Tag Archives: Sterling Medical Advice

Identifying Risks of Domestic Violence

October 20, 2018Endocrine/Metabolic, Mental Health, Surgical Care, Trauma844-SMA-TALK, Behind the Curtain, domestic violence, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, cycle of violenceJeffrey Sterling, MD

Introduction

Lower your risks of domestic violence. Today we point to knowledge as the key to preventing potential life-threatening episodes in the household. This is the second in a Straight, No Chaser series on domestic violence. The previous post focused on the scope of domestic violence. Another post will focus on actions to take if you find yourself in a relationship in which domestic violence occurs.

Considerations reflecting risks of domestic violence

Certain environments or conditions may increase your risk of becoming a victim of domestic violence. Here are certain considerations that suggest you may be at risk:

Certainly drugs and alcohol can exacerbate an already volatile situation.
Also, be aware that pregnancy is a particularly sensitive time emotionally. During this time, abuse may start or increase.
Finally, women with fewer resources or greater perceived vulnerability are at even greater risk for domestic violence and lifetime abuse. Unfortunately, this is especially true for girls, those experiencing physical or psychiatric disabilities and those living below the poverty line.

Sadly, children have several risks of domestic violence. Often, they are at risk even if they do not initially witness it directly. To protect them and yourself, evaluate your mate or others in a position to exert control over you. Abusers are masterful at isolating, manipulating, intimidating and controlling those they abuse. Abusers don’t always attack with a frontal assault. Abuse may begin slowly and progress. You may accommodate certain demands in an effort to “keep the peace” in your relationship and then find yourself beyond an easy retreat from a once generous and loving person who is now intimidating and threatening.

The insidious nature of abuse must be reemphasized. What may seem, at first, to be an isolated incident complicated by theoretically understandable factors may grow into a way of life with seemingly small events triggering abuse. Your abuser may change from an individual showing regret and remorse to someone who seems repulsed by your existence, blaming your every action (or inaction or anticipated action) for the abuse that follows.

Conditions suggesting increased risks of abuse

The following conditions and circumstances have been associated with propensities for abuse. Don’t consider these as absolute predictors as much as risk factors about which you should be aware.

Whirlwind romance
Abnormal desire to be with you all the time
Tracking what you’re doing and who you’re with
Jealousy at any perceived attention to or from others
Attempting to isolate you in the guise of loving behavior, including going to lengths to convince you that your friends and family don’t adequately care for you (e.g., “You don’t need to work or go to school” or “We only need each other”)
Hypersensitivity to perceived slights
Quick to blame you or others for the abuse
Pressuring you into doing things you aren’t comfortable with (e.g., “If you really love me, you’ll do this for me”)

Do you have risks of domestic violence? Ask yourself these questions.

Are you ever afraid of your partner?
Has your partner ever hurt or threatened to hurt you physically or someone you care about?
Does your partner ever force you to engage in sexual activities that make you uncomfortable?
Do you constantly worry about your partner’s moods and change your behavior to deal with them?
Does your partner try to control where you go, what you do and who you see?
Does your partner constantly accuse you of having affairs?
Have you stopped seeing family or friends to avoid your partner’s jealousy or anger?
Does your partner control your finances?
Has he/she threatened to kill him/herself if you leave?
Does your partner claim his/her temper is out of control due to alcohol, drugs or because he/she had an abusive childhood?

If you answered yes to some or all of these questions, you could already be at risk for or suffering abuse.

It’s personal. The risks of domestic violence are real indicators of danger. We understand, and we can help. Please … contact us if you’re in need of support. Our expert crisis counselors are here for you, 24/7. 1-844-SMA-TALK or www.SterlingMedicalAdvice.com. You don’t have to “endure with dignity.”

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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. As a thank you, 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!

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Receive introductory pricing with orders!

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! Like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.

Focus on Domestic Violence

October 19, 2018Mental Health, 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

October is Domestic Violence Awareness Month, although it doesn’t take a break during other months. Are you concerned about domestic violence? Probably, you should be. You are not alone. Domestic violence (DV) occurs in every culture and society. Also, it occurs in all age groups and in men and women. DV occurs in all races, income levels and religions. Likewise, it occurs in heterosexual and homosexual relationships. Furthermore, it is estimated that one in four women and one in nine men will be victims of DV at some point in their lives. That’s right. As a result, many (if not most) emergency rooms now screen every single woman for domestic violence. Therefore, you need to know the signs of danger and what you can do to get help.

This is the first in a three-part series on domestic violence. This post will focus on the scope of DV. Another post will focus on identifying risk factors. Finally, the third will focus on actions to take if you find yourself in a relationship in which it occurs.

A simple definition of domestic violence

Domestic violence is the abuse that one person with control in a household inflicts on another. Perpetrators can include parents or other caregivers, siblings, spouses or intimate partners. DV reveals itself in several forms, including sexual (e.g., rape), physical (e.g., biting, hitting, kicking) and mental abuse (e.g., constant criticisms or threats, limiting ability to lead otherwise normal lives). These forms tend to center around abnormal control of an aspect of another’s life. Even more, the level of mental control is such that victims of DV often internalize the activity as normal. They also assign fault to themselves and/or accept responsibility for the abuse.

Domestic violence is a crime in all 50 states of the U.S.

First of all, it is a crime.

Above all, victims do not cause abuse and are not responsible for it.

Domestic violence and mental health

Domestic violence has consistent adverse effects on mental health.

Children suffering from domestic violence often display developmental delays and aggressive behavior. Also, they have difficulty performing in school and tend to have low self-esteem. Furthermore, they are at greater risk for being diagnosed with a psychiatric disorder.
Domestic violence increases the diagnoses of anxiety disorder, depression, panic attacks and post-traumatic stress disorder. It is also associated with an increase in substance abuse.
DV increases the incidence of psychotic episodes, suicide attempts and homelessness. It’s presence also slows recovery from those suffering from other mental illness.
DV increases the risk of retaliatory violence against the perpetrators.

Please … contact us if you’re in need of support. Our expert crisis counselors are here for you, 24/7. 1-844-SMA-TALK or www.SterlingMedicalAdvice.com. You don’t have to “endure with dignity.”

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The Day You Get Diagnosed With HIV

October 18, 2018Infectious Disease, Health Prevention844-SMA-TALK, AIDS, Behind the Curtain, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This blog focuses on the conversation physicians have with patients newly diagnosed with HIV. It is the seventh and final blog in the series on HIV and AIDS.

To read a discussion of HIV being eliminated from the body, click here.
For an explanation of what HIV and AIDS are, click here.
For an explanation how HIV and AIDS are contracted, click here.
To learn about signs and symptoms of HIV and AIDS, click here.
For an explanation of the risk of contracting HIV from specific acts of sexual intercourse, click here.
Also, for an explanation of the risk of contracting HIV from specific acts of sexual intercourse, click here.

The conversation on the day you get diagnosed with HIV

I’ve had many occasions to tell a patient they were HIV(+). Over the last 20 years of my doing so, that message has changed. It used to be a death sentence. Now, we are discussing a chronic disease that will need to be battled for a lifetime. That said, the responses still haven’t changed much. There are different conversations. Those for whom the diagnosis is a complete surprise (such as those who would have received it from a blood transfusion) tend to be quite emotional. Those who suspect they’ve been infected (e.g. through IV drug use or risky sexual practices) are often quite remorseful.

In general, the responses are much like they were for an earlier generation being told they’d contracted “The Big C (Cancer).”

A typical scenario

As I walk into the room, the patient is already in complete shock. It’s as if they’re thinking about the error of their ways and simultaneously not thinking at all.
The moment requires finesse. It’s easy to blow in and out of a room and drop this bomb of news; after all, it’s a busy emergency room. However, this is important. This is a moment when someone’s life will irreparably change. It will either be the first day of the rest of their life or the beginning of the end of their life.
Patients tend to want this information in private, although to a physician, this is a big red flag. This isn’t private information. Everyone in his or her life immediately became affected. Furthermore, it’s important to start lining up one’s support from the very beginning. I want the patient to have loved ones around to hear this information if they will consent.
“I need you to pay attention. Stay with me.” I tell patients this regardless of the outcome. The fact that this information is being provided in an ER instead of a primary care physician’s office is important. It usually means behavior modification begins immediately, regardless of the verdict.
Let’s get this out-of-the-way, because that’s what he or she wants to know. “You’re HIV(+).” Again: “I need you to pay attention, and stay with me.”

Topics to consider and discuss

We will discuss different topics.

What it means to be HIV(+).
What it means to have AIDS.
How the rest of one’s life is going to look with and without treatment.
What this will mean to one’s family, friends and other loved ones.
How to give the patient the best opportunity for success.

The conversation can be devastating or empowering. You may find this surprising, but a significant number of patients take this news as a rallying cry. In the same way a smoker is suddenly able to stop smoking cold turkey on the day of a heart attack, newly HIV(+) patients find the strength to stop IV drug abuse and alter other high risk activities.

Here’s a bit of a disclaimer. It’s really not all about friends/family support. Efforts to inform and protect friends and family begin immediately. These are the very people who immediately become at risk once a significant other becomes HIV(+). They deserve to know they are at risk. In many ways it’s easiest to inform them from the very beginning. It’s certainly in their best interest to know as soon as possible.

Back to you and your diagnosis: you may have noticed I haven’t given you much time to breathe or grieve. You will have plenty of time for you to experience denial, anger, bargaining, depression and acceptance after you leave the emergency room. In real-time, the virus is here. The need for risk management begins immediately. Unfortunately, it is likely this wasn’t being handled previously. The most important purpose of your visit wasn’t the launching of your grieving process but the mobilization of resources to treat you and protect others.

Summary

A final point: you really don’t want to go through this. Seeing the utter despair, fear and depression indicates that life at best will be very challenging to live. The steps to minimize your risks are so straightforward. It’s agonizing to see those newly diagnosed mentally retracing their steps. They know that wearing condoms, not being promiscuous or not engaging in needle use was within their control. Make better choices on the front end. After all, you probably wouldn’t knowingly step in front of a moving truck.

You really want to get tested.

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Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, 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. Likewise, please share our page with your friends on WordPress! Also like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.

HIV and STD Risks From Sexual Activities Other Than Intercourse

October 17, 2018Genital/Urinary, Infectious Disease, Obstetrics and Gynecology844-SMA-TALK, AIDS, Anal sex, Behind the Curtain, Female condom, HIV, Hiv And Aids, HIV/AIDS, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction – HIV and STD risks

This blog focuses on your HIV and STD risks from sexual activities other than intercourse. It is the sixth blog in an ongoing series on HIV and AIDS.

To read a discussion of HIV being eliminated from the body, click here.
For an explanation of what HIV and AIDS are, click here.
For an explanation how HIV and AIDS are contracted, click here.
To learn about signs and symptoms of HIV and AIDS, click here.
Also, for an explanation of the risk of contracting HIV from specific acts of sexual intercourse, click here.

Today, your sexual IQ goes up, and hopefully your risk for sexually transmitted infections (STIs), including HIV, goes down.

First of all, here are some terms you should understand.
Rimming: oral-anal contact
Fingering: digital sexual stimulation

Next, let’s review.

Performing Oral Sex On A Man

You can get HIV by performing oral sex on your male partner. The risk is not as pronounced as it is with unprotected vaginal or anal sex, but oral sex clearly is a mode of transmitting HIV.
You are also at risk for getting other sexually transmitted infections (STIs), including herpes, syphilis, chlamydia and gonorrhea.
Using condoms during oral sex reduces the risk of contracting HIV and other STIs.
You reduce the risk of contracting HIV from oral sex if your male partner does not ejaculate in your mouth.
You reduce the risk of contracting HIV from oral sex if you do not have open sores or cuts in your mouth.

Receiving Oral Sex If You Are A Man

The risk of contracting HIV is less with receiving oral sex than many other sexual activities, but it is still present.
You reduce the risk of contracting HIV from receiving oral sex if you do not have open sores or cuts on your penis.
Oral sex also presents a risk of contracting other STIs, most notably herpes.

Performing Oral Sex On A Woman

Significant levels of HIV have been found in vaginal secretions. There is a risk of contracting HIV from this activity. Fortunately, the risk is not as great with other sexual activities.
You can contract other STIs from performing oral sex on a woman.
Furthermore, there are effective barriers you can use to protect yourself from contact with your partner’s vaginal fluids. You can use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (According to the Centers for Disease Control and Prevention, plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)

Receiving Oral Sex If You Are A Woman

The risk for contracting HIV while receiving oral sex is significantly lower than for unprotected vaginal sex, but it is still present.
It is also possible to contract other STIs while receiving oral sex.
There are effective barriers you can use (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.

Oral-Anal Contact (Rimming)

The risk of contracting HIV by rimming is very low but comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.

Digital Stimulation (Fingering)

There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.
The use of medical-grade gloves and water-based lubricants during fingering eliminates this risk.

If you have any additional questions, please feel free to ask questions or provide comments. I cannot more highly endorse the websites at cdc.gov and the US Department of Health and Human Services.

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HIV and STD Risks From Specific Acts of Sexual Intercourse

October 16, 2018General Health and Wellness, Infectious Disease, Obstetrics and Gynecology844-SMA-TALK, AIDS, Anal sex, Behind the Curtain, Female condom, Hiv And Aids, HIV/AIDS, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction – HIV and STD risks

This blog focuses on your HIV and STD risks from specific acts of sexual intercourse. It is the fifth blog in an ongoing series on HIV and AIDS.

To read a discussion of HIV being eliminated from the body, click here.
For an explanation of what HIV and AIDS are, click here.
For an explanation how HIV and AIDS are contracted, click here.
To learn about signs and symptoms of HIV and AIDS, click here.

Let’s be clear that we’re explicitly discussing the types of sexual behaviors that will lead to transmitting HIV and other sexually transmitted infections (STIs). Over the next two days, we will run the gamut of sexual behavior and its implications.

What we hope to accomplish here is to identify those activities that place you at significant risk for contracting HIV and other sexually transmitted infections (STIs). The take-home message is you really should identify your partner’s health status before you begin sexual activity.

Sexual activity terminology

Today we will focus on four types of sexual activity and discuss the risks of each. Let’s start with some terminology.

Receptive sex risks speak to risks to the receiver.
Insertive sex risks speak to risks to the giver.
Bottoming is a way of describing receptive anal sex.
Topping is a way of describing insertive anal sex.

Now, let’s review.

Receptive Vaginal Sex

Vaginal sex without a condom is a high-risk behavior for HIV infection.
HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
If you currently have an STI or vaginal infection, your risk for contracting/transmitting HIV is increased because your tissue will be inflamed. This has nothing to do with the presence or absence of symptoms.
Female condoms protect HIV infection if used correctly. However, the risk still exists for any area exposed and infected (in the presence of an open sore or bleeding, for example).
Barrier birth control methods (such as diaphragms, IUDs and cervical caps) DO NOT protect against STIs or HIV infection. If infected semen or sperm contacts inflamed or otherwise injured vaginal tissue, the risk of transmission/contraction is present.
Birth control pills do not protect against HIV or other STIs.

Insertive Vaginal Sex

HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
Condom use is a critical means of protection against STIs that are present without obvious symptoms. Use condoms with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Receptive Anal Sex (Bottoming)

Bottoming without a condom provides the highest risk for contracting HIV, more so than any other sexual behavior.
HIV has been identified in pre-ejaculatory semen. “Pulling out” prior to ejaculation may not decrease your risk.
Rectal douching before anal sex can increase your HIV risk. Douching irritates the rectal tissue and can make you more receptive to contracting HIV. Soap and water in a non-abrasive manner are adequate means of cleanliness.
If bottoming, you will best minimize the risk of transmitting HIV and other STIs by always using a water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize irritation to the rectum during sex and subsequent transmission.

Insertive Anal Sex (Topping)

Topping without a condom is a high-risk behavior for transmission of HIV and other STIs. An infection may be present. If small sores, scratches or tears are also present, they would provide a ready path of entry and transmission of HIV.
Similarly, those same lesions in your partners rectum could harbor infected cells in blood, feces or other fluid, which, when contacted, could infect you through your penis.

Check back for the next post in this series on HIV/AIDS. It will focus on HIV and STD risks from sexual activities other than intercourse.

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What Are The Symptoms of HIV and AIDS?

October 15, 2018Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, Acquired Immunodeficiency Syndrome, AIDS, Behind the Curtain, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This is the fourth blog in an ongoing series on HIV and AIDS and focuses on symptoms of HIV and AIDS.

To read a discussion of HIV being eliminated from the body, click here.
For an explanation of what HIV and AIDS are, click here.
For an explanation how HIV and AIDS are contracted, click here.

The National Institutes of Health has a nice method of categorizing HIV signs and symptoms, which I’ll replicate here. There are several take home messages, and I’ll use the pictures to communicate them.

HIV Positive Without Symptoms

Many people who are HIV-positive do not have symptoms of HIV infection, and symptoms only evolve as their condition deteriorates toward AIDS (Acquired Immunodeficiency Syndrome). Sometimes people living with HIV go through periods of being sick and then feel fine.

Signs and Symptoms of Early HIV

As early as two–four weeks after exposure to HIV (but sometimes as far out as three months later), people can experience an acute illness, often described as “the worst flu ever.” This is called acute retrovirus syndrome (ARS) or primary HIV infection. This represents the body’s natural response to HIV infection. During primary HIV infection, there are higher levels of virus circulating in the blood, which means that people can more easily transmit the virus to others.

Symptoms resemble a flu-like syndrome, including fever, chills, nights sweats, muscle aches and fatigue. Other symptoms may include a rash, sore throat, swollen lymph nodes and ulcers in mouth. It is important to state that not everyone gets ARS when they become infected with HIV.

Signs and Symptoms of Chronic or Latent Phase HIV

After the initial infection and seroconversion, the virus becomes less active in the body, although it is still present. During this period, many people do not have any symptoms of HIV infection. This period is called the ‘chronic’ or ‘latency’ phase. This period can last up to 10 years—sometimes longer.

Signs and Symptoms of HIV and AIDS

While the virus itself can sometimes cause people to feel sick, most of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that attack the infected individual’s compromised immune system.

When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome at late stages.
Don’t wait until symptoms are discovered late. You are much better off with HIV and AIDS being diagnosed early based on risk factors and exposures. That said, use the knowledge provided of symptoms of HIV and AIDS to prompt evaluation and testing.

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How Do You Contract HIV and AIDS?

October 14, 2018Genital/Urinary, Infectious Disease844-SMA-TALK, AIDS, Behind the Curtain, Blood, Blood transfusion, Body fluid, HIV, HIV-AIDS, HIV/AIDS, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Fortunately, this isn’t 1983, but HIV and AIDS are still far too common. Thankfully, we now know how HIV infection is contracted. Yet, HIV and AIDS awareness are still critical. Be knowledgeable to be empowered!

This is the third blog in an ongoing series on HIV and AIDS.

To read a discussion of HIV being eliminated from the body, click here.
For an explanation of what HIV and AIDS are, click here.
For an explanation of the signs and symptoms of HIV and AIDS, click here.

How HIV lives

First, let’s address a simple principle. The HIV virus can live and reproduce in high levels in blood and other body fluids, including breast milk, rectal mucus, semen (and pre-semen) and vaginal fluids. Exposure and transmission of these fluids cause HIV infection. In special circumstances (such as healthcare workers), individuals may become exposed to other areas that may contain high levels of HIV, including amniotic fluid (in pregnancy women), cerebrospinal fluid (from the brain and spinal cord) and synovial fluid (from various joints).

Now please take a moment and look at the lead picture. In addition to those circumstances listed, you should know that fluids such as feces, nasal fluid, saliva, sweat, tears, urine or vomit don’t by themselves contain high enough levels to transmit HIV. Unfortunately, these fluids often mix with infected blood. In these cases, the blood exposure is prompting transmission.

HIV transmission

HIV transmission occurs in specific ways.

During anal, oral or vaginal sex – You have contact with your partner’s body fluids during sex. When your partner is infected, contact areas are very likely to be high in HIV viral load. These areas include the anus, mouth, penis, vagina or vulva. HIV infection is transmitted through small breaks in these surfaces. One of the reasons HIV infection rates are higher in individuals with herpes and syphilis is because those diseases cause open sores, creating additional opportunities for HIV-infected body fluids to enter the body.
During pregnancy, childbirth or breastfeeding – Babies have constant contact with their mother’s potentially infected body fluids. Means of transmitting HIV from mother to child include through amniotic fluid, blood and infected breast milk.
From injection drug use – Injecting drugs puts you in contact with blood. You can directly deliver HIV into your bloodstream with contaminated needles and their contents.
As a result of occupational exposure – Healthcare workers must be constantly diligent against this method of transmission. Risks of HIV transmission to healthcare workers occur through blood transferred from needle sticks and cuts, and less commonly through contact of infected body fluids splashed into the eyes, mouth or into an open sore or cut.
From a blood transfusion or organ transplant – Fortunately, this is now very rare. The stringency of screening requirements in the US has been largely successful in regards to this method of transmission. Still, it is possible to transmit HIV through blood transfusions or organ transplants from infected donors.

