Tag Archives: Straight No Chaser

Straight, No Chaser: Do You Even Know How to Eat Healthy?

January 4, 2014Diet and Nutritionhealthy eating plate, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We’re still in New Year’s resolutions mode! Yesterday we introduced you to why you exercise, and later we’ll teach you how. Today’s post is about your diet. So many times we hear “Eat Healthy,” as if we actually know what that means. Well today you’ll learn. Of course, whether you choose to do it is up to you!

For many years, pyramids were the way nutritionists would communicate about healthy eating. In case you weren’t aware, there has been a paradigm shift, and plates are in. Of course it seems rather obvious that it’s easier to communicate these things in a way representing how we eat. For the definitive source, I return to the Harvard School of Public Health. See the lead picture above. (Go Crimson!)
I’m going to make this very simple (or should that have been “digestible”) and simply discuss the contents of your plate.
Here’s your Healthy Eating Plate blueprint for a typical meal:

Fill half of your plate with produce—that means fruits and vegetables. The broader the variety, the better. Sorry, but potatoes and French fries don’t count as vegetables!
Fill a quarter of your plate with whole grains. Whole grain foods help lower the risk of coronary heart disease, stroke, obesity and diabetes. The sure way to know you’re choosing a whole grain food is simply in the name. When you’re grocery shopping, the product will actually say “whole grain.” This is not the same as multigrain.
Fill the rest of your plate with a healthy source of protein such as fish, poultry, beans or nuts.
You may have noticed a glass bottle in the picture. This is meant to represent a reminder to use healthy oils—such as olive and canola—when cooking, on salad, and at the table. You’ll notice the absence of butter and fatty salad dressings on the plate.
Regarding beverages, do yourself a favor. Try to drink water, and rediscover how refreshing it is. You don’t have to pay for another beverage just because you’re used to doing so. Tea or coffee are healthy options if you use little or no sugar. Milk and other dairy products should be limited to one to two servings a day.

In a subsequent post, we provide a series of healthy eating and dieting tips to get you through your days. I hope you take the time to integrate this basic scheme into your eating habits. If you do, you will be well on your way to a sustainable lifestyle change that should have been the basis of any diet-related New Year’s resolution!
Feel free to ask your SMA expert consultant any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress
Copyright © 2008. For more information about The Healthy Eating Pyramid, please see The Nutrition Source, Department of Nutrition, Harvard School of Public Health, www.thenutritionsource.org, and Eat, Drink, and Be Healthy, by Walter C. Willett, M.D., and Patrick J. Skerrett (2005), Free Press/Simon & Schuster Inc.

844-SMA-TALK

January 3, 2014UncategorizedMedical advice, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Chat with your doc recently? Probably not. I can tell you from experience that s/he isn’t ignoring you. Just swamped and bracing for an avalanche of newly insured patients per the Affordable Care Act and expansion of Medicaid developments.
Not to worry. Your personal healthcare consultants at SterlingMedicalAdvice.com can inform and advise you whenever the need arises.
Call us at 844-SMA-TALK. Please SHARE us with your friends and family!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: The Benefits of Exercise and Other Physical Activity

January 3, 2014General Health and WellnessCardiovascular disease, exercise, physical activity, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

At Straight, No Chaser, we understand it’s the most optimistic time of the year. You’ve made many New Year’s resolutions, usually related to smoking cessation, eating better, lowering your levels of stress and starting an exercise routine. We’re here to help. The next several posts will feature our best advice to educate and motivate you as you pursue those goals.
As we begin the conversation on exercise, we will split the conversation into the “why” and the “how.” This post will remind you of why keeping your body moving is so important and why, no matter your age, sex, ethnicity, physical condition or presence of existing disease, you can improve from your current state.
Remember that your heart is a muscle, the purpose of which is to pump blood with its nutrients and oxygen around the body, supplying your organs. The more efficiently that muscle performs, the healthier you’ll be, because your vital organs will stay nourished. It’s important to restate that everything is relative, so starting with most any regular activity that’s more than your current baseline will improve your conditioning and eventually your health.
How, you might ask! Here are medically established ways that a routine of regular exercise provides physical and mental health benefits.

Exercise controls your weight by burning calories.
Exercise reduces your risk of cardiovascular disease by improving your heart’s function. It lowers the risk of both heart attacks and strokes.
Exercise reduces your risk for type 2 diabetes and combinations of high cholesterol, high blood pressure and high glucose levels (together known as metabolic syndrome).
Exercise specifically reduces your risk of colon and breast cancers, and it probably reduces your risk of endometrial and lung cancers.
Exercise improves the functioning of your immune system.
Exercise strengthens your bones and muscles, and it keeps your joints functioning well.
Exercise maintains your mobility and agility, it improves your ability to perform the activities of daily living and prevent falls as you age.
Exercise slows the development of arthritis.

Exercise improves your mental health and mood by stimulating pleasurable parts of your brain and improving blood flow to your brain.
Exercise reduces the rate of depression.
Exercise reduces the development of insomnia and other sleep disorders.

The sum total of these facts is that exercise increases your chances of living longer.

At Straight, No Chaser we talk a lot about healthy and unhealthy decisions and the impact these decisions have on the length and quality of your life. There aren’t many lifestyle decisions you can make that will more positively impact those than the decision to stay physically active. Furthermore, that decision doesn’t need to be followed by the fear that in order to improve your health you have to turn your body into that of a stereotypical teenager, body builder or model. Moderate activity will produce measurable health improvements. In a subsequent post, we will explore the “how” of physical activity to improve your health, but for now, don’t just sit there. Do something!

If you can sprint, do so.

If you can’t sprint, jog.

If you can’t jog, walk.

Even it you can’t walk, move what you can!

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

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: The Gall(stones) of Some People

January 2, 2014GastrointestinalBile, Bile duct, Cholesterol, Conditions and Diseases, Gallbladder, Gallstone, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United StatesJeffrey Sterling, MD

Now that we’ve gotten past the twin holidays associated with large meals, it’s a good time to discuss topics related to your New Year’s resolutions of eating less, eating healthier and exercising more. Let’s start with a condition especially associated with eating large meals—gallstones.
To know them is to hate them. If you’re 40ish and in most instances overweight and/or obese, you may have been told you have gallstones. Many of you reading this will have already had their gallbladders removed; some are scheduled to do so. Today’s topic is one that points out how a little maintainence can go a long way in preventing a lot of trouble.
To understand the topic, I’ll provide some basic medical information.

The gallbladder is part of the digestive system, specifically the biliary tract. The biliary tract produces enzymes and the bile in the liver that helps the small intestine digest food. The gallbladder is where the bile gets stored. It releases bile when you eat.
Gallstones are hard particles that develop in the gallbladder as a result of an imbalance in these enzymes, such as occurs when bile contains too much cholesterol.

Your risk for gallstones increases if you’re in the following (independent) risk classes:

Female: Estrogen may increase cholesterol levels in bile. It may also decrease the contractions of the gallbladder that expels the juices from it. That stagnation produces an environment in which gallstones may form.
Obesity and a bad diet: Obesity increases the amount of cholesterol in bile, promoting stone formation. A bad diet (i.e., high in calories/carbohydrates and low in fiber) also increases the presence of gallstones.
Over 40 years old
Family history of gallstones
Mexican American
Native Americans have the highest rate of gallstones in the U.S., with almost 65% of women and 30% of men having them. They have genetic factors that increase the amount of cholesterol in their bile.
Rapid weight loss: Those of you on extremely low-calorie diets and having bariatric surgery increase your risks. As the body breaks down fat during fasting, the liver secretes increased levels of cholesterol into bile.

