Tag Archives: Surgery

Straight, No Chaser: Hernias Are Why Your Doctor Asks You to Turn Your Head and Cough!

Genital/Urinary, Surgical Care, , , , , , , , , , , ,

Hernias

Hernias are an uncomfortable topic (no pun intended, for many reasons). Hernias are yet another example of body parts not being in their proper place. They are caused by weak muscles or tissue allowing other tissue to push through in the face of pressure.  Hernias can be found in many places and can be caused by many things.
Here are some examples of places hernias occur:
hernias

  • In your groin, different types of hernias occur when either the intestine or bladder pushes through groin (inguinal canal) or the abdominal wall.  The most common type of hernias here are called inguinal hernias.
  • In the upper thigh, the intestine can push through a different space where arteries are normally carried.  These are called femoral hernias.
  • In your abdomen, your intestine may protrude through an area where you’ve had surgery (rendering that area relatively weak).  These are called incisional hernias.
  • The small intestine can protrude through the area immediately at or near your belly button. These are called umbilical hernias.
  • Part of your stomach can push through an opening in your diaphragm near the end of the feeding tube (your esophagus). These are called hiatal hernias.

The ‘so-what’ of hernias is similar to other outpoutchings throughout the body. Prolapsed intestines (to use one example) can become unable to be relocated into the proper area (an irreducible or incarcerated hernia) or once trapped, it may have blood flow cut off from that part of your intestine (a strangulated hernia).  This could lead to death of that tissue. Given the contents of your intestines, any such situations could lead to rupture and infection throughout your body (sepsis). Such complications are life-threatening and require immediate surgery.
Here are causes and risk factors (remember the common denominators are pressure and weakness of the affected area):

  • Lifting heavy objects is a particular risk if your abdominal muscles are weak. Men are structurally weaker in the groin anyway.
  • Pregnancy and obesity lead to femoral hernias and umbilical hernias (although this type is most common in newborns).
  • Surgery obviously places you at risk for an incisional hernia, particularly if you’re inactive.
  • Pressure within the abdomen is also increased by sneezing, coughing, diarrhea and constipation (Don’t strain!).
  • Smoking, obesity and poor dietary habits also increase the risk by lessening muscle strength.

Don’t let this happen to you! I welcome any questions.  Hold the comments!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Appendicitis – When a Little Something Causes a Lot…

Gastrointestinal, Surgical Care, , , , , , , ,

appendicitis
There’s not much that causes as much legitimate angst in parents as a child with appendicitis. In case you don’t know what the fuss is all about, the appendix is a 3 1/2 inch pouch on the edge of the large intestine near the right lower part of your abdomen. It’s actually like a long, skinny skin tag that (as best as we know) has no purpose other than to seemingly get inflamed, rupture and require surgery. The problem with it is that it’s a pouch (Pouches are bad things in the body. They always seem to twist or otherwise get blocked, leading to problems. This happens with aneurysms and hemorrhoids, twisting otherwise occurs with torsion of ovarian cysts or the testes. These stories don’t end well.). This particular pouch has the misfortune of being filled with stool, so if it gets sufficiently blocked or inflamed to the point where it ruptures, your abdomen will contain loose stool, which as you can imagine will cause a nasty infection rapidly (This is called peritonitis.). Appendicitis is a surgical emergency, because left untreated, the peritonitis caused by rupture will lead to septic shock.

appendicitis

Appendicitis is very common, occurring in one of fifteen individuals, usually between ages 10-30. It is more dangerous in the young and old, because they are both less able to describe symptoms and more likely to have abnormal presentations. Both of these scenarios lead to delayed diagnosis and treatment, which as you might imagine, doesn’t give patients the best opportunity for good outcomes.

appy rlq

Symptoms classically involve abdominal pain, followed by nausea, vomiting and fever, although other symptoms involving the digestive and urinary systems may be present. Often, the pain begins near the umbilicus (belly button) and seemingly migrates to the right lower portion of the abdomen. The pain may lead to a ‘board-like’ feel of the abdomen. This is a bad sign when it happens.

The below video is a virtual depiction of appendectomy surgery via a technique known as laparoscopy. Use your discretion in choosing to view.


