Tag Archives: Sterling Medical Advice

How To Complete End of Life Planning

November 29, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Cardiopulmonary resuscitation, CPR, Decision making, Do not resuscitate, Family, Health care proxy, POA, Power of attorney, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Decisions about your final days need to include end of life planning. Now that you’ve had a chance to wrap your mind around the concept of needing to make end of life decisions (review this previous post if you missed that blog), let’s discuss some specific mechanisms by which you can ensure your wishes are honored.

Living Will

This document, also known as medical directives, addresses those scenarios where you are unable to communicate your near death choices. The key consideration is that a living will keeps the power and decision-making in your hands, even when you’re incapacitated or otherwise unable to state your preference. You’ll want to have a copy of this form with you or with your family.

Do Not Resuscitate (DNR)

A DNR form takes the living will consideration straight to the end of life question and explicitly states your preference not to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if needed. Your physician will retain a copy of this document in your medical record as a way of alerting other medical providers (such as in the emergency room–if and when you show up there) of your desire.

Healthcare Power of Attorney (POA)

end of life planning - durable power of attorney

The healthcare POA is your designee to carry out your medical wishes beyond what you have explicitly stated. A healthcare POA may serve more than one function.

If you haven’t made DNR or living will type decisions, a POA will make those decisions for you.
If you’ve made some decision and not others, the POA will fill in the gaps.
Making a POA designation is literally putting your life in someone else’s hands. Be very careful who you choose for this role. Some people will simply designate next-of-kin or a family member. Others will want someone objective with no other motives (e.g., financial) than fulfilling their wishes. Either choice is much better than no choice, which too often leaves family members with competing interests and potentially having to carry the burden of making decisions for you that you could have made in advance.
Your POA will not be able to overturn decisions you’ve designated on the DNR form or your living will.
Your POA will not be able to make any decisions for you while you’re still able to do so unless you ask him/her to do so.

It’s important to know that you can simultaneously have a living will, DNR declaration and a Healthcare POA. If you’re able, it may be wise to engage an attorney to sort through the various documents.

I hope for your sake and the comfort of any family you may leave behind that you take the time to engage in end-of-life planning for yourself and others in your family. I’ve seen all too often how messy it gets when issues aren’t addressed in advance. You really don’t want that happening to you at the end of your life.

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End of Life Decision Making

November 28, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Blood flow, Brain, Death panel, Decision making, Education, Futile medical care, health, health care provider, Health care proxy, Heart failure, Hypertension, Intubation, Patient Protection and Affordable Care Act, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Terminal illness, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This Straight, No Chaser post addresses considerations related to end of life decision making.

Having this conversation when death is staring you or a loved one in the face is not the most ideal situation. Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.”

I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. It needs to sink in: at any age your life could be at risk, and at any age you could die. When your life is threatened, if you have specific desires, someone will need comply with decisions you have made. It could happen today. You need protect yourself – now. You’re much more protected having declared your interests and desires than not. Read on.

Advanced Directives

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

Items to Consider

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

As you can see, these are serious questions to consider. I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In our next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has you thinking and planning on having important conversations.

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Patient Rights and Responsibilities

November 27, 2018General Health and Wellness, Public Health844-SMA-TALK, Behind the Curtain, Patient Bill of Rights, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This point highlights patient rights and responsibilities.

Even if you didn’t know it, you have rights as a patient. In 1998, the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry adopted a Consumer Bill of Rights and Responsibilities. This is summarized in this Straight, No Chaser post. These rights apply universally to plans offered to federal employees and largely by health insurance plans and facilities.

Access to emergency services

If you have any health-related consideration that makes you believe your health is in danger, you have the right to be screened and stabilized using emergency services such as your local ER. You should be able to use these services whenever and wherever you need them. This is true even if they’re out of your network! This should occur without needing to wait for authorization and without fear of any financial penalty from your insurance provider.

Choice of providers and plans

You have the right to choose healthcare providers who can give you high-quality health care when you need it.

Complaints and appeals

You have the right to a fair, fast and unbiased review of any complaint you have against your health plan, doctors, hospitals or other healthcare personnel. These complaints may include excessive waiting times, hours of operation, the actions of healthcare personnel, and/or the adequacy of health care facilities.

Confidentiality (privacy) of health information

You have the right to talk privately with healthcare providers and have your healthcare information protected. Patients also have the right to read and copy their own medical records. You have the right to ask that your doctor change your record if it’s not correct, relevant or complete.

Information for patients

You have the right to accurate and easy-to-understand information about your health plan, healthcare professionals, and healthcare facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be given so you can make informed healthcare decisions.

Respect and non-discrimination

You have a right to considerate, respectful care from your doctors, health plan representatives and other healthcare providers. You have the right to treatment that does not discriminate against you based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information or source of payment.

Taking part in treatment decisions

You have the right to be informed about your treatment options and take part in decisions about your care. You have the right to ask about the pros and cons of any treatment, including no treatment at all. As long as you are able to make sound decisions, you have the right to refuse any test or treatment, even if it means you might have a bad health outcome as a result. You can also legally choose someone who can speak for you if you cannot make your own decisions.

Consumer responsibilities

In a healthcare system that protects consumers’ or patients’ rights, patients have certain responsibilities. For instance, patients must tell their healthcare providers about any drugs or supplements they are taking. Similarly, you should inform them about health conditions and medical or surgical problems you’ve had in the past or have presently. Patients must ask questions or request further information from healthcare providers. This is especially important if they do not completely understand health information and/or instructions they’ve been given.

Patients must also take responsibility for their lifestyles to help improve their own health. Such considerations include following a treatment plan, exercising, and not using tobacco. Having patients involved in their care increases the chance of the best possible outcomes and helps support a high quality, cost-conscious healthcare system.

Patients are also expected to do things like treat healthcare workers and other patients with respect. They should try to pay their medical bills and follow the rules and benefits of their health plan coverage.

Knowing your rights is an important way to ensure you are receiving the best care possible. Take the time to learn these rights and use them to your advantage.

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25 Tips That WILL Increase Your Life Expectancy

November 22, 2018General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, life expectancy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Want to increase your life expectancy and live better longer? You may want to keep this post. I haven’t exactly found the Fountain of Youth, but I do know what activities lead to a longer life expectancy. In honor of Thanksgiving, and in the spirit of being thankful for life, here are 25 tips that you can incorporate into your daily life to help you live a younger life every day and a longer life.