The symptoms of gallstones (a “gallbladder attack”) are pretty typically pain, nausea and vomiting, although many people with gallstones go without symptoms for a long time. Gallstones become especially problematic when they block the tubes (bile ducts) that transport the “digestive juices,” either through size or location. These attacks usually occur in the right upper portion of the abdomen (right below the chest and liver), which is where the gallbladder is located. Attacks tend to occur after a heavy meal, and they usually produces symptoms in the evening or late into the night.
See your physician ASAP if you develop any of the following symptoms:

Abdominal pain in the right upper portion of your abdomen that lasts more than four hours
Nausea and vomiting
Fever with abdominal pain
Jaundice (a yellowish coloration of the skin and/or the whites of your eyes)
Changes in the color of your stools (lightening) or urine (assume a tea-like color)

After diagnosis, treatment typically involves pain management and prevention of excessive fluid losses and dehydration. Surgery to remove the gallbladder due to excessive stones or symptoms is one of the most common adult operations in the U.S. Patients normally do fine after gallbladder removal, as the digestive tract can redirect the flow of bile and other digestive enzymes. Those that cannot undergo surgery have different treatment options, involving dissolving gallstones.
In summary, if this topic was particularly unappetizing, remember that in most cases, the risk and rate of formation of gallstones can be reduced by a high fiber, lower calorie diet, measured weight loss and exercise. Use this information to your advantage as you pursue those New Year’s resolutions!
Feel free to ask your SMA expert consultant any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: The Affordable Care Act and The Math of the US Healthcare System

January 1, 2014Public HealthACA, Affordable Care Act, Facebook, Health Care, Health system, Medicaid, Patient Protection and Affordable Care Act, Single-payer health care, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United States, WordPressJeffrey Sterling, MD

As we begin 2014 with the implementation of the Affordable Care Act and states’ implementation of Medicaid expansion (well in most of the country), it bears reviewing why this was necessary. Joining me in this conversation is Dr. Bill Vostinak, a prominent orthopedist.
Prior to approval of the Affordable Care Act, and in spite of the loud and incorrect proclamations that we have the “best healthcare system in the world,” the U.S. would have been easily challenged on its purported effectiveness of our healthcare system based on a simple review of the following objective data points. (Our apologies in advance to those who value opinions over facts—or math.)

Let’s start by appreciating just how much the U.S. has been spending on our healthcare system and what type of access Americans have had to it.
The U.S., by a large margin, has the highest healthcare expenditures in the world. We spend approximately 17% ($1 in every $6) of our gross domestic product (GDP) on healthcare. The next closest nation spends 11%. (For clarification, that’s an incremental increase from the above chart of 2000.)
Despite our exorbitant national costs, only 84.9% of U.S. citizens have healthcare insurance. That translates to 50 million Americans who were uninsured prior to today. We rank 33rd in the world.
Have you ever heard the quote that “85% of Americans are happy with their healthcare?” (Congratulations if that statement applies to you.) Do you realize that in a nation of over 320 million, that leaves 48 million Americans unhappy? Even if you got past the “48,000,000″ number, which is a massive number of citizens, consider the 85% number.
This is America. 85% is barely a B-grade in school. Is that the standard we seek? And … do the math. Notice the nearly exact match, likely not coincidental, between the number of individuals dissatisfied with their healthcare and the number of uninsured Americans. Basically, you’re satisfied if you have insurance, and if you don’t … not so much. Alternatively, 85% satisfaction may be based on the perception of insurance carrying the individual’s burden of medical costs.
Now let’s move to quality.
In an infamous ranking of healthcare systems around the world, the World Health Organization (WHO) ranked the U.S. system 38th based on routine outcomes-based metrics such as disability-adjusted life expectancy, speed of service, protection of privacy, quality of amenities, and fairness of financial contribution. WHO Ranking
Amid predictable criticism of the U.S. regarding the WHO study, Bloomberg performed its own analysis and discovered that among advanced economies, the U.S. spends the most on healthcare (on a relative cost basis) with the worst outcome. Bloomberg ranked the U.S. 46th among all nations in efficiency given the average expenditure of $8,608 per year per individual. Bloomberg Report
In terms of infant mortality, about 11,300 newborns die each year within 24 hours of their birth in the U.S., with 50 percent more first-day deaths than all other industrialized countries combined. Infant Mortality
Save the Children’s 14th annual “State of the World’s Mothers” report ranked the U.S. 30th out of 168 countries in terms of best places to be a mother. Criteria included child mortality, maternal mortality, economic status of women, educational achievement and political representation of women. SaveTheChildren.org
An important distinguishing factor in comparing U.S. healthcare with other systems is tying it to employment rather than citizenship. Labor and other costs of American goods and services make it difficult for American corporation to compete in world markets. Add the large fixed cost of healthcare, and competing is nearly impossible.
It is reprehensible to suggest that the effort to cover 50 million uninsured Americans is some socialist plot or anything other than the humane thing to do. Let’s just stop with the selfishness and nonsense about there being no value to the efforts being made to improve access to/quality of healthcare (which reintroduces preventive and mental healthcare considerations) than we had previously. If you don’t believe us, just do the math. Even after a full implementation of the ACA, estimates suggest than some 20 million Americans will still be uninsured.
America is alone among the major industrial nations of the world in not having universal healthcare. That’s the collective decision of the country. Hopefully, these most recent steps through the ACA will represent significant steps toward efficiency, effectiveness and full inclusion. So, how do other countries deliver quality care for less? We’ll save that for another discussion.
Feel free to ask your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

The Straight, No Chaser Comprehensive Safe Sex Guide

December 31, 2013Infectious Disease, Obstetrics and Gynecology, Health PreventionAnal sex, Condom, Dental dam, HIV, Human papillomavirus, National Institutes of Health, Safe sex, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This edition of Straight, No Chaser is a keepsake, whether for your own reference or as a conversation piece/teaching guide for others. I suspect that due to the volume and wealth of information contained within, you’ll refer to this post time and again (or so I hope). For additional information, refer to the U.S. Center for Disease Control and Prevention and/or the National Institutes of Health websites.

STAYING STD-FREE
The best ways to stay STI free is to confirm it and then avoid it. If you want to reduce your risk of acquiring HIV and other STIs (sexually transmitted infections) through sexual contact, here are your options.

Abstain from sex.
Be monogamous.
Prove both you and your partner(s) are negative. Get yourself and your partner(s) tested, preferably prior to engaging in sexual activity and subsequently every three to six months, especially if you and/or your partner have more than one sexual partner.
If and once you establish that you’re STI-free, learn how to use condoms and do so every time you have sex.

A special note about protecting yourself from HIV
HIV can be spread by having unprotected sexual contact with an HIV-positive person. “Unprotected” means any vaginal, anal or oral sex without barrier protection, like a condom or dental dam. Some of the ways to reduce your risk of getting HIV through sexual contact include the following:

Don’t have sex. Abstinence is the best way to be certain that you won’t contract HIV. Although HIV is occasionally transmitted in other ways, vaginal, anal and oral sex are the most common ways that HIV is transmitted.
Be monogamous. To be clear, this means you are in a sexual relationship with only one person and both of you are having sex only with each other. For the purposes of contracting HIV, sex includes vaginal, oral or anal sex activity. Monogamy is optimally effective if you also confirm early and often that both you and your partner are not infected with HIV.
Get yourself and your sexual partner(s) tested: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status likely will be difficult and uncomfortable, but it’s important to start the discussion BEFORE you have sex.

FRANKLY, “DON’T ASK, DON’T TELL” IS JUST DUMB WHEN IT COMES TO STIs.
This is actually quite simple. No excuses. You need to ask your sexual partner(s) and any possible future partners the following questions.

Have you been tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
When was the last time you were tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
If you’ve been tested, what were the results of your tests?

SAFER-SEX ACTIVITIES
These activities carry no risk of HIV transmission:

Non-sexual massage
Casual or dry kissing
Masturbation (without your partner’s body fluids)
Frottage—also known as “dry humping” or body-to-body rubbing

You can still contract other STIs, like herpes, HPV, or pubic lice (“crabs”) if you have bare skin-to-skin contact with your partner.

CONDOM USE
Here are two questions for both males and females.

