Tag Archives: SterlingMedicalAdvice.com

Basic Questions and Answers about Anemia

December 2, 2018Diet and Nutrition, Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, anemia, Behind the Curtain, Folic Acid, iron deficiency, Sterling Medical Advice, SterlingMedicalAdvice.com, Thalassemia, There are 72 Hours in a Day, Vitamin B12, Vitamin CJeffrey Sterling, MD

Introduction

This Straight, No Chaser address your basic questions and answers anemia!

What is anemia?

Anemia is a condition defined by blood containing a lower than normal number of red blood cells or if the blood cells present don’t contain sufficient hemoglobin (the protein that carries oxygen throughout the body). Anemia from iron deficiency is the most common nutritional deficiency.

What causes anemia?

There are many causes of anemia and many different types of anemia, but the most common causes are blood loss (the moss common cause), a lack of red blood cell production and higher than normal rates of destruction of red blood cells.

What are the symptoms of anemia?

One of the major points of blood is it is the vehicle for carrying blood and removing carbon dioxide (waste) from your body. The presence of anemia means the absence of sufficient oxygen through the body. This produces symptoms such as fatigue (the most common symptom), weakness, shortness of breath, dizziness, headaches, cold feeling in the hands and feet, pale skin and chest pain. Severe or long-lasting anemia can cause actual damage to your heart, brain, and other organs in your body and can lead to death.

Are there risk factors?

Practically, the biggest risk factor is being a woman of child-bearing age because of the ongoing blood loss that occurs from menstruation. Additional major risk factors include a poor diet (meaning one low in iron, vitamins or minerals), blood loss from surgery or an acute injury, long-term or serious illnesses and infections, and a family history of inherited anemias (e.g. sickle cell anemia or thalassemia).

How do you diagnose anemia?

It’s important to note that all anemia is not created equal. Furthermore, symptoms don’t have to be present. Anemia is rather easily identified with a simple blood test (the complete blood count, aka CBC). In many instances, that’s the beginning of the assessment. Additional tests may be needed to identify the specific test of anemia.

How do you treat anemia?

Believe it or not, in many instances, the treatment of anemia isn’t as simple as taken an iron supplement, and thus medical assessments should be considered essential. Treatment for anemia depends on the type, cause, and severity of the underlying condition. Anemia treatment may involve dietary changes and/or supplements, but it may require other medicines, procedures, or surgery to treat blood loss.

What can I do?

Focus your efforts on these specific actions:

Prioritize getting routine evaluations and evaluations as needed in the midst of suggestive symptoms.
If you fall into a risk category, your diet and iron supplementation matters. Your body needs iron to make hemoglobin. You can enhance iron absorption by eating red meats, chicken, turkey, pork, and fish/shellfish. If you don’t eat meat, foods that are good sources of iron include dark green leafy vegetables. This include such spinach, tofu, peas, dried fruits (prunes, raisins and apricots), prune juice and iron-fortified cereals and breads. Maintaining Vitamins B12, Vitamin C and folic acid, are also important in maintaining healthy cells and absorbing iron.

The good news is anemia can often be easily identified, treated and controlled. As with many other conditions, early diagnosis and treatment are key for improving one’s quality of life and life expectancy.

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Urinary Tract Infections (UTIs)

November 25, 2018Genital/Urinary, Infectious Disease844-SMA-TALK, Behind the Curtain, Conditions and Diseases, cystogram, cystography, E. coli, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, urinary tract infections, UTIsJeffrey Sterling, MD

Introduction

Ladies, have you ever been told that you get urinary tract infections (aka UTIs or “bladder infections”) because you didn’t wipe front to back instead of back to front? Men, have you ever been told that this could be a sign that your prostate needs to be examined This Straight, No Chaser answers simple questions on urinary tract infections. With over 8 millions cases and 100,000 hospitalizations a year due to these, it’s information you should know. We offer the information in question and answer format.

What are urinary tract infections? Are they the same as a bladder infection?

What these questions really ask is “What is the urinary tract?” The body’s drainage system serves to remove excess fluid and bodily waste. It includes the following organs:

The kidneys serve to filter blood and produce approximately 1-2 quarts of urine per day as a result of this process.
The ureters are tubes extending from the kidneys to the bladder, carrying filtered urine within them.
The bladder is the pouch within which you store urine until you’re ready to release it.
The urethra is a tube at the bottom of the bladder through which urine gets expelled.

A UTI is an infection anywhere along this path. Infections at different parts of the urinary tract can display different symptoms and have different complications.

What causes a UTI?

Bacteria are the most common cause of UTIs, particularly those that live in the bowel (such as E. coli) and are within or in close proximity to the vagina. Under most circumstances the body is very effective at removing bacteria and other microorganisms from the urinary tract (urinating just washes them out!), but some of us are at increased risk due to diminished defenses or other circumstances in which these microorganisms can grow.

Why do women get UTIs, and it seems like men don’t?

It is true that women get UTIs about four times more frequently than men, but anyone of any age or sex can be infected. Here are some reasons why.

Women have a shorter urethra, which makes it easier for bacteria to reach the bladder.
Also, the opening of a woman’s urethra is near the vagina and anus, where bacteria live.
Women who use a diaphragm are also more likely to get UTIs than women who use other forms of birth control.
The male prostate produces secretions that slow bacterial growth.

Are there other risk factors for UTIs?

Yes. Others at higher risk for UTIs include the following.

those having diabetes or have lowered immune systems
those habitually needing a tube to drain their bladder
those with urinary tract abnormalities that block the flow of urine
those with spinal cord injuries or other nerve damage

Additionally, once a man has a UTI, it’s more likely he’ll have the problem again because the bacteria are extremely difficult to reach once they set up shop in the male prostate.

Are UTIs serious?

Unless you describe the annoying symptoms as serious, most UTIs are not serious. However, UTIs can lead to severe complications if left untreated, including the following:

Long lasting or recurrent kidney infections can cause permanent damage and scarring to the kidneys, which can create insufficient kidney function and produce high blood pressure and other problems.
Kidney infections can enter the blood stream and become life threatening.

What are the signs and symptoms of a UTI?

You should see your physician if you develop any of the following signs or symptoms:

A burning sensation with urination
Bloody, cloudy, dark or otherwise discolored urine
Fever or chills
Foul-smelling urine
Frequent or urgent need to urinate, regardless of the amount actually expressed
Pain in your back or side below the ribs

How are UTIs diagnosed?

UTIs are diagnosed based both on symptoms and a lab test. Many of you have experienced your urine being sent to a lab from the emergency room or your doctor’s office. Based on a combination of symptoms, the presence of bacteria and white blood cells that have accumulated to fight the infection, the diagnosis will be made. If you have frequent infections, infections that don’t respond well to treatment, atypical presentations or are sick enough to be hospitalized, your urine may be cultured in an effort to grow the bacteria causing your symptoms. This allows more precise treatment regimens to be given. In other circumstances, tests may be done to check the normalcy of your urinary tract, including an ultrasound or CT scan. Further details on when and why this would be done is available on www.sterlingmedicaladvice.com.

An additional Straight, No Chaser will discuss prevention and treatment options for UTIs.

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Prevention and Treatment of Lead Poisoning

December 27, 2018Detoxification, Environmental, Toxicology/Drugs844-SMA-TALK, Behind the Curtain, Conditions and Diseases, lead poisoning, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This point is about prevention and treatment of lead poisoning.

What you need to know about protecting yourself from lead poisoning and its effects is reducible to awareness, baseline testing, prevention and treatment.
We covered what you needed for awareness in the previous Straight, No Chaser.
However your goal really should be prevention via avoidance, as much as is possible. However, to prevent, you must have a level of awareness. Think about these things:

Do you have a child in your house between ages 6 months and 3 years old? If so, be reminded that children wander around putting things in their mouths.
Are you in an old house, or do you have old plumbing?
Do you live near a busy road or near bridges?

If you are in a high-risk situation, your ideal level of awareness should include preventive considerations such as getting your home tested and your blood lead level checked. If anyone in the home has been found to have high lead levels, the entire household should be checked.

Prevention

Whatever your level of exposure, you want to engage in preventive strategies to prevent further exposure that could lead to disease. Here are a few quick tips to do so:

Avoid dust in your home, because you just never know!
Wash everyone’s hands prior to eating.
Throw away old painted toys, unless you’re sure lead based paint was not used.
Use filters for your water, switch to bottled water for drinking and cooking, and/or let any tap water run for approximately one minute prior to drinking or cooking with it.
Avoid storing wines in lead crystal decanters for long periods of time.

Treatment

If you have been found to have any significant levels of lead in your blood, you have a role in your treatment. If your levels and symptoms are significant enough to be hospitalized, that will occur and you’ll receive medicine that facilitates the removal of lead from the body, called chelating agents. However, in the absence of that, your job likely will be to maintain a healthy diet that includes calcium, iron and Vitamin C, all of which help decrease lead absorption within the body.

Prognosis

As mentioned, you want to avoid lead poisoning. Each year in the United States, approximately 310,000 kids aged 1-5 years old have unsafe levels of lead in their blood. In these children, even mild lead poisoning can have a permanent impact on attention and IQ. Remember, the developing brain is more susceptible to the toxic effects of lead. Those with higher lead levels have a greater risk of long-lasting health problems and must be closely followed because of the potential damage to the brain, nervous system, muscles and other systems. Adults who have had mildly high lead levels often recover without problems, but in general, a complete recovery from chronic lead poisoning may take months to years.

If you suspect you may have lead paint in your house, get advice on safe removal from the U.S. Department of Housing and Urban Development (HUD) at 800-RID-LEAD, or the National Information Center at 800-LEAD-FYI. Another excellent source of information is the National Lead Information Center at (800) 424-5323.

If you suspect you or someone in your family is suffering from the effects of lead, call 911 immediately and/or call 1-800-222-1222 to speak with a local poison control center for further instructions while you await the paramedics to arrive.

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Frequently Asked Questions About Lead Poisoning

December 26, 2018Neurology, Pediatrics/Kids Health, Public Health, Skin/Dermatology, Toxicology/Drugs, Health Prevention, Musculoskeletal System844-SMA-TALK, Behind the Curtain, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Medically speaking, it really wasn’t long ago when dozens of cases of lead poisoning in Flint, Michigan occurred. Of course, this was a result of elevated levels of lead in the city’s drinking water supply. This followed inadequate preventive treatment of the water supply, which is a necessary step in the provision of public health. The water had become contaminated from aging pipes in the Flint river, which became relevant after the city switched its water supply from Detroit sources in 2014. It’s hard to fathom that the number of poisonings was so high the city declared a state of emergency. It’s even harder to accept the suboptimal response that occurred to the emergency.

In case you’re wondering, yes, this could happen to you. If you read on, we’ll tell you how to minimize your exposure. Let’s review some frequently asked questions.

What is lead poisoning? Why is it dangerous?

Lead is a chemical element (“mineral”) that is quite poisonous in humans. Swallowing or breathing lead dust can cause major health problems, both immediately (with a very high exposure), or more commonly, over time with ongoing exposures to low levels. The particular concern is in exposure to children. As is the case with head injuries or most any other type of insult to a developing child’s brain and nervous system, a significant risk to one’s mental development occurs apoteksv.se. The younger the child, the more dangerous the exposure is; the highest risks are in the unborn.

How does one get poisoned? What are the risk factors?

Lead used to be very common in gasoline and house paint in the U.S., but lead based paint was banned in 1978. It is estimated that approximately 4 million Americans are still significantly exposed to potentially toxic levels of lead, because lead basically is everywhere, including old house paint, new toys, dust, dirt and gasoline. Children living in cities with older houses are more likely to have high levels of lead.

Most common exposures

Here’s a quick list of lead exposures (there are many other potential exposures):

Homes, toys and furniture painted in the US before 1978 and any toys made outside the US (no, the paint doesn’t have to be peeling);
Plumbing, pipes, faucets and the water flowing through them;
Soil contaminated by car exhaust (think near expressways or busy streets) or house paint scrapings (think old abandoned buildings); and
Storage batteries

Take these exposures seriously, because lead exposure comes from swallowing, touching and/or breathing objects containing lead particles. Once in the body and bloodstream, it spread, causing damage throughout. Two notable areas of concern are the effects of lead on blood cells (causing anemia) and on bones (preventing healthy, strong teeth and bone function due to reducing the absorption of calcium.

How does lead poisoning get identified? What are the signs and symptoms?

Lead poisoning can affect many different parts of the body, and symptoms can range from nothing obvious to dramatic mental impairment. Symptoms are more prominent as blood lead levels get higher.

Lead is much more harmful to children than adults because it can affect children’s developing nerves and brains. The younger the child, the more harmful lead can be. Unborn children are the most vulnerable.

It’s important to reiterate that many with lead poisoning won’t have signs of illness early on. If you believe your environment poses a risk, you should ask to be checked. Symptoms are often nonspecific, but if you can remember groupings of symptoms, you’d be on the right track.

Early Symptoms

Behavioral problems may exist such as irritability, difficulty concentrating, sluggishness or fatigue.
Digestive tract problems may exist, such as loss of appetite, a metallic taste in one’s mouth, weight loss, nausea, vomiting, constipation and/or abdominal pain.
Neurologic problems may exist, such as headaches, muscle and joint weakness or pain, seizures.
Pale skin from anemia is also often a prominent finding.

Longer Term Health Problems

damage to the nervous system (such as poor muscle coordination, speech and language problems), kidneys, and/or hearing
decreased bone and muscle growth
developmental delay

The next Straight, No Chaser will address prevention and treatment strategies.

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Colorectal Cancer Screening via Colonoscopy

January 24, 2019Gastrointestinal, General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer, Health Prevention844-SMA-TALK, Behind the Curtain, Colon, colonoscopy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post is about the screening colonoscopy.

Two previous Straight, No Chaser posts have highlighted recommended screening examinations for men and women between ages 40-64. In today’s post, I want to pay special attention to one examination in particular. The screening colonoscopy seems to generate large amounts of fear (and homophobia).

Colon cancer is the second most common cause of cancer in the United States after lung cancer (stop smoking!). As previously noted in the post on recommended screenings, everyone should have a screening colonoscopy at least by age 50. Certain groups of individuals, such as African-Americans and those with positive family history for colon cancer should have the test done earlier. Simply put, colonoscopy is definitive in screening and diagnosing colorectal cancer. Furthermore, it is one of the most successful ways to both prevent and treat early cancer.

How a colonoscopy is done

First, you have to do a bowel prep. Over a few days, you’ll eliminate certain foods (e.g. corn, nuts) from your diet. Next, you’ll progress to an all liquid diet. This will be followed by taking a few doses of a very strong laxative to completely clean out the contents of your intestines (those of you looking for a good detox should be so lucky). I actually lost 3.5 pounds doing this.

The exam involves using a tube (colonoscope) to view your digestive tissue from your rectum all the way up the large intestine (approximately 5 feet). It includes cleaning away and suction stool that blocks the view, direct visualization of the intestines and real-time removal of suspicious tissue (e.g. polyps) that could be cancerous or early signs of cancer. You may or may not choose to be sedated (put to sleep) during this. Of course, my medical curiosity was such that I wanted to see everything on the screen in real time, so I went without any medications, and yes, I lived to tell the story: the level of discomfort never got higher than a 3 on a scale of 1-10.

A few words about colorectal cancer

The point here is simple and straightforward: Most people in whom colon cancer is found and treated early will not only be alive 5 years later, but many will live a normal life span. On the other hand, when it’s not, colorectal cancer is very dangerous because it often doesn’t cause noticeable signs or symptoms until the cancer is advanced and much more difficult to treat. The screening colonoscopy gives you the best chance to know where you stand.

Your risks

So this isn’t that complicated. The following conditions are associated with advanced risk.

Advanced age
African-American
Positive family history for colon cancer or inflammatory intestinal conditions
Live a sedentary lifestyle
You have a low-fiber, high-fat diet

Here are a few words about your diet. You should know that according to the American Institute for Cancer Research, just 1.7 ounces of processed meats consumed daily (equivalent to less than two strips of bacon) roughly increase a person’s risk for colorectal cancer by 21 percent. More definitely, no amount of processed meat is considered safe for consumption.

Thankfully, my colonoscopy was perfectly normal: I keep telling you diet is 75% of health (unless you’re either lucky or unlucky in your genetic makeup)! The actual colonoscopy took just over 10 minutes, and I won’t have to go through this for another 10 years. Isn’t that investment of time worth giving yourself the best chance for a clean bill of colon and rectal health?

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Lactose Intolerance – It’s Explosive!

December 22, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Calcium, Dairy, Dairy product, Hispanic, Lactose, Lactose intolerance, Milk, Native Americans, Pinto beans, Small intestine, Soy milk, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Turnip greensJeffrey Sterling, MD

Introduction

So I’m at dinner with a group of friends, and somehow the topic gets to lactose intolerance. For 15 minutes. They were really into it. At dinner! You know what it is. Everyone seemingly knows someone who has it, even if (hopefully) you aren’t reminded of it too often. Lactose intolerance is a state where you simply have difficulty digesting lactose (one of the sugars we consume, most notably in milk and other dairy products) because of a deficiency in the enzyme that breaks it down, called lactase. Lactose intolerance occurs more often in Black, Asian, Hispanic and Native Americans, but that doesn’t mean your body read that book.

So by now you may be thinking “What is there to discuss besides the odoriferous emanations produced?” (In case you didn’t get the reference that’s from an old Right Guard commercial featuring Charles Barkley.) Well, the biggest concern from a health standpoint is to ensure you’re still getting enough calcium to keep your bones strong and enough Vitamin D.

Here are 3 sets of practical facts to help you get through it all.

If you have lactose intolerance, that doesn’t mean you’re allergic to dairy products.

This is an important distinction. There’s nothing immediately life-threatening about the ingestion of dairy products if you’re lactose intolerant, as there might be if you were allergic. Just be aware of the cramping, bloating, flatulence, nausea, vomiting, diarrhea and gas that may ensue.

If you’re lactose intolerant, that doesn’t mean you can’t necessarily have any dairy or won’t ever be able to have dairy.

Lactose intolerance occurs in many shades of grey. Some people get worse with age; others get better as they learn to work around it. Some develop lactose intolerance at birth, others later in life, and others develop it after injury or surgery to the small intestine (which is where lactase is normally produced). Some can ingest small amounts of certain products without symptoms. In the privacy of your own surroundings, you should discover for yourself if you’re affected every time you have dairy or whether or not only large amounts of certain products cause symptoms (e.g. Try not to eat the entire gallon of ice cream.). You should also gauge your response to dairy after taking various lactase-containing supplements.

If you’re lactose intolerant, you still can get adequate calcium. Here’s a few suggestions.

Soy and rice products have exploded (in a different way) on the market. Consider soy milk, soybeans and tofu.
Many juice, bread and cereal makers have taken to providing calcium.
Some fruits and veggies are great sources. Consider broccoli, collard and turnip greens, kale, okra, pinto beans, rhubarb, and spinach. Oranges are a good source of calcium.
Other great foods include almonds, salmon, sardines and tuna.

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Differing Effects of Medications in the Elderly

December 21, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Drug, Drug interaction, Drugs and Medications, health, Mental Health, Old age, Pharmaceutical drug, Pharmacy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This Straight, No Chaser addresses the differing effects of medications in the elderly.

The elderly are living longer and more productively. Part of being able to do so is by maintaining an understanding of how your actions affect you. As you’d believe, one common action of many of the elderly is taking medications. You should be aware that medications have changing effects with aging. Also, you should be aware that there are many different reasons for that fact.

It’s the physiology

First of all, changes in our physiology due to aging make the effects of drugs less predictable and consistent than in younger people. A slower metabolism, increases in body fat and alterations in the function of the kidney and liver (major mechanisms for drug elimination) have important ramifications for what ingested substances will do. Thus, the elderly require more stringent monitoring of drug levels and effects, and you may find that your physician needs to adjust medication doses. This same consideration explains why side effects are more common among the elderly.

Be reminded the presence of other diseases brings additional effects and challenges. Just as with one’s own relatively diminished function, disease imposes the same type of changes onto the body. This can speed the presence of side effects and toxicity as well as adjust the effective dose of a medication.

Drug Interactions

Have you ever seen the individual with a small ‘army’ of medications? Think about it. The more medications one takes, the more likely drug interactions will ensue and changes in effectiveness in any single medication may occur. This effect incrementally increases with each additional drug one takes. Similarly, the more medications one is taking, the most likely one is to make a mistake in taking the correct medication at the right time. Now consider your independently living parents or grandparents. The elderly often are more prone to make these types of errors.

What can you do about this? Get organized, and get help! Those daily medication containers are good solutions to incorrectly dosing medications. If you’re especially organized, a log is great—not necessarily for you, but for the physician that will be trying to figure out why you’re dizzy or have an altered mental status if and when that occurs.
Talk with each doctor you see or a pharmacist about what to expect from the combination of medications you take; it can make your lives a lot less complicated.

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Taking Vitamins and Mineral Supplements

December 19, 2018Diet and Nutrition, General Health and Wellness, Toxicology/Drugs, Health Prevention844-SMA-TALK, Annals of Internal Medicine, Behind the Curtain, Big Bang Theory, CBS, Edgar Miller, Johns Hopkins School of Medicine, Multivitamin, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, VitaminJeffrey Sterling, MD

Introduction

This Straight, No Chaser discusses the use of vitamins and mineral supplements.

If any of you are familiar with the hit comedy The Big Bang Theory on CBS, you may recall this scene from one of the first episodes featuring the genius, physicist and would-be Noble Prize winner and the ditzy, would-be actress:

http://www.youtube.com/watch?v=m0Eo7ju54aY

Sheldon (as Penny selects vitamin supplements): Oh boy.
Penny: What now?
Sheldon: Well, there’s some value to taking a multivitamin, but the human body can only absorb so much, what you’re buying here are the ingredients for very expensive urine.
Penny: Well, maybe that’s what I was going for.
Sheldon: Well then you’ll want some manganese.

The Prevailing Medical View on Widespread Use of Supplements

My views on these things have migrated over the years, and although I’ll share it with you, I still defer to the standard of care on medical matters. That standard is based on an editorial from the prominent medical journal Annals of Internal Medicine. In short, the findings of the editorial, based on a review of relevant recent literature and covering approximately half a million individuals are that taking supplements and multivitamins to prevent chronic diseases is a complete waste of money. Pointedly, the title of the editorial is “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.” In other words, the vast majority of uses of vitamins and minerals are unwarranted and constitute a waste of your well earned dollars.

Here are a few points that reflect the prevailing opinion on supplements.

Physicians have every reason to embrace improvements in medicines and technology when they exist and no reason to shoot down them down when they’re effective. If there was evidence of widespread supplement use, you’d be hearing about it from your physicians.
Your individual opinions, anecdotes and personal experience do not constitute medical fact. Just because you felt better or believe your memory seemed to have improved after taking a certain pill doesn’t mean the cause of your improvement was the pill.
There is a phenomenon called the placebo effect that explains more than you’re willing to admit. It’s more or less “the power of positive thinking.” The placebo effect is a measurable, observable, or felt improvement in health or behavior not attributable to an administered medication or invasive treatment. Even though placebos are not active medicines, they seem to have an effect in about 1 out of 3 patients. This is thought to represent the body mobilizing to address the concern for which you decided to take the pill. In this example, vitamins aren’t placebos because they actually have an effect on the body. However, the improvements you’re experiencing aren’t directly attributable to those pills.

But you love them…

More than half of all adults in the United States take a multivitamin and/or additional supplements, including those touted to prevent cancer, heart disease and boost memory.
“The (vitamin and supplement) industry is based on anecdote, people saying ‘I take this, and it makes me feel better,’ said Dr. Edgar Miller, professor of medicine and epidemiology at Johns Hopkins University School of Medicine and co-author of the editorial. ”It’s perpetuated. But when you put it to the test, there’s no evidence of benefit in the long term. It can’t prevent mortality, stroke or heart attack.”

The vitamin and supplement industry rakes in nearly $12 billion annually, according to the researchers, with multivitamins its most popular product.

Try Diet Instead Unless Told Otherwise

With that, allow me to again extol the virtues of a good diet.

Most everything you’re looking for in a bottle can be obtained by a healthy diet. This is especially true with generous servings of fruits and vegetables.
It is a fair point to make that a large number of us do not engage in a healthy diet, so much so that a multivitamin would be beneficial. Of course, that begs the question “If someone is not compliant with the direction to eat health foods, why would you presume they’d be compliant taking a multivitamin daily?” These pills are not inexpensive. Your better course of action is in spending that money on healthier food choices.
It is appropriate to note that if you are suffering from a nutritional deficiency, you will benefit from a vitamin supplement. Of course, the deficiency would have diagnosed by your physician, and the supplement would have been recommended by your physician. Short of that, in most cases, you’re allowing your fears to be played upon.

Finally, and this is where I’ve migrated, if you simply have the money to spread (or burn as the case may be), and you choose to view supplement use as akin to an insurance policy, there’s usually no harm (medically speaking) to your doing so. I am an advocate of your taking any positive step forward for your health. I just wish you’d do so in an evidenced-based manner. This would be in your best medical – and financial – interests.

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Questions About Genetically Engineered Foods (GMOs)

December 17, 2018Diet and Nutrition, Public Health844-SMA-TALK, Behind the Curtain, bioengineered foods, Food and Drug Administration, GMO, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post discusses and answers frequently asked questions about genetically engineered foods (GMOs).

Have you ever bred an animal, say a dog? Have you ever taken a vitamin or supplement? Of course you have, so let’s start the conversation there. Imagine you live in a world with shortages of food or fresh water, a diminished food supply, an inability to maintain the freshness of food, or have local conditions that require an abundant need for use of pesticides? What if your food supply could become a vehicle for delivery of vaccines or other medications? These are the arguments used to support the use of genetically engineered foods (aka bioengineered foods, aka GMOs), because all of these conditions exist in large parts of the world.

Even if you didn’t previously understand the logic for the use of genetically engineered foods, you’ve been using them for a long period of time if you live in the U.S. Upwards of 70% of processed foods on US grocery store shelves contain a genetically modified ingredient. If you’re eating corn (or anything with high-fructose corn syrup, such as cereals, sodas or snacks), potatoes, soybeans, squash or tomatoes, you’re likely eating food that has been genetically altered.

Let’s review frequently asked questions.

What are GMOs?

The actual question should be “What are genetically engineered foods?” These foods have genes from other organisms (plants, animals or microorganisms) inserted into their genetic codes, introducing new traits to the affected foods once grown. GMO is short for genetically modified organisms.

Why would anyone want to do this?

There are many great reasons to want to do this. In fact, we have a long history of breeding. Dogs came from wolves. Long-stemmed roses are a result of breeding. Unfortunately, natural processes of doing this can take thousands of years. Science has evolved to the point that genetically desirable traits can be extracted from one source and placed into another.

So what would the benefits of doing this be?

Since you’re selecting (i.e. genetically engineering) what you want your food to be, you can create many different benefits. Here’s a list of some of those.

Ability to use food as medicine or vaccines
Faster growing (plants and animals)
Increased desirability of traits (e.g. less fat absorbent even when fried)
Increased food supply
Less need for water, fertilizer and pesticides
Less susceptible to pests and diseases
Longer shelf life
More drought tolerant
More nutritious
Tastier

What are the potential risks?

Let’s start by pointing out that the risks are theoretical. Perhaps “concerns” would be a better descriptor. The nature of concerns generally revolves around the notion that scientists may prove unable to control the science, and some genetic changes can end up different than planned and harmful. In some conceived scenarios, modified organisms could produce extinction of naturally occurring organisms, with resultant adverse effects on the environment (that requires a certain existing balance). Other risks could include cross-communication of allergies and antibiotic resistance (e.g. you could exhibit a peanut allergy while eating a tomato).

Is this why many speak out against it?

It’s hard to say. There are several reasons cited against GMOs, some of which are political, others of that are scientific and still others that could be ethical or religious.

You may be aware that the 28 countries of the European Union (EU) have banned GMOs. Why, you might ask? The official line is organically produced food is healthier and closer to nature, so it has to be better!
You should also be aware that the US dominates the world bioengineered food market. As such, if GMOs become the natural order of things, there is a certain reality other countries would have to accept when it comes to trade.
A different theoretical concern is a public health concern that we can’t afford the risk of creating any potential adverse effects to the environment, our food supply or to our health.
Still other fears center around the thought that farmers could be rendered irrelevant with these mass produced foods.

Are they safe?

I’ve mentioned “theoretical” on a few occasions. To be fair, there currently have been no adverse effects (to a medical or scientific certainty) demonstrated from using genetically engineered foods. To this point, GMOs have avoided significant regulation from the Food and Drug Administration (FDA), largely because the ice cream looks and tastes the same, and despite the craze toward organic foods, doesn’t appear to cause any harm. That said, no one is suggesting that either sufficient research has been done or that the long-term effects have been determined.

Disclosure Issues

Another question asks why consumers aren’t simply informed as to whether the products they purchase are GMO products. Labeling would address that issue, but to this point the FDA hasn’t felt the need to do so and views a requirement to do so as punitive without cause. This lack of transparency is causing quite of a bit of concern, but I’d remind you that you don’t know (and usually don’t want to know) how most of your food supply is created (something about not wanting to know how the sausage is made comes to mind).

The bottom line is, at this point genetically engineered foods are regarded as safe. There are no reports of illness or injury due to consumption of these foods. You can rest assured that more research on the matter will be forthcoming. You’ve already been using them and would find it extremely difficult to avoid them in the US, even if you tried. The decision to avoid them at this point is either based on fear, politics or dissatisfaction with the level of scientific evidence supporting what is being seen in real time. The issue of labeling genetically modified foods as such is still an ongoing battle.

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Low Back Pain

December 18, 2018Neurology, Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

For many, low back pain begins with a slip and subsequently becomes a slippery slope that never seems to end. This Straight, No Chaser will help you understand why you’re having pain.

Lower back pain is a tricky subject for an emergency physician, and it’s seen everyday. In fact, over 40 million Americans suffer from various forms of chronic low back pain. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.

Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.

Let’s point at four situations that produce or exacerbate your back pain.

Bad form (born with or otherwise acquired)

Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

Strains

Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.

Fractures

A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.

Arthritis and Normal Deterioration (aging)

There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.

Here are a few clues to help you hone in on whether your back pain requires emergency attention:

Direct blow to your back
Fever and new onset back pain
Loss of control of your bowel movements or bladder function
New onset back pain after age 65
Numbness and tingling in both of your legs
Nighttime back pain
Sudden sexual dysfunction
Weakness and/or loss of motion or sensation in your legs
Weight loss and new onset back pain
Work related back injuries

What can you do to prevent or reduce the pain at home?

Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
Wear low-heeled shoes whenever you can, ladies!
Learn how to stretch your back.

Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
Sleep on your side. Try a pillow between your knees.
Walk. Did you know walking is the best (and easiest) exercise for your back?

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How to Avoid the Most Frequent Causes of Death

December 16, 2018General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, accidents, Asthma, Behind the Curtain, Cancer, COPD, Heart disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This Straight, No Chaser reviews the most frequent causes of death and how to avoid them.

It is interesting and curious to hear everyone obsess over how esoteric and rare conditions can potentially kill you. Here are some words to the wise: common things happen commonly. I’m going to make this a very simple post (with links to previous Straight, No Chaser posts covering the individual topics in greater detail). Let’s help you extend your life expectancy by offering very simple tips (three to five for each) to prevent and combat the five most common causes of death. This list is by no means comprehensive, but if you follow the achievable steps mentioned, you’ll be much better off than if you don’t.

The Five Most Frequent Causes of Death

According to the Centers for Disease Control and Prevention (CDC), here are the five most common causes of death in the United States for the year ending 2016. I’ve also included the number of annual deaths per condition; click on the heading for those blogs.

Heart disease: 635,260
Cancer: 598,038
Accidents (unintentional injuries): 161,374
Chronic lower respiratory diseases: 154,596 (e.g., asthma, COPD, emphysema, chronic bronchitis)
Stroke (cerebrovascular diseases): 142,142

Heart disease

Learn early recognition of heart attacks.

Stop smoking and exposing yourself to second-hand smoke.
Exercise daily. Walk at least two miles each day. It’s a final common denomination of other problems and is a major contributor to cardiovascular disease. You want your LDL (“bad cholesterol” levels) low and your HDL (“good cholesterol” levels) high. If your LDL and/or overall levels are high, it’s an immediate prompt to reduce your belly, change your diet and exercise more.
Limit your calories. Never supersize anything. Eat only until you’re full. Learn about healthy plate sizes.

Cancer

Get screened! Early detection is the key to survival.

Don’t use tobacco in any form.
Eat more fruits and vegetables and less red meat.
Become physically active: strive for at least 30 minutes of moderate to vigorous activity at least five days a week.
Limit sun exposure and avoid tanning. (Skin cancer is the most common of all cancers.)
Limit alcohol intake to one to two drinks/day (women and men, respectively).

Accidents

Secure your surroundings!

Learn CPR.
Wear safety belts (shoulder and lap) every trip. Seat belts reduce auto crashes by approximately 50%.
Stop all distracted driving (drinking, cell phone use, eating, etc.).
If you’re going to swim, and even if you know how to swim, take a formal lesson that focuses on life-saving maneuvers.
Install smoke and carbon monoxide detectors in your home.

Chronic lower respiratory diseases

Asthma and COPD can take your breath away.

Stop smoking and exposing yourself to second-hand smoke.
Get your home tested for radon.
Follow workplace guidelines for workplace exposures to particles known to cause cancer.

Stroke

Learn early detection.

Control your blood pressure. This is the most important risk factor in stroke prevention. High blood pressure increases your risk for a stroke four-fold.
Control your blood sugar levels. Diabetics have a 1.5 times higher risk of stroke.
Control your cholesterol.
Stop smoking. Smoking increases your risk for a stroke between 1.5-2.5 times above the risk of non-smokers.
Control your weight through diet and exercise, which is bundled in each of the first three considerations.

There is no fountain of youth. Your cure won’t be found in a bottle, a fad or any other quick fix. It really is about diet, exercise and risk management. The choices you make matter. Remember, although these tips were focused on prevention, early detection and treatment at the time of crisis give you the best chance to survive. Learn early detection of heart attacks and strokes, learn CPR, get screened for cancer and learn how to survive car crashes. It’s not that hard if you’re actually trying.

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Sexually Transmitted Infections Vlog

December 15, 2018General Health and Wellness, Genital/Urinary, Infectious Disease, Obstetrics and Gynecology844-SMA-TALK, Behind the Curtain, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This is a Straight, No Chaser Sexually Transmitted Infections vlog.

The Straight, No Chaser vlog series presents “health care basics” to keep you safe, healthy and out of the emergency room. If you’ve been a regular or even an infrequent follower of Straight, No Chaser, you know we’ve had a lot to say on sexually transmitted infections (diseases). Today we revisit the topic because out of sight is not out of mind when it comes to these. So give us two minutes of your time, and let’s see if you’re up to speed with your healthy habits! Happy Holidays!

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Treatment of Food Poisoning

December 13, 2018Diet and Nutrition, Gastrointestinal, Infectious Disease844-SMA-TALK, Behind the Curtain, ceralyte, Conditions and Diseases, food poisoning, Gastroenteritis, Oral rehydration therapy, oralyte, pedialyte, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

The vomiting, diarrhea, fever, abdominal cramps and all around bad feelings you may get with food poisoning is extremely unpleasant. We’ve previously discussed preventive measures you can take to minimize your risks, but you should also want to know what measures to take in the event you actually develop food poisoning. Of course, with over 250 different illnesses related to various forms of food poisoning, there’s a wide variety of treatment, some of which means to treat the specific disease (and its cause) and others that only treat the symptoms.

The threat

I always tell patients that although the vomiting and diarrhea are dramatic nuisance symptoms, the real concern is the risk of dehydration from these fluid losses. Given the body is approximately two-thirds water, altering that balance can lead to disturbances of many of the body’s functions and increase the risk of more serious infections. Thus the key to treatment is staying ahead of fluid and electrolyte losses that occur. Perhaps you’re wondering “How can I do that if I’m vomiting?”

Here are five very important treatment principles for you to remember.

First things first: if you have severe diarrhea, your favorite sports drink is not the cure. The composition of fluids and electrolytes in your stool is different from in your sweat, so these drinks don’t optimally replace your losses.

I want you to become familiar with oral rehydration therapy/solution (ORT). It’s how most of the rest of the world first treats fluid losses from vomiting and diarrhea. You may have heard of Ceralyte, Oralyte or Pedialyte, all of which are examples. ORT represents the best possible fluid for you to take and is readily available without a prescription at your local pharmacy or grocery store.
Here’s the deal with staying hydrated: you can’t hold a lot on your stomach. You need to dial back as much as possible so that you can tolerate something. That’s why you sip on chicken soup instead of steak when you’re sick. You’re likely to have more success keeping down teaspoons of fluid at a more frequent interval (say, every few minutes) than trying to chug a lot of fluid all at once.
Preparations of bismuth subsalicylate (Pepto-Bismol is a common example) can reduce the duration and severity of simple diarrhea.
If you have diarrhea and cramps with a fever or bloody stools, you should not take antidiarrheal medication without an evaluation by a physician. Even if they make you feel better, these medicines can make your food poisoning much worse.

Here’s one other point that you should understand as you’re going into your doctor’s office or the emergency room: don’t expect to receive an antibiotic to treat your vomiting and diarrhea. Most of these episodes are caused by viruses, which are self-limited and will resolve within two to three days. Furthermore, viruses don’t respond to antibiotics. In fact, efforts to use antibiotics in many of these cases only contribute to antibiotic resistance later on when you actually need them. Antibiotic resistance is discussed in detail in this Straight, No Chaser post.

When to Seek Help

Finally, here are symptoms that should prompt you to see your physician.

Bloody stools
Diarrhea lasting more than 3 days
High fever (oral temperature over 101.4 F)
Signs of dehydration, such as a decrease in urination, a dry mouth and throat, and dizziness with standing
Vomiting with inability to keep down liquids

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Understanding Food Poisoning

December 12, 2018Detoxification, Gastrointestinal844-SMA-TALK, Behind the Curtain, Campylobacter, Centers for Disease Control and Prevention, Conditions and Diseases, E. coli, Food and Drug Administration, food poisoning, foodborne illness, Staph, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vibrio, YersiniaJeffrey Sterling, MD

Introduction

We make a decision with everything we place into our mouths. We also exhibit a large amount of trust that the food we eat is safe. Most of the time that’s true, but unfortunately sometimes it’s not. Here are some questions and answers to understanding the scope of food poisoning.

How frequent is food poisoning?

According to 2011 data from the U.S. Centers for Disease Control and Prevention (CDC), every year in the U.S. approximately 1 in 6 Americans (almost 50 million people) gets sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases.

What causes food poisoning?

Over 250 different foodborne diseases have been described, most of which are infections. The most common foodborne illnesses are caused by norovirus and by the bacteria Salmonella, Clostridium perfringens, and Campylobacter. Staph Aureus (yes, that Staph) is another prominent but less common cause of food poisoning. Poisonous chemicals or other harmful substances can cause foodborne diseases if present in food.

What are the most common symptoms of food poisoning?

Even though there are many different foodborne diseases, they share a commonality of entering your system through your gastrointestinal tract. As a result, the first symptoms are caused and expressed from there. They typically include nausea, vomiting, diarrhea and abdominal cramps.

Why do foodborne diseases seem to occur in outbreaks?

Actually, the overwhelming majority of cases of food poisoning don’t occur in outbreaks, but of course you wouldn’t know that because having diarrhea is not something people typically will tell you… When outbreaks occur, it’s because a group of people happened to eat the same contaminated item. This would explain how instances of groups of friends or strangers could have been involved. Contamination that occur closest to the food supply’s distribution result in the widest outbreaks. Look at the above picture. If contaminated food from the producer makes it all the way through the distribution chain, individuals in multiple states could end up with the same infection.

What foods are most associated with foodborne illness?

Foods that mingle the products of many individual animals: Raw milk, pooled raw eggs and ground beef have increased risk because contamination in any one of the multiple animals involved can contaminate the entire mixture.
Raw foods of animal origin: Foods such as meat, poultry, shellfish, eggs and unpasteurized milk are the most likely foods to be contaminated.
Raw fruits and vegetables: Washing reduces but doesn’t eliminate pre-existing contamination, such as that occurring from the fresh manure that fertilizes vegetables. Furthermore, water itself may be contaminated.
Shellfish: Because “filter-feeding” shellfish strain microorganisms from the sea over many months, they are particularly likely to be contaminated if there are any in the seawater.

An additional Straight, No Chaser will discuss treatment options. Refer to this post for preventative tips.

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Protecting Yourself From Food Contamination and Foodborne Illness

December 11, 2018Diet and Nutrition, Infectious Disease844-SMA-TALK, Behind the Curtain, contamination, E. coli, food poisoning, Norovirus, pasteurization, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vibrioJeffrey Sterling, MD

Introduction

This post is about food contamination and minimizing your risk of foodborne illness.

Those of you who are regular readers of Straight, No Chaser may have heard me say that everything you place in your mouth either harms or helps you. Your mouth is the direct point of entry to your body. You should be concerned about the substances you ingest. Today’s post begins a Straight, No Chaser series that will discuss food safety, food poisoning, prevention and treatment of food borne illnesses – just in time for you to correctly handle all of those holiday leftovers! Today we start with food safety.

Allow me to suggest that bacteria are as much (if not more) of a part of this world as humans, and it is to be expected that they would be present in our food supply. Our issues are when does present become contaminated, and when does contaminated become illness? Understanding these issues makes it easier to take appropriate preventative and treatment measures when needed.

Here are some examples of how our food becomes contaminated.

Microorganisms (e.g. bacterial, viruses) exist in the intestines of healthy animals, even those raised for human consumption. Even a small amount of spillage of intestinal contents during slaughter can lead to contamination.
Fruits and vegetables can be contaminated when washed or irrigated with contaminated water (which sometimes contains animal manure or human sewage).
Salmonella can infect a hen’s ovary (remember the ovaries produce eggs) so that the contents of a normal-appearing egg can be contaminated even before the shell is formed.
Vibrio bacteria are normally present in seawater. Oysters and other shellfish can develop concentrations of Vibrio high enough to cause infections.
Microorganisms such as norovirus can concentrate in human sewage that is dumped into the sea. This contaminates the water supply.
Infected food handlers and food conditions pass microorganisms on to customers. Examples of this include Shigella bacteria, hepatitis A virus and norovirus. Knives, other utensils and table surfaces also are methods of transferring disease when unclean.
When certain foods are left out (i.e. not refrigerated), minimal contamination can become highly infectious in a matter of hours due to rapid growth of microorganisms. Conversely, in most instances refrigeration or freezing prevents virtually all bacteria from growing. Certain other foods (e.g. salted meats, jams, pickled vegetables) require high salt, sugar or acid levels to prevent bacterial growth.
When certain foods are adequately cooked (the ideal internal temperature is 160 degrees Fahrenheit), most microorganisms will be killed.

Protecting yourself from foodborne illness

Professionals in public health, industry, governmental regulatory agencies, and academic research have roles to play in making the food supply less contaminated. So do you. I would like to advocate for one simple step for you to take as you shop for food that will promote food safety.

Buying pasteurized milk rather than raw unpasteurized milk prevents an enormous number of foodborne diseases every day and has done so for 100 years. Juice pasteurization has more recently proven to be important in preventing certain E. coli infections. Basically, you can lower your risk by purchasing pasteurized products.

Courtesy of the Centers for Disease Control and Prevention, here are some additional simple precautions to reduce the risk of foodborne diseases:

COOK

Cook your meat, poultry and eggs thoroughly.

Using a food thermometer to measure the internal temperature of meat is a good way to be sure that it is cooked sufficiently to kill bacteria. Remember, the internal temperature of meat should be above 160 degrees Fahrenheit.
Eggs should be cooked until the yolk is firm.

SEPARATE

Don’t cross-contaminate one food with another.

Avoid cross-contaminating foods by washing hands, utensils and cutting boards after they have been in contact with raw meat or poultry and before they touch another food.
Put cooked meat on a clean platter, rather back on one that held the pre-cooked, raw meat.

CHILL

Refrigerate leftovers promptly.

Bacteria can grow quickly at room temperature, so refrigerate leftover foods if they are not going to be eaten within 4 hours.
Large volumes of food will cool more quickly if they are divided into several shallow containers for refrigeration.

CLEAN

Wash produce.

Rinse fresh fruits and vegetables in running tap water to remove visible dirt and grime.
Remove and discard the outermost leaves of a head of lettuce or cabbage.
Because bacteria can grow well on the cut surface of fruit or vegetable, be careful not to contaminate these foods while slicing them up on the cutting board, and avoid leaving cut produce at room temperature for many hours.
Wash your hands with soap and water before preparing food and before touching others.
Avoid preparing food for others if you yourself have a diarrheal illness.
Changing a baby’s diaper while preparing food is a bad idea that can easily spread illness.

REPORT

Report suspected foodborne illnesses to your local health department.

Calls from concerned citizens are often how outbreaks are first detected. Play your part.
If a public health official contacts you to find out more about an illness you had, your cooperation is important. In public health investigations, it can be as important to talk to healthy people as to ill people.

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Answers to Questions about Vomiting and Diarrhea

December 10, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Coronavirus, Diarrhea, Gastroenteritis, health, Influenza, Intestine, Norovirus, Oral rehydration therapy, Rotavirus, Sterling Medical Advice, SterlingMedicalAdvice.com, Stomach, Straight No Chaser, There are 72 Hours in a Day, VomitingJeffrey Sterling, MD

Introduction

You’ve all been there and done that. It’s always a bad day when you get the so-called stomach flu… First of all ‘the flu’ is a respiratory disease (affects the lungs, not the stomach and intestines), and the influenza viruses don’t cause that syndrome of vomiting and watery diarrhea. So, what you’re actually getting is gastroenteritis (gastro = stomach, entero = intestines, and itis = inflammation), an inflammation of the stomach and intestines.

Gastroenteritis means inflammation of the stomach and small and large intestines. Most cases of gastroenteritis are infections caused by a variety of viruses that results in vomiting or diarrhea. Other symptoms may include belly cramping, fever and headache from all that retching. There are other (bacterial) causes of vomiting and diarrhea. However, the overwhelming number of cases is due to viruses. Your physician will know when the other considerations come into play. Here’s a few points you really want to know.

Is vomiting and diarrhea ever serious?

In most cases of viral gastroenteritis, the symptoms and condition are rate limited and will come and go without much further ado. Your symptoms will last up to 10 days in most cases.
The concern isn’t nearly as much with the vomiting and diarrhea as it is with the dehydration that can result from all those fluid losses. Dehydration can cause all manner of electrolyte abnormalities, leading to serious acute illness and even death. In fact, diarrhea and dehydration have long been the number one cause of death worldwide outside of the United States.

Is it contagious?

Absolutely. This is one of the main reasons you wash your hands, especially after using the bathroom. Fecal-oral (yes, anus to mouth) transmission of viruses makes gastroenteritis and many other illnesses contagious. Hand shaking and other forms of contact (including eating food poorly handled or undercooked) extend the risk of transmission.

How can I avoid gastroenteritis?

There are good options available to you.

Avoid food and water that you believe to be contaminated, perhaps because others have had problems with it.
Frequent hand washing is very important.
Similarly, wash and disinfect possibly contaminated clothing and surfaces, preventing this before it gets started.
A vaccine is available for two of the more common causes of gastroenteritis. Discuss whether it’s appropriate for your child with his/her pediatrician (it needs to be given during your child’s first year of life).

How will it be treated?

Fluids, fluids and more fluids will be given. Unless you can’t keep anything down at all, the fluids should be given by mouth. It’s interesting to note that the U.S. overuse intravenous (IV) fluids much more in these instances than the rest of the world. Learn about oral rehydration therapy (ORT). It’s how the rest of the world (very successfully) treats most cases of vomiting and diarrhea. Furthermore, ORT is roughly approximated by all those popular rehydration brands. The key is to take in enough fluids to stay ahead of the fluid losses. ORT is available over the counter, and remember that you don’t have to guzzle it. As little as a teaspoon at a time still can keep you hydrated.

It’s important to discuss some other treatment considerations.

Antibiotics don’t work against these viruses, so in this example, they won’t be helpful.
In select instances, your physician may provide symptomatic treatment for vomiting and diarrhea, but in the absence of this, they should be avoided. There are significant consequences to taking these medications. Get your physician involved in taking that risk.

In summary, you don’t always have to run to the ER when you get the runs. Stay hydrated, my friends.

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The Holiday Heart Syndrome

December 9, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

There’s something about the holiday season and flickering. We’re all aware that Christmas lights are meant to do so, but did you know that your heart is more inclined to flicker and flutter this time of year (sorry, but I’m not talking about mistletoe)? In a previous Straight, No Chaser, we discussed a mental consideration concerning the holiday season: the increased rate and risks of depression, known as The Holiday Blues. Unfortunately, health issues associated with the holidays don’t stop there. There are defined physical risks associated with the holidays as well. The disturbing aspect of today’s topic is you’re not immune to this even if you’re otherwise healthy.

The Holiday Heart Syndrome

Holiday heart syndrome is a real condition, and it has been described as such since the 1970s. It’s the result of eating and drinking alcohol too much (with or without excessive caffeine intake and a lack of sleep). Does this sound familiar for this time of year? The combination of these indulgences places an undue level of strain on the heart, which causes the heart to develop an abnormal rhythm, most commonly atrial fibrillation. Interestingly, certain foods, alcohol and caffeine all have direct effects on the heart, and indirectly they can also affect the heart through increase of certain hormones (such as epinephrine) that stimulate the heart.

Curiously, holiday heart syndrome is notable for its occurrence in those without existent heart disease. Still, it can be especially concerning in uncovering existing disease or exacerbating disease in those having it. For example, someone with underlying cardiovascular disease featuring microclots can have such clots dislodge during an episode of atrial fibrillation, causing a stroke.

Prognosis

Fortunately, by far the common course of holiday heart syndrome is benign. The abnormal heart rates will slowly resolve as the levels and effects of alcohol and/or other substances decline. That said, the risk is such that you don’t just want to sleep off an occurrence.
Symptoms are pretty obvious, given that you’d have been eating and drinking to excess. You’d also note that your heart was racing and perhaps pounding, as if it was attempting to jump out of your chest. Heart rates in the 120s are pretty typical for holiday heart syndrome (a normal heart rate is between 70-100 beats per minute). This tidbit is important to know; if your heart rate is higher than this, something more serious could be occurring. Under either circumstance, you need to be evaluated and treated in the emergency room setting with hydration and observation of the heart rhythm and rate.

Lessons

The lessons here are pretty straightforward:

Holiday heart syndrome suggests that indulgences that occur during the holidays can cause symptoms. By no means does it suggest that these symptoms are restricted to the holidays. Overindulgence in food and drink can cause abnormal heart rhythms at any time. That includes weekends, spring break and birthdays, in addition to holidays.
The combination of vodka and the energy drink Red Bull make these symptoms more likely to occur.

What you can do

Following alcohol-related abnormal heart rhythms, it is advisable for patients to avoid significant exertion. Excessive stimulation that raises epinephrine levels can precipitate recurrent and possibly cause more serious episodes. Most patients without underlying heart disease should be able to gradually resume full physical activity over the next few days. Once everything is back to normal, most patients do not require further therapy if they refrain from alcohol use. Patients with underlying heart disease, heart disease that’s discovered during evaluation, or those with severe symptoms on presentation (e.g., blackouts or simultaneous low blood pressure) may be candidates to receive certain heart medications.

At the end of the day, Holiday Heart Syndrome is yet another example of the virtue of enjoying life in moderation. Failure to do so can turn the holidays into the most dangerous time of the year. Cheers!

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Hypertension Vlog: A Ticking Time Bomb

December 8, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, high blood pressure, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Welcome to the Straight, No Chaser hypertension vlog!

The Straight, No Chaser vlog (video blog) series presents “health care basics” to keep you safe, healthy and out of the emergency room. Straight, No Chaser has addressed high blood pressure (hypertension) on many occasions, simply because it’s just that important. Hypertension is a common denominator for so many additional illnesses and in many deaths. We address it in today’s vlog because it is a health care basic. Learn what’s needed to keep yours under control. Happy Holidays!

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Frequently Asked Hypertension Questions

December 7, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Conditions and Diseases, high blood pressure, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

In this post, we answer frequently asked hypertension questions.

High blood pressure (hypertension) is so prevalent and such a consequence of the way we live that you must already have an understanding of some basic principles if you care at all about your health. Feel free to offer your own questions or comments.

How do I know if I have high blood pressure?

You know by the numbers. Consider these defining blood pressure levels.
Normal – Systolic: < 120 mmHg, Diastolic: < 80 mmHg
At risk (pre-hypertension) – Systolic: 120–139 mmHg, Diastolic: 80–89 mmHg
High Systolic – Systolic: 140 mmHg or higher, Diastolic: 90 mmHg or higher
If you don’t already have a diagnosis of hypertension and are anywhere at or above the pre-hypertension stage, get checked by your physician.

But when should I get go to the emergency room for high blood pressure?

I’ll always want to see you if your bottom number (diastolic blood pressure) is at or above 110-115, regardless of whether you appropriately take your medication. Don’t look for symptoms to guide you. High blood pressure is called “the silent killer.”

If I do have high blood pressure, will I be placed on medication?

I really hope not, but honestly, approximately two-thirds of individuals in the U.S. who have high blood pressure are poorly controlled – even on medication. This means medication will be necessary for most. That said, theoretically, medication should be viewed as necessary only when necessary and only when other measures don’t work. You should discuss this with your individual physician and make every effort to improve your diet and exercise regimens. If and when you’re placed on medication, the choice of medication will be based on your age, sex, ethnicity, mobility, existing health profile and other considerations.

You mentioned I could have a heart attack or stroke from this? How would I know if that’s happening?

Check here for Heart Attack Recognition and here for Stroke Recognition where I discuss signs and symptoms. Remember, time is tissue, meaning you must not delay if you develop these symptoms.

What else can I do?

Be healthy! Don’t smoke. Limit alcohol intake. Lower your stress level. This is only a broken record if you’ve received the message and have implemented the recommendations.

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High Blood Pressure (Hypertension)

December 6, 2018General Health and Wellness844-SMA-TALK, Behind the Curtain, Blood, Blood flow, Blood pressure, Heart failure, Hypertension, Kidney, Muscle, Myocardial infarction, Organ, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Hypertension (aka high blood pressure) is called the silent killer. It’s common for me to see someone who thought they were ‘fine’ drop dead from its effects, never knowing it was about to happen and not having been aware of the warning signs and risk factors.

In lay terms, your heart is just a muscular pump pushing blood (containing oxygen and nutrients) around the body keeping stuff alive. The more you poison that pump (by ingesting unhealthy foods and inhaling other toxins) and strain the muscle by adding weight and clogging its vessels so it has to pump against more force (by being obese, not exercising and engaging in other unhealthy behaviors), the more likely that muscle is to strain until it gives out. Once it does, blood isn’t delivering what’s needed to your vital organs, and that’s when bad stuff happens.

Organs Placed at Risk by High Blood Pressure

The vital organs in question and those bad effects include the following:
• The heart itself (no blood flow and no oxygen = heart attack; when the heart’s not strong enough to pump blood around the body = congestive heart failure)
• The blood vessels, especially the heart’s main offshoot, the aorta (too much strain = aneurysm, an outpouching from the main tubular system, stealing valuable blood from the rest of the body)
• The brain (no blood flow and no oxygen = stroke; aneursyms also occur in the brain)
• The kidneys (not enough blood flow or adequate enough function to clear the toxins from the kidney = renal failure)
• The eyes (poor blood flow and/or diseased eye blood vessels leads to vision loss)

The Bottom Line on Hypertension

The heart is a muscle best thought of as a machine. Here’s three easy things you can do to reduce your risks.
• Get off your rump viagra priser. Any exercise helps to get your heart pumping and blood flowing; strive for 20” three times a week at the very least.
• Close your mouth. Everything in moderation is cool, but introduce some fruits and vegetables into your life.
• Lose the salt shaker. At least taste your food first. It’s likely the food was already prepared with salt.

Did I mention to stop smoking? Any questions?

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