use at your discretion.

Tips on How You’ll Be Treated
Fire-related injuries commonly involve burns and bony injuries (bruises, sprains, fractures), which will be addressed as needed. However, the most important fire-related injuries involve the airway. These injuries may be due to the heat’s effects on the airway (burns, swelling and inflammation) and/or the effects of carbon monoxide and/or cyanide (inability to oxygenate). One important fact for families to realize is the presence of any soot/burns anywhere near or in the mouth or nose needs to be evaluated. Such signs and symptoms are powerful predictors of potential airways damage and imminent failure.

Straight, No Chaser: National Minority Organ Donor Awareness Month

August 26, 2018Health Prevention844-SMA-TALK, August, Behind the Curtain, Chronic kidney disease, health, Kidney transplantation, Minority group, Organ donation, Organ transplantation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, United StatesJeffrey Sterling, MD

August is National Minority Donor Awareness Month, which brings attention to the more than 118,000 people nationwide waiting for lifesaving organ transplants. Of the these men, women and children listed on the national organ transplant waiting list, 56% are minorities. People of most races and ethnicities in the U.S. donate in proportion to their representation in the population. Minorities are disproportionately affected by illnesses, like high blood pressure and diabetes, which can lead to end-stage renal disease and the need for dialysis or a kidney transplant. This contributes to a disproportionately higher number of minority patients on the national organ transplant waiting list.
Here’s a representation of waiting list candidates by ethnicity:

Caucasians: 43.7%
African-Americans: 29.6%
Hispanics/Latinos: 18.4%
Asians: 6.7%
Native Americans and Alaska Natives: 1%
Native Hawaiians and other Pacific Islanders: 0.5%
Multiracial: 0.5%

In 2012, 11,309 minority patients received organ transplants; while there were 2,762 minority deceased donors and 1,711 minority living donors. The wait is long and, sadly, 18 people die every day because the transplant they desperately needed did not come in time. These facts make the need for more donors from ethnic minority groups critical. However, minority organ donation often lags due to misinformation about the need and process.
Learn The Facts (most information provided by U.S. Department of Health and Human Services)
These facts may help you better understand organ, eye, and tissue donation:

Fact: Regardless of age or medical history, anyone can sign up to be a donor. The transplant team will determine at an individual’s time of death whether donation is possible.
Fact: Most major religions in the United States support organ donation and consider donation as the final act of love and generosity toward others.
Fact: If you are sick or injured and admitted to a hospital, the number one priority is to save your life. Hospitals simply are not in the business of allowing patients to die to harvest their organs.
Fact: When matching donor organs to recipients, the computerized matching system considers issues such as the severity of illness, blood type, time spent waiting, other important medical information, and geographic location. The recipient’s financial or celebrity status or race does not figure in.
Fact: An open casket funeral is usually possible for organ, eye, and tissue donors. Through the entire donation process, the body is treated with care, respect, and dignity.
Fact: There is no cost to donors or their families for organ or tissue donation.
Fact: Every state provides access to a donor registry where its residents can indicate their donation decision.
Fact: Federal law prohibits buying and selling organs in the U.S. Violators are punishable by prison sentences and fines.
Fact: People can recover from comas, but not brain death. Coma and brain death are not the same. Brain death is final.

In order to sign up to be on the donor registry, or to receive more information, visit http://organdonor.gov/becomingdonor/stateregistries.html.
Meet the challenge. Address the need.

Understanding and Avoiding Golf Injuries

August 25, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Golf injuries, Golfers Elbow, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This Straight, No Chaser post is about golf injuries.

As we watch Tiger Woods’ body continuing to crumble before our eyes, it’s a good time to review golf injuries. Not just because of him but for the average weekend warrior (or hacker as the case may be). We’re in the middle of summer, which for many means a lot of golf.

They’re Getting Worse

You should be aware that golf-related injuries continue to be on the rise. I’m not talking about the struck by lightning, hit by a golf ball or club, driving your cart into the adjacent lake or being bit by a crocodile variety. I’m talking about overuse of specific parts of your body that are involved in the golf swing. 80% of golf-related injuries are reportedly due to such overuse considerations. It’s also estimated that 40% of amateurs and 60% of professionals will experience an injury related to such overuse. It should be intuitive and is certainly true that the risk for such injuries increase with age.

Types of Injuries

Here are the three most common sets of golf injuries in amateurs (professionals have slightly different injury patterns and frequencies). I’ll also address how they occur and what you can do to prevent them. Keep it in the short grass.