How you get HIV and AIDS

How does one get AIDS?
AIDS is a progression of HIV into its later stages, after severe damage to the immune system. You don’t “get AIDS” as much as HIV progresses to AIDS in certain circumstances. It seems like not long ago HIV could progress to AIDS in a matter of a few years. Fortunately, with the development of specialized medications in the 1990s, people with HIV are living much longer with HIV before they develop AIDS.

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Do You Know the Definition of AIDS?

October 13, 2018Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, Acquired Immunodeficiency Syndrome, AIDS, Behind the Curtain, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This is the second blog in an ongoing series on HIV and AIDS. Click here for the introductory blog.

What is AIDS?

After all these years, it’s still an interesting and important enough question to ask. However, do you know how to answer it? At least, most know that AIDS is a devastating disease caused by the HIV virus.

However, courtesy of the National Institutes of Health, consider the following:
A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.
I – Immuno – Your body’s immune system includes all the organs and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is “deficient,” or isn’t working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (meaning infections not typically present in persons with normal immunity).

You will be diagnosed with AIDS if you have one or more specific opportunistic infections, certain cancers (such as Kaposi’s sarcoma) or a very low number of CD4 cells (a measure of the strength of your immune systems function). If you have AIDS, you will need medical intervention and treatment to prevent death.

Check back to Straight, No Chaser for additional posts on HIV/AIDS, including risk factors and symptoms, progression/complications and treatment.

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HIV Awareness Month – Can HIV Be Eliminated From the Body?

October 12, 2018Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, AIDS, Behind the Curtain, Blood transfusion, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

It’s HIV Awareness Month. Certainly you’ve noticed there’s a lot less chatter about HIV lately. Don’t be lulled into a false sense of security. It is still causing death. Let’s review the latest on HIV in the next few posts.

Look at the above picture. You would think it shows Ervin “Magic” Johnson donating blood. As most everyone knows, Magic famously retired from the NBA after contracting HIV. As we delve into this post, remember two important points.

He never contracted AIDS (we’ll get into the difference between HIV and AIDS in an upcoming post).
He is said to no longer have a detectable viral load of HIV. To paraphrase his words, “I’m cured of HIV.”

So does this mean it’s safe for certain “former” HIV(+) patients to donate blood? Can they now engage in activities others who are not HIV(+) can? HIV is a fascinating virus, and the more you know about it, the better off you are. This is especially particular when it comes to protecting yourself from contracting the virus. Several of our posts have addressed HIV/AIDS.

Considerations

In the meantime, consider the following. You’ve had many diseases over your life.

When you had pneumonia or the flu, did you forever stop kissing once you recovered?
For those of you who have had gonorrhea, syphilis or chlamydia, did you forever stop having sex once you were treated?
Back when you had chickenpox, did you forever stop hugging once the virus and rash disappeared?

I bring this points up to point out that at some point, once we truly discover a cure for HIV and actually are successful at eliminating the virus from the body of those infected, it makes sense that you could see someone who was HIV positive donating blood.

However…

That is not a picture of Magic Johnson donating blood. Probably, he is having blood drawn. Alternatively, it could be a picture of someone else donating blood with Magic’s head photoshopped onto it. How do I know this, even without going directly to the source?

HIV Awareness in the news…

A case study exists that is about as close to this scenario as it gets. A baby thought to have been “cured” of HIV recently has now been re-diagnosed with the virus. She was born to a HIV(+) mother. Consequently, she was pre-emptively treated with three antiretroviral drugs for 18 months. Unfortunately, doctors lost track of the infant. Subsequently, she was brought to a clinic for a visit after ten months of receiving no HIV medication. The medical team found no evidence of the virus in her blood. As a result, she was declared “functionally cured.”

Unfortunately, the virus has now returned. The child was found to have high levels of HIV in her blood during a routine visit to the University of Mississippi Medical Center. This is where she was originally discovered to be HIV(-). Decreased levels of CD4+ cells, the white blood cells targeted by HIV, along with the appearance of antibodies against the virus in her blood, suggest that her remission had come to an end, and that traces of virus remaining in her body had escaped from immune control.

The Bottom Line

There have now been several cases of cures and relapses. Here’s a bottom line consideration. Give medicines as early as possible. This keeps the virus in check. However, one should not expect early treatment to completely eliminate HIV.

You may wonder how it’s possible for HIV to become undetectable or to relapse once seemingly “eradicated.” We know the HIV virus can hide away in tissues such as lymphoid and gut cells (see above picture). Unfortunately, medicines can only reach the virus located in the blood. This is why you don’t stop therapy! The virus can emerge from these other locations and relaunch its attack. This explains why most HIV patients need to take antiretroviral drugs daily over the course of their lives,.

The biggest hope for tackling the problem is to find drugs that flush inactive HIV out of its hiding places in the body. This would facilitate all the virus being eliminated. Accordingly, this would effectively cure the patient and eliminate the need to take more antiviral drugs.

Furthermore, this isn’t much of a surprise. Other diseases go dormant inside the body. The classic example of this is the family of herpes viruses. Many of you are aware that a herpes simplex virus can reappear after decades of being absent. Similarly, chicken pox and shingles – diseases caused by the herpes zoster virus – can reappear after having run their course during the initial infection. At this point, it appears that HIV is more like the herpes viruses in this regard than examples of other infections and disease that can be completely eradicated.

The latest on blood transfusions and transplants

There are theoretically reasonable possibilities about the prospect of receiving blood or organ donations from someone who had been HIV-positive. However, in the US it’s been decided it is currently not yet prudent to do so. Even though HIV can be completely eliminated from the blood of patients, the ethical bridge hasn’t yet been crossed. Unfortunately, that is not the same as eliminating HIV from the body. Thus, the American Red Cross and others involved in blood transfusions will not accept donations from anyone ever having been HIV(+).

For those in need of a life-saving blood transfusion, having individuals step up to donate is vitally important. Please consider doing so.

Stay tuned to Straight, No Chaser. HIV awareness will continue this week with additional posts on topics of interest.

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How’s Your Dental Hygiene?

October 11, 2018Dental, Health Prevention844-SMA-TALK, Behind the Curtain, dental emergencies, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

If you ignore your teeth, they’ll go away.

You may not think that bad dental hygiene can land you in the emergency room, but it does! One thing in particular I’ve noticed over the years is how oblivious some people are to their smiles—especially their teeth. We see it all: loose teeth, missing teeth, broken teeth, infected teeth, sensitive teeth, erupted wisdom teeth, gingivitis, bad breath, dental infections (especially abscesses), things stuck in the teeth, mouth cancer, yeast infections, rashes inside the mouth and other conditions. The mouth is the gateway to the body. Through it, you introduce many substances that can infect or otherwise damage you. Clinically, the appearance of your mouth, gums and teeth are often a direct statement about how well you care for the rest of your body.

You would think dental hygiene is an especially difficult proposition, but it’s actually quite simple. According to the American Dental Association (ADA), all you really need to commit to good dental hygiene is less than five minutes at a time, at least twice a day. Surely that’s not too much to ask of yourself for yourself, is it?
Let’s identify three sets of conditions you should be prepared to address with your activities. Each measure contains simple tips and habits you should employ to keep your smile making the right kind of introduction.

Prevention and self-maintenance

Brushing and flossing keep your gums and teeth healthy by removing plaque and food particles that can serve as a source for infection and tooth decay. Here are your essentials.

Brush for two minutes at a time.
Brush at least twice a day and preferably after each meal.
Flossing is important. There are particles that collect under the gums and between the teeth that your toothbrush can’t reach.

Avoid the stainers. Tobacco products (e.g., cigarettes, chewing tobacco and cigars), excessive red wine and coffee contain a high quantity of very strong chemicals that stain and damage your teeth. Cranberry and grape juices also may stain teeth if consumed in excess. Besides cosmetic considerations, the staining isn’t the problem as much as fact that the chemicals causing the staining are also damaging your teeth and gums.

Prevention and professional maintenance

Do you have a dentist?

Regular dental checkups are very important for the ongoing maintenance of your teeth and the early identification of dental problems—before excessively expensive and painful options are needed.
Dental exams provide an opportunity for identification of several medical conditions and diseases whose symptoms can appear in the oral cavity (mouth).

Recognizing possible dental emergencies

It is simultaneously understandable and befuddling that patients go without dental care as long as they do. By the time they come to the ER, invariably, some of these symptoms have been present and were ignored. If you’re experiencing the following symptoms, you’d do well to see the dentist early, before you end up in the ER.

Teeth have become sensitive to hot or cold stimuli
Gums are swollen and/or they bleed with brushing, flossing or eating
Continually bad breath or bad taste in your mouth
Difficulty chewing or swallowing
Pain or swelling in your mouth, face or neck
Spots or a sore that doesn’t look or feel right in your mouth and it isn’t going away
Jaw sometimes pops or is painful when opening and closing, chewing or when you first wake up
An uneven bite
Mouth is becoming unexplainably drier than normal
You have a medical condition such as diabetes, cardiovascular disease, eating disorder or are HIV positive with new dental problems.
You are undergoing medical treatment such as radiation, chemotherapy or hormone replacement therapy with new dental problems.

Upcoming Straight, No Chaser posts will evaluate individual dental emergencies.

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Depression – How to Avoid It, When to Get Help

October 10, 2018Mental Health844-SMA-TALK, Behind the Curtain, Depression, National Suicide Prevention Lifeline, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This is the third post in a series on depression and suicide. In our first post, we focused on the magnitude of clinical depression and suicide. In the second post, we provided tools for depression self-awareness. Finally, in this post we provide tips for you to address depression and an inclination toward suicide. Remember that 844-SMA-TALK and www.sterlingmedicaladvice.com provide crisis mental health services for those in need.

Avoiding Depression

As a physician, I’m not willing to advise you on how to ‘care’ for yourself at home if you’re clinically depressed. I can discuss how to avoid depression (to the extent possible) and what warning signs should prompt emergent access to care. If you’re good at accomplishing the items listed below, you have less of a chance of being unhappy and clinically depressed.

Avoid alcohol and other mood-altering drugs.
Eat healthily.
Exercise regularly.
Get enough sleep.
Remove yourself from negativity, including your choices in friends, mates and work environments.
Surround yourself with positivity, including your choices in friends, mates and work environments (Please note this is a different consideration than the previous bullet point.).
Learn how to relax and where to go to relax. These considerations include such things as yoga, meditation and your religion/spirituality, not the business end of a bottle or drug use.

Warning Signs

Look out for these potential warning signs for suicide: Remember that approximately 30% of suicides are preceded by the individual declaring intent. Be alert for the following additional considerations:

Increasing levels of depression, withdrawal, reckless behavior, alcohol and other drug use, and/or desperation.
Notice activity that could be a prelude to a suicide attempt, such as obtaining knives, firearms or large quantities of medication.
Changing one’s will and settling one’s life affairs in the midst of depression
Ongoing comments about lack of worth and desire to end it all.

When to get help

The following considerations should prompt an immediate visit to an emergency room or other treatment facility.

You have a compelling, overwhelming feeling that you want to hurt yourself, with or without an actual plan.
You have a compelling, overwhelming feeling that you want to hurt someone else, with or without an actual plan.
Experiences of voices or seeing things or people who are not there occur.
You find yourself crying often and uncontrollably for no apparent cause.
Your depression has affected your activities of daily living (work, school, consistent forms of recreation or family life) for longer than 2 weeks.
You think your current medications are affecting you abnormally and are possibly contributing to making you feel depressed.
You have been told or believe that you should cut back on drinking or other drug use.

I wish you and your loved ones all the best in avoiding and/or dealing with this disastrous condition. I welcome any comments, thoughts or questions.

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Are You Depressed and/or Suicidal?

October 9, 2018Mental Health844-SMA-TALK, Behind the Curtain, Depression, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicide, Suicide prevention, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

In our first post on clinical depression and suicide, we looked at the scope of the disease, and in the next post we will provide tips for you to address depression and an inclination toward suicide. In this post, we carefully tread onto your tendencies that may clue you into the need for help. Remember that 844-SMA-TALK and http://www.sterlingmedicaladvice.com provides crisis mental health services for those in need.

I have a strong distaste for do-it-yourself websites that want to ‘screen’ you for depression. Folks, if you’re wondering whether you’re clinically depressed, you don’t need validation from some makeshift online questionnaire. That said, if you’d like to learn something, go ahead and find one. More importantly, seek assistance immediately from a qualified counselor or therapist. They do wonderful work and can get through to you before you get to yourself.

Instead of a quiz, I will simply give you common signs and symptoms consistent with the diagnosis. Note the progression in the symptoms. The bottom line is: odds are, you already know if you need help. Yes, there are different depression syndromes; I’m not getting into that. You and a psychiatrist or therapist can sort that out. Don’t be reassured by a quiz when you already know better.

Signs of depression

You may be depressed if…

You feel sad, hopeless, empty, or numb to the point where you wallow in these emotions, and they dominate your existence.
There exists a loss of interest in your normal activities of daily living. It’s not just that you don’t enjoy things. You don’t even want to be bothered with them. The desire to have sex goes away. You don’t enjoy your friends. You don’t want recreation. Your interest in eating, sleeping goes away. Alternatively, you may not be able to stop sleeping. Perhaps you can’t breathe (because of your crippling anxiety). You might actually be depressed if you have these symptoms and didn’t get the ideas from listening to the lyrics of a Toni Braxton song.
You find yourself exceedingly irritable and/or anxious. These feelings are explosive and over the top. You’re waiting, ready and looking for a reason to embrace gloom, doom or anger.

More signs

Difficulty moving forward and making decisions exists. This occurs for many reasons. Your attention may be shot. Your interests aren’t there. You’re overwhelmed. Stuck in a rut is not only where you are, it’s where you want to be.
You feel worthless and blame yourself for any and everything. Again, these feelings are explosive, dramatic and over the top.
Thoughts of death and suicide start to occur. This is where things get beyond scary. You may simply have a passive wishing that things would end and a belief that your friends, family and the rest of the world would be ‘better off’ without you. There may be fleeting voices that aren’t your own suggesting or commanding suicide as an option. You may see visions of people telling you to harm yourself. You may have an active plan. When depression gets to this point, nothing good is going to happen without intervention. Never allow someone to make such comments and then pretend as if they were insincere.

Precipitants

Now consider these most common precipitants for suicide:

Difficulties with one’s intimate partner
Difficulties with one’s physical health
Problems with one’s job
Problems with one’s finances

You will have a lot better chance getting someone help at a warning stage than preventing someone from doing something once they have a weapon in their hands. Approximately 30% of suicides result after the individual has expressed an intent to do so. Listen up…

Take the signs of depression and any expressed thoughts of suicide seriously.

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Personality Disorders Screening Quiz – Now It’s Your Turn!

October 8, 2018Mental Health844-SMA-TALK, Behind the Curtain, personality disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction – Personality Disorders Screening Quiz

First of all, it’s been an interesting week of responses from you on the series of personality disorders. The most common comment was a request for an ability to test oneself. I’ll provide that information to you, but beforehand, here are the links to the other Straight No Chaser posts on personality disorders.

Introduction: Understanding Personality Disorders
Paranoid, Schizoid and Schizotypal Personality Disorders – Cluster A
Narcissistic, Histrionic, Antisocial and Borderline Personality Disorders – Cluster B
Obsessive-Compulsive, Avoidant and Dependent Personality Disorders – Cluster C

We need a disclaimer here. The link to this personality quiz states pretty clearly that it’s for entertainment purposes only. The results will provide you with a trend, not a diagnosis. It’s a good way to reinforce the information from the previous posts and to learn a little bit more about yourself. In case you were wondering, I scored Doctor Personality Disorder.

Here’s the link to the quiz.

Finally, I welcome any feedback or questions you have about the topic or the quiz. I think it’s safe to say that most of you should have fun with this quiz.

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Obsessive-Compulsive, Avoidant and Dependent Personality Disorders

October 7, 2018Mental Health844-SMA-TALK, Avoidant Personality Disorder, Behind the Curtain, Dependent Personality Disorder, Obsessive Compulsive Personality Disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction – Personality Disorders Part 4

The final group of personality disorders we will review involves excessive fears expressed through thoughts or behaviors. They include avoidant, dependent and obsessive-compulsive personality disorder. Collectively these comprise the Class C Personality Disorders. Let’s review symptoms of each.

Avoidant personality disorder

think of the shy, hypersensitive loner

Social inhibition, timidity and isolation (e.g. avoiding new activities or meeting strangers)
Abnormal fear of disapproval, embarrassment or ridicule
Avoidance of work and social activities that require interpersonal contact
Constant feelings of inadequacy, inferiority or unattractiveness
Extreme shyness in social situations and personal relationships
Hypersensitivity to criticism or rejection

Dependent personality disorder

You’re happy or sad based entirely on others’ treatment of you.

Difficulty disagreeing with others due to excessive fears of disapproval
Excessive dependence on others, feels the need to be taken care of, and is submissive and clingy
Fears having to care or provide for one’s self
Inadequate self-confidence, requiring excessive advice and reassurance from others, even with small decisions
Inadequate self-confidence such that one has difficulty starting or doing projects on own
Tolerance of poor or abusive treatment
Urgent need to start a new relationship when one has ended

Obsessive-compulsive personality disorder

think overly preoccupied with control and order

Desire to be in control of people, tasks and situations with an inability to delegate
Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved (e.g. inability to finish a project because standards of perfection aren’t met)
Inability to discard previously held broken or worthless objects
Inflexibility about morality, ethics or values
Neglect of friends, family and enjoyable activities because of excessive commitment to work or a project
Preoccupation with details, orderliness and rules
Rigid and stubborn
Tight, miserly control over budgeting and spending money

Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder (OCD). OCD is a type of anxiety disorder. It is important to remember that everyone can exhibit some of these personality traits now and again. That said, when these patterns of behavior interfere with one’s activities of daily living, lend a hand. Get help.

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Narcissistic, Histrionic, Antisocial and Borderline Personality Disorders

October 6, 2018Mental Health844-SMA-TALK, Behind the Curtain, Borderline Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction – Personality Disorders Part 3

Again, we must start with a disclaimer about personality disorders. We don’t want all the armchair psychiatrists out there to start diagnosing everyone. The Cluster B personality disorders are defined by drama, erratic and emotional behaviors. They include narcissistic, histrionic, antisocial and borderline personality disorders.

This group of patients is defined by overly emotional or predictable behavior. Remember that symptoms aren’t enough. Also, some degree of social dysfunction must be present for these diagnoses to be made.

Antisocial personality disorder

think of a dangerous habit of manipulating, exploiting, or violating the rights of others.

Typical symptoms will include some of the following.

Aggressive, violent and/or criminal behavior
Disregard for others’ needs, feelings and safety
Disregard and violation of others’ rights
Excessively and repeatedly irresponsible
Impulsive behavior with lack of remorse
Ignoring the safety of self or others
Habitual deceit, lying, stealing and cheating
Recurring problems with the law

Borderline personality disorder

think of ongoing patterns of unstable emotions that result in impulsive actions and chaotic relationships.

Frequent and explosive bouts of anger
Impulsive and risky behavior (e.g. habitual gambling, binge eating, unsafe sex)
Intense fear of being alone or abandoned
Ongoing feelings of emptiness
Paranoid worsened by stress
Unstable or fragile self-image
Unstable and intense relationships
Up and down moods, often as a reaction to interpersonal stress
Suicidal thoughts, threats and behaviors

Histrionic personality disorder

think of overly dramatic and emotional actions meant to draw attention to oneself.

Constantly seeking and demanding attention
Easily influenced by others and believes relationships are closer than they are
Excessively concerned with physical appearance
Excessively emotional, dramatic or sexually provocative to gain attention
Speaks dramatically with strong opinions but few facts or details to back them up
Shallow, rapidly changing emotions

Narcissistic Personality Disorder

Think of an excessive sense of self-importance and self-preoccupation with a lack of empathy for others

Arrogance
Envy of others or belief that others envy you
Exaggeration of achievements or talents
Unreasonable expectations of constant praise, admiration, favors and advantages
Fantasies about power, success and attractiveness
Inability to recognize others’ needs and feelings
Unfounded belief that you’re special and more important than others

It is important to remember that everyone can occasionally exhibit some of these personality traits. That said, when these patterns of behavior interfere with one’s activities of daily living, lend a hand. Get help.

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Paranoid, Schizoid and Schizotypal Personality Disorders

October 5, 2018Mental Health844-SMA-TALK, Behind the Curtain, paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction – Personality Disorders Part 2

First of all, what do you really know about paranoid and other personality disorders? Maybe you are reading this because you may be wondering if these disorders are applicable to someone you know. Another good read would be to gain perspective on your own habit. Whereas it’s important to get friends and family to help if needed, resist the urge to practice armchair psychology. Although the idea of a personality disorder is something that may lead to playful banter, these issues can be quite serious.

In this post, we discuss the group of disorders that involves especially odd thinking or behavior. As a group, these are known as Cluster A personality disorders. Although there are three disorders in this group (paranoid, schizoid and schizotypal), we’ll focus on paranoid personality disorder.

Another important consideration is that those with personality disorders do not necessarily have psychosis. As is the case with all personality disorders, a single cause is unknown. There is a mix of genetic predisposition and environmental triggers that appear to play roles.

Paranoid Personality Disorder

Individuals with paranoid personality disorder (PPD) have a long history of distrust and suspicion. Consequently, this often leads to social isolation and poor functioning. Even more, PPD often results in compromised school, work and personal relationships. It is more common in men and families with psychotic disorders.

Symptoms may include the following:

Constant feeling of being in danger
Unjustified belief that others have hidden motives and are trying to harm, deceive or exploit
Unjustified suspicion of the loyalty or trustworthiness of others
Hesitance to confide in others due to unreasonable fear that others will use the information against you
Perception of innocent remarks or unthreatening situations as personal insults or attacks
Angry or hostile reaction to perceived slights or insults, with a tendency to hold grudges
Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful
Inability to work together with others
Detachment and social isolation
Lack of insight that feelings are unjustified

Furthermore, treatment is difficult because people with this condition are often very suspicious of doctors. Fortunately, medications and behavioral (talk) therapy can often be effective. This type of therapy is effective at reducing paranoia and limiting the impact on the person’s daily functioning.

The other two disorders in Cluster A are schizoid and schizotypal personality disorders. Causes and treatments are similar to those in PPD, but here are some of the defining symptoms of each.

Schizoid Personality Disorder

Think of an excessively flat personality

Appearance of indifference to others
Inability to take pleasure in activities or accomplishments
Inability to pick up on social cues
Little emotional expression
Little interest in sex or interpersonal relationships

Schizotypal Personality Disorder

Think of abnormal thoughts and activities

Belief that incidents or events have hidden messages meant specifically for you
Belief that you can influence people and events with your thoughts (aka magical thinking)
Inappropriately indifferent responses to others
Inappropriate or flat emotions
Lack of comfort with close relationships, even with family
Odd perceptual experiences, such as hearing a voice say your name
Social anxiety

Above all, it’s not enough to have some symptoms. A level of social dysfunction is necessary to establish a diagnosis.

Click here for an introduction to personality disorders.

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Understanding Personality Disorders

October 4, 2018Mental Health844-SMA-TALK, Behind the Curtain, personality disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction – Understanding Personality Disorders, Part 1

Personality disorders are a much bigger deal than we make them. In fact, we really take mental health for granted. Your ability to cope and exist within your environment is a primary determinant of your quality of life. As a result, mental illness is commonly seen and often is severe. On the one hand, many live with psychoses: unhealthy and debilitating mental disorders that take people beyond normal function. On the other hand, many others live with personality disorders. As a result, these conditions create limitations in one’s ability to interact with the world and all within it. These patterns of behaving, thinking and functioning lead to difficulties perceiving and responding appropriately.

This series of posts review the three categories of personality disorders (known as clusters) and treatment options. These categories of disorders were developed based on similar traits and symptoms. Remember, they are not mutually exclusive, and an individual can suffer from more than one disorder at a time.

Today, we address what puts you at risk and when personality or mental disorders require medical intervention. It is a medical fact that you are not likely to maintain a steady state of functioning with these disorders. Also, these disorders tend to progress and become worse without intervention. We want these posts to provide insight into human behavior and allow you to obtain any help you or a loved one may need.

Norms of Behavior

It’s fair to say that society shapes behavioral norms and judges behavior based on one’s adherence to those norms. Thus, your environment has a large role in the determination of normal or abnormal behavior. That said, there are objective standards for behavioral deviancy. You should be especially sensitive of deviancy during childhood, as this is when personality develops.

In general, your personality is a result of the interaction between genetic and environmental considerations. You start with genetic factors passed by parents (e.g. your temperament). These are combined with how your environment embraces, molds and enhances your genetic inclinations. In simple terms, that means you may be prone to certain behaviors (even abnormal personality disorders) from birth. However, expression of these behaviors likely require circumstances and/or events in your life to stimulate full development and expression.

Factors that trigger personality disorders

Beyond the interaction of genetic and environment, a precise cause of personality disorders isn’t known. Fortunately, we can identify certain factors that increase the risk of developing or triggering personality disorders.

Family history of mental illness, including personality disorders
Low level of education and lower social and economic status
Verbal, physical or sexual abuse during childhood
Neglect or an unstable or chaotic family life during childhood
Being diagnosed with childhood conduct disorder
Variations in brain chemistry and structure

Know when to get help

Finally, when should you see a physician for a possible personality disorder? Basically, the short answer is always. If you have any signs or symptoms of a personality disorder, see your doctor or mental health provider ASAP. Remember, it’s better to have been evaluated and found normal than to have needed an evaluation and not have obtained it.

If you or a loved one is having personality disorder-type issues, here are considerations you’ll want to have addressed.

What can I do to help myself?
What type of personality disorder might I have?
How do you treat my type of personality disorder?
Will talk therapy (psychotherapy) help?
Are there medications that might help?
How long will I need to take medication?
What are the major side effects of the medication you’re recommending?
How long will treatment take?
How does my support system become empowered to best help me?
What other support is available?

Finally, click here for tips on mental health and happiness!

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Challenges to Your Mental Health and Happiness

October 3, 2018General Health and Wellness, Mental Health, Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, Depression, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

You all have challenges to your mental health and happiness. We are mindful that there are as many of you unsuccessful as there are successful in navigating these challenges. Everyone has thoughts about the keys to happiness, but we can objectify the conversation! Let’s identify what is most likely to make you unhappy and lead to depression. You may find this hard to believe, but outside of medical causes of psychiatric illness and factors outside of your control, there are actually three choices we make that most commonly adversely impact your happiness and good mental health. Take it as you will, but the data is quite clear. Stay away from these circumstances, and you’re less likely to be unhappy. Sometimes mental health is achieved via addition by subtraction.

Health Problems

People who are sick or have significant illness in their families generally aren’t happy. Although this may seem obvious and perhaps unfair, given that some illnesses and conditions are inherited or occur haphazardly, be mindful of the things you can control. Of course, this gets to the negative effects of obesity and smoking. More so than any other health-related activities/conditions, these will eventually lead to deteriorating health and subsequent unhappiness.

Job Problems

You don’t have enough to do with your time? As the saying goes, an idle mind is the Devil’s workshop. It should be pointed out that neither too much work nor the wrong type of work (i.e., low job satisfaction) seems to promote either happiness or solid mental health. On average, people change careers seven times during their lifetimes. It’s often due to a search for happiness and actually is a good thing to do to avoid being stuck in a bad situation. Follow the job you love, and you’re more likely to be both happy and successful.

Relationship Problems

You make bad relationship choices? Well there’s one specific choice that is shown to be most likely to reduce your happiness—choosing a neurotic partner. What’s neurotic? For one particularly disruptive example, think about the so-called Drama Queen/King. A neurotic partner responds emotionally to events that wouldn’t affect most people, and their reactions tend to be more intense than normal. They’re more likely to interpret minor frustrations as hopelessly difficult. Their negative emotional reactions persist for unusually long periods of time. In short, if you want to be really unhappy, become attached to such a person. They will negatively affect your world, keeping you embroiled in drama and unhappiness, no matter how good the financial, physical, or other parts of your relationship.

Now your results may vary but probably won’t. I’m not make judgements, just sharing the data. Your life choices have consequences as related to your mental health. Choose wisely!

Click here for more on avoiding depression.

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Tips to Avoid SIDS and SUID (Sudden Unexpected Infant Deaths)

October 2, 2018Pediatrics/Kids Health, Surgical Care, Health Prevention844-SMA-TALK, Behind the Curtain, SIDS, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, sudden infant death syndrome, sudden unexpected infant deaths, SUID, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Whether you’re expecting, a parent or even a grandparent, most have heard of SIDS (Sudden Infant Death Syndrome). Unfortunately, what you’re really concerned about is Sudden Unexpected Infant Deaths (SUID). SIDS is the leading cause of this category.

SUID is defined as sudden and unexpected deaths in infants less than one year of age. In order for a death to be a SUID case, the causes must not be immediately apparent. There are approximately 4,000 SUID infant deaths per year in the U.S. The three most frequently reported causes of SUID are as follows: SIDS, cause unknown, and accidental suffocation and strangulation in bed. Half of SUID cases are due to SIDS.

Tips for the first year of life

This post provides tips modified from recommendations by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP). They are meant to help you reduce the risk of SIDS and SUID in your home. Consider these tips applicable for the first year:

Place your baby to sleep on his back for every sleep and nap.
Place your baby to sleep on a firm sleep surface. Never put your baby to sleep on a chair, sofa, waterbed, cushion, or sheepskin.
If your baby falls asleep in a car safety seat, stroller, swing, infant carrier, or infant sling he should be moved to a firm sleep surface as soon as possible.

Tips about bed equipment

Do not use a crib that is broken or missing parts, or has drop-side rails.
Cover your baby’s mattress with a fitted sheet. Do not put blankets or pillows between the mattress and the fitted sheet.

Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the crib. Pillows, quilts, comforters, sheepskins, bumper pads, and stuffed toys can cause your baby to suffocate.

Things parents can do to avoid SUID and SIDS

Place your baby to sleep in the same room where you sleep but not the same bed. Keep the crib or bassinet within an arm’s reach of your bed. You can easily watch or breastfeed your baby by having your baby nearby. Babies who sleep in the same bed as their parents are at risk of SIDS, suffocation, or strangulation. Too often, parents can roll onto babies during sleep or babies can get tangled in the sheets or blankets.

Breastfeed as much and for as long as you can. Studies show that breastfeeding your baby can help reduce the risk of SIDS.
Schedule and go to all well-child visits. Your baby will receive important immunizations. Recent evidence suggests that immunizations may have a protective effect against SIDS.
Keep your baby away from smokers and places where people smoke. Keep your car and home smoke-free. Don’t smoke inside your home or car and don’t smoke anywhere near your baby, even if you are outside.

Do not let your baby get too hot. Keep the room where your baby sleeps at a comfortable temperature. In general, dress your baby in no more than one extra layer than you would wear. Your baby may be too hot if she is sweating or if her chest feels hot.
Offer a pacifier at nap time and bedtime. This helps to reduce the risk of SIDS. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 3 to 4 weeks.

More Tips

Do not use home cardiorespiratory monitors to help reduce the risk of SIDS. Home cardiorespiratory monitors can be helpful for babies with breathing or heart problems but they have not been found to reduce the risk of SIDS.
Do not use products that claim to reduce the risk of SIDS. Products such as wedges, positioners, special mattresses, and specialized sleep surfaces have not been shown to reduce the risk of SIDS. In addition, some infants have suffocated while using these products.

Give your baby plenty of “tummy time” when she is awake and you are present. This will help strengthen neck muscles and avoid flat spots on the head. Always stay with your baby during tummy time and make sure she is awake.

If you’re an expectant mom, go to all prenatal doctor visits. Do not smoke, drink alcohol, or use drugs while pregnant and after birth.

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Keep these tips handy. We certainly don’t want your sudden bundle of joy to become a victim of Sudden Infant Death Syndrome.

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Your Questions About E-Cigarettes (Vaping)

October 1, 2018General Health and Wellness, Respiratory/Lungs, Toxicology/Drugs844-SMA-TALK, Behind the Curtain, CDC, Centers for Disease Control and Prevention, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, E-cigarettes, VapingJeffrey Sterling, MD

Let’s talk about using E-cigarettes, aka vaping. Here are five questions you commonly ask.

What is vaping, and how is it different from smoking cigarettes?

E-cigarettes are battery-operated devices that typically resemble a pen or cigarette. They enable smokers to get their “nicotine fix” without being exposed to all the other chemicals contained within regular cigarettes. E-cigarettes have chambers in which you place liquid nicotine with additional ingredients and flavorings. Heating the liquid turns the liquid into vapor. This is why the name “vaping” is applied when one uses an e-cigarette.

Is vaping safe?

On an absolute scale, the answer is no. On a relative scale, the answer is likely “safer than regular cigarettes.” Simply put, nicotine is addictive, and it produces withdrawal symptoms and cravings. Nicotine causes several other problems of note. It exacerbates problems for those with heart disease and causes damage to blood vessels. Also, nicotine harms the developing brains of kids and could affect memory and attention. Pregnant women or those attempting to become pregnant must avoid nicotine exposure, because nicotine clearly causes damage to unborn babies. E-cigarettes do not remove all the chemicals found in cigarettes; formaldehyde and other cancer-inducing products are still present.

Is vaping safer than smoking cigarettes?

The basis for e-cigarettes being safer than regular cigarettes is the production of toxins with burning that occurs when smoking cigarettes. Vaping doesn’t reach the threshold of burning, so the thousands of chemicals found in cigarettes don’t produce the same effect. A safe estimate of the relative safety of e-cigarettes compared to regular cigarettes would be that vaping is about 75% safer than smoking cigarettes, but it bears repeating: neither is safe. Fortunately, the risks of second-hand vaping are very low, according to currently research.

Is vaping effective at getting people to stop smoking cigarettes?

The American Heart Association recommends that e-cigarettes should only be used as a last-ditch effort toward quitting cigarette smoking. Unfortunately, most of the e-cigarette use in the US occurs in addition to cigarette use, as opposed to replacing cigarette use.

How is vaping affecting childhood smoking? Does it lead kids to smoke?

One commonly expressed concern is that kids who start vaping may continue as smokers throughout life. The concern arises due to the many kid-friendly flavors in e-cigarettes.

The journal Pediatrics published a study in 2016 showing a six-fold increase in cigarette use in those who used e-cigarettes compared to those who did not. A 2015 study produced in the Journal of the American Medical Association showed a similar finding. Yet, the overall trend of childhood smoking remains encouraging. Data from the CDC show that while use of e-cigarettes went up to 24% in 2015, cigarette smoking dropped to a historic low — to just under 11%.

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