Tips 1-5

1. Take a walk. Just give yourself a brisk 30-minute walk three times a week. Effect? Reverse your age by about 10 years.

2. Eat more fish. Doing so one to two times a week can reduce your heart attack risk by approximately one-third.

3. Lift weights. Yes, it gets tougher, but I’m not recommending a Schwarzenegger workout. Lifting reverses muscle and bone loss if you do it twice weekly. For those in their 50s or 60s, it can produce strength scores similar to those in their late 30s.

4. Get a pet. This is a pretty easy way to avoid depression and all that comes with it.

5. Hydrate. Your body is almost 70% water. Not soda, water. Learn to embrace clear fluids. When you’re not going clear, coffee and wine also have significant health benefits.

Tips 6-10

6. Equip your home. Everyone should have a functioning smoke alarm, carbon monoxide detector and fire extinguish, and everyone in your home should know where they are and how to use them.

7. Put a helmet on your head. 1,000 people die every year in the U.S. from motorcycle, bicycle, scooter or skydiving injuries related to not wearing protective helmet.

8. Engage in safe sex. Yes, people are still dying prematurely and living compromised lives because of the failure to wear condoms while others protect themselves.

9. Be optimistic. This keeps the negative effects of the body’s physiologic stress response from harming you.

10. Reduce your red meat intake. Even the daily intake of just one serving of red meat equivalent to the size of your fist decreases life expectancy by approximately 13 percent.

Tips 11-15

11. Spend time with friends. Healthy social networks have been shown to add as much to your life expectancy as healthy endeavors such as lowering high blood pressure and reducing high cholesterol levels.

12. Be generous. Studies consistently show that those who help others report better health than those who don’t. It may just be correlation, but being on the right side of this fence makes the world a better place.

13. Sleep. Seven hours a day gets done what your body needs to function optimally.

14. Discover blueberries. There’s been much talk about “superfoods.” Blueberries meet the criteria. Consuming approximately two cups a day has been shown to prevent chronic diseases, reduce depression and improve memory.

15. Enjoy sex and orgasms. There are a million jokes about the benefits of sex, but legitimate benefits include burning calories, reducing stress, inducing sleep and reducing pain.

Tips 16-20

16. Snack on nuts. Healthier nuts include almonds, cashews and pistachios. Eating them five days a week has been shown to add nearly three years to your life expectancy.

17. Get up! Sitting for more than three hours at a time independent of other activities can reduce your life expectancy. Take breaks, stretch and move around.

18. Maintain adequate intake of vitamins. You shouldn’t need supplemental vitamins if your diet is appropriate, buy if it’s not, here are the daily requirements that ensure optimal function. Vit C (1200 mg/day), Vit D (400-600 IU/day), Vit E (400 IU/day), Vit B6 (6 mg/day), calcium (1000-1200 mg/day) and folate (400 mcg/day).

19. Measure your blood pressure. Work to maintain your blood pressure at or below 115/75. This will help you function as much as approximately 25 years younger than someone of a blood pressure at or about 160/90.

20. Brush. Floss. Daily brushing and flossing can improve your functioning by approximately six years.

Tips 21-25

21. Wear your seatbelt. The combination of seatbelt wearing and driving within five MPH of the posted speed limit can improve your life expectancy by approximately three and a half years.

22. Eat fiber. The number to know here is 25. If you get 25 grams of daily fiber in your diet, that improves your function by approximately two and a half years over consuming half that amount. Look for high fiber dietary options.

23. Learn to laugh. Laughter actually does have clinical benefits. It strengthens your immune system by decreasing the stress-induced release of certain hormones. Learn to take or tell a joke!

24. Love fruits and vegetables. The more fruits and vegetables you eat compared to red meat, the better your life expectancy becomes.

25. Consume medical care, information and advice. Being proactive about your health increases both your life expectancy and life functioning compared to someone a dozen years younger who does not. This includes getting recommended screenings and immunizations. Also, have you heard of www.sterlingmedicaladvice.com?
Here’s a bonus tip: Avoid getting hit by that truck.

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Preventing and Treating Urinary Tract Infections (UTIs)

November 26, 2018General Health and Wellness, Infectious Disease844-SMA-TALK, Behind the Curtain, Conditions and Diseases, cystitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Urinary tract infection, UTIJeffrey Sterling, MD

Introduction

This post addresses preventing and treating urinary tract infections.

At some point, you’ve got to be on board with the notion that you need to prevent some of the things that ail you. All men who have UTIs are at higher risk for having another one. About one of every five women who have a UTI will have another one. Many women have three or more UTIs a year. This Straight, No Chaser will address preventative and treatment considerations for urinary tract infections. Check back to this Straight, No Chaser for a discussion of the how and why you get UTIs.

Some individuals have unfortunate anatomy, and others have increased risk factors due to diseases (e.g. diabetes) or a lowered immune system. Even in these individuals, improving daily habits and lifestyle choices may help you prevent repeat UTIs. There actually is a fair amount of controversy regarding methods of preventing and treating UTIs. The information I am providing represents the latest consensus information from the U.S. Department of Health and Human Services.

Fluids

Drinking lots of fluid (preferably water) can help flush bacteria from your system. Unless you have kidney or heart failure, you should try to drink six to eight, 8-ounce glasses a day.
Regarding cranberries and cranberry juice, the jury is still out. This is what we do know: there is a substance in cranberries that assist in preventing bacteria from sticking to the walls of your urinary tract. The ability to attach to the walls of your urinary tract keeps bacteria from being flushed out and allows them to grow and multiply. It seems that the amount of this substance in the typical glass of cranberry juice you’re drinking or serving of cranberries you’re eating is sufficient to completely prevent or treat UTIs. It is more likely that the benefit you’re receiving simply comes from drinking fluids. The bottom line? Drinking cranberry juice isn’t hurting you and may be helpful.

Bathroom Habits

It’s just a good idea to urinate often. Whenever you feel the urge, and it’s convenient, eliminate the waste. Also, make a habit of urinating after sex, as soon as it’s convenient. These steps prevent bacteria from staying in your bladder longer than necessary, preventing the growth that can become a UTI.
It’s true: always wipe from front-to-back after using the toilet. A back-to-front wipe can deliver bacteria straying from the rectum (and inclined to cause a UTI) close enough to your urethral opening to get things started.