Lumbar Strain/Development of Low Back Pain:

We spend so much time learning to extend the club, coil and uncoil while swinging a golf club about 100 MPH (some of us, myself included, at an ever faster rate; professionals average speeds of approximately 120 MPH). The very premise of doing this for three and a half to five and a half hours at a time (shame on you, slow golfers!) is not the most natural consideration based on our bodies’ design. Studies of professionals show that about 1/3 of them have experienced significant low back pain of at least two weeks’ duration. And they know what they’re doing!

What to do? This may be close to blasphemy to many golfers, but studies show that not carrying your golf bag (i.e. using a caddy or a golf cart) cuts the rate of golf injuries in half. That’s not saying don’t walk! Even the pros don’t carry their own bags. A second consideration (or perhaps it should be first) is learning proper technique. Additionally, flexibility training that increases the range of motion of the lumbar spine and extension and rotation of the lead hip (left hip in right-handed golfers) should decrease low back pain. Personally, I’ve had great success with golf-tailored stretching exercises and modified yoga techniques. Try it. The only thing you have to lose is the pain and maybe a few strokes.

Elbow Injuries – Medial and Lateral Epicondylitis

Consider these the plague of the hacker. Both conditions are inflammatory problems involving tendons of the elbow. Medial epicondylitis is known as ‘golfer’s elbow’, although it occurs in other sports such as bowling, lifting weights and sports involving throwing. It’s typically associated with those times that you (excuse me, your playing partners…) hit the ground before the hitting the ball, and you feel that shiver in your elbow. Lateral epicondylitis is known as ‘tennis elbow’, although golfers may be affected on the lateral side as well. This typically occurs when you over-involve your right hand in your swing; eventually the overuse will produce inflammation in that tendon. Similar conditions exist in the wrist as well.

What to do? Get better, for starters! Proper swing mechanics reduce the incidence of both golfer’s and tennis elbow. Additionally, good health (including an exercise regimen inclusive of strength training and stretching) and pre-round stretching maneuvers help to reduce the likelihood of these conditions presenting during your round. Additionally, if the situation becomes truly painful, typical treatments include recommendations to rest, use ice and anti-inflammatory medications, and to immobilize the involved area.

Shoulder Injuries

Failure to have proper mechanics also rears its ugly head and affects the lead shoulder in golfers. Strains, bursitis, tendonitis and eventually arthritis are all frequently seen problems in golfers.

What to do? Again, it’s about prevention, strengthening and stretching the muscles and tendons in and around your rotator cuff and developing good technique that reduces undue strain on your areas being called into action during the swing.

If I had one tip to give you, I’d recommend that you always take at least 10 minutes before your round to stretch. Doing so will reduce your injury risk by half. Yet, only 10-20% of golfers actually consistently do this. Jumping from a cramped car to swinging a golf club 100 MPH is a formula for disaster.

My Advice

If I had one piece of advice to give you, it’s simply to discover an exercise regimen that includes strengthening (muscles and core), flexibility and cardiovascular considerations. Obviously, the second would be to get lessons, which by itself will improve your risk profile.

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Straight, No Chaser: Your Teens Are Healthier Than You!

August 24, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, teen health, There are 72 Hours in a DayJeffrey Sterling, MD

Your teens are healthier than you. From the department of good health news – on some very important measures, somehow it seems as if our youth have actually received and read the memo on health. According to a recent survey from the Centers for Disease Control and Prevention (CDC), several measures of health have improved significantly in the teen population – with a few important exceptions.

These improvements include the following.

Cigarette smoking. Cigarette smoking among U.S. high school students has reached an all time low. Teen smoking is down to 15.7%. It was just over 15 years ago (in 1997) that the rate was 36.4%. Unfortunately, this still translates to 2.7 million high school students who smoke.
Armed trauma. The proportion of students threatened or injured with a gun, knife or other weapon on school property has dropped to 6.9%, from a peak of 9.2% in 2003. In the presence of so many school shootings, a ray of hope exists.
Fist fights. The proportion of students involved in fist fights was reported at 25%, which is down from 42% in 1991. The number of students having had a fight at school within the last year sits at 8%, which is down from 16%.
Soda consumption. 27% of teens had at least one soda daily, down from 34% in 2007.
TV viewing. 32% watched three daily hours of TV, down from 43% in 1999.
Other: Overall, teens are drinking less alcohol and are having less sex with more birth control use by females.