Treatment involves surgery (an appendectomy) in the overwhelming majority of cases. Your job is to maintain a high level of suspicion and remember a few very important pearls of wisdom. First is seek medical attention without delay. Also, don’t eat, drink or take any medicine if you think this is what’s going on. Surgery requires an empty stomach, and certain medicines may mask the pain (leading to diagnostic difficulties) or facilitate early rupture of the appendix. In case you were wondering, there’s no definitive way to prevent appendicitis, but it is less frequent in those on high fiber diets. Score another point for fruits and vegetables.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Hernias Are Why Your Doctor Asks You to Turn Your Head and Cough!

Gastrointestinal, Surgical Care, , , , , , , , , , , ,

Hernias

Hernias are an uncomfortable topic (no pun intended, for many reasons). Hernias are yet another example of body parts not being in their proper place. They are caused by weak muscles or tissue allowing other tissue to push through in the face of pressure.  Hernias can be found in many places and can be caused by many things.
Here are some examples of places hernias occur:
hernias

  • In your groin, different types of hernias occur when either the intestine or bladder pushes through groin (inguinal canal) or the abdominal wall.  The most common type of hernias here are called inguinal hernias.
  • In the upper thigh, the intestine can push through a different space where arteries are normally carried.  These are called femoral hernias.
  • In your abdomen, your intestine may protrude through an area where you’ve had surgery (rendering that area relatively weak).  These are called incisional hernias.
  • The small intestine can protrude through the area immediately at or near your belly button. These are called umbilical hernias.
  • Part of your stomach can push through an opening in your diaphragm near the end of the feeding tube (your esophagus). These are called hiatal hernias.

The ‘so-what’ of hernias is similar to other outpoutchings throughout the body. Prolapsed intestines (to use one example) can become unable to be relocated into the proper area (an irreducible or incarcerated hernia) or once trapped, it may have blood flow cut off from that part of your intestine (a strangulated hernia).  This could lead to death of that tissue. Given the contents of your intestines, any such situations could lead to rupture and infection throughout your body (sepsis). Such complications are life-threatening and require immediate surgery.
Here are causes and risk factors (remember the common denominators are pressure and weakness of the affected area):

  • Lifting heavy objects is a particular risk if your abdominal muscles are weak. Men are structurally weaker in the groin anyway.
  • Pregnancy and obesity lead to femoral hernias and umbilical hernias (although this type is most common in newborns).
  • Surgery obviously places you at risk for an incisional hernia, particularly if you’re inactive.
  • Pressure within the abdomen is also increased by sneezing, coughing, diarrhea and constipation (Don’t strain!).
  • Smoking, obesity and poor dietary habits also increase the risk by lessening muscle strength.

Don’t let this happen to you! I welcome any questions.  Hold the comments!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Appendicitis – When a Little Something Causes a Lot…

Gastrointestinal, Surgical Care, , , , , , , ,

 
appendicitis
There’s not much that causes as much legitimate angst in parents as a child with appendicitis. In case you don’t know what the fuss is all about, the appendix is a 3 1/2 inch pouch on the edge of the large intestine near the right lower part of your abdomen. It’s actually like a long, skinny skin tag that (as best as we know) has no purpose other than to seemingly get inflamed, rupture and require surgery. The problem with it is that it’s a pouch (Pouches are bad things in the body. They always seem to twist or otherwise get blocked, leading to problems. This happens with aneurysms and hemorrhoids, twisting otherwise occurs with torsion of ovarian cysts or the testes. These stories don’t end well.). This particular pouch has the misfortune of being filled with stool, so if it gets sufficiently blocked or inflamed to the point where it ruptures, your abdomen will contain loose stool, which as you can imagine will cause a nasty infection rapidly (This is called peritonitis.). Appendicitis is a surgical emergency, because left untreated, the peritonitis caused by rupture will lead to septic shock.

appendicitis

Appendicitis is very common, occurring in one of fifteen individuals, usually between ages 10-30. It is more dangerous in the young and old, because they are both less able to describe symptoms and more likely to have abnormal presentations. Both of these scenarios lead to delayed diagnosis and treatment, which as you might imagine, doesn’t give patients the best opportunity for good outcomes.

appy rlq

Symptoms classically involve abdominal pain, followed by nausea, vomiting and fever, although other symptoms involving the digestive and urinary systems may be present. Often, the pain begins near the umbilicus (belly button) and seemingly migrates to the right lower portion of the abdomen. The pain may lead to a ‘board-like’ feel of the abdomen. This is a bad sign when it happens.

The below video is a virtual depiction of appendectomy surgery via a technique known as laparoscopy. Use your discretion in choosing to view.