Birth Control

Using a diaphragm or spermicide increases bacteria growth and can lead to UTIs. If you’re not having an issue with this, that’s fine, but if you are, you may want to consider a different form of birth control. Furthermore, unlubricated or spermicidal condoms increase irritation of the vaginal walls, which may help bacteria grow and may lead to transport up the urinary tract. This is yet another reason why lubricated condoms without spermicide or a nonspermicidal lubricant are better options for safe sex.

Clothing

Does wearing cotton underwear and loose-fitting clothes prevent UTIs? Probably not. Does doing so keep the area around the urethra dry? Yes. Nylon underwear and tight-fitting jeans can trap moisture and help bacteria grow. Use this information to your advantage. This is another example of how altering your habits may help and won’t hurt the cause.

Instrumentation

Whether you’re a patient using a catheter to assist yourself with emptying your bladder, or if you’re placing objects into your genital orifices for other purposes (e.g. sexual stimulation), you should appreciate the risks found in not exercising good hygiene with these objects. The immediate proximity of these objects to your urinary tract certainly increases the risks of UTIs.

Treatment

Treatment is usually straightforward. It’s typically based on eliminating the organisms most likely to be causing the infection. Treatment regimens range from 3 days to more than a week depending on certain considerations. Important factors in this regard include severity, resistance patterns in your area, whether you get frequent UTIs and whether you have certain risks or anatomical abnormalities in your urinary tract. Men should receive a longer course of treatment as a rule due to the involvement of the prostate.
Other treatment considerations involve pain control and plenty of fluids.

If your frequency or severity of UTIs requires as much, you may be referred to a urologist for specialized treatment considerations. However, for most people, this isn’t necessary because treatment is sufficient – and prevention is even easier.

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What is a spinal tap, and why is it done?

November 30, 2018Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease, Medical Treatment, Neurology844-SMA-TALK, Behind the Curtain, Cerebrospinal fluid, Facebook, Lumbar puncture, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, TwitterJeffrey Sterling, MD

Introduction

A spinal tap (lumbar puncture) induces a lot of angst. Although the reason for the procedure should, the procedure itself really shouldn’t.

What is a spinal tap?

A lumbar puncture (spinal tap) is performed to obtain cerebrospinal fluid (CSF – the naturally occurring fluid that bathes the spinal cord) from the spinal column. It most typically evaluates the presence of infection (as in meningitis). However, it can also detect other conditions such as multiple sclerosis, Guillain-Barre syndrome or cancer involving the spinal cord. In some instances, a lumbar puncture is a treatment. Medicines and anesthetics can be placed in the cerebrospinal fluid via lumbar puncture. Also, it can be used to lower the pressure in the brain caused when too much fluid is present.

Here’s a video that would be helpful to view before you or a family member has a lumbar puncture. It is provided courtesy of Cure Search for Children’s Cancer.

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Does drug use cause kidney damage?

November 24, 2018Detoxification, General Health and Wellness, Toxicology/Drugs844-SMA-TALK, Acute tubular necrosis, Behind the Curtain, health, Kidney, Renal failure, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, WasteJeffrey Sterling, MD

Introduction

This post addresses your question on drug-induced kidney damage.

Drug-Induced Kidney Damage

Each kidney filters about 1700 liters of blood per day and concentrates fluid and waste products into about one liter of urine per day. Because of this, the kidneys receive more exposure to toxic substances in the body than almost any other organ. As a result, they are highly susceptible to injury from toxic substances.

You actually produce an immune response to drug use. Inflammation from this immune response to drugs may injure the structures of the kidney. This usually causes various types of glomerulonephritis or acute tubular necrosis (tissue death). Injury to the kidney may result in short-term damage with minimal or no symptoms. It may also be life threatening from bleeding and associated shock, or it may result in acute renal failure or chronic renal failure.

In short, your kidneys are yet another reason to avoid illicit drug use.

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Tips to Deal with Depression and The Holiday Blues

November 21, 2018General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Depression, Disorders, health, Major depressive disorder, Mental disorder, Mental health professional, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Have the holiday blues? I don’t mean to bring anyone down during what is supposed to be the ‘most wonderful time of the year,’ but in reality there are many people hurting. For some, life’s tragedies happen this time of year the same as they might any other time. For others, this may have already happened, and this time of year is a permanent reminder of an unfortunate experience. There are others still who struggle with depression, anxiety and mental illness all year. The holiday season can exacerbate these feelings and may make holidays especially long, depressing and potentially dangerous times.

Today’s Straight, No Chaser is not meant to drag you into the dumps but to empower you with tips to assist you in the event this is a difficult time for you. By the way, I’m extremely thankful that you’ve chosen to give me moments of your day and life. I take that gift seriously and hope you continue to find it a worthwhile use of your time.

Here’s five tips to support your holiday mental health.

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

Get Help!

Know when you need professional help. If your support system doesn’t sufficiently address your needs, and you’re feeling severely depressed, can’t function or are suicidal or homicidal, find a physician or mental health professional ASAP. Of course, you can always contact your SterlingMedicalAdvice.com expert. If you type mental health, depression or other keywords into the search bar above, you can access many other Straight, No Chaser blogs on behavioral health concerns that may provide you the support you need. I wish you all the best today and throughout the year, and hopefully the picture above will reflect the only type of blues you’ll have to deal with this year.

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Treatment of Acid Reflux (Gastroesophageal Reflux Disease)

November 20, 2018Gastrointestinal, Medical Treatment844-SMA-TALK, acid reflux, antacids, antihistamines, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This Straight, No Chaser post addresses the treatment of acid reflux.

If you experience heartburn two times a week or more, you may have gerd. Because there are significant differences in the severity of GERD, you should know when varying forms of treatment may be necessary. This Straight, No Chaser focuses on treatment of mild symptoms. For discussion of more severe GERD, visit www.sterlingmedicaladvice.com or discuss the options listed below with your healthcare provider.

Mild symptoms

As is the case for many diseases, simple dietary changes away from foods that increase acid producing and reflux symptoms often can be sufficient. As a reminder, such foods include alcohol, caffeine, chocolate, fatty foods and peppermint. With mild symptoms, over the counter medications such as antacids or antihistamines might be all that’s needed. Additional considerations such as the following have been shown to be helpful in some people with mild reflux and is worth the effort.

avoiding large meals and eating meals late
avoiding tight-fitting clothing
elevating the head of your bed six to eight inches
increasing the chewing of gum or use of oral lozenges (this is related to saliva production, which can neutralize acid)
quitting smoking (smoking actually reduces saliva production)
weight loss

If and when medicines are used for mild symptoms, there are two classes of medicines used.