And now, the not so good news…

Condom use: Condom use is declining among the sexually active, being reported at 59%, down from a peak of 63% in 2003. Remember, HIV and other sexually transmitted diseases/infections haven’t gone away at all; we’ve just gotten better in controlling them. Now is not the time to get comfortable.
Texting and driving: 41% of those who drove admitted to texting or e-mailing while driving. This is bad anyway you look at it.
Cigar and other forms of smoking: Cigars are now as popular as cigarettes with high school boys. Cigars were smoked by 23% of 12th grade boys in the month before the survey. Smokeless tobacco use hasn’t changed since 1999, holding at about 8%. Other surveys have shown increases in e-cigarette and hookah use.
Computer time: 41% of teens report using a computer for non-school reasons at least three hours a day, up from 22% in 2003. Apparently this is where the TV time has gone.

What this really means is (wait for it!) your teens are educable. Discuss these topics with them and why it’s important to make healthy decisions. Of course it helps if you model the behavior.

Aspirin – It’s Not Just for Heart Attacks Anymore

August 23, 2018Cardiology/Heart844-SMA-TALK, Aspirin, Behind the Curtain, Digestive Tract Cancer, heart attack, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Should you take an aspirin a day? If so, why?

Aspirin isn’t just for heart attacks anymore… not that it ever was! Aspirin has been known to be a pain reliever for thousands of years. Let’s take a brief look at the additional qualities that should make aspirin one of the meds you’d want to have if stranded on a deserted island.

Heart attacks

Many doctors routinely prescribe a daily aspirin to help prevent heart attacks. In fact, the research was so good that a Nobel Prize in medicine was awarded to those discovering that aspirin prevents the clot formation that leads to heart attacks. It has been estimated by the American Heart Association that up to 10,000 American lives would be saved every year if an aspirin (325 mg) was taken at the first signs of a heart attack. However, it is important to note that the US Food and Drug Administration (FDA) updated its recommendations to state daily use of aspirin should only be in those instances in which individuals already have cardiovascular disease, due to aspirin’s side effect profile.

Strokes

Aspirin has the same preventive effects on stroke development as it does for heart attacks, and daily preventive medicine is now part of many lives for that reason.

Cancer prevention

Aspirin appears to have preventative benefits for certain digestive cancers. Just this week, research published in the Annals of Internal Medicine finds that daily aspirin use at recommended levels for at least five years was associated with a 27% less likelihood of developing colorectal cancer. Additional evidence is strong for presentation of esophageal and stomach cancers, but outside of the digestive tract, conclusive evidence hasn’t presented of yet.

So if you’ve been told to take a daily aspirin to reduce your risk of a heart attack because you likely fell into one a high-risk category, here are some logistical considerations about what to do.

Frequently Asked Questions

1) Is there a better time of day to take an aspirin?

Recent data suggests that most heart attacks occur early in the morning. The best time to take an aspirin is relatively soon before you have that heart attack. However, since your heart doesn’t give you a heart attack alarm clock (and many of us aren’t especially mindful of heart attack recognition), the best move would seem to be to take an aspirin before going to bed, and recent research supports that an aspirin taken before going to bed offers the most protection from a heart attack. There are limitations to doing this (e.g. taking aspirin on an empty stomach if you have a history of ulcers may not prove to be the most pleasant thing), and you should discuss such timing with your physician.

2) Is there a better dose of aspirin to take?

That’s a question your physician will answer and is dependent on your personal situation. That said, doses as low as 75-81 mg have been shown to be effective. You may be placed on any dose up to 325 mg/day. It really is important to take an aspirin dose recommended by your physician for this consideration.

3) Is it better to chew or swallow an aspirin?

Chewing an aspirin is the quickest way to achieve effective blood levels. In case you were thinking about taking an Alka-Seltzer (which contains aspirin), that’s also good – but it’s just not as good as chewing an aspirin.

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Straight, No Chaser: The Tortured Mind of a Genius

August 22, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Bipolar disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Thinking back to the suicide of Robin Williams brings to mind a saying I’ve heard for years: “Genius lives on the other side of the fence from insanity.” This has been demonstrated time and again in some of history’s most celebrated geniuses, including renowned artists Vincent van Gogh and Frida Kahlo, literary giants Virginia Woolf, George Orwell, Leo Tolstoy, Edgar Allan Poe, Leo Tolstoy and Sylvia Plath, musicians such as Mozart and Beethoven, scientists such as Sir Isaac Newton and any number of modern-day comedic geniuses.

The idea of the tortured genius is not new; in fact the concept is, well, tortured. This concept has been viewed and researched from many different angles, and the following conclusions are both proven by research and generally accepted within the population at large.

Out of great pain and struggle comes creativity.
The pressures of success can be too much for one to handle and can drive one into depression and toward suicide.

The fundamental questions one might consider when looking at your eccentric, friendly neighborhood genius are as follows:

Are genius and insanity both products of the same fountain of creativity coming from the brain?
Is creativity a product of mental illness?
Is mental illness a product of creativity compared against societal norms?
Is genius just a form of insanity?