Have you ever learned how to safely and appropriately use condoms?
Do you use condoms consistently?

To maximally reduce your risk of getting HIV or other STIs, you must use a new condom with every act of vaginal, anal or oral sex. If you don’t use them for oral but do for vaginal and anal, you have still lowered your risk, just not as much as you could have. Also, you must use condoms correctly, as depicted in the above diagram, to appropriately reduce your risk. Learning correct usage also will keep condoms from breaking or slipping off, which reintroduces the risks.
I also want you to understand that all condoms are not created equal. Latex condoms are highly effective against HIV and other STIs. Do you or your partner have a latex allergy? If so, the next safest condom choice is a polyurethane or polyisoprene condom. Just tell your pharmacist at the drug store that you’re allergic to latex, and s/he’ll take it from there. On the other hand, lambskin condoms do NOT protect against HIV. The particle size of the virus allows it to maneuver and slip through lambskin.
Condoms alone have never been enough. Did you know that you should always use a water-based lubricant when you use a condom for either vaginal or anal sex? I want to restate this: that’s water, not petroleum jelly. Water-based lubricants reduce friction and help keep the condom from breaking. Do NOT use an oil-based lubricant (such as petroleum jelly, hand lotion or cooking oil). Oil-based lubricants can damage condoms, making them less effective.
Both male condoms and female condoms will help protect you against HIV and other STIs. If you’ve learned to enjoy sex with a male condom, you can learn to enjoy it with a female condom or a dental dam. Additionally, there are many of you who have contracted STIs. If you wish to continue to enjoy a variety of sexual activities, learning to use the full range of barrier protection may be a better option for you and your partner than abstaining.
Condoms do not provide 100% protection against all STIs, but you are always safer using a condom than not. You can get certain STIs, like herpes or HPV, from contact with your partner’s bare skin, even if one of you is wearing a condom, but condoms lessen the risk. Take the time to explore and inspect each other if you’re confused or concerned about the possibility of your partner having an STI.
Spermicides only serve the purpose of reducing the risk of becoming pregnant. They are ineffective in preventing contraction of HIV and other STIs. They actually irritate rectal and vaginal walls, in effect increasing the chances of HIV infection should infected fluids come into contact with these areas.

ABOUT SEX TOYS
This is pretty straightforward. Using sex toys can be safe, but think of staying clean and “not sharing.”

It is important that you use soap and water to clean your toys after each use. If the instructions allow for a stronger disinfectant, you may do so.
As a rule, don’t share your toys. The nature of how toys are typically used likely increases the risk of vaginal or anal irritation, which increases the risk for HIV or other STI transmission.
If you “must” share your toy with your partner while still trying to be safe, use a condom on the toy before you use it, and change the condom before your partner uses it.

CIRCUMCISION
We’ve discussed circumcision at length in Straight, No Chaser. (Click here for a dedicated post on circumcision.) There has been ongoing interest and research over the past few years about circumcision and its effect on preventing HIV infection. The bottom line? In 2007, the World Health Organization reported that male circumcision reduced the transmission of HIV by 60% from women to men in three randomized, controlled studies in Uganda, Kenya, and South Africa.
There is much less available data for men who have sex with men and how circumcision might affect HIV transmission through anal sex. In addition, recent studies show that circumcision does NOT protect women from contracting HIV from male partners.
Let’s be careful in interpreting the results of these findings.

Circumcision is only additionally effective when earlier preventative efforts have not been taken. Advocating circumcision is not an appropriate substitute for any of the numerous safety measures and habits previously discussed to reduce one’s risk for HIV and other STIs.
Failure to have a circumcision does NOT increase one’s HIV and other STI risk in the presence of appropriate safe-sex activities.

So there you have it. Knowledge is power. We appreciate that this posting was not balanced by the human decisions and passions that come into place with sexual activity. We recommend that you adopt a posture of “safety first” to create that balance! Good luck, and feel free to ask your SMA expert consultant any questions you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: When Good Drugs Do Bad—Drug Interactions

December 30, 2013Toxicology/DrugsAdverse effect, Benadryl, Drug, Drug interaction, Facebook, health, Pharmaceutical drug, Pharmacy, Prescription medication, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Substance abuse, WordPressJeffrey Sterling, MD

“Be sure to let your doctor know if you grow a third foot.”
Ok, well maybe that is about the only side effect you haven’t heard at the end of one of those commercials that seem to spend half of its time describing the side effects. If you pay attention to a pharmaceutical commercial, though, you’ll appreciate that even though medicines do a world of good, sometimes they cause significant problems. Those problems can become sped up or magnified by the effects of taking several drugs at a time. Alternatively, combinations of medications may make one or more of the drugs less effective. Regarding the medicines you’re taking, you should be clear if drug interactions can be minor and insignificant or serious and life-threatening. Let’s review the various types of drug interactions.

Drug/drug interactions: Two or more different drugs taken together may interact and cause an unwanted effect or change how the drug acts in the body. Here are some common examples:

An individual who already takes a sedative (e.g., sleeping pill) to help combat insomnia develops an exacerbation of their seasonal allergies. To treat the allergies, they decide to take an over-the-counter (OTC) antihistamine (like diphenhydramine, branded as Benadryl). Diphenhydramine also may cause drowsiness, so the combination of the medications may pose a danger to the person, especially if s/he is operating heavy machinery, such as driving a car.
Caffeine (which is a drug) in everyday foods—such as coffee and chocolate—also can interact with certain other drugs. In fact, caffeine is known to interact with over 80 different drugs, including about a dozen with which it produces serious effects. These include commonly used medications like aspirin, ciprofloxacin (branded as Cipro), guafenesin (the generic name for your favorite cough medicines) and diazepam (branded as Valium).
Nicotine (another drug) in tobacco products can interact with other medications, especially nicotine-replacement products. So if you’re taking medicine to help with your smoking cessation efforts, and you’re still smoking, you’re making the problem worse!

Drug/food interactions: If you’re a fan of grapefruit or chocolate, then it’s likely that your physician has cautioned you on drug/food interactions. These occur when certain foods or beverages interfere with the metabolism of certain medications. In the example of grapefruit, it’s known to interfere with metabolism of medications used to lower cholesterol levels (called statins). This can lead to adverse drug effects and actual liver damage. Other examples are to be found in the many foods (e.g., red wine, aged cheese) that affect the antidepressant class of drugs known as MAO inhibitors.
Drug/condition interactions: You see these all the time. Many different medication instructions warn you not to take them if you have certain medical conditions, as the medications may make the medical condition worse. Prominent examples include over-the-counter cold, cough and flu remedies that advise you not to take if you have heart disease or high blood pressure. Also if you have kidney or liver disease, any medicine that gets metabolized via one of those routes may have difficulty and delays in getting metabolized and excreted, leading to longer than desired activity of the given drug.
Drug/alcohol interactions: This is actually a subcategory of the drug/drug interaction because alcohol is a drug. It deserves special mention because drinking alcohol while taking certain medications can cause adverse effects related to the additive effects of alcohol and various drugs. Any medication involving the central nervous system or one’s mental state would likely be worsened by alcohol.
The best way to guard against these concerns is to discuss any new medications with your physician or pharmacist prior to taking them. Be smart about medicines you’re putting in your body and don’t be cavalier about them; the wrong combinations can turn a medicine into a toxin.
One final note: don’t be lulled into complacency by herbal preparations as some form of replacement. Herbals are still medicines and work via the same active ingredient as the pharmaceutical drug they’re replacing. As such, they are subject to cause the same types of problems listed above. Even more concerning is that as a class, comparatively less research has been done on herbals. Therefore, the full extent of side effects and drug interactions is not defined. Not knowing the full extend of an herbal medicine’s side effect profile isn’t the same as saying the herbal doesn’t have side effects, and you shouldn’t interpret things that way.
Feel free to contact your SMA expert consultant for any questions you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Straight Talk About Vasectomies