Antacids — Antacids such as Maalox, Myalanta and Tums are commonly used for short-term relief of acid reflux. The frustration you may have experienced in taking them is related to the fact that these medicines only neutralize stomach acid very briefly after each dose.
Histamine antagonists (aka antihistamines) — These medicines, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac), reduce acid production in the stomach and are often helpful as a first line effort.

Moderate to severe symptoms

For patients with moderate, severe or refractory symptoms of acid reflux, or for those with complications of gastroesophageal reflux disease, different treatment options must be used.

Proton pump inhibitors (PPIs) — This class of prescription medicine is stronger and more effective than the histamine antagonists listed above. When these are necessary, it typically takes an eight-week course of treatment to optimize dosing and produce the best results that can be achieved.
Surgical treatment — When PPIs are ineffective, surgical options such as strengthening the lower esophageal sphincter and repairing any hiatus hernias (conditions in which the stomach partially slips through the diaphragm into the chest, facilitating more escape of acid into the esophagus) may be necessary.

There’s a lot you can do to avoid taking medicines and needing surgery. Make those better choices and live a healthier, happier life!

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Acid Reflux (Gastroesophageal Reflux Disease)

November 19, 2018Gastrointestinal844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Do you have acid reflux? I’m at the point in life where I rarely eat after 8 pm. That has defined health benefits, but it’s also protective from today’s Straight, No Chaser topic. Gastroesophageal reflux, aka GERD, aka acid reflux, aka reflux causes all types of problems during the night. You should be surprised and feel fortunate if reflux doesn’t bother you at some point. Let’s tackle this spicy topic via a question and answer format:

What is reflux?

Most simply put, acid reflux occurs whenever stomach contents back up into your food pipe (esophagus) and/or mouth.

Why does this occur?

Your feeding tube (esophagus) has a connection to the stomach at its lower end. This connection is made via a circular ring of muscle called the lower esophageal sphincter (LES). The LES relaxes and contracts to allow food to enter and prevent it from traveling back up into the esophagus. Unfortunately, there are a number of conditions that cause the sphincter to relax, such as episode overeating, lying flat and the presence of a hiatal hernia (more on that in the next blog).

Is this a disease?

Some degree of acid reflux is actually normal, but it does rise to the level of a disease (gastroesophageal reflux disease, aka GERD) when symptoms create difficulties for the patient.

What are the symptoms?

You know them, and you hate them! The most common symptoms include heartburn, difficulty with swallowing (including pain or food getting stuck; this is called dysphagia), regurgitation and vomiting. In fact, heartburn occurs in 10 million adults in the US every day. In severe cases, the acid can cause hoarseness due to the effects on the vocal cords or go back down the air tube (trachea) and into the lungs (this is called aspiration). Here are some additional symptoms you may experience.

Asthma “only” at night
Chronic cough
Chronic sinus infections
Non-burning chest pain
Painful swallowing
Persistent sore throat
Persistent laryngitis/hoarseness
Recurrent lung infections
Sense of a lump in your throat
Stomach (upper abdominal pain)
Waking up with a choking sensation
Worsening dental disease

Do foods cause heartburn or acid reflux?

You already know they do! Here’s a quick list of common food that worsen or trigger symptoms:

Alcohol (think red wine)
Caffeinated drinks, including coffee, soda and tea
Chocolate
Citrus fruits and products, including oranges and orange juice
Peppermint
Spicy foods, such as black pepper, garlic, raw onions and tomatoes.

When should I seek help for reflux?

Although you should feel free to contact your healthcare provider for any symptoms, you should be aware that the following signs and symptoms may indicate a more serious problem. The presence of any of these should prompt you to visit and emergency room or otherwise contact your physician immediately. Please do not assume because you’ve had these symptoms previously, that the symptoms represent the same thing they always have.

Chest pain
Choking
Difficulty or pain with swallowing, or a sensation that your food gets stuck
Unexplained weight loss
Vomiting blood or have Bleeding (vomiting blood or dark-colored stools)

In the next Straight, No Chaser, we’ll review some complications, how GERD is diagnosed and treatment options.

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The Frustration of Acute Bronchitis

November 17, 2018Respiratory/Lungs844-SMA-TALK, Acute bronchitis, Behind the Curtain, Bronchitis, Chronic bronchitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

We’ve all experienced acute bronchitis. Don’t remember? Imagine what it looks like when someone gets hit in the jaw. There’s the redness, swelling from excess fluid in the area, warmth and pain. Those are the components of inflammation. Now imagine those symptoms in your lungs as you’re trying to breathe and deliver oxygen to the rest of your body. Off the top of my head, I can’t think of a more frustrating diagnosis than bronchitis for both patients and physicians alike. I’ll get into the reasons for that soon enough, but a bit of explanation is definitely in order.

What is bronchitis?

Bronchitis is inflammation of a portion of the airways (the bronchi). Far and away, bronchitis is seen in smokers and after a viral, upper airway infection (e.g., a cold, the flu). In that last statement I slipped in two words that create the frustration regarding this condition: viral and smokers. There’s still more to come on what that means for you.

Symptoms of Acute Bronchitis

Everyone reading this has suffered from bronchitis at some point, and, based on what’s already been said, it’s easy to figure out what the symptoms would be. The inflammation of your airways leads to a cough, shortness of breath, chest discomfort, a mild fever and fatigue. If you have asthma, you’re likely to start wheezing. Another major source of frustration is even after the bronchitis has gone away or been treated, the cough stays around for up to an additional four weeks. This gives many the impression that they’re still sick, and leads them to demand that the doctor do something to “fix it.”

The frustration of acute bronchitis

There are a few more problems dealing with or treating acute bronchitis.

You think it’s worse than it is.

Bronchitis is actually the most common cause of coughing up blood. Coughing up blood or producing blood-tinged mucus tends to make people anxious, and they often start thinking of things like cancer. That train of thought makes some people want to take every test possible to rule out cancer, “just to be sure.” Now your physician knows better and isn’t going to do that unless you have additional symptoms or tell a story more consistent with cancer. That often leads to a lot of frustration and sometimes anger.

You don’t take responsible for your part in causing bronchitis.

Bronchitis is most often caused by smokers who don’t stop smoking even while they’re suffering. It is a very tense conversation (from both sides) when you return to the ER five days after being seen and diagnosed with bronchitis, and you’re complaining because you’re not better. Folks, even if your physician puts out the fire, if you continue to relight the match, it’ll continue to blaze.