Be reminded that there are many different forms of mental illness, featuring wildly different clinical signs. Regarding creativity, it is most strongly linked to mood disorders, most notably bipolar disorder (previously known as manic-depressive disorder), in which individuals display dramatic mood swings between extreme happiness (aka as “mania”) and severe depression.
Medical research on this issue has uncovered some interesting facts:

The same patterns of brain activity occur both when normal individuals display creativity and when bipolar individual emerge from depression and head toward mania.
Both geniuses and psychotic individuals have abilities that others don’t when it comes to processing stimuli into brain patterns and then converting these patterns into conscious thought. Psychotic individuals are less able to “filter” stimuli. Instead, they are better able to entertain loose association that other individuals might not make and then deliver these associations to the brain as ideas. In other words, a genius’ beautifully and brilliantly constructed picture or sentence could be interpreted as a normal person’s “nonsense.” Sounds like a lot of conversations that occur about art and music such as jazz, doesn’t it?
Geniuses and psychotic individuals are more able to entertain contradictory ideas at the same time than those who are not. This leads to more complex forms of thought and expression. Again, the notion of “nonsense” vs. “expression of genius” comes into play here.

Perhaps the important consideration here is found in the notion of functionality. A prominent part of the definition of various psychoses is the inability to function. Perhaps the difference between creative, eccentric and psychotic individuals is to be found in the relative ability to channel that creativity toward productive and societal-accepted endeavors. Of course the concern with the tortured genius is in spite of all evidence to the contrary, including fame, fortune and love, some of these individuals still spiral into depression and other mental illnesses. In some instances, this ends tragically with the loss of life.

Be mindful that those individuals who display abnormality of thought – even if what you see is creativity or extreme intelligence – have abnormality of thought, or at least unconventional means of thinking. Sometimes this results in horrible outcomes. Take the time to care and make sure your genius isn’t a tortured one.

Self Assessment for Signs of Early Dementia or Alzheimer’s

August 21, 2018Geriatrics/Elderly Care, Mental Health, Neurology844-SMA-TALK, Alzheimer's disease, Behind the Curtain, dementia, mental-health, Neurology, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post offers tools for self assessment for signs of early dementia or Alzheimer’s disease.

Each of us has elderly family members for whom we may be concerned about their memory or other possible signs of dementia. You don’t have to stand by powerless and let them dwindle away. Early detection of dementia gives the best chance for a higher quality during the rest of one’s life. Isn’t that how we’d all want our loved ones to spend their golden days? This Straight, No Chaser post adapts information provided by the Alzheimer’s Association. Any positive responses can suggest an issue warranting further investigation. The goal here is straightforward. If any concerns arises after completing this, you should print out the sheet, and take it to your physician, requesting an evaluation.

Self Assessment Questions

_____ 1. Memory loss that disrupts daily life.

One of the most common signs of Alzheimer’s, especially in the early stages, is forgetting recently learned information. Other signs include forgetting important dates or events; asking for the same information over and over; relying on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. Typical age-related changes involve sometimes forget names or appointments, especially if you remember them later.

_____ 2. Challenges in planning or solving problems.

Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. Typical age-related changes include making an occasional error when balancing a checkbook.

_____ 3. Difficulty completing familiar tasks at home, at work or at leisure.

People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. Typical age-related changes include occasionally needing help to use the settings on a microwave or to record a television show.

_____ 4. Confusion with time or place.

People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. Typical age-related changes include occasionally getting confused about the day of the week, especially if s/he figures it out later.

_____ 5. Trouble understanding visual images and spatial relationships.

For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not recognize their own reflection. Typical age-related changes of vision changes are related to cataracts and do not indicate Alzheimer’s.

_____ 6. New problems with words in speaking or writing.

People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a watch a “hand clock”). Typical age-related changes involve sometimes having trouble finding the right word.

_____ 7. Misplacing things and losing the ability to retrace steps.

A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. It’s more typical to displace things from time to time, such as a pair of glasses or the remote control.

_____ 8. Decreased or poor judgment.

People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. It’s less concerning for anyone of any age to make a bad decision once in a while.

_____ 9. Withdrawal from work or social activities.

A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. It’s more typical for anyone of any age to sometimes feel weary of work, family and social obligations.

_____ 10. Changes in mood and personality.

The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. It’s more typical for people as they age to develop very specific ways of doing things and to become irritable when a routine is disrupted.

It is worth restating: early diagnosis provides the best opportunities for treatment, support and future planning. For more information, call the Alzheimer’s Association at 800.272.3900 or your SterlingMedicalAdvice.com expert consultants.

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