December 29, 2013Genital/Urinary, Surgical Carehealth, National Institutes of Health, Pregnancy, Reproductive Health, Semen analysis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Surgery, Vas deferens, VasectomyJeffrey Sterling, MD

A couple’s conversation about having a vasectomy can either be a tense one or it can be a display of trust and cohesion. The decision by a man to have a vasectomy can be a soul-searching “moment of truth.” In this Straight, No Chaser, let’s look at seven of the issues surrounding vasectomies. At the end there’s an illustration of the procedure. Yes, it involves a clip.
A vasectomy is a surgical procedure that involves cutting the tube (the vas deferens) that carries sperm from the scrotum to the testes. The vasectomy prevents sperm from leaving the testes so that the man can’t impregnate a woman.
Issue 1: Why would you want it?
The answer to this is relatively straightforward. You’d want a vasectomy if you don’t want any, or any more, children. This is a form of sterilization.
Issue 2: When would it be a good option?
If you’re in a relationship and both partners agree that you’ve either had all the children you want or don’t want the risk of having any children, a vasectomy would be a reasonable option. Other considerations may include if you can’t use other forms of birth control, if pregnancy would be medically unsafe, or if the risk of genetic disease or a birth defect in your offspring is greater than you’re willing to accept.
Issue 3: When wouldn’t it be a good option?
This gets a little dicey and relates to levels of instability, either in your relationship or other personal situations. A decision to have a vasectomy to please your partner or salvage a relationship may not be the best choice. If you’re young or unmarried, you are subject to many life changes that may prompt reevaluating whether you really want a child. For example, if you marry/remarry, children may become more important than they currently are. A vasectomy is a surgical procedure with risks. A decision to have it done as a convenience (e.g., because you are unreliable or don’t want to use other forms of birth control) is irresponsible.
Issue 4: How successful is the procedure?
Vasectomies are very successful and have a failure rate of approximately 1 in 2,000. Comparatively speaking, the analogous procedure in females (tubal ligation) has a failure rate of 1 in 200-300. Typical failure rates are due to having sex too soon after the procedure. It takes time for existing sperm to be cleared from both ends of the vas deferens; that existing sperm can still impregnate a woman. This is a major reason why men should wait a week after the surgery and until the sperm count has been documented to be zero in the seminal fluid. To a much lesser extent, rare spontaneous reconnection of the clipped portions of the vas deferens may produce failures.
Issue 5: What complications exist?
Vasectomies are generally very safe, and the complications associated with it are those seen with any surgery. These include pain, swelling and infection. Remember, as we just discussed, the circumstances under which post-vasectomy pregnancies can occur.
Issue 6: What happens should I choose to have it reversed?
It is important for men considering a vasectomy to read and fully understand the next sentence. If you have a vasectomy, you should not consider it reversible. That said, you can spend a lot of money for a microsurgical reversal procedure that is successful about 50% of the time if done within 10 years of the vasectomy and approximately 25% of the time if done after 10 years. Be advised that such reversals are associated with a higher level of birth defects.
Issue 7: About what other considerations should I be concerned?

Men seemingly are most often concerned about post-vasectomy ability to have an erection or orgasm. Vasectomies do not diminish a man’s ability to have either.
You should be concerned about the spread of sexually transmitted infections (STIs), which a vasectomy does not prevent. A false sense of confidence may exist after a vasectomy knowing that pregnancy is extremely unlikely, but that has nothing to do with STIs. In fact the greater inclination to have unprotected sex after a vasectomy may put men at greater risk for transmitting or receiving STIs.
Vasectomies do not increase the risk of testicular or prostate cancer.

Most men are satisfied with vasectomies, because most men who have vasectomies do so in the context of a stable and healthy relationship. Men who are most likely to seek reversals do so in the context of unexpected life events (e.g., new partner/marriage with a desire for kids). Sometimes their reconsideration is in response to a tragedy. If you are considering a vasectomy, please only do so after a solemn view of the rest of your life. If you believe it to be stable, you will likely be satisfied with the outcome.
The following clip (click the link) is courtesy of the National Institutes of Health and demonstrates the logistics of the various approaches to the procedure. Feel free to leave any comments or ask any questions you may have.
Vasectomy
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Straight, No Chaser: The Treatment of Arthritis

December 28, 2013Geriatrics/Elderly Care, Medical Treatment, Orthopedics/Bones, Musculoskeletal SystemArthritis, Conditions and Diseases, Disease-modifying antirheumatic drug, health, Non-steroidal anti-inflammatory drug, Omega-3 fatty acid, Pain, Pharmaceutical drug, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The thing about treating arthritis is you’d better do it. If you’re not lucky enough to have a form that readily responds to treatment or if you didn’t get early treatment, your arthritis will progress and create an incrementally worse situation for you. Given that we’re discussing arthritis, we’re talking loss of mobility somewhere, maybe in your legs or hands, and pain.
The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause often cannot be cured.
Treatment considerations for arthritis fall into three general categories: lifestyle changes, medication and surgery. Let’s review each.
Lifestyle
The best time to enact lifestyle changes is before you’re struggling to return to normalcy. Exercise is a lifelong habit that will improve the quality and extend the quantity of your life. For starters, exercise maintains and improves muscle tone. It also strengths your bones and cartilage. This will reduce pain, fatigue and stiffness over the long term.
Exercise should include a tolerable level of aerobic activity, flexibility exercises to sustain your range of motion and strength training to maintain and improve your muscle tone. Physical therapy is another component; massage, heat and ice application, splints and other treatments are important in maintaining blood flow, mobility and positioning as stiffness and deformity increase over time.
Medication
Using medication for arthritis is a very delicate act. Many if not most arthritics are aging and may have other medical issues. Medications in these settings have risks for side effects and drug interactions, including kidney, liver and heart damage, stroke, ulcers and bleeding. Any medications should be coordinated with your physician. Typical over-the-counter (OTC) medical regimens begin with acetaminophen, then move to NSAIDs (non-steroidal anti-inflammatory agents such as ibuprofen, aspirin or naproxen).
When OTCs don’t work, your doctor may prescribe medicines, including steroids and other medications called biologics, immunosuppressants and DMARDs (disease-modifying anti-rheumatic drugs). These drugs all are effective in certain patients but can have serious side effects.
Surgery
Surgery is an option if and when other therapies haven’t worked and if the patient is healthy enough to have it. There are two primary options. Arthroplasty rebuilds the joint, and joint replacement starts from scratch.
Let’s start back where I’ll always hope you start: prevention. Here are some lifestyle change tips for holding off the onset of arthritis or slowing down its advance.

If you are overweight, do what you can to slim down. Weight loss significantly reduces joint pain in the legs and feet.
Eat a healthy diet full of fruits and vegetables. Among other things, a rich supply of vitamin E yields benefits you’ll need. Also eat foods rich in omega-3 fatty acids (e.g., salmon, mackerel, herring, flaxseed, canola oil, soybeans and soybean oil, pumpkin seeds, and walnuts).
Sleeping eight to 10 hours a night and taking naps during the day can help you both prevent and recover from flare-ups more quickly.
Avoid staying in one position for too long.
Try stress-reducing activities, such as meditation, yoga or tai chi.
Avoid positions or movements that place extra stress on your sore joints.
Change your home to make activities easier (e.g., grab bars in the shower, the tub, and near the toilet).
Consider capsaicin cream over your painful joints. Typically expect improvement after three to seven days if it’s going to help.

If and when you develop arthritis, it’s going to be a tough time. Get ahead of the challenge and take care of yourself in advance. Feel free to ask questions or leave comments.
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Straight, No Chaser: The Inevitable Disease (Assuming You Live Long Enough)

December 28, 2013Geriatrics/Elderly Care, Orthopedics/Bones, Musculoskeletal SystemArthritis, Conditions and Diseases, Facebook, health, Inflammation, Joint, Musculoskeletal Disorders, Osteoarthritis, Psoriatic arthritis, Rheumatoid arthritis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Actually, humans have a few different “inevitable” diseases, but today we’re discussing arthritis, specifically degenerative joint disease (osteoarthritis). For this conversation, the inevitability of arthritis is based in the gradual wear and tear on your joints. It seems our design includes an expiration date on our joints. By now, you’re likely wondering why. The answer is in the definition.
Arthritis is inflammation of one or more of your joints.

Inflammation is a process of some form of attack to an area, producing symptoms that usually include redness, swelling, warmth and pain.
A joint is the area where two bones meet.

It stands to reason that when regular use becomes wear and tear, ongoing inflammation ensues, the structure of your bones and joints changes and function decreases. This is why you see decreased movement and deformities in the involved joints of arthritics.
What I just described was a reasonable description of osteoarthritis, the most common form of arthritis, but in fact there are over 100 different types of arthritis. Given its importance in helping you understand and treat yourself and/or your loved one with arthritis, let’s review the common and distinguishing mechanisms.

Arthritis involves the breakdown of cartilage, which is the tissue coating the ends of two bones at a joint. Its purpose is to keep the bones in place and moving smoothly. When cartilage is damaged, the bones rub together. This damage results in pain, swelling, stiffness, warmth and redness—inflammation.
The causes of this inflammation are broad but typically center on four mechanisms:

The aging process itself causes sufficient wear and tear on the body, including bones and cartilage, such that the joints will suffer. This represents the most common form of arthritis: degenerative joint disease, aka osteoarthritis.
When you break bones, especially near a joint, the resulting damage and/or insufficient healing will expedite the development of arthritis.
When you develop certain infections, they can occur in the bones/joints or target those areas. This also can lead to arthritis.
The body’s immune system sometimes mistakenly views certain parts of the body as foreign. When this occurs, it will attack healthy tissue, including bones and cartilage. These conditions are known as autoimmune disorders, and they cause inflammation and can lead to acute and chronic arthritis.

You’ve heard of many different forms of arthritis. If you know anyone with any of the following diseases, they likely have arthritis as part of (if not the predominant feature of) the disease.

Ankylosing spondylitis
Gonococcal (i.e., due to gonorrhea) arthritis and other arthritis due to other bacterial infections
Gout
Juvenile rheumatoid arthritis (in children) and rheumatoid arthritis (in adults)
Psoriatic arthritis
Reactive arthritis (Reiter syndrome)
Scleroderma
Systemic lupus erythematosus (SLE)

The inflammation and other symptoms usually go away if you can find and treat the cause. If it doesn’t go away, or if it goes untreated, chronic arthritis will develop.
Here are the various conversations you should have with your physicians regarding arthritis:

“I have a family history of arthritis. Should I be concerned?”
“I have a newly swollen joint but didn’t strain or sprain anything.”
“All of a sudden my joint (or joints) have really started hurting.”
“My skin in my (knee, elbow or other joint) is very hot and very red.”
“I have arthritis, and now I’m having problems moving my joint.”
“I have arthritis, and the swelling is much worse.”
“I have arthritis, and my pain has lasted more than three days.”
“I have arthritis, and I have developed a fever plus my joints are really aching.”
“I have arthritis, and I seem to be losing weight.”

This afternoon, I’ll discuss general treatment of arthritis and tips you can use to help yourself or your loved one with arthritis. I welcome any questions or comments you may have on this topic.
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Straight, No Chaser: When the Patient Knows Better

December 27, 2013General Health and Wellness, Public HealthAsthma, Conditions and Diseases, Cough, health, Influenza vaccine, medicine, Physician, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

So … your friendly neighborhood ER physician chats with a patient.

Client: “Doc, I’m sick. I need my asthma medicine. I need steroids, an inhaler and some antibiotics.”
Expert: “Oh really. How do you know that?”
Client: “Oh, I get the same thing this time every year.”
Expert: “Hmm. Same time every year, huh? Would you mind telling me your symptoms first?”
Client: “Cough, chest tightness, wheezing. I’m telling you. Same thing every year.”
Expert: “Have you gotten your flu shot this year?”
Client: “I haven’t had the flu shot since 2005, but I’m going to get it in January. But this is my asthma! C’mon, Doc. I just need my antibiotics and my asthma medicine.”
Expert: “There’s an adage in medicine that has been proven true a million times over. A physician that treats himself has a fool for a patient. Now, if physicians won’t treat themselves …”
If I’ve heard it once, I’ve heard it a million times.

“I know my body.”
“I’ve had the exact thing before.”
“I read it on the Internet.”
“I had a friend with the same thing.”
“I just want to make sure.”
“Well you have to do something, don’t you?”

Medicine is a science. By that, I mean a real science made of facts—not opinions, educated guesses or perspectives. There are seemingly a million paraprofessionals and incredibly intelligent people on the periphery of healthcare who have what we describe as an “experience base.” That means they “know” it because they’ve seen it or just read it. That is completely different than a knowledge base. Physicians have completed between seven and 10 years after undergrad learning, understanding and mastering the human body. What does that mean to you? Basically, the methodology for practicing medicine is not the linear A+B=C (i.e., “I have this symptom, therefore it must be this disease”).
Yes, this applies to you. Even you, dear “I know my body better than you do” reader. When you tell your physician that you’ve seen or experienced something before, you’re basically suggesting your sample size of one defines the entire universe of medicine. Even as it applies to you, the body is a wondrously complex creation with many, many variables affecting a single breath or heartbeat.
So, when your physician is telling you something different than what you believe or expect to hear about your condition, it’s not that s/he isn’t listening to you. It’s that s/he has listened to you and has come to a different determination. That’s why physicians have the power to write prescriptions, and you (and even pharmacists) don’t.
Of course, none of this is to say that your input isn’t valuable. It is valuable, and that’s why the physician asks you the questions. This is not even to say that physicians don’t make mistakes. This is to challenge you to allow the conversation to occur. Ask your own questions. Demand an explanation from your caregiver. Insist on being part of the care team and a partner in your treatment plan. Learn what to look for, what you can do at home and what should prompt additional measures. If you are stuck on a course of treatment before the conversation occurs, it is just as pointless as if a physician refuses to listen to your concerns.
Cut your physicians some slack. Many of you get so frustrated and outright angry when you don’t get your way. Physician’s offices and emergency rooms are not grocery stores. It’s not as if docs own the pharmaceutical company or the hospital. They’re just trying to care for you as best they can. As much as physicians love to provide satisfaction to patients, caring for you appropriately is of a higher order. Many of you understand this, and as such physicians continue to have among the highest rating of “trust” among professionals. It’s a privilege to take care of patients. The overwhelming majority of us still understand that fact.
Postscript: It was the flu.
PPS: A little advice from a friendly online SMA expert might have saved her the trip to the ER.
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Straight, No Chaser: The Challenges and Frustration of Acute Bronchitis

December 26, 2013Respiratory/LungsAcute bronchitis, Bronchitis, Bronchus, Chronic bronchitis, Cough, Fever, health, Inflammation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Tobacco smoking, WordPressJeffrey Sterling, MD

Imagine what it looks like when someone gets hit in the jaw. There’s the redness, swelling from excess fluid in the area, warmth and pain. Those are the components of inflammation. Now imagine those symptoms in your lungs as you’re trying to breath and deliver oxygen to the rest of your body. Off the top of my head, I can’t think of a more frustrating diagnosis than bronchitis for both patients and physicians alike. I’ll get into the reasons for that soon enough, but a bit of explanation is definitely in order.
Bronchitis is inflammation of a portion of the airways (the bronchi). Far and away, bronchitis is seen in smokers and after a viral, upper airway infection (e.g., a cold, the flu). In that last statement I slipped in two words that create the frustration regarding this condition: viral and smokers. There’s still more to come on what that means for you.
Everyone reading this has suffered from bronchitis at some point, and, based on what’s already been said, it’s easy to figure out what the symptoms would be. The inflammation of your airways leads to a cough, shortness of breath, chest discomfort, a mild fever and fatigue. If you have asthma, you’re likely to start wheezing. Another major source of frustration is even after the bronchitis has gone away or been treated, the cough stays around for up to an additional four weeks. This gives many the impression that they’re still sick, and leads them to demand that the doctor do something to “fix it.”
There are a few more problems dealing with or treating acute bronchitis.

Bronchitis is actually the most common cause of coughing up blood. Coughing up blood or producing blood-tinged mucus tends to make people anxious, and they often start thinking of things like cancer. That train of thought makes some people want to take every test possible to rule out cancer, “just to be sure.” Now your physician knows better and isn’t going to do that unless you have additional symptoms or tell a story more consistent with cancer. That often leads to a lot of frustration and sometimes anger.
Bronchitis is most often caused by smokers who don’t stop smoking even while they’re suffering. It is a very tense conversation (from both sides) when you return to the ER five days after being seen and diagnosed with bronchitis, and you’re complaining because you’re not better. Folks, even if your physician puts out the fire, if you continue to relight the match, it’ll continue to blaze.
Bronchitis is not pneumonia, which is an infection of the lungs. In most cases where bronchitis has an infectious cause, that cause is a virus. Viruses do not respond to antibiotics. You physician understands that you’re sick. Just because you’re sick and coughing, that doesn’t mean you need antibiotics or that antibiotics will cure you. Inappropriate antibiotic use is not without long-term complications that you should want to avoid. (Click here for a discussion on inappropriate antibiotic use.) In most cases, assuming you remove the source of inflammation (e.g., cigarette or cigar smoke, dust, allergens), your symptoms will improve on their own within a week, and all you need is supportive therapy such as cough, fever and pain medicines along with fluids and rest. You must also practice good hygiene to avoid spreading any viruses that may be causing the bronchitis.
What complicates this is when your weakened state and continued exposure to whatever is causing the inflammation allows a bacterial infection to land on top of your bronchitis. Ask your physician if it’s possible that this is what is going on. S/he will know how to proceed, including potentially using antibiotics.
In a majority of cases, a diagnosis of bronchitis will be a big source of frustration for patients because, from the physician’s standpoint, bronchitis is an easily diagnosed condition due to an obvious cause (such as a cold or cigarette smoking). As such, your physician is likely not to order a lot—or any—tests. Now from the patient’s standpoint, don’t you just hate going to the physician’s office or ER when you’re sick and “nothing” gets done? Well, especially in an ER setting, tests are not used to make diagnoses. They’re meant to be ordered if the results will change the management of the condition or might lead to a change in what is done with you (e.g., admit you to the hospital). Most often, that’s just not going to be the case with bronchitis. Now if after 3–5 days symptoms haven’t improved, you’ve stopped smoking and the mucus you’re coughing up looks a certain way, there’s plenty that will be done differently in most cases.

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

You have a documented high fever or have had a documented fever for more than three days.
You have greenish or bloody mucus, or you are coughing up only blood.
You have shaking chills.
You have chest pain or shortness of breath.
You have heart or lung disease (such as asthma or COPD/emphysema).

Over time, bronchitis can become chronic if the source of the inflammation isn’t removed. If you find yourself with ongoing symptoms for over three months, you will fall into a different category known as chronic bronchitis. Your physician will need to address additional considerations for you.
So often patients with bronchitis are looking for a “quick fix.” As is often the case, that fix is to be found in prevention. In this case, good hygiene and avoidance of smoke and other lung irritants can save you a lot of the shortness of breath and chest pain associated with bronchitis (pun intended).
Feel free to contact your SMA expert consultant if you have any questions on this topic.
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Straight, No Chaser: The Intersection of Health and Happiness, aka Merry Christmas!

December 25, 2013Mental HealthChristmas, Facebook, Hanukkah, Happiness, Harvard School of Public Health, health, mental-health, Merry Christmas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Today is Christmas, and we want to celebrate the best parts of you! Even better, do that for yourself and allow that to translate into better health. We have previously discussed your bad habits and how they negatively impact your health. Click here for that discussion. The literature on negative energy and health is well documented and robust. In short, avoid negativity and those that bring it to you! That said, we’re following our own advice and going positive today. That’s the other half of the “health and emotions” equation:

STATE OF MIND = STATE OF BODY.

So here we go.

Research from the Harvard School of Public Health (Go, Crimson!) led by Laura Kubzansky, Associate Profession of Society, Human Development and Health, identified personal attributes that actually do translate into better health. Specifically these personality traits have been shown to help avoid or healthfully manage depression, diabetes, heart attacks, strokes and other diseases.
Her landmark 2007 study followed over 6,000 men and women for over 20 years, discovering that a sense of enthusiasm, hopefulness, engagement in life and the ability to face life’s stresses with emotional balance appears to reduce the risk of coronary heart disease. Her studies have also demonstrated that children with a positive outlook and ability to focus on a task at age seven are in better health with fewer illnesses 30 years later. An additional finding of hers is that optimism cuts the risk of coronary heart disease in half.
This isn’t that hard. It just requires a rewiring of some of our outlook on life. Make a change today. Become a more positive person; become a healthier person! Incorporate these mental lifestyle changes and reap the benefits.

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

Speaking of Christmas, the Straight, No Chaser team greatly appreciates your readership, support and feedback. In a matter of a few months, over 3,000 of you both follow us and like us on Facebook. We’ve had readers in over 105 countries around the world. Most of all you’ve helped us successfully launch www.SterlingMedicalAdvice.com (SMA). We’ll continue to give you information to make a difference in your lives. Please continue to share your stories. It is very fulfilling and fascinating to hear how these efforts have made a difference in your lives. Feel free to continue to send us topic requests. We generally find a way to work them into the schedule.

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

Feel free to ask your SMA expert consultant if you have any questions on this post.

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Straight, No Chaser: Flu Myths and Questions

December 24, 2013Infectious DiseaseCDC, Center For Disease Control and Prevention, Centers for Disease Control and Prevention, Disease, health, Influenza, Influenza vaccine, Influenza-like illness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Vaccination, Vaccine, WordPressJeffrey Sterling, MD

Every year 36,000 people die and over 200,000 are hospitalized each year due to the flu—in the U.S. alone. If you’re not getting a vaccine every year, you are subjecting yourself to a significantly higher risk and allowing fears and myths to get the better of you. Knowledge is power. Learn the facts.
Does the flu shot give you the flu?
No, no, no. The influenza vaccine cannot cause flu illness. There are vaccines that involve the delivery of live virus, including mumps, measles, rubella, chicken pox and polio. Influenza is not in that category. Flu shots are made either with ‘inactivated’ vaccine viruses that are not infectious or they contain no flu vaccine viruses at all (and instead have recombinant particles that serve to stimulate your immune system).
The most common side effects from the influenza shot are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. These symptoms are among the same symptoms you see with influenza, so it’s easy to confuse them as flu symptoms. They are not.
Controlled medical studies have been performed on humans in which some people received flu shots and others received shots containing salt water. There were no differences in symptoms other than increased redness and soreness at the injection site for those receiving influenza vaccine. The flu shot does not give you the flu.
I swear I’ve gotten the flu right after getting the flu shot! How is that possible if I can’t get the flu from the flu shot?
I always remind people that the flu vaccine does an even better job of preventing you from dying from the flu than it does in preventing you from catching the flu (and it does that at a 70–90% rate). It primes your immune system to better fight off the influenza virus when you’re exposed to it.
There are several reasons why someone still might get a flu-like illness after being vaccinated against the flu:

Influenza is just one group of respiratory viruses. There are many other viruses that cause similar symptoms including the common cold, which is also most commonly seen during “flu season.” The flu vaccine only protects against influenza, so any other infection timed correctly can give you similar symptoms.
When you get immunized against influenza, it takes the body up to two weeks to obtain the desired level of protection. There is nothing preventing you from having been infected before or during the period immediately before immunity sets in. Such an occurrence will result in your obtaining the flu despite being vaccinated.
An additional reason why some people may experience flu-like symptoms despite getting vaccinated is that they may have been exposed to a strain of influenza that is different from the viruses against which the vaccine is designed to protect. The ability of a flu vaccine to protect a person depends largely on the match between the viruses selected to make the vaccine and those causing illness among the population that same year.
It is also the case that the flu vaccine doesn’t always provide adequate protection against the flu. This is more likely to occur among people that have weakened immune systems or people age 65 and older. Even if the vaccine is 90% effect, some individuals will contact the flu despite having been vaccinated.

Please don’t get the wrong message from this section. These explanations are the exceptions, not the rule. In the overwhelming number of cases, the influenza vaccine does an excellent job of protecting against and prevent disease from the influenza virus.
Is it better to get the flu than the flu vaccine?
No. Influenza causes tens of thousands of deaths every year. If you have asthma, diabetes, heart disease or are especially young or old, you are placing yourself at significant risk by not getting vaccinated. Even if you aren’t in one of the above categories and are otherwise healthy, a flu infection can cause serious complications, including hospitalization or death.
Why do I need a flu vaccine every year?
The Center for Disease Control and Prevention (CDC) recommends a yearly flu vaccine for just about everyone six months and older. Once vaccinated, your immune protection decreases over time. These boosters are scheduled and dosed to help you maintain the best level of protection against influenza. Additionally, the virus mutates (changes) every year, so what you were covered for this year may not apply next year.
You can make a decision not to get vaccinated, and Straight, No Chaser has posted tips for you to protect yourself in the event you choose not to. (Click here to review.) However, you’re doing so in the face of the solid consensus of medical evidence and research. You should seriously question the motives or knowledge of someone who suggests that you should not get vaccinate for influenza, particularly if they profess to be involved in healthcare. Get vaccinated.
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Straight, No Chaser: The Medical Complications and Medication Treatment of Alcoholism

December 23, 2013Toxicology/DrugsAcamprosate, Alcoholic beverage, Alcoholism, Delirium tremens, health, Naltrexone, Neurological disorder, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There are interesting commonalities of certain drugs like alcohol and cigarettes. One is users that really enjoy them are able to do so for a long time while being oblivious to the growing danger those activities pose. Another commonality is even more so than mentally, when things go wrong physiologically, they really go very wrong.
Possible Complications
Alcoholism and alcohol abuse pose threats to many aspects of your health, including the following.

Birth defects (fetal alcohol syndrome)
Bleeding throughout your digestive tract, including the esophagus (up to and including rupture), gastritis (inflammation of the stomach) and ulcer disease.
Brain cell damage
Brain disorder called Wernicke-Korsakoff syndrome (includes dementia, mental status changes)
Cancer of the esophagus, liver, colon, and other areas
Changes in the menstrual cycle (period)
Delirium tremens (DT’s)
Dementia and memory loss
Depression and suicide
Erectile dysfunction
Heart damage
High blood pressure
Increased risks for behavioral disorders including depression and suicide
Increased risks for sexually transmitted infections (STIs)
Increased risks for trauma, including motor vehicle collisions, violence and head injuries with intracranial bleeding
Inflammation of the pancreas (pancreatitis)
Insomnia
Liver disease, including alcoholic hepatitis, cirrhosis and cancer
Nerve damage
Nutritional deficiencies

Treatment
Medical goals and patient goals are often different and seem to depend on the extent of perceptible injury that has occurred at the time of the decision to quit drinking. Often, patients will want to reduce drinking instead of stopping completely. Continued drinking in moderation is only as viable an option as the patient’s level of alcohol-related level of disease and the patient’s ability to stay limited in consumption and focused toward that goal.
Ideally, abstinence (the complete stopping of alcohol intake) is the goal, and it needs to be the goal if and when the desire to stop drinking is coupled with the presence of significant alcohol-related disease.
As everyone knows, the management of alcoholism requires multiple simultaneous approaches, including family and social networks. It is often the family network that helps the alcoholic come to the understanding that alcohol intake has disrupted his or her ability to function normally. It is a most unfortunate occurrence when this has not occurred prior to the development of significant medical disease. Individuals with alcohol problems are more likely to take the steps necessary to successfully withdraw from alcohol use.
Regarding the medical aspects of alcohol cessation, withdrawal is a very important consideration and is best done in a controlled manner. Components of effective withdrawal address the various medical and mental health considerations reviewed earlier and medical avoidance treatment.
Medical avoidance treatment includes medicine that prevent relapse via various methods, and they include the following:

Antabuse (generic name: disulfiram) is a well known and commonly used medicine that works by producing very unpleasant side effects with virtually any alcohol intake within two weeks of taking the medicine.

Naltrexone (brand name: Vivitrol) is an injectable medicine that works to decrease alcohol cravings.
Acamprosate is a drug that has been shown to lower relapse rates in those who are dependent on alcohol.

This is part of an ongoing series on alcohol use and abuse.

Click here to review the symptoms suggestive of alcoholism.
Additional posts will review a severe form of alcohol withdrawal, delirium tremens (the DTs) and non-medical aspects of treatment.

Feel free to contact your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: How to Prevent Getting the Flu Without Receiving the Flu Vaccine

December 22, 2013General Health and Wellness, Infectious Disease, Health PreventionCenters for Disease Control and Prevention, Flu Symptoms, Hand sanitizer, health, Influenza, Oseltamivir, Pharmaceutical drug, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, ZanamivirJeffrey Sterling, MD

Many people choose not to get the influenza vaccine (the “flu shot”) for various reasons. One of those reasons is due to an allergy to eggs. If you have an egg allergy, your options to combat influenza are different and don’t contain vaccination.
The best way to avoid the flu is prevention. Consider adopting these healthy habits before you ever get exposed:

Wash your hands frequently with warm soapy water. You know when they’re dirty. Most certainly wash your hands before you use them to eat or put anything else in your mouth.
If you can’t wash your hands, use an alcohol-based hand sanitizer.
If your hands are dirty and neither soap nor sanitizer is available, still rinse and dry your hands with warm water if you can.
Use disinfectant to clean surfaces.
Avoid unnecessarily touching your eyes, nose, or mouth.
Politely limit close contact with people who are ill, coughing and sneezing.
When coughing or sneezing use the bend of your elbow or a facial tissue to help cover your nose and mouth. Learn to avoid coughing or sneezing into your hands.
When you become sick, stay home. It’s the proper thing to do to avoid spreading your infection to others.

Vitamin C, echinacea and zinc have long been touted to prevent colds and influenza. There are no studies confirming or refuting this claim. Despite assurances that these and other herbal medicines are safe alternatives because they’re “natural”, the active ingredients in them are the same as found in certain prescription medicines. Thus they too may interact with other medications and worsen certain medical conditions. Given this, you should discuss your use of supplements with your physician or pharmacist prior to use.
Another level of defense for you involves use of certain antiviral prescription medications. If you are exposed to someone (e.g. a family member) with influenza, and especially if you begin having flu-like symptoms, immediately contact your physician to discuss taking medicines to prevent catching the flu. Such medications include Tamiflu® (generic name: oseltamivir), Relenza® (generic name: zanamivir), Flumadine® (generic name: rimantadine) and Symmetrel® (generic name: amantadine). If you make the request more than 24-48 hours after the onset of symptoms, you likely won’t be given the medication, since it isn’t likely to be effective outside of this timeframe.
Feel free to contact your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Alcohol Abuse and Alcoholism

December 21, 2013Toxicology/DrugsAlcohol, Alcohol abuse, Alcoholism, Drink, Facebook, National Institutes of Health, Physical dependence, Self-esteem, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Substance abuse, United States, Withdrawal, WordPressJeffrey Sterling, MD

With all the focus of late on other forms of drug use and abuse (e.g., methamphetamine, marijuana), alcohol abuse seems to be lacking the attention it deserves. Fully one in six people in the United States has a drinking problem. In this segment of the Straight, No Chaser series on alcohol, we will explore problem drinking.
For an additional personal look at if you drink too much, click here.
“Problem drinking” is a way of describing alcohol intake that causes problems with your functioning. Alcohol abuse is an episode or continued excessive alcohol consumption that causes problems with your daily living activities, such as family or job responsibilities. Of course, a single episode of alcohol abuse can cost you your life if you’re an impaired driver who runs into a tree or some other calamity befalls you.
Alcoholism is alcohol dependence, which is comprised of two separate considerations:

Physical addiction to a drug is defined by tolerance and withdrawal symptoms. Tolerance is when you become acclimated to the same dose of drug, meaning, in this case, the same amount of liquor no longer gives you the same buzz. Withdrawal symptoms occur when you experience effects from no longer having the drug in your system.
Mental addiction to alcohol is illustrated by its increasingly prominent role in your life. Your life becomes centered around the pursuit and consumption of alcohol. It creates problems with your physical, mental and social health, controlling your life and relationships.

