Tag Archives: SterlingMedicalAdvice.com

Even More Breast Cancer Myths!

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

Introduction

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

More Breast Cancer Myths

6. “Breast cancer is preventable.”

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

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

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

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

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

9. Caffeine causes breast cancer.

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

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

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

Even More Breast Cancer Myths!

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

Not true. Neither has any connection to breast cancer.

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

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

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

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

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

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

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

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

16. “Breast cancer is a death sentence.”

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

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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!

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. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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.

Five Breast Cancer Myths

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

Introduction

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

Breast Cancer Myths

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

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

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

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

3. “Men don’t get breast cancer.”

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

4. “I heard breast implants cause cancer.”

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

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

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

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How to Perform the Breast Self-Exam

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

Introduction

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

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

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

Special considerations

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

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

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

How to perform the breast self-exam

Horizontal positioning

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

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

Standing position

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

Summary

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

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

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

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

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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!

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.

October is Breast Cancer Awareness Month

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

Introduction

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

Breast Cancer is Different

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

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

Breast Cancer Awareness

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

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

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

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

Introduction

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

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

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

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

Escaping Imminent Domestic Violence Abuse

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

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

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

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

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

Dealing With Your Abuser

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

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

After You’ve Escaped

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

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

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

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

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

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

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

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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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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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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