You ignore what works and what doesn’t.

Bronchitis is not pneumonia, which is an infection of the lungs. In most cases where bronchitis has an infectious cause, that cause is a virus. Viruses do not respond to antibiotics. Your physician understands that you’re sick. Just because you’re sick and coughing, that doesn’t mean you need antibiotics or that antibiotics will cure you. Inappropriate antibiotic use is not without long-term complications that you should want to avoid. In most cases, assuming you remove the source of inflammation (e.g., cigarette or cigar smoke, dust, allergens), your symptoms will improve on their own within a week, and all you need is supportive therapy such as cough, fever and pain medicines along with fluids and rest. You must also practice good hygiene to avoid spreading any viruses that may be causing the bronchitis.

The initial snapshot of your condition can change for the worse.

What complicates this is when your weakened state and continued exposure to whatever is causing the inflammation allows a bacterial infection to land on top of your bronchitis. Ask your physician if it’s possible that this is what is going on. S/he will know how to proceed, including potentially using antibiotics.

In a majority of cases, a diagnosis of bronchitis will be a big source of frustration for patients. From the physician’s standpoint, bronchitis is an easily diagnosed condition due to an obvious cause (such as a cold or cigarette smoking). As such, your physician is likely not to order a lot—or any—tests. Now from the patient’s standpoint, don’t you just hate going to the physician’s office or ER when you’re sick and “nothing” gets done? Well, especially in an ER setting, tests are not used to make diagnoses. They’re meant to be ordered if the results will change the management of the condition or might lead to a change in what is done with you (e.g., admit you to the hospital). Most often, that’s just not going to be the case with bronchitis. Now if after 3–5 days symptoms haven’t improved, you’ve stopped smoking and the mucus you’re coughing up looks a certain way, there’s plenty that will be done differently in most cases.

When you need to see a physician for acute bronchitis

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

A documented high fever or have had a documented fever for more than three days.
Greenish or bloody mucus, or you are coughing up only blood.
Shaking chills.
Chest pain or shortness of breath.
Pre-existing heart or lung disease (such as asthma or COPD/emphysema).

Over time, bronchitis can become chronic if the source of the inflammation isn’t removed. If you find yourself with ongoing symptoms for over three months, you will fall into a different category known as chronic bronchitis. Your physician will need to address additional considerations for you.

So often patients with bronchitis are looking for a “quick fix.” As is often the case, that fix is to be found in prevention. In this case, good hygiene and avoidance of smoke and other lung irritants can save you a lot of the shortness of breath and chest pain associated with bronchitis (pun intended).

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COPD (Chronic Obstructive Pulmonary Disease)

November 18, 2018Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Chronic bronchitis, COPD, emphysema, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

November is COPD Awareness Month. Unfortunately, you already know a lot about COPD without realizing it or even having to think about it. You’ve seen patients walking around with the oxygen tanks or tubes in their noses. However, that’s just the extreme. COPD is the third or fourth leading cause of death in the US depending on the source, with millions of individuals diagnosed. You also know COPD and cancers are why your doctors always warn you against smoking in any form. You know smoking is the leading cause of this. This Straight, No Chaser provides a brief overview of COPD and answers some key questions.

What Is COPD?

Chronic obstructive pulmonary disease is a lung disease that makes it hard to breathe and advances in severity over time.
Appreciate that air goes from your mouth or nose through the windpipe (trachea) through several branches of airways, eventually connecting to blood vessels meant to carry oxygen to the organs of your body. These same blood vessels drop off waste gas known as carbon dioxide, which we exhale with each breath out.

Airway Changes Causing COPD

In COPD, less air flows in and out of the airways because of one or more of the following:

The airways and air sacs lose their elasticity. Elasticity is the stretchiness your lungs need to fill up with and push out air. In COPD, these sacs act less like a balloon and more like a lead pipe.
The airways make more mucus than usual, which clog them and make breathing more difficult. The inflammation caused by smoke and other irritants produce mucus. It’s not a good thing when instead of breathing air, you’re attempting to breathe a smoke-filled swamp of snot-like material.
The walls of the airways become thick and inflamed. Over time, inflammation can cause permanent changes in the walls of the airways to compensate for the environment you’ve created.
The walls between many of the air sacs are destroyed. Ongoing inflammation overwhelms the body’s ability to repair itself, and eventually sheets of tissue in your airways are destroyed beyond repair, providing you with less tissue to exchange oxygen from the lungs to the blood vessels that carry oxygen through the body.

What causes COPD?

Cigarette smoking is far and away the leading cause of COPD. Most of those with COPD are current or former smokers. Heredity, childhood respiratory infections, and long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust may contribute to or cause COPD.

I’ve been told I have bronchitis. Is that the same thing?

There’s acute bronchitis, and there’s chronic bronchitis. In the US, COPD refers to two separate but similar conditions, emphysema and chronic bronchitis; most with COPD have both conditions. Now if you have acute bronchitis, it means something (like and likely cigarette smoke) is currently inflaming your airways. Over time this can permanently damage the airways and produce an ongoing state of inflammation – chronic bronchitis – with airway wall thickening and increased mucus production within the lungs. Let the smoker beware.

How is this different from emphysema?

In emphysema, the walls between many of the air sacs are damaged, losing their shape and elasticity. This damage also can destroy the walls of the air sacs, leading to fewer, larger and less efficient air sacs instead of many more efficient tiny ones. If this happens, the amount of gas exchange in the lungs is reduced, meaning you’re not getting enough oxygen in you and enough carbon dioxide out of you.

What are some symptoms of COPD?

COPD can cause coughing with mucus production, wheezing, shortness of breath, chest tightness, decreased ability to exert yourself and walk around. Even more symptoms may develop as a result of inadequate oxygen supply and inadequate carbon dioxide disposal.

How can I know if I have COPD?

One big problem with COPD is many have the disease and don’t know it until it starts becoming quite advanced. It’s safe to assume that if you’re a smoker and have difficulty breathing, you’re experiencing changes to your airways that aren’t in your best interest. You are advised to get evaluated. You are best advised to remove yourself from the source of the inflammation (in other words, stop smoking).

How does COPD affect my life?

For starters, it shortens it. It also markedly increases your cancer risk. At some point all the damage and changes to your lungs is going to cause some abnormality. Given this is the area you use to breathe, deliver oxygen to your organs and eliminate toxins from your body, all manners of things can go wrong, and they often do. COPD is a chronic, progressive disease. You may or may not pick up on the slow creep of diminishing ability to perform routine activities, or maybe you’ll just attribute them to aging (COPD occurs most often in middle-aged to elderly individuals). Once severe enough, COPD may prevent you from doing even basic activities like walking, breathing without difficulty, or taking care of yourself.

What’s the cure for this?

Here’s the frightening part: we’re talking about irreversible lung tissue change and destruction. Once layers of your airways have been ripped out (figuratively), they aren’t coming back. The damage is done. Prevention is your best defense.

So how is it treated?

There is no real treatment without removing the trigger feeding the ongoing inflammation. In other words, you’ll have to stop smoking to stop further progression. Additional measures involve support.

Supplemental oxygen may be needed to deliver enough oxygen to the tissues as an effort to combat the destruction and inflammation of tissue meant to facilitate oxygen exchange.
Medicines to reduce the inflammation and mucus may be prescribed.
Medicines to better open the airways past the clogging caused by inflammation and mucus may be prescribed.

Your physician will discuss these and other options. The truth is COPD has no cure. Once you have been diagnosed with COPD, efforts switch to slowing the progression and implementing measures to improve the quality of your life within the parameters defined by the advancement of your disease.

Finally, here is a short video from the National Institutes of Health.

[youtube https://www.youtube.com/watch?v=BIdHQQEXPDk?version=3&rel=1&fs=1&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent]

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The Intersection of Health and Happiness

December 25, 2018General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, Merry Christmas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction – Merry Christmas!

Shouldn’t we be pursuing life, liberty health and happiness? That’s why we’re hear. Straight, No Chaser isn’t a medical encyclopedia. It’s a tool to empower you to make choices that best suit your lifestyle – the intersection between health and happiness. Even though today is Christmas, remember we offer you the gift of knowledge every day.

After more than 20 years as a physician, I still am fascinated at the health trade-offs people make for their pleasure – or “quality of life.” We have previously discussed your habits and how some of them negatively impact your physical and mental health. Click here for that discussion. The literature on negative energy and health is well documented and robust. In short, avoid negativity and those that bring it to you! That said, we’re following our own advice and going positive today.

To that end, here’s the other half of the “health and happiness” equation:

STATE OF MIND = STATE OF BODY.

This is science!

Research from the Harvard School of Public Health (Go, Crimson!) led by Laura Kubzansky, Associate Profession of Society, Human Development and Health, identified personal attributes that actually do translate into better health. Specifically these personality traits have been shown to help avoid or healthfully manage depression, diabetes, heart attacks, strokes and other diseases.

Her landmark 2007 study followed over 6,000 men and women for over 20 years, discovering that a sense of enthusiasm, hopefulness, engagement in life and the ability to face life’s stresses with emotional balance appears to reduce the risk of coronary heart disease. Her studies have also demonstrated that children with a positive outlook and ability to focus on a task at age seven are in better health with fewer illnesses 30 years later. An additional finding of hers is that optimism cuts the risk of coronary heart disease in half.

The keys to mental health and happiness

This isn’t that hard. It just requires a rewiring of some of our outlook on life. Make a change today. Become a more positive person, and you’ll become a healthier person! Incorporate these mental lifestyle changes and reap the benefits.

Emotional vitality: a sense of enthusiasm, hopefulness, engagement
Optimism: the perspective that good things will happen and that one’s actions account for the good things that occur in life
Supportive networks of family and friends
Good “self-regulation,” i.e., bouncing back from stressful challenges and knowing that things will eventually look up again
Healthy behaviors such as physical activity and eating well
Avoidance of risky behaviors such as unsafe sex, drinking alcohol to excess, and regular overeating

Thank you

Speaking of Christmas, the Straight, No Chaser team greatly appreciates your readership, support and feedback. Over 40,000 of you both follow us and like us on social media and WordPress. We’ve had readers in over 200 countries around the world with well over 1,000,000 page clicks. Most of all you’ve helped us successfully launch multiple vehicles to continue our health mission around the world (see www.jeffreysterlingmd.com for a look-see). Also, thank you for supporting our books, all of which are about empowering you.

We’ll continue to give you information to make a difference in your lives. Please continue to share your stories. It is very fulfilling and fascinating to hear how these efforts have made a difference in your lives. Feel free to continue to send us topic requests. We generally find a way to work them into the schedule.

Thank you so much. Merry Christmas, Happy Hanukkah, Happy Kwanzaa, peace and blessings throughout the holiday season.

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Lung Health – Know The Signs of Danger

November 16, 2018Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post addresses lung health! I would suggest you should be in complete awe of your lungs. Did you know you take over 20,000 breaths a day? Your lungs bring air into your body and eliminates waste (carbon dioxide) when you exhale. The lungs transfer oxygen into the bloodstream and launches it throughout body’s cells as life-sustaining fuel. This Straight, No Chaser skips ahead in the process of lung function to discuss the relevance of everyday symptoms you experience as signals of danger.

Concerning Signs and Symptoms

If you have any of these warning signs or symptoms, discuss them with your physician as soon as possible.

Chronic Cough

In this definition, chronic means the cough has been present for at least a month. This is an important early symptom and should not be ignored – smokers, that means you.

Shortness of Breath

To be clear: you expect to be short of breath after you exercise or otherwise exert yourself. The shortness of breath that should be particularly concerning doesn’t go away after exercising or occurs after little or no exertion. The feeling that it is hard to breathe in or out is also a warning sign and is also indicative of respiratory illness.

Chronic Mucus Production

Mucus (aka sputum or phlegm) is produced by the airways as a defense response to infections or irritants. Ongoing production for more than a month could indicate lung disease.

Wheezing

Wheezing is often described as noisy or musical breathing and is a sign that something blocking your lungs’ airways or making them too narrow, such as a physical obstruction, inflammation or increased mucus production.

Coughing up Blood

If you are coughing up blood, the blood may be coming from your lungs or higher up in your respiratory tract. It is a sign of a health problem.

Chronic Chest Pain

Chest pain lasting more than a month should be taken as a warning sign. Lung involvement is more likely if it is associated with worsening while breathing or coughing.

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Great American Smokeout: Tips for Smoking Cessation

November 15, 2018General Health and Wellness, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, smoking, Smoking cessation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

The Great American Smokeout is a great time to get serious about smoking cessation. Don’t wait to make it a New Year’s resolution. Do it now. Can’t do it now? Do it Monday. In fact, do it every Monday. It’s a fight. If you fall down, start it back up again. It’s the fight of your life (or should I say for your life)!

Try all of these tips to help

If you decide to quit after your current (last) pack, throw away one cigarette for every one you smoke.
Count (figuratively or literally) all the money you’re saving by not smoking.
Throw away (not give away) all cigarettes, cigars, matches, lighters, humidors, cigar cutters and anything else you associate with smoking. You’ll realize how sad it is if and when you find yourself rummaging through the garbage to get a fix.
Tell everyone (loudly) that you’ve quit. Empower them to help and hold you accountable. Enlist another smoker friend to go through the journey with you.
If you do fall off the wagon, smoke a different cigarette brand. Odds are you won’t like it as much, and that will help combat the natural ease you have with smoking.
Contact your physician and ask for help.

Here’s a marvelous best-practices schemata of appropriate interplay between a physician and a patient trying to stop smoking.

If your physician and you decide to place you on a patch or otherwise medicate you, follow instructions carefully and precisely.

More tips

Practice deep breathing. Part of the euphoria of smoking is nothing more than the physiologic sensations produced by deep inhalations.
Keep other things in your mouth. Mints and chewing gum (low-calorie) are great. Brushing your teeth also serves many purposes. Drinking water when you want to smoke will often remove the urge.
Make it past the first day. Then make it past the first week.

Let’s START!

I personally love the START method, which includes several of the above methods. Let me know if it works for any of you.
S: Set a quit date.
T: Tell your friends, family and associates that you’re quitting, and enlist their help.
A: Anticipate and act on the plan you’ve set and challenges you’ll meet.
R: Remove (trash) cigarettes, cigar and other paraphernalia from your environment.
T: Talk with your physician about options and additional support.
For those of you affected (either first or second-hand), this is huge and important. I really wish you all the best. I welcome any comments or questions.

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Fifteen Tips to Care for Diabetic Skin, Part 2

November 14, 2018Diet and Nutrition, Endocrine/Metabolic, Infectious Disease, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Diabetes, diabetic foot ulcers, diabetic skin care, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post provides diabetic skin care tips!

In the previous Straight, No Chaser, we discussed the frailty of diabetic skin and discussed how that sets one up for skin infections, abscesses, ulcers, amputations and even death. Your best defense from these set of illnesses and tragedies is knowledge, prevention and prompt action. Here are some steps you can take to better care for the diabetic in your life. In the event you know a diabetic who appears healthy, I want you to pay special attention to him/her. Diabetes is a chronic and insidious disease. These changes occur over years, and your challenge is to slow the process down as long as possible.

If you have diabetes, these tips may help prevent skin damage and infections:

Diabetic Skin Care Tips 1-5

1. Do the best you can to control your blood glucose levels. The more out of control it is, the more damage it causes.

2. You must check your feet every single day for the rest of your life. Diabetics develop decreased sensitivity to their feet. It is extremely common to step on a sharp object and not realize that you’ve done so. A splinter or nail is an excellent medium for an infection.

3. Eat fruits and vegetables. Your skin needs all the nourishment it can get.

4. Develop better hygiene. Wash and dry your skin often and thoroughly; this will keep you less exposed to infections.

5. Make a point of keeping your groin, armpits and other areas prone to heavy sweat dry. Those moist areas in particular are most prone to becoming infected. Talcum powder is a good choice to use.

Diabetic Skin Care Tips 6-10

6. Stay hydrated. It’s an uphill battle with the frequent urination and high blood sugar (glucose) levels. Dehydration causes your skin to be more brittle and prone to infections.

7. Stay moisturized! Apply lotion early and often, especially after baths. Note those dry, cracked feet and get ahead of that happening if possible.

8. Remember: if you’re diabetic, at some point your hands will retain sensation longer than your finger. It’s common to see scald injuries from stepping in water hot enough to burn you without you feeling it initially. Check the water with your hands before stepping into a tub.

9. Use a milder, less irritating soaps that includes moisturizer. Speaking of tubs, avoid bubble baths. Sorry.

10. Consider investing in a humidifier to prevent skin drying, especially in dry or cold climates.

Diabetic Skin Care Tips 11-15

11. Always take any skin wounds seriously, especially those on your feet. Avoid placing alcohol on any of your wounds.

12. Invest in some sterile gauze. If you develop a scratch or other wound, control the wound with it after cleaning.

13. Limit your self-help to cleaning and gauze wrapping. Only place topical antibiotics or take antibiotics for a skin infection under your physician’s supervision.

14. Always ask your physician to check your skin during an examination and ask him/her to teach you what to look for.

15. Immediately consult your physician or access the local emergency room if you have a burn, scratch, abscess (boil) or laceration that seems serious.

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Diabetic Skin Problems, Part 1

November 13, 2018Diet and Nutrition, Endocrine/Metabolic, Infectious Disease, Skin/Dermatology844-SMA-TALK, Amputation, Behind the Curtain, diabetic foot ulcers, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Today we begin a discussion on diabetic skin problems.

Diabetic Skin Problems

If you are diabetic or caring for a diabetic, one of the things you’ve likely noticed is that the skin doesn’t always seem to look, feel or perform normally. Perhaps the first thing I’d want you to know as a means of understanding what’s going on is this combination of facts: the skin is the body’s largest organ and diabetics have issues with blood flow. Given all the area needing blood flow, it stands to reason that diabetics invariably would have skin problems.

Skin Problems Cause Infections – and Amputations

On a practical level, appreciate that infections are the most common cause of death in diabetics. Even a small cut or scratch in this population can lead to loss of a limb if unrecognized and left untreated. Unfortunately, amputations among diabetics happens all too often. Is it preventable? With 100% confidence, yes. You can sufficiently reduce your risk of this ever happening. That said, there’s a reality that approximately 1/3 of all diabetes will have some type of skin problem, ranging from eczema and other localized itching problems to infections, abscesses, and gangrene.

How Diabetic Skin Problems Develop

By now you are likely wondering two things: How does this happen, and how can I prevent/help this?

First, diabetics suffer from frequent and excessive urination from those high blood glucose levels. This can lead to dehydration. Dehydrated skin is dry, red and has a waxy appearance. It becomes cracked, itchy, easily injured, harder to heal and easier to infect. Remember how diabetics have problems with poor blood circulation? That reduces the bodies’ ability to fight infections. So the first course of action for diabetics (beyond understanding the risks) is to be diligent in preventing infection.

I will dedicate a separate post to give you all the knowledge you need to prevent diabetic cuts, scratches and skin infections or to have them treated. In the meantime, the same rules apply to diabetics as they do to everyone else: an ounce of prevention is worth a pound of care. Diet and exercise can stave off the day when you’re fighting for your life because of a diabetic foot ulcer.

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Straight, No Chaser Diabetes Vlog

November 12, 2018Diet and Nutrition, Endocrine/Metabolic, Health Prevention844-SMA-TALK, Behind the Curtain, Diabetes, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Diabetes Vlog

The Straight, No Chaser vlog (video blog) series presents “health care basics” to keep you safe, healthy and out of the emergency room. Today’s Straight, No Chaser offers a diabetes vlog. Learn about the early indicators of diabetes, over 18 Million people are undiagnosed. Please don’t let that be you!

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Diabetes Basics and the Importance of Education

November 11, 2018Diet and Nutrition, Endocrine/Metabolic, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Diabetes, Diet, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Today we focus on diabetes basics.

Diabetes is a disease in which education is vital. For a diabetic, knowing the disease well allows him or her to better prevent long-term consequences of the disease. It also allows the diabetic to make real-time adjustments when sick or otherwise in danger acutely. In Straight, No Chaser, we’ve provided a series of posts meant to empower diabetics (and you can review any or all of them via the search box on the right). Remember, it all should start with a basic understanding of the disease.

Diabetes Basics

We eat, and the process of digestion is for the purpose of converting food into glucose (sugar) that’s used by our body for energy. The blood delivers the glucose to different organs of the body where the cells take it up for use. In order for that process to work, an organ that’s part of the digestive tract called the pancreas has to produce a hormone called insulin. Insulin facilitates the glucose getting from the blood to inside the cells. Diabetes is a disease where insulin isn’t being made by the pancreas or isn’t working optimally.

Now think about what happens when you’re not getting sugar into your cells. It’s as if you’re starving (because physiologically, you might as well be). You get symptoms such as weight loss, hunger, fatigue and excessive thirst. Because your cells don’t have energy, they aren’t functioning well. In fact, blood and nerve vessels lose significant function, resulting in significant vision loss and lack of sensitivity in your extremities. Anyone who’s been a diabetic for about 10 years know this because you’re wearing glasses and because you’ve lost a fair amount of sensation, especially in your feet. There are other symptoms that are variations of the same theme, including excessive urination, dry skin, increased infection rate and slower healing from those infections – all due to poor function of your blood vessels.

Risk Factors

Sometimes diabetes is a disease that happens to you because of unlucky genetics (or simply a family history). Other times it is a disease that you find. Risk factors for developing diabetes includes obesity, older age, and physical inactivity. Gestational diabetes (i.e. that occurring during pregnancy) is an entirely different conversation.

Prevention and Treatment

Let’s take a moment to discuss prevention and treatment. There are different types of diabetes, but the risk of one form of diabetes in particular can be reduced by – you guessed it – diet and exercise. In fact, diet, exercise and medications are the three legs of the diabetes treatment stool regardless of type. Some patients require regular insulin injections and others require pills. Still others who are successful with diet and exercise are able to markedly reduce, and in some instances eliminate medications.
If you’re a diabetic, make an investment in your education. It could not only save your legs or eyes, but it may just save your life. I welcome your questions and comments.

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Prevention and Treatment Considerations for Diabetic Eye Conditions

November 10, 2018Endocrine/Metabolic, Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, cataracts, Diabetes, Diabetic retinopathy, Glaucoma, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This posts addresses prevention and treatment considerations for diabetic eye conditions.

Several of you asked about the treatment of the eye conditions resulting from diabetes. This last Straight, No Chaser addressing Diabetes Awareness Month will focus on treatment approaches.

The first point – and one that can’t be overemphasized – is treatment is not a cure. As long as diabetes continues (and especially continues to be uncontrolled), symptoms will progress, and the diabetic-related causes of eye disorders will create ongoing difficulties, even after treatment of past problems has occurred. Thus, the first consideration is to understand steps you can take to prevent or slow the progression of the effects of diabetes on your eyes.

Preventive Measures

There actually are several preventive measures within your control. Consider implementing these.

Keep your blood glucose and blood pressure as close to normal as you can. This involves dieting, exercising and taking your medication as prescribed.
Have an eye care professional examine your eyes annually – even if your vision is normal, and especially if your vision is normal. If you have good control of your diabetes, your eyes will tell part of that story, and you need to stay ahead of evolving problems. Of course, discovering problems early and getting prompt treatment gives you the best opportunity to maintain normal vision and to prevent advancement to more serious stages. Be proactive and ask your eye care professional to check for signs of cataracts and glaucoma.
If you are diabetic and planning to get pregnant, ask your doctor if you should have an eye exam.
If you are diabetic and pregnant, see an eye care professional during your first 3 months of pregnancy.
Don’t smoke.

Surgical Options

Recall that damaged older vessels or fragile new vessels has a propensity to bleed into the eye. This blood interferes with your ability to see normally. This severe, advanced diabetic retinopathy is treated with laser surgery, which helps to shrink the abnormal blood vessels, thus reducing bleeding into the eye. The procedure involves 1,000 to 2,000 laser burns in the area of the retina (the lining in the back of your eye that senses light), causing the abnormal blood vessels to shrink. Even as laser surgery saves much of your sight, patients often notice reduction or loss of side vision, color vision and/or night vision.

If the bleeding is especially severe, you may need a surgical procedure called a vitrectomy. This procedure removes blood from the center of your eye.

These procedures stabilize vision and in some instances may dramatically improve it. Focal laser treatment reduces the risk of vision loss by 50 percent and the risk of blindness by 90 percent. However, laser surgery most often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early should be your most important strategy to prevent vision loss. There are additional medical treatment options emerging meant to replace the need for surgery. If you suffer from diabetic retinopathy, discuss these options with your eye doctor.

Please remember, that although both laser treatments and vitrectomies are very effective in reducing vision loss, they are not cures. Once you have proliferative retinopathy, you always will be at risk for new bleeding. That said, people with progressive diabetic retinopathy have less than a five percent chance of becoming blind within five years of early treatment.

An Eye Health Checklist

Please use the preventive strategies and understand the treatment options available to you. Failure to do so could be devastating.

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