Treatment involves surgery (an appendectomy) in the overwhelming majority of cases. Your job is to maintain a high level of suspicion and remember a few very important pearls of wisdom. First is seek medical attention without delay. Also, don’t eat, drink or take any medicine if you think this is what’s going on. Surgery requires an empty stomach, and certain medicines may mask the pain (leading to diagnostic difficulties) or facilitate early rupture of the appendix. In case you were wondering, there’s no definitive way to prevent appendicitis, but it is less frequent in those on high fiber diets. Score another point for fruits and vegetables.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress
 

Straight, No Chaser: When Foreign Bodies are Ingested

General Health and Wellness, , , , , , , , , ,

jingle bell
Let’s talk about our kids and the things they put inside themselves. Pediatric foreign body ingestion/insertion is a common emergency room presentation. Maybe it’s just part of them exploring their world. In fact, I recall getting a pearl in my ear and a dime in my nostril as a child; maybe I wanted to start saving at a young age…
The bottom line is kids get in trouble. And it’s not always their fault. Families sometimes leave things lying around the house. Children may be fed something they can’t handle. Then there’s always the older sibling putting stuff in them…
More than 100,000 cases of accidental pediatric foreign body ingestion occur each year. I’m going to address the three main orifices where things are placed and let you know the dangers, potential solutions and what to expect if and when you show up in the emergency room. Yep, three different holes, because different types of insertions occur, each with their own risks. I guess they figure if there’s a hole, something needs to go in it.
Ears:

FB+ear

What Happens: Kids will put anything that will fit in their ears, but the problems arise when something either gets stuck or breaks off in an ear. This can include such things as a cotton swab, food, a toy (a bead, something waxy, or something pointy) or whatever else they get their hands on. This poses a significant risk of infection, bleeding and possible rupture of the eardrum, which can lead to an entirely new set of complications.
What You Need to Know: Regardless as to the nature of the item, removal of the item is going to be very dramatic. At home, you should be very conservative in your efforts to get anything out of a child’s ear. Blind efforts may lead to pushing the item further back on the eardrum, possibly rupturing it, or jabbing it into the ear canal, causing damage and potentially setting up an infection. Such efforts usually make it even more difficult for health professionals to get at it once you come to the ER or your doctor’s office.
What happens in the ER: Drama. Depending on the size, shape and depth of the object, tools to flush it out, suck it out, scoop it out or pick it out may be used. There is no guarantee of success, and if the object is unable to be easily retrieved (without an unacceptable risk of further ear damage), the child may either be put to sleep to make the process easier, or you may be referred to an ears, nose and throat specialist.
Nose:

FBnose

What Happens: Somehow kids think that because of the shape of the nostrils, round things just belong in there. Those smooth pearls, beads, marbles and kernels fit just right.
What You Need to Know: The particular danger with items placed in the nose is they can become dislodged into the airway and choke the child. You should be mindful of this as you try to get that object out yourself. One strategy that you might safely try (assuming no blood or significant pain or other apparent injury exists) is to ‘blow your child a kiss’. Put your mouth around the kids mouth and give a big puff. Sometimes this will pop the object out of the nostril! More easily, if the child is big enough to blow his/her nose, try that while occluding the unaffected nostril.
What Will Happen in the ER: We may try the same things described above. We may also use a piece of equipment called an Ambu-bag to deliver that same type of puff. If that doesn’t work, we have additional means to enter the nose and try to remove the object. The most important consideration is to protect the child’s airway.
Throat to the Stomach or Lower Airway:

FBstomach

What Happens and What You Need to Know: More foreign object ingestions and aspirations (passage down the airway) occur in children younger than 3 years than in other age groups, although they do occur in all ages. Even relatively immobile infants may get something inappropriate in their mouths despite not being able crawl or pick up objects and put them in the mouth. Their relative inability to chew, coupled with faster breathing rates increases the odds of objects entering the windpipe instead of the food pipe. We see simple things such as nuts, raisins, coins, magnets, seeds, foods (e.g. hot dogs and grapes), as well as toys, pins, batteries, balloons, bones and many other items. Your pediatrician has likely advised you to avoid giving certain foods until the child is at least 5 years old.
Objects that have entered or passed through the throat will leave a sensation that something is still in the throat, particularly if it scratched something on the way down. Objects in the airways run the risk of partial or complete obstruction of different parts of the airway. This can be immediately life-threatening if severe enough obstruction has occurred. There’s no guesswork here; the child will be having difficulty breathing, coughing, gasping and likely turning blue.
What Will Happen in the ER:

FBnoseremoval_sq2__8_

Management of swallowed or aspirated foreign body depends on the size of both the object and child and the object’s location.
1) If it’s in the stomach or beyond: unless there are multiple sharp objects that suggest something’s been perforated, little will be done, and you’ll be instructed to wait and watch for it in the stool.
2) If it’s in the airway, this is an emergency, and a lung specialist will need to get the object out with a special scope.
3) If it’s in the food pipe but not yet in the stomach or beyond, what’s done will depend on the size and location. Esophageal foreign bodies (that is, those in the food pipe) generally require early removal by a specialist because of their potential to cause respiratory problems (by manual pressure onto the windpipe) and complications to the esophagus itself (scratches, burns or even rupture). Most notably, ingestion of those annoying button batteries, and their lodging in the esophagus require urgent removal even if no symptoms are present because of an unacceptably high risk of complications. Sharp foreign bodies (except for single straight pins) are especially dangerous and prone to complications and most likely will also need to be removed.
So, after all that, is there any wonder why we ask you to child-proof your home? The dangers are real, and the drama of an ER visit for these things is avoidable and worth being diligent at home. Have a great, safe, healthy and happy weekend.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: Hernias Are Why Your Doctor Asks You to Turn Your Head and Cough!

Gastrointestinal, Surgical Care, Musculoskeletal System, , , , , , , , , , ,

Hernias

Hernias are an uncomfortable topic (no pun intended, for many reasons). Hernias are yet another example of body parts not being in their proper place. They are caused by weak muscles or tissue allowing other tissue to push through in the face of pressure.  Hernias can be found in many places and can be caused by many things.
Here are some examples of places hernias occur:
hernias

  • In your groin, different types of hernias occur when either the intestine or bladder pushes through groin (inguinal canal) or the abdominal wall.  The most common type of hernias here are called inguinal hernias.
  • In the upper thigh, the intestine can push through a different space where arteries are normally carried.  These are called femoral hernias.
  • In your abdomen, your intestine may protrude through an area where you’ve had surgery (rendering that area relatively weak).  These are called incisional hernias.
  • The small intestine can protrude through the area immediately at or near your belly button. These are called umbilical hernias.
  • Part of your stomach can push through an opening in your diaphragm near the end of the feeding tube (your esophagus). These is called hiatal hernias.

The ‘so-what’ of hernias is similar to other outpoutchings throughout the body. Prolapsed intestines (to use one example) can become unable to be relocated into the proper area (an irreducible or incarcerated hernia) or once trapped, it may have blood flow cut off from that part of your intestine (a strangulated hernia).  This could lead to death of that tissue. Given the contents of your intestines, any such situations could lead to rupture and infection throughout your body (sepsis). Such complications are life-threatening and require immediate surgery.
Here are causes and risk factors (remember the common denominators are pressure and weakness of the affected area):

  • Lifting heavy objects is a particular risk if your abdominal muscles are weak. Men are structurally weaker in the groin anyway.
  • Pregnancy and obesity lead to femoral hernias and umbilical hernias (although this type is most common in newborns).
  • Surgery obviously places you at risk for an incisional hernia, particularly if you’re inactive.
  • Pressure within the abdomen is also increased by sneezing, coughing, diarrhea and constipation (Don’t strain!).
  • Smoking, obesity and poor dietary habits also increase the risk by lessening muscle strength.

Don’t let this happen to you! I welcome any questions.  Hold the comments!
hernia

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and 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 © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Appendicitis – A Whole Lot over Quite a Little…

Gastrointestinal, Surgical Care, , , , , , ,

appendicitis
There’s not much that causes as much legitimate angst in parents as a child with appendicitis. In case you don’t know what the fuss is all about, the appendix is a 3 1/2 inch pouch on the edge of the large intestine near the right lower part of your abdomen. It’s actually like a long, skinny skin tag that (as best as we know) has no purpose other than to seemingly get inflamed, rupture and require surgery. The problem with it is that it’s a pouch (Pouches are bad things in the body. They always seem to twist or otherwise get blocked, leading to problems. This happens with aneurysms and hemorrhoids; twisting otherwise occurs with torsion of ovarian cysts or the testes. These stories don’t end well.). This particular pouch has the misfortune of being filled with stool, so if it gets sufficiently blocked or inflamed to the point where it ruptures, your abdomen will contain loose stool, which as you can imagine will cause a nasty infection rapidly (This is called peritonitis.). Appendicitis is a surgical emergency, because left untreated, the peritonitis caused by rupture will lead to septic shock.

appendicitis

Appendicitis is very common, occurring in one of fifteen individuals, usually between ages 10-30. It is more dangerous in the young and old, because they are both less able to describe symptoms and more likely to have abnormal presentations. Both of these scenarios lead to delayed diagnosis and treatment, which as you might imagine, doesn’t give patients the best opportunity for good outcomes.

appy rlq

Symptoms classically involve abdominal pain, followed by nausea, vomiting and fever, although other symptoms involving the digestive and urinary systems may be present. Often, the pain begins near the umbilicus (belly button) and seemingly migrates to the right lower portion of the abdomen. The pain may lead to a ‘board-like’ feel of the abdomen. This is a bad sign when it happens.

The below video is a virtual depiction of appendectomy surgery via a technique known as laparoscopy. Use your discretion in choosing to view.

Treatment involves surgery (an appendectomy) in the overwhelming majority of cases. Your job is to maintain a high level of suspicion and remember a few very important pearls of wisdom. First is seek medical attention without delay. Also, don’t eat, drink or take any medicine if you think this is what’s going on. Surgery requires an empty stomach, and certain medicines may mask the pain (leading to diagnostic difficulties) or facilitate early rupture of the appendix. In case you were wondering, there’s no definitive way to prevent appendicitis, but it is less frequent in those on high fiber diets. Score another point for fruits and vegetables.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Straight Talk About Vasectomies

Genital/Urinary, Surgical Care, , , , , , , , , ,

vasectomy
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
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 © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: That Doesn't Belong There, Little Johnny!

Head/Eyes/Ears/Nose/Throat, Pediatrics/Kids Health, , , , , , , ,

jingle bell
Let’s talk about our kids and the things they put inside themselves. Pediatric foreign body ingestion/insertion is a common emergency room presentation. Maybe it’s just part of them exploring their world. In fact, I recall getting a pearl in my ear and a dime in my nostril as a child; maybe I wanted to start saving at a young age… Bottom line: kids get in trouble. And it’s not always their fault. Families sometimes leave things lying around the house. Children may be fed something they can’t handle. Then there’s always the older sibling putting stuff in them…
More than 100,000 cases of accidental pediatric foreign body ingestion occur each year. I’m going to address the three main orifices where things are placed and let you know the dangers, potential solutions and what to expect if and when you show up in the emergency room. Yep, three different holes, because different types of insertions occur, each with their own risks. I guess they figure if there’s a hole, something needs to go in it.
Ears:
What Happens: Kids will put anything that will fit in their ears, but the problems arise when something either gets stuck or breaks off in an ear. This can include such things as a cotton swab, food, a toy (a bead, something waxy, or something pointy) or whatever else they get their hands on. This poses a significant risk of infection, bleeding and possible rupture of the eardrum, which can lead to an entirely new set of complications.
What You Need to Know: Regardless as to the nature of the item, removal of the item is going to be very dramatic. At home, you should be very conservative in your efforts to get anything out of a child’s ear. Blind efforts may lead to pushing the item further back on the eardrum, possibly rupturing it, or jabbing it into the ear canal, causing damage and potentially setting up an infection. Such efforts usually make it even more difficult for health professionals to get at it once you come to the ER or your doctor’s office.
What happens in the ER: Drama. Depending on the size, shape and depth of the object, tools to flush it out, suck it out, scoop it out or pick it out may be used. There is no guarantee of success, and if the object is unable to be easily retrieved (without an unacceptable risk of further ear damage), the child may either be put to sleep to make the process easier, or you may be referred to an ears, nose and throat specialist.
Nose:
What Happens: Somehow kids think that because of the shape of the nostrils, round things just belong in there. Those smooth pearls, beads, marbles and kernels fit just right.
What You Need to Know: The particular danger with items placed in the nose is they can become dislodged into the airway and choke the child. You should be mindful of this as you try to get that object out yourself. One strategy that you might safely try (assuming no blood or significant pain or other apparent injury exists) is to ‘blow your child a kiss’. Put your mouth around the kids mouth and give a big puff. Sometimes this will pop the object out of the nostril! More easily, if the child is big enough to blow his/her nose, try that while occluding the unaffected nostril.
What Will Happen in the ER: We may try the same things described above. We may also use a piece of equipment called an Ambu-bag to deliver that same type of puff. If that doesn’t work, we have additional means to enter the nose and try to remove the object. The most important consideration is to protect the child’s airway.
Throat to the Stomach or Lower Airway:
What Happens and What You Need to Know: More foreign object ingestions and aspirations (passage down the airway) occur in children younger than 3 years than in other age groups, although they do occur in all ages. Even relatively immobile infants may get something inappropriate in their mouths despite not being able crawl or pick up objects and put them in the mouth. Their relative inability to chew, coupled with faster breathing rates increases the odds of objects entering the windpipe instead of the food pipe. We see simple things such as nuts, raisins, coins, magnets, seeds, foods (e.g. hot dogs and grapes), as well as toys, pins, batteries, balloons, bones and many other items. Your pediatrician has likely advised you to avoid giving certain foods until the child is at least 5 years old.
Objects that have entered or passed through the throat will leave a sensation that something is still in the throat, particularly if it scratched something on the way down. Objects in the airways run the risk of partial or complete obstruction of different parts of the airway. This can be immediately life-threatening if severe enough obstruction has occurred. There’s no guesswork here; the child will be having difficulty breathing, coughing, gasping and likely turning blue.
What Will Happen in the ER:
Management of swallowed or aspirated foreign body depends on the size of both the object and child and the object’s location.
1) If it’s in the stomach or beyond: unless there are multiple sharp objects that suggest something’s been perforated, little will be done, and you’ll be instructed to wait and watch for it in the stool.
2) If it’s in the airway, this is an emergency, and a lung specialist will need to get the object out with a special scope.
3) If it’s in the food pipe but not yet in the stomach or beyond, what’s done will depend on the size and location. Esophageal foreign bodies (that is, those in the food pipe) generally require early removal by a specialist because of their potential to cause respiratory problems (by manual pressure onto the windpipe) and complications to the esophagus itself (scratches, burns or even rupture). Most notably, ingestion of those annoying button batteries, and their lodging in the esophagus require urgent removal even if no symptoms are present because of an unacceptably high risk of complications. Sharp foreign bodies (except for single straight pins) are especially dangerous and prone to complications and most likely will also need to be removed.
So, after all that, is there any wonder why we ask you to child-proof your home? The dangers are real, and the drama of an ER visit for these things is avoidable and worth being diligent at home. Have a great, safe, healthy and happy weekend.
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Straight, No Chaser: Hernias – Turn Your Head and Cough!

Gastrointestinal, Musculoskeletal System, , , , , , ,

hernias
Hernias are an uncomfortable topic (no pun intended, for many reasons). Hernias are yet another example of body parts not being in their proper place. They are caused by weak muscles or tissue allowing other tissue to push through in the face of pressure.  Hernias can be found in many places and can be caused by many things.
Here are some examples of places hernias occur:

  • In your groin, different types of hernias occur when either the intestine or bladder pushes through groin (inguinal canal) or the abdominal wall.  The most common type of hernias here are called inguinal hernias.
  • In the upper thigh, the intestine can push through a different space where arteries are normally carried.  These are called femoral hernias.
  • In your abdomen, your intestine may protrude through an area where you’ve had surgery (rendering that area relatively weak).  These are called incisional hernias.
  • The small intestine can protrude through the area immediately at or near your belly button. These are called umbilical hernias.
  • Part of your stomach can push through an opening in your diaphragm near the end of the feeding tube (your esophagus). These is called hiatal hernias.

The ‘so-what’ of hernias is similar to other outpoutchings throughout the body. Prolapsed intestines (to use one example) can become unable to be relocated into the proper area (an irreducible or incarcerated hernia) or once trapped, it may have blood flow cut off from that part of your intestine (a strangulated hernia).  This could lead to death of that tissue. Given the contents of your intestines, any such situations could lead to rupture and infection throughout your body (sepsis). Such complications are life-threatening and require immediate surgery.
Here are causes and risk factors (remember the common denominators are pressure and weakness of the affected area):

  • Lifting heavy objects is a particular risk if your abdominal muscles are weak. Men are structurally weaker in the groin anyway.
  • Pregnancy and obesity lead to femoral hernias and umbilical hernias (although this type is most common in newborns).
  • Surgery obviously places you at risk for an incisional hernia, particularly if you’re inactive.
  • Pressure within the abdomen is also increased by sneezing, coughing, diarrhea and constipation (Don’t strain!).
  • Smoking, obesity and poor dