Tag Archives: Sterling Medical Advice

Diabetic Retinopathy and Other Eye Problems

November 9, 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

Unfortunately, if you’re diabetic, diabetic retinopathy is likely in your future. Don’t ignore this.

As you likely know, diabetics have a large amount of blood glucose (sugar) circulating in their blood. The high level of glucose can cause damage to many cells, including your eyes. If you are diabetic, your challenge is to learn how to slow down the process. This Straight, No Chaser addresses relatively frequent effects of diabetes on your eyes.

How does diabetes hurt my eyes?

Diabetes has direct (through the effects of high blood glucose) and indirect (through high blood pressure) effects on four parts of your eye: the lining in the back of your eye that senses light (the retina), the jelly-like fluid that fills the back of the eye (the vitreous), the lens (serves to focus light on the retina) and the optic nerve (the main nerve from the eye to the brain).

How can diabetes hurt the retinas of my eyes?

Diabetic retinopathy is the term for the most common eye problem of diabetics. The retinas have tiny blood vessels that are easy to damage and do become damaged by high glucose levels. As retina problems get worse, new blood vessels grow. These new blood vessels are fragile and susceptible to leaking blood into the back of the eye. The leaking blood keeps light from reaching the retina. This can result in a sensation of seeing floating spots or almost total darkness.
Over time, these damaged blood vessels can form scar tissue and pull the retina away from the back of the eye, causing detachment of the retina. A detached retina can cause loss of sight or blindness if you don’t take care of it right away.

How do I know if I have retina damage from diabetes?

You may or may not have any signs of retina damage, but here are the more common signs.

blurry or double vision
dark or floating spots
pain or pressure in one or both of your eyes
rings, flashing lights, or blank spots
trouble seeing things out of the corners of your eyes

What other eye problems can happen to people with diabetes?

Cataracts and glaucoma are two other eye disorders that occur at a higher frequency in diabetics.

A cataract is a cloud over the normally clear lens of your eye. Remember, the lens focuses light onto the retina, so the presence of a cataract makes everything you look at seem cloudy. You need surgery to remove the cataract, which replaces the bad lens with a permanent plastic lens.

Glaucoma is a condition resulting from pressure building up in the eye. Eventually, this will damage the optic nerve, which will progressively reduce your vision. Treating glaucoma involves eye drops to lower the pressure in your eyes or surgery for advanced cases.

Of course, you want to know what steps you can take to prevent or slow the occurrences of these eye conditions. These will be discussed in an upcoming Straight, No Chaser.

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Low Blood Sugar – Hypoglycemia

November 8, 2018Endocrine/Metabolic844-SMA-TALK, Behind the Curtain, Blood sugar, Conditions and Diseases, Diabetes mellitus, Endocrine Disorders, Glucose, health, Insulin, Pancreas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Low blood sugar is as dangerous as high blood sugars. They just cause danger in different ways.

In a previous post, I provided an overview of diabetes. Everyone knows about diabetes, and most understand how dangerous diabetes is over the long-term. However, as an emergency physician, I’m more concerned with what will kill you immediately, and on that front, low blood glucose (sugar) is usually much more concerning. I want you to know up front that a low enough blood glucose will kill you – now. As we say in the ER, a high glucose level will hurt you and may kill you, but a glucose level that goes to zero means ‘Cancel Christmas’.

If you’re not sure if it’s low blood sugar or high blood sugar, feed them!

Therefore I will start with a simple statement. Any diabetic (or individual known to have low glucose levels) with altered mental status needs to be given juice, or if they can handle it, some soft food to chew on. If they’re in the midst of a high sugar reaction, it won’t make much of a difference. However, if that glucose level was zero, you’ve just saved a life. Now let’s briefly discuss symptoms and causes.

Symptoms and Causes of Hypoglycemia

Low glucose levels can present many different ways including dizziness, jitteriness, numbness, tingling, blackouts, seizures and other symptoms. However, it’s usually the confusion or other change in mental status that’s most predominant and concerning. Just remember, this is not something about which you should wait around to see if it gets better.

Regarding causes, unintentional overdosing of insulin or oral medication (particular the sulfonylureas class of medicines) are especially concerning and common. Sometimes a family member, particularly a child, may take such a medicine to disastrous effects. Beyond that, heavy alcohol consumption on an empty stomach is another common cause due to its effects on the liver (Alcohol locks glucose stores in the liver, preventing release to the blood; as a result you have less to use.).

Other causes are more exotic and fortunately less common; they will be evaluated upon arrival to the hospital when a rapid response isn’t seen with simple administration of glucose. Dysfunction of certain organs (the adrenal and pituitary glands, the liver due to hepatitis, or tumors of the pancreas – the organ that produces the insulin that drives glucose into your cells – can cause problems with regulating either glucose itself or insulin. These conditions can drive your blood glucose dangerously low.

So, the causes are varied, but the message is simple. Be careful with insulin administration, remember to check those blood sugar levels and act promptly in the face of mental status changes. Usually I note that time is tissue, but in this example, you’ll run out of time before your tissues are damaged.

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What You Must Know About X-Ray Safety

November 7, 2018General Health and Wellness, Health Prevention844-SMA-TALK, anaphylaxis, Behind the Curtain, contrast media, radiation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

X-ray safety is as important as using x-rays for proper evaluation.

After the question of “Can I get an x-ray,” the next most common question I get (which should be the first) regarding x-rays is “Do I need this x-ray?” The answer is not just based on the presence or absence of a medical indication but the medical indication relative to the risk. I’ll provide examples of that consideration shortly. The point of this Straight, No Chaser is to get you to more frequently think of the risks of irradiating your body parts. After all, inappropriate doses of radiation have a much greater chance of contributing to cancer than turning you into a superhero.

Let’s start by getting this off the table: x-rays are safe when used appropriately and with care during each case. Radiologists and x-ray technologists are trained to toe the line between inadequate production of x-rays and overexposure such that patients are placed at risk. Additionally, your physicians consider the risk-benefit ratio with each study ordered. This is why instances exist when your physician (especially emergency physicians) may advise against having x-rays done.

What exactly are the risks of x-rays and other medical imaging studies?

It’s about the risks of radiation and the potential contribution to cancer. You accept these risks everyday. Some of you tan, play golf, surf and otherwise expose yourself to the sun. It’s the cumulative exposure that poses risks, and these risks are miniscule. That said, there are circumstances in which the risks become pronounced, such as irradiation during pregnancy, in children or due to dye materials (called contrast media) such as barium or iodine used to enhance development of the film during special x-ray studies.
In some people, the injection of a contrast medium can cause the following side effects:

A feeling of warmth or flushing
A metallic taste in the mouth
Hives
Itching
light-headedness
Nausea
Severely low blood pressure and shock (anaphylaxis, due to an allergic reaction)
Cardiac arrest

How much radiation is involved in these studies?

The radiation exposure from one chest x-ray is roughly equivalent to the amount of radiation exposure you obtain from natural surroundings in 10 days.

Aren’t x-rays dangerous during pregnancy?

One of the rules of emergency medicine is we don’t focus on potential side effects when confronted with a defined life threat. The issue of the effect of x-rays on an unborn fetus is secondary to the need to treat the mother. In other words, the best way to protect the fetus is to protect the mother. Even so, the theoretical risk exists, and your physician will take steps to minimize the risk if possible. This may occur by choosing another test (such as an ultrasound) that doesn’t involve radiation. The vast majority of medical x-rays do not pose a critical risk to a developing child. In fact, x-rays of the head, arms, legs and chest do not usually expose the baby directly to radiation.
Regarding standard x-ray examinations of the abdomen, they are not likely to pose a serious risk to the child. Some abdominal and pelvic studies such as CT, nuclear medicine scans and interventional radiologic studies deliver greater amounts of radiation to a developing pregnancy.

What can I do to minimize risks and ensure x-ray safety?

I’ll offer two simple recommendations that will help reduce your risk. In both of these instances, alternative evaluation and treatment options might be available that can provide the desired level of care.

Work with your physician in obtaining x-rays. The instances when you receive x-rays when your physician suggests they are not necessary are not in your best interest.
Inform the radiologist that you are or might be pregnant.

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X-Ray Basics and Your Questions

November 6, 2018General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, x-raysJeffrey Sterling, MD

Introduction

In this post, we’ll review your questions and some x-ray basics.

“C’mon, Doc. I just want to be sure!” If I’ve heard it once, I’ve heard it a million times. You love x-rays. They’re cool, and they sometimes tell you what’s wrong. How much do you know about them? What should you know about the different types of tests done? What about the risks? This Straight, No Chaser explores the how and why of different radiologic studies.

How do x-rays work?

X-rays are forms of radiant energy that pass through the part of the body being examined. While doing so, a special film or monitor allows a radiologist to view pictures of internal structures.

What are x-rays used for?

X-rays have other uses than determining whether you have broken bones. There are many other uses, including the following:

Chest x-rays help in evaluating punctured lungs, the presence of pneumonia or lung masses (e.g. abscesses or cancer), heart size, shape and abnormal content (e.g. calcium deposits).
Abdominal x-rays help identify punctures of various organs, the presence of blocked intestines (bowel obstructions), hernias, constipation and many other conditions.
X-rays also identify bones that have been dislocated (moved from the normal location in a joint) or suffer from arthritis or infection, and they can often detect foreign objects. X-rays can confirm the placement of tubes your physician has placed (e.g. breathing tubes, tubes through the nose or penis or special IV tubes) and facilitate certain medical procedures.

I’ve heard CT scans are just fancy x-rays. Is this true?

That’s overly simplistic but not entirely inaccurate. CT scans do involve the passage of a fan-shaped beam around the area in question, produce higher quality images than regular x-rays. This also involves more radiation.

What is fluoroscopy?

An easy way to understand radiology is to call it “screening.” In this example, the x-ray beams are being viewed in real-time via a moving picture on a TV screen. This type of study can be especially important for the identification and removal of foreign objects in the skin or for looking at the stomach and intestine.

Are ultrasounds and MRIs also x-rays?

No. Although x-rays are used as a generic term by many in the lay population, these procedures are different and would be better called radiologic or medical imaging studies. Ultrasounds and MRIs (magnetic resonance imaging) don’t use x-rays, so they are safer. Many are familiar with the use of ultrasounds in pregnancy, but they are helpful in many situations, including trauma, identification of gallstones, the presence of abscesses and many other scenarios. MRIs growing in popularity because of its superiority in identification of many conditions, particularly neurologic concerns. However, its limited availability is a problem.

What about nuclear medicine studies?

In this type of study, radioactive materials called isotopes are injected into a vein, swallowed or inhaled. These isotopes concentrate in a specific area (body organ or tissue) when the emissions (known as gamma rays) are detected by a special camera. These emissions present a picture of the affected area.

What else do I need to know? Why is my doctor always refusing to order x-rays?

In the hands of a good physician, these tests confirm diagnoses, not make them. In many instances, a good examination eliminates the need for x-rays. An example of this concept has been previously discussed in a Straight, No Chaser post on ankle x-rays. Also remember that for injuries, x-rays look at bones. Your muscle spasm, ligament and tendon injuries won’t show up on an x-ray, so it’s a waste of time and money to do the test.
The rest of the story is about safety. These x-rays, gamma rays and radioactive isotopes bring risk. Although they won’t turn you into the Incredible Hulk, your physician is considering your lifetime exposure and risk. Avoiding unnecessary x-rays is a key part of that. This risk will be discussed in greater detail in another post.

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Causes of Eye Pain

November 5, 2018Ophthalmology/Eyes844-SMA-TALK, amaurosis fugax, Behind the Curtain, Conjunctivitis, floaters, Glaucoma, keratitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, uveitisJeffrey Sterling, MD

Introduction

Do you ever get eye pain? Look at the picture. What would you do if that was your eye? Would you try to remove the object or be too afraid, fearing that you could permanently damage it? Does the amount of pain you’re in make a difference? Eye pain is a good example of how people use the ER in general. For as many people who come to the emergency room for seemingly minor things, there’s even more that delay coming because of a thought that things will get better. When it comes to your eyes, you only have two and can’t afford to lose even one. This Straight, No Chaser focuses on eye pain that likely represents a true emergency and for which waiting should not be an option. If you have any of these signs or symptoms, come in while you still can see (if indeed you still can).

Sudden vision loss

The problem with sudden vision loss is that it didn’t happen by accident, and it’s not likely to get better without prompt relief. This could represent a stroke involving the eyes’ blood vessels (amaurosis fugax), a blockage of those blood vessels (central retinal artery occlusion), a retinal detachment and a few other critical considerations. The point to be made is that in most of these examples, you should assume that only a limited amount of time exists to repair the damage before the eye injury causes permanent damage.

Eye pain

Yes, there’s a lot of benign things that cause eye pain, but there are some serious considerations, including the following:

Burns (seen very commonly in welders and those using chemicals)
Conjunctivitis (yep, even this can be serious when caused by gonorrhea or a herpes virus – wash your hands!)
Glaucoma
Inflammation of various components of the eye (uveitis, keratitis)
Migraines
Scratches and ulcers to the eye surface (the cornea – do not sleep in your contacts unless this has been approved by your eye doctor; it just sets you up for bad things to happen)
Trauma
Tumors

Something is in your eye

Whether a chemical splash, a piece of metal, a branch or other foreign body, there are several concerns you should have. In the example of the chemical splash, something may be burning through the layer of your eye, putting it at risk for rupture. One word – IRRIGATE! If some object is in there that you cannot remove by blinking, odds are it’s not going away. Don’t cause more damage than is already there by digging around in your eye. Get evaluated.

Visualization of flashing lights and floaters

The most concerning cause of this phenomenon is a retinal detachment, which is a serious eye-threatening emergency. Visualize (no pun intended) wallpaper peeling off a wall. Unfortunately in this analogy, the retina is like the film in your camera, capturing the images of the world you see. If your retina’s gone from its natural position, you’re not seeing anything.

Eye hope you’ve found this post illuminating.

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Questions About LASIK Surgery

November 4, 2018Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, LASIK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

You’ve heard about Lasik surgery, but what do you actually know about it? Typically, you pay attention when you’re about 40 years old. At this point, your eyes are starting to act up on you. Or perhaps you’re younger and/or too vain to wear glasses. Or you have a phobia about having anything in your eyes, so contacts just aren’t an option. There are many different scenarios that lead one to consider Lasik surgery, but what do you really know about it? It is worth the considerable cost (and risks)?

What is LASIK surgery? What is it trying to accomplish?

LASIK (Laser-Assisted In Situ Keratomileusis; you’re supposed to ignore the order of the letters) is a surgical procedure that permanently changes the shape of the outer covering of the eye (the cornea) in an effort to reduce one’s dependency on glasses or contact lens. It does this by positioning your eye apparatus to bend light rays so they focus better on your retina, producing vision that is clearer and sharper. I’ll defer the details of the procedure to the attached video.

How will I know if I’m a candidate?

The testing is pretty involved but in general, it is worth getting evaluated if you have one of the following conditions. The shape of your eyes (i.e., longer, shorter, flatter) may prevent light rays from hitting the retina optimally. When this is the case, your vision (focus) will be off one way or another.

Nearsightedness (myopia) is having more clear vision for objects that are closer compared to those further away.
Farsightedness (hyperopia) is having more clear vision for objects that are further compared to those closer.
Astigmatism is a disruption of both near and distant vision due to unevenness in the cornea.

So should I consider Lasik a medical procedure or cosmetic surgery?

You’d do well to have a healthy fear of any surgery, especially on your eyes. Your ophthalmologist (eye doctor) should explore non-invasive options before offering surgery. However, when you choose or need it, the result can be pleasing when a skilled and experience surgeon does it.

So what are the risks of Lasik surgery?

As with any surgery, LASIK eye surgery carries risks:

Undercorrections and overcorrections. Optimal results require removal of a rather exact amount of tissue. If not done, your vision won’t be quite clear. If too little tissue (undercorrection) was done, an enhancement surgery may help.
Vision returning to pre-surgery vision. Over time, your eyes may worsen and even go back to the level of vision you had before surgery.
Visual loss or changes. Surgical complications can lead to worsening or loss of vision.
Astigmatism. Astigmatism is a result of unevenness in the cornea. It can be produced by uneven tissue removal during surgery.
Glare, halos, double vision and difficulty seeing at night.
Dry eyes. LASIK causes a temporary decrease in tear production. The resulting dryness in your eyes can negatively affect your vision.
Flap problems. The process of folding or removing the flap in the front of your eye during surgery can lead to infections, inflammation and excess tears.

Your eye doctor will discuss your risks and the potential benefits of LASIK surgery. It’s estimated that more than eight of 10 who undergo the procedure are able to forego contacts or glasses – for the majority of their activities. I welcome your questions or comments. Enjoy the following video, courtesy of the U.S. Food and Drug Administration.

Lasik

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Questions About Your Contact Lenses

November 3, 2018Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, Contact Lenses, Corneal abrasion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Subconjunctival hemorrhage, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

You’d likely be surprised to know how often patients are seen in emergency rooms for complications related to use of contact lenses. If you or a loved one are using contact lenses, they’re quite safe, but you must be diligent. Failure to do so can lead to some pretty significant complications.

Which is better: disposable or regular contact lenses?

The development of disposable contact lenses has lessened the risk of various eye problems. This isn’t the same as saying regular lenses aren’t good or even just as good. Daily use (i.e. disposable) contacts don’t require cleaning solutions, which were commonly used for contacts in the past to increase the longevity of them. When you’re next ready for lenses, ask about silicon hydrogel lens. Evidence suggests they are even better for comfort and lower risk for eye problems.

Can I wear my contact lenses when I go swimming?

You can, but you shouldn’t, according to the FDA (Food and Drug Administration). Swimming can cause absorption of chemicals (including chlorine) and bacteria from the water, leading to an eye infection. Additionally, contacts can adhere to the eye after swimming. This can lead to ulceration of parts of the eye (e.g. cornea).

Can I wear my contact lenses while I sleep?

You can use extended wear contacts while you sleep if this has been approved in advance by your optometrist or ophthalmologist. They can be used for up to seven days if recommended as such. Remove your daily wear contacts prior to sleep – even a nap.

What steps help prevent fungal infections caused by contact lenses?

First, you should understand your risks, which include prior eye damage or a diminished immune system. Fungal infections are a particular concern for those wearing soft contact lens with risk factors. To reduce your risk, be sure to thoroughly wash your hands with soap and water. Be especially careful to avoid lint on your hands before handling your contacts. Avoid extending the use of your contact lens beyond the recommendations of your eye provider. Be sure to keep your lens case clean, and replace the case every 3-6 months. In the unlikely event you’re still using Bausch & Lomb ReNu ® with MoistureLoc® Multi-Purpose Solution, discard it. It’s been recalled due to an increase rate of eye fungal infections.

How do I know if my contact lenses have caused an eye infection?

Be on the lookout for redness, swelling, tearing and/or eye discharge, light sensitivity, blurred vision and pain that doesn’t improve after removal of the contacts. If you have symptoms like this, remove the contacts and get medical assistance.
Remember to pause before inserting anything in your eyes. The consequences of bad decisions can be devastating and irreversible.

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Questions About Color Blindness

November 2, 2018Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, color blindness, color deficiency, Conditions and Diseases, cones, nystagmus, retina, rods, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Do you suffer from color blindness? Have you ever found yourself at school, work or elsewhere and discovered that you were wearing different colored socks or pants than you thought? If so, the answer may be yes.

 
A person with color deficiency may not be able to see the number 5 among the dots in this picture.

What are the main symptoms of color blindness?

Classic color blindness involves difficulty in seeing colors and the brightness of colors, coupled with an inability to differentiate between shades and other variations of similar colors. Usually the perception of red and green or blue and yellow are affected. There can be a lot of variation in symptoms, ranging from mild to complete and including greater or lesser difficulty in bright or dim light.

Why does color blindness occur?

In the back of your eyes, you have two different types of cells affecting your ability to detect light. One cell type is called cone cells; these detect color. There are three types of cone cells: those that detect red, green and blue. Our brain perceives color based on degrees of input from these cells. Any absence or malfunction in these cells can produce color blindness. It stands to reason (and is true) that different degrees of color blindness could result from the extent of malfunction to these cells.

Who is at risk?

Most people with color blindness are born with it.
One of 10 males has some form of color blindness.
Women seldom suffer from color blindness, but those that do are likely to pass it to their sons.
Color blindness is more common among those of Northern European heritage.
Certain drugs, most notably plaquenil (a drug used to treat rheumatoid arthritis) can cause color blindness.
Certain medical conditions, including Alzheimer’s, Parkinson’s, alcoholism, glaucoma, leukemia and sickle anemia increase the risk of acquiring color blindness.

Are there other symptoms?

Except in the most severe form, color blindness does not affect the sharpness of vision. In rare instances one may experience poor vision, light sensitivity, involuntary rapid eye movement and visualization of everything as shades of gray. These symptoms aren’t likely to occur suddenly, so you’d have ample opportunity to see an ophthalmologist (eye doctor) prior to this level of malfunction.

What is done about it?

Color blindness has no cure. However, treating the underlying cause is the best way to address most forms. Also, you may be given special eye wear that improves color detection.

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Questions About Lazy Eye (Amblyopia)

November 1, 2018Ophthalmology/Eyes844-SMA-TALK, amblyopia, Behind the Curtain, cataracts, Conditions and Diseases, hyperopia, lazy eye, myopia, ptosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

We all get concerned when it comes to things that damage or put our vision in danger. As such, you should be aware of the most common condition causing visual problems in children. You know it as lazy eye, but the medical term is amblyopia. This occurs in approximately 2 to 3 of every 100 children. Unfortunately, the issue isn’t just its occurrence in children but its persistence into adulthood. Amblyopia is also the most common cause of visual impairment among young and middle-aged adults affecting one eye.

Here are some questions and answers of concern. These may help you understand some terms your ophthalmologist (eye doctor) or optometrist uses with you.

What exactly is lazy eye?

Amblyopia (aka lazy eye) is the condition that exists when the vision of one eye is reduced due to that eye not working appropriately with the brain. The brain adjusts by favoring the other eye.

Let’s get medical for a moment. Appropriate eye function requires accurate interaction between the eyes and the portions of the brain necessary for vision. Each eye focuses light on the retina, which is located in the back of the eye. Cells within the retina stimulate nerve signals that travel along the optic (eye) nerves to the brain, which interpret and responds to these signals.

What are some common causes of lazy eye?

As noted, the correct function and interaction between the eyes and brain are necessary. Many things can go wrong along the way, all of which serve to cause unclear focusing. Here are some examples.

Strabismus: misalignment of the eyes

Cataracts: clouding of the front part of the eye

Nearsightedness (myopia; better focus on closer objects) results from the eye being too long from front to back.

Farsightedness (hyperopia; better focus on objects at a distance) results from the eye being too short from front to back.

Astigmatism: condition associated with irregularly shaped eyes; produces difficulty focusing on both near and far objects

How is lazy eye treated?

Most of the focus on treating amblyopia involves catching it early and treating the child. It is during this time that the eye, the brain and the connections between them are developing, and the opportunity for improvement is greatest. Generally speaking, treatment involves forcing the child to use the eye with weaker vision. There are two common ways to treat lazy eye:

Patching: Placing an adhesive patch on the stronger eye for weeks to months forces the brain/eye apparatus to use the affected eye. This stimulates more complete development of the needed areas in the brain and eye.
Atropine: Using this eye medication causes blurring in the strong eye, forcing use of the affected eye. This works as well as patching.

Is this the same as eye drooping or lid lag?

No. “Lazy” eyelids (aka ptosis) are not the same as malfunctioning eyes. Lazy eye refers to the latter impotenzastop.it. That said, the two are not mutually exclusive.

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Treating Halloween Mishaps

October 31, 2018Diet and Nutrition, Toxicology/Drugs, Health Prevention844-SMA-TALK, Behind the Curtain, choking, food poisoning, Halloween, Sprained ankle, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Syncope, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

In the previous Straight, No Chaser, we offered you tips for a safe Halloween. However, safety tips are only as good as your inclination to use them. Even when an ounce of prevention is worth a pound of cure, you should still have access to that pound. In this post, we remind you of the treatment measures you may need to employ in the event something untoward happens at that Halloween party or while trick or treating.

Halloween Mishaps

Upset stomach? There are two pretty big reasons why this happens.

Eating all those sugary treats can cause all types of problems, including an upset stomach. Ration out the treats, especially the first night. You’d do well to make sure the trick-or-treaters have a generous dinner in advance of the activities.
Have you ever thought of all the different hands that touch the contents of those bags? You’d better be sure to wash hands and any foods prior to ingestion, whether wrapped or unwrapped.
If vomiting and diarrhea ensue from any food poisoning, review the linked Straight, No Chaser for treatment considerations.

Sprained ankle?

It can get pretty exciting out there, and kids can easily get distracted. Falls and ankle sprains can be expected on those sugar-induced sprints to the next house.
Review the linked Straight, No Chaser for treatment considerations.

Faints?

Are those tricks too scary? Did the excitement prove too much to handle?
Review the linked Straight, No Chaser for treatment considerations.

Choking?

You must be mindful that all candies are not appropriate for children. Peanuts and candy corn have a nasty habit of getting lodged in the throats of very young children.
Learn what steps to take in the event this happens. Review the linked Straight, No Chaser for treatment considerations.

Keep in mind that common things happen commonly. The horror tales of legend aren’t likely to be a part of your Halloween, nor are you likely to come across any ghouls, goblins, vampires or zombies unless you come across a Thriller reenactment.
Be safe and have a Happy Halloween!

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Halloween Health Tips

October 30, 2018Diet and Nutrition, Toxicology/Drugs, Health Prevention844-SMA-TALK, Behind the Curtain, Halloween, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Have you ever said the phrase “Halloween safety tips?” Well, are you taking the young ones trick-or-treating this year? Straight, No Chaser and the Centers for Disease Control and Prevention (CDC) want you to have a safe halloween. Today and tomorrow’s posts will offer safety tips and treatment considerations in the event something goes wrong.

Keys to a SAFE HALLOWEEN

Remember: have a SAFE HALLOWEEN!

SAFE

Swords, knives, and other costume accessories should be short, soft, and flexible. Objects don’t have to have the consistency of a knife to stab or otherwise impale.
Avoid trick-or-treating alone. Walk in groups or with a trusted adult.
Fasten reflective tape to costumes and bags to help drivers see you.
Examine all treats for choking hazards and tampering before eating them – slow down! Limit the amount of treats you eat.

HALLOWEEN

Hold a flashlight while trick-or-treating to help you see and others see you. Always walk; don’t run from house to house.
Always test make-up in a small area first in case an allergy may be present. Remove it before bedtime to prevent possible skin and eye irritation.
Look both ways before crossing the street, and use crosswalks wherever possible.
Lower your risk for serious eye injury by not wearing decorative contact lenses.
Only walk on sidewalks whenever possible, or on the far edge of the road facing traffic to stay safe.
Wear well-fitting masks, costumes, and shoes. The idea is to avoid blocked vision, trips, and falls.
Eat only factory-wrapped treats, and throw away homemade treats made by strangers.
Enter homes only if you’re with a trusted adult. Only visit well-lit houses. Never accept rides from strangers.
Never walk near lit candles or luminaries. Be sure to wear flame-resistant costumes.

Safe Partying and Trick-or-Treating

Expecting trick-or-treaters or party guests? Follow these tips to help make the festivities fun and safe for everyone:

Provide healthier treats such as low-calorie treats and drinks. For party guests, offer a variety of fruits, vegetables, and cheeses. Get creative as to keep things festive.
Use party games and trick-or-treat time as an opportunity for participants to get their daily dose of 60 minutes of physical activity.
Be sure walking areas and stairs are well-lit and free of obstacles that could result in falls.
Keep candle-lit jack o’lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended.
Remind drivers to watch out for trick-or-treaters and to drive safely.

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An Introduction to Intersex (aka Hermaphroditism)

October 29, 2018Genital/Urinary844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Intersex, Hermaphrodite, HermaphroditismJeffrey Sterling, MD

Introduction

Today we address the challenges faced by intersex individuals. In the past, the term hermaphrodite was more common, but for many reasons that is no longer the case. In general, intersex speaks to a discrepancy between one’s external appearance and the internal genitals (ovaries and testes).

Let me start by discussing why this is so confusing. We want clarity and easy ways to categorize sexuality. However, the evolution of sexuality is such that there are at least four factors to consider:

External appearance
Gender identity
Internal and external organs
Genetics (chromosomes)

Intersex Categories

There are many ways in which those considerations interact with the others. As a result, a myriad of options and realities for separate individuals exists. To make things easier to understand, It helps to divide intersex into 4 categories.

The 46 chromosomes, XX intersex (genetic female constitution). In this example, the external genitals appear male. Excess exposure by the female fetus to male hormones is a typical cause for this condition.
The 46 chromosomes, XY intersex (genetic male constitution). In this example, the external genitals are incompletely formed, ambiguous, or even female.
True gonadal intersex occurs with both XX and XY chromosomal structure. These individuals must have both ovarian and testicular tissue. This tissue could be joined together, or it could present as one ovary and one testis.
Complex or undetermined intersex disorders of sexual development represent many other presentations. In these examples, there are no discrepancies between internal and external genitalia. Many chromosome configurations other than simple 46, XX or XY can produce intersex individuals. Examples include 45, XO (only one X chromosome), and 47, XXY, 47, XXX. In the latter cases, an extra sex chromosome is present. Still, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes.

Future Conversations

This is a very complicated topic, and this introduction and identification of current efforts to classify means to offer a fundamental consideration. Intersex does not represent a “one size fits all” consideration. It also does not present a uniform set of treatment options. A basic level of understanding, empathy and tolerance for what is an anatomic challenge is very important to these individuals. Future Straight, No Chaser posts will address ethical questions, treatment options and mental health challenges faced.

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Breast Cancer in Men

October 28, 2018Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, Behind the Curtain, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

I won’t overstate the case, but you should be aware that breast cancer in men does occur. That said it occurs at a much lower rate than it does in women. I know what you may be thinking, but it’s not that obvious. Both males and females have breast tissue. The big difference is women come equipped with a much greater support of certain hormones that stimulate development of breast tissue. You know this to be true because there are circumstances in which males, either through natural occurrence of abnormally high levels of those hormone levels or by stimulation (such as occurs with certain medicines), can develop noticeable sized breasts (called gynecomastia in non-cancerous circumstances and also present in breast cancer). This Straight, No Chaser offers information you should know to avoid a higher risk of developing breast cancer.

Data on Breast Cancer in Men

How often does breast cancer occur in males?

It is estimated that in 2018, approximately 2500 men are expected to be diagnosed with breast cancer.
Less than 1% of all breast cancers develop in men.

Risk Factors

What are the risk factors for breast cancer in men?

Age: Increases in age correspond to an increased risk. In fact, age in the greatest risk for men. In fact, the average age of men diagnosed with breast cancer is about 68.
High estrogen levels: Estrogen stimulates growth of breasts, both in normal and abnormal circumstances. The following are circumstances that can produce high estrogen levels in men.
- Obesity increases estrogen production.
- Certain conditions or treatment with hormonal medicines that include estrogen.
- Heavy alcohol use can damage the liver, which can result in a diminished ability of the liver to regulate estrogen levels.
- Similarly, other causes of liver disease also result in higher estrogen levels.
- You can also get significant estrogen exposure if hormones are used in the beef cattle you eat.

Klinefelter syndrome is a genetic disorder involving the presence of additional X chromosomes (the “female” chromosome). Men with this syndrome have lower levels of male hormones (androgens) and higher levels of female hormones (estrogen), resulting in a higher risk of developing gynecomastia and breast cancer.
Radiation exposure: Receiving radiation therapy to the chest before age 30 (such as occurs with treatment of Hodgkin’s disease) may increase the risk of developing breast cancer.

A family history of breast cancer or genetic alterations: Other men in one’s family with breast cancer, or a breast cancer gene abnormality also increases the risk of breast cancer. Men identified as having certain abnormal genes, including BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer of 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. The message here is if you have a family history of breast cancer, consider getting checked for the presence of these genes.

Summary

If you are a male with significant risks, your next step is to have a conversation with your physician. In case you haven’t seen the rest of the Straight, No Chaser series on breast cancer, use the following links for information on the rest of the story.

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Breast Cancer Treatment Options

October 27, 2018Hematology & Oncology/Blood Disorders/Cancer, Medical Treatment, Obstetrics and Gynecology844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

The next to last post in this series on breast cancer focuses on breast cancer treatment. Of course, there is no universal treatment of every breast cancer diagnosis. Everything is based on the specific type of breast cancer and the extent of progression upon diagnosis. Management usually involves a team approach in order to balance multiple considerations. As a result, this often leads to different treatment modalities being used together.

Breast Cancer Treatment Options

My goal today is to give you a general understanding for the different components of treatment, not to get into the nuances of individual treatment regimens. I certainly recommend you engage your personal physician and resources such as the CDC and the American Cancer Society. These will provide you with any and all additional, up-to-date details you may desire.

We treat breast cancer in several complementary ways. These include surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. Let’s review the basics of each.

Surgery: Sometimes, the cancer advances to a level where it can only be removed surgically. Surgical options include cutting out the area affected by the cancer (a lumpectomy), removing the entire breast (a mastectomy), and/or removing the areas where the cancer will drain and spread to other parts of the body (lymph node biopsy/resection). Of course, options aren’t actually quite this simple. Efforts to spare skin and tissue and to retain a cosmetic appearance are important considerations. If the risk of breast cancer in that breast is sufficiently high, sometimes the other breast is removed. Additional surgical considerations include breast reconstruction after surgery, which may include one’s own tissue or a synthetic breast implant. These are options to be discussed with a plastic surgeon prior to breast cancer surgery.

Chemotherapy: Chemotherapy is the use of medication to kill or reduce the cancer. Chemotherapy may be given via an IV (into the veins) or by pills. Typically, it is given before surgery to reduce tumor size, after surgery or with other therapy to reduce the risk of recurrence, or as a primary treatment option.

Radiotherapy (radiation therapy): High energy rays can be aimed at the cancer cells in an effort to kill them. Alternatively, radioactive material can be placed in the body.

Additional Breast Cancer Treatment Options

Hormonal therapy: As mentioned in this post, certain cancer cells are stimulated by hormones to grow. Hormonal therapy blocks cancer cells from getting the specific hormones that assist growth. Different drugs in this class act in a variety of different ways, both direct and indirect, with the same end result of diminishing the ability of hormones to stimulate tumor growth. Yes, this treatment option would be better named hormonal blocking therapy. Hormonal therapy also can be used as a primary treatment option or after other treatment options to reduce the chance of recurrence.
Biological therapy: Biological therapy serves to boost the body’s immune system to better help it fight the cancer. It also is of assistance in addressing immune-reducing side effects other cancer treatments may create.
Targeted drugs: An additional treatment modality is the use of targeted drugs, which attack specific abnormalities within cancer cells. The most notable example of such an abnormality is the presence of a human growth factor receptor 2 (HER2), a protein that helps breast cancer cells grow and survive..

Complications and Side Effects

Complications and side effects of breast cancer treatment are plentiful. These vary based on the treatment given. For example, surgery carries a risk of bleeding and infection. Risks of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Also, breast tissue may be altered in texture and may appear swollen. Rarely, damage to the heart or lungs may occur. Common side effects of chemotherapy include hair loss, nausea, vomiting, fatigue and an increased risk of developing infection. Finally, rare side effects can include premature menopause, damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.

Your Decision Making Team

The teams of medical, radiological and surgical cancer specialists who treat breast and other cancers do phenomenal work. Accordingly, you can do your part in reducing your risks and engaging in practices (breast self-exam and mammograms). This will allow for early detection. Remember, the days of increasing rates of breast cancer are behind us. Thankfully, breast cancer survivors abound! There are approximately 2.8 million survivors in the US. You now have the tools to be included in those numbers should (heaven forbid) you find yourself afflicted by breast cancer.

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Breast Cancer Risk Factors

October 26, 2018Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

A concerning reality is breast cancer risk factors tell the story of acquiring breast cancer. Even as a physician, I am left to think about the horror of risk factors. Most notably, simply being a woman brings a lifetime risk of acquiring breast cancer that’s 1 in 8. The only thing I can think of off-hand and relate to similarly is the risk for trauma being an inner-city minority kid. This risk of breast cancer is compounded by the reality that there is no way to prevent it. Thus, this must be emphasized early and often. Risk factor identification and reduction, coupled with early evaluation, detection and treatment are absolutely vital.

The Reach of Breast Cancer

Breast cancer is the second most common cancer contracted by American women (after skin cancer). It is the second most common cause of death from cancer (after lung cancer). More than a quarter of a million new cases will be diagnosed in women yearly. Approximately 40,000 women will die from complications of breast cancer annually, representing over 100 deaths every day.

In the event the previous information seemed like too much gloom and doom, understand that the tide has been stemmed. After more than two decades of increase, rates of new cases of breast cancer began dropping in 2000 and have stabilized. This is largely thought to be due to declining rates of post-menopausal hormone use. As you may know, such hormone use has been shown to increase the risk of both breast cancer and heart disease.

Breast Cancer Risk Factors

Speaking of risks, I don’t especially like this part of the conversation because it always comes across as if everything is a risk factor. There are still controversies about what is or isn’t a risk. As a result, patients end up confused and paralyzed into inaction. Therefore, I’ll mention just enough for you to understand and work with. If you have specific questions on what you’ve heard that I haven’t already addressed in the breast cancer myth posts (Parts I and II), feel free to ask.

There are risk factors you can’t change, like aging, family history and being a woman. Having these risk factors simply means you need to be more diligent in performing self exams. Also, it especially means you must seek early care for suspicious findings. Now, there are other risk factors you can minimize and are under your control. These include the following:

Alcohol use
Choosing not to breast feed
Obesity
Oral contraceptive use
Postmenopausal hormonal therapy

The bottom line is your risk factors don’t cause cancer, and the absence of risk factors doesn’t ensure you won’t have breast cancer. For example, men contract breast cancer as well. What it all comes down to is you must be diligent in performing exams and getting evaluated and treated if something abnormal is discovered. We’ll discuss some of that next.

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Even More Breast Cancer Myths!

October 25, 2018Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

We’re continuing from the earlier post with more breast cancer myths, well because you have so many questions! In fact, I’m doubling up on what you received earlier in Part I of Breast Cancer Myths.

More Breast Cancer Myths

6. “Breast cancer is preventable.”

Unfortunately, this is not true. All of our efforts are geared toward lowering risks, early detection and effective treatment.

7. “Obesity doesn’t affect my risk of getting breast cancer.”

Not true. Post-menopausal women with weight gain are at especially increased risk.

8. African-American women have an increased risk due to hair straighteners and relaxers.

This myth was taken head on and debunked by the National Cancer Institute in a large 2007 study including women with significant use over a 20-year period.

9. Caffeine causes breast cancer.

Not according to the evidence. There’s even evidence suggesting a benefit, but the data on this is just as inconclusive as that suggesting a link to breast cancer.

10. Mammograms increase breast cancer risk due to the radiation load.

The risks of radiation are so relatively insignificant that they’re mentioned as an afterthought compared to the benefits received from early and frequent evaluation.

Even More Breast Cancer Myths!

11. “Tight clothes and underwire bras will make me get breast cancer.”

Not true. Neither has any connection to breast cancer.

12. “Small breasts give me less of a chance of having cancer!”

Not true. Larger breasts are sometimes more difficult to evaluate, but that’s not the same as saying the risk of cancer is increased in women with larger breasts.

13. “These lumps I have are ok because I’m breastfeeding.”

The fact you can discover normal changes in your breast tissue doesn’t mean that all lumps discovered while breastfeeding are normal. Get evaluated.

14. “Deodorant and tanning cause breast cancer, don’t they?”

No. Cell phones don’t either. Tanning does increase the risk of skin cancer, but that’s a topic for another day.

15. “I heard having a baby when I’m older increases my risk of breast cancer.”

Well, not just any baby, but having one’s first baby later in life is a significant consideration. Women who give birth for the first time after age 35 are 40 percent more likely to get breast cancer than women who have their first child before age 20.

16. “Breast cancer is a death sentence.”

Most women survive breast cancer. Give yourself the best opportunity to do so by reducing your risks, learning the principles of early detection and getting prompt treatment if ever diagnosed. We’ll focus on these considerations in the next posts.

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Five Breast Cancer Myths

October 24, 2018Hematology & Oncology/Blood Disorders/Cancer, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, medical myths, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Breast cancer myths: are you afraid of them? Before I get into the details of what you need to know about breast cancer, it’s important to clear the table of some of the persistent breast cancer myths and fears that exist. The disease is tough enough as it is without the fear factor impeding our ability to fight back. Please be patient with me here. If you find these myths ridiculous, then good for you, as it indicates that you’re informed on the matter. Just understand that these are real questions that other physicians and I hear often. Remember, knowledge is power.

Breast Cancer Myths

1. “If a family member of mine has breast cancer, that means I’ll get it too.”

It is only true to say that women who have a family history of breast cancer have a higher risk of developing it. Overall, only approximately 10% of women diagnosed with breast cancer have a family cancer, and most women with breast cancer have no family history. In other words, a family member with breast cancer isn’t a life sentence for you, and it shouldn’t stop your efforts to lower your other risks and focus on early detection and treatment.

2. “All lumps in my breast are breast cancer.”

There are two important points for you to remember. First, any persistent change in the breast or armpit (axilla) should not be ignored. Remember, I will be stressing the importance of early evaluation for the purposes of detection. That said, only a small percentage of breast changes represent cancer (about 80% of lumps are benign). The really good news is if you learn and perform consistent breast exams, you will detect these changes earlier than anyone else and very often early enough to make a difference.

3. “Men don’t get breast cancer.”

Unfortunately, I know this not to be the case within my family. Annually, there are over 400 breast cancer deaths among men from over 2000 new cases being diagnosed. Men should pay attention just as women do because unfortunately, in part due to the delayed detection, the death rate of breast cancer in men is higher than in women.

4. “I heard breast implants cause cancer.”

No. There’s no increased risk with breast implants and breast cancer. However, you can legitimately say implants sometimes obscure the view of possible cancer on a mammogram.

5. “The risk of breast cancer is always 1 in 8.”

Actually it’s 1 in 8 during a woman’s lifetime. However, the important distinction is the risk increases as one ages, from 1 in 233 in a woman’s 30s up to 1 in 8 across the board by age 85.

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How to Perform the Breast Self-Exam

October 23, 2018Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, Breast self-examination, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Beginning in their 20s, women should be aware of the benefits and limitations of breast self-exam (BSE) as a screening tool for breast cancer. Women should know how their breasts normally look and feel. It is extremely important to report any new breast changes to a health professional as soon as they are found. Still, finding a breast change does not necessarily mean there is a cancer.

A woman can notice changes by being aware of how her breasts normally look and feel. Feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (with a BSE) also helps. Similarly, using a specific schedule to examine breasts maintains a heightened awareness of normalcy.

If you choose to do BSE, the information below is a step-by-step approach for the exam.

Special considerations

The best time for a woman to examine her breasts is when they are not tender or swollen. Women who examine their breasts should have their technique reviewed during periodic health exams by their health care professional.

Women with breast implants can do BSE, too. It’s helpful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that implants push out the breast tissue; this may actually make it easier to examine. Women who are pregnant or breastfeeding can also choose to examine their breasts regularly.

It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts. Not performing BSE makes it especially important to immediately report any changes to your doctor.

How to perform the breast self-exam

Horizontal positioning

Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Make overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

Standing position

While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

Summary

This procedure for doing breast self-exam is different from some previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman’s ability to find abnormal areas.

I need to acknowledge and thank the multiple sources that continue to compile and disseminate information to the public. These include the Centers for Disease Control and Prevention, the American Cancer Society and the Susan G. Komen Foundation. We highly recommend them should you need additional or more thorough information. I welcome your questions and comments.

[youtube=http://www.youtube.com/watch?v=omfbsthDsbc]

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

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October is Breast Cancer Awareness Month

October 22, 2018Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

How’s your breast cancer awareness? Breast cancer affects so many of us. If it doesn’t affect you or your family as well, I hope it’s not because you haven’t been paying attention. Sadly, one in eight women will be diagnosed with breast cancer in their lifetime. It’s more likely than not that every single one of us has been affected by this, either directly or through a friend or family member.

Breast Cancer is Different

All cancer is devastating, but something about breast cancer is different. We’ve found the way to eradicate certain cancers and have made remarkable progress on others. Aside from the hereditary component, breast cancer seems so…random, so dehumanizing and so debilitating to so many.

Unlike so many of the things I address as an emergency physician, breast cancer isn’t like trauma, STDs and many other conditions, where one is often directly suffering the consequences of their behavior. It is vital that you appreciate the need and value for early detection to give yourself the best possible chance for the best possible outcomes. I’ll be discussing all these considerations in detail throughout the week.

Breast Cancer Awareness

I appreciate the sentiment behind a National Breast Cancer Awareness Month, but if I could offer you anything on this, it would be a plea to be ‘aware’ every month, and use this month as a (re)commitment to take basic steps that will reduce your risk, a charge to maintain steps for early evaluation and a prod to point you toward prompt treatment if and when needed.

In fact, those three areas will be the topics of my next few posts. In the meantime, please share this or other information about breast cancer with any and all females in your life. I also hope you choose to engage your family, friends and others in conversations geared to improving breast cancer awareness. Odds are many of them have been or will be affected by breast cancer.

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Domestic Violence Abuse – How to Get Out of an Abusive Situation

October 21, 2018Mental Health, Neurology, Trauma844-SMA-TALK, Behind the Curtain, domestic violence, national domestic violence hotline, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Remember: You are not to blame, and you need not face domestic violence alone.

How would you escape eminent domestic violent abuse?. This is the third post in a Straight, No Chaser series on domestic violence. The first post focused on the scope of domestic violence. The second post focused on risk factors and identifying whether your situation places you at risk.

There has been a lot of recent attention in the news on domestic violence and debates about responses and responsibility. Hence, this post aims to refocus attention on where it needs to be. Better conversations on domestic violence start with getting the abused individual safely out of harm’s way.

When it comes to domestic violence, it is the immediate danger that can make it difficult for you to figure out the safest next move. Thus, it becomes important to know in advance the how and where of your escape plan.

Escaping Imminent Domestic Violence Abuse

If you are in a crisis situation, first make sure you and any other family members (e.g., children, parents) are safe. Leave the scene immediately. Find safe haven wherever it exists, such as an emergency shelter or the home of a friend or family member. You can find a shelter by calling (800) 799-SAFE. Call the police if you think you can’t leave home safely or if you want to bring charges against your abuser. If possible, take house keys, money and important papers with you. The staff members at emergency shelters can help you file for a court order of protection.

Be advised: Do not use drugs or alcohol at this time, because you need to be alert in a crisis. Even while you do what you feel you must do, be aware that use of weapons (even in a life-saving defense) will likely complicate and confuse matters.

If you can, just in case, plan your escape. Establish escape routes and a safe haven. Secure important documents.

Where Do I Go If I’m Mentally or Physically Hurt?

Talk to a physician or get to an emergency department. We are prepared to check you for any life-threatening consequences to your abuse, treat any medical issue, provide mental health support and make referrals. Should you find an emergency shelter, counseling and support groups are available for you and your children.

Dealing With Your Abuser

Your primary focus should be on finding help for yourself and escaping the danger.

First of all, call the police if you believe that you are in danger.
Also, call the National Domestic Violence Hotline 1-800-799-SAFE (7233), your state domestic violence coalition and/or a local domestic violence agency. Furthermore, seek out and speak with a family law advocate at your local crisis center. He or she can help you press charges against the perpetrator, file a temporary restraining order and advise you on how to seek a permanent restraining order.
Don’t keep your circumstances hidden. Discuss them with a physician, nurse, therapist, friend, family member or spiritual advisor when you first believe yourself to be in a dangerous environment. Be careful to avoid advice that attempts to place you back in harm’s way or to do anything that is not best for you or your family. Don’t let someone talk you into doing something that isn’t right for you.
Document any attempts at contact by the perpetrator. Save any new messages (especially threatening ones).
Keep photographs that show any injuries you received. You will need this should you pursue legal action (e.g., press charges or file a restraining order).
While it’s best to avoid the abuser completely, if you must meet to exchange documents or personal effects, do it in broad daylight where plenty of people are around, particularly those you know. Due to safety concerns, it is preferable to have someone else make those exchanges, if possible.

After You’ve Escaped

You need to remain detached from your former situation as much as possible and implement changes in your life. Consider these following tips:

Establish a new routine because someone looking for you will search places you’ve frequented in the past.
Maintain an escape plan in your new location. It may seem counterintuitive, but avoid a route that takes you through areas with potential weapons – your attacker may end up with them instead of you.
Change your mobile or home phone number immediately after you’ve escaped the situation.

Being subjected to repeated domestic violence can extract a devastating psychological toll. Although many domestic violence survivors do not need mental health treatment, and many symptoms resolve once they and their children are safe and have support, for others, treatment is a major component of their plan for safety and recovery.

Again, the National Domestic Violence Hotline 1-800-799-SAFE (7233). You should definitely memorize it, but I hope you never have to use it. Unfortunately, the odds reveal that many of you probably will.

I hope you have found the information in this series helpful. Be safe!

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Feel free to ask your SMA expert consultant any questions you may have on this topic. Take the #72HoursChallenge, and join the community. Also, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK. Please share our page with your friends on WordPress! Also like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.

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