Many of you ask if alcoholism is hereditary. Hereditary means a specific thing medically, so the answer is no. However, we believe genes play a role and increase the risk of alcoholism. It is most likely that genetics “load the gun,” but environment “pulls the trigger.”
Regarding environment, there’s no fixed equation to if and when you’ll become dependent, but there is a correlation with certain activity and an increased risk. Consider the following activities as suggestive of a significant risk for development alcoholism:

Men who have 15 or more drinks a week (One drink is either a 12-ounce bottle of beer, a 5-ounce glass of wine or a 1.5 ounce shot of liquor.)
Women who have 12 or more drinks a week
Anyone who has five or more drinks at a time at least once a week
Anyone who has a parent with alcoholism

Here are some less hard signs, but these situations also have been shown to increase risk, according to the National Institutes of Health:

You are a young adult under peer pressure
You have a behavioral health disorder such as depression, bipolar disorder, anxiety disorders, or schizophrenia
You have easy access to alcohol
You have low self-esteem
You have problems with relationships
You live a stressful lifestyle
You live in a culture in which alcohol use is more common and accepted

Straight, No Chaser: Fifteen Tips to Care for Diabetic Skin

December 20, 2013Endocrine/Metabolic, Health PreventionAntibacterial, Blood sugar, Diabetes mellitus, health, Infection, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, WordPress, WoundJeffrey Sterling, MD

In this previous post, we discussed the frailty of the diabetic skin and discussed how that sets one up for skin infections, abscesses, ulcers, amputations and even death. Your best defense from these set of illnesses and tragedies is knowledge, prevention and prompt action. Here are some concern steps you can take to better care for the diabetic in your life. In the event you know a diabetic who appears healthy, I want you to pay special attention to him/her. Diabetes is a chronic and insidious disease. These changes occur over years, and your challenge is to slow the process down as long as possible.
If you have diabetes, these tips may help prevent skin damage and infections:

Do the best to can to control your blood glucose levels. The more out of control it is, the most damage it causes.
You must check your feet every single day for the rest of your life. Diabetes develop decreased sensitivity to their feet. It is extremely common to step on a sharp object and not realize that you’ve done so. A splinter or nail is an excellent medium for an infection.
Eat fruits and vegetables. Your skin needs all the nourishment it can get.
Develop better hygiene. Wash and dry your skin often and thoroughly; this will keep you less exposed to infections.
Make a point of keeping your groin, armpits and other areas prone to heavy sweat dry. Those moist areas in particular are most prone to becoming infected. Talcum powder is a good choice to use.
Stay hydrated. It’s an uphill battle with the frequent urination and high blood sugar (glucose) levels. Dehydration causes your skin to be more brittle and prone to infections.
Stay moisturized! Apply lotion early and often, especially after baths. Note those dry, cracked feet and get ahead of that happening if possible.
Remember: if you’re diabetic, at some point your hands will retain sensation longer than your finger. It’s common to see scald injuries from stepping in water hot enough to burn you without you feeling it initially. Check the water with your hands before stepping into a tub.
Use a milder, less irritating soaps that include moisturizer. Speaking of tubs, avoid bubble baths. Sorry.
Consider investing in a humidifier to prevent skin drying, especially in dry or cold climates.
Always take any skin wounds seriously, especially those on your feet. Avoid placing alcohol on any of your wounds.
Invest in some sterile gauze. If you develop a scratch or other wound, control the wound with it after cleaning.
Limit your self-help to cleaning and gauze wrapping. Only place topical antibiotics or take antibiotics for a skin infection under your physician’s supervision.
Always ask your physician to check your skin during an examination and ask him/her to teach you what to look for.
Immediately consult your physician or access the local emergency room if you have a burn, scratch, abscess (boil) or laceration that seems serious.

Straight, No Chaser: The Skin Problems of Diabetics, Part 1

December 19, 2013Endocrine/Metabolic, Health PreventionBlood flow, Blood sugar, Conditions and Diseases, Diabetes mellitus, diabetic foot ulcers, Endocrine Disorders, health, Infection, Pancreas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you are diabetic or caring for a diabetic, one of the things you’ve likely noticed is that the skin doesn’t always seem to look, feel or perform normally. Perhaps the first thing I’d want you to know as a means of understanding what’s going on is this combination of facts: the skin is the body’s largest organ and diabetics have issues with blood flow. Given all the area needing blood flow, it stands to reason that diabetics invariably would have skin problems.
On a practical level, appreciate that infections are the most common cause of death in diabetics. Even a small cut or scratch in this population can lead to loss of a limb if unrecognized and left untreated. Unfortunately, amputations among diabetics happens all too often. Is it preventable? With 100% confidence, yes. You can sufficiently reduce your risk of this ever happening. That said, there’s a reality that approximately 1/3 of all diabetes will have some type of skin problem, ranging from eczema and other localized itching problems to infections, abscesses, and gangrene.
By now you are likely wondering two things: How does this happen, and how can I prevent/help this?
First, diabetics suffer from frequent and excessive urination from those high blood glucose levels. This can lead to dehydration. Dehydrated skin is dry, red and has a waxy appearance. It becomes cracked, itchy, easily injured, harder to heal and easier to infect. Remember how diabetics have problems with poor blood circulation? That reduces the bodies’ ability to fight infections. So the first course of action for diabetics (beyond understanding the risks) is to be diligent in preventing infection.
I will dedicate a separate post to give you all the knowledge you need to prevent diabetic cuts, scratches and skin infections or to have them treated. In the meantime, the same rules apply to diabetics as they do to everyone else: an ounce of prevention is worth a pound of care. Diet and exercise can stave off the day when you’re fighting for your life because of a diabetic foot ulcer.
Click here for an explanation of basic facts about diabetes.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: "…Stop Wasting Money on Vitamins and Mineral Supplements."

December 18, 2013Diet and Nutrition, General Health and Wellness, Toxicology/Drugs, Health PreventionAnnals of Internal Medicine, Big Bang Theory, CBS, Edgar Miller, Johns Hopkins School of Medicine, Multivitamin, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United States, VitaminJeffrey Sterling, MD

placebo
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.
Vitamins have been all over the news the last few days, based on an editorial published in this week’s edition of 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. In fact, the title of the editorial is “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.”
And with that folks, let us declare today a Straight, No Chaser kind of day. I’m going to make this real simple.
Point #1: I’m a physician and a scientist. 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 it worked, we’d tell you.
Point #2: Opinions, anecdotes and personal experience do not constitute medical fact. Just because you felt better or believe your memory improved after taking a certain pill doesn’t mean the cause of your improvement was the pill.
Point #3: There is a phenomenon called the placebo effect that explains more than you’re willing to admit.
The placebo effect is a measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered. 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 experiences aren’t directly attributable to those pills.
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.
With that, allow me to again extol the virtues of a good diet.
Point #4: Most everything you’re looking for in a bottle can be obtained by a healthy diet, especially generous in 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.
Point #5: It is an appropriate point to make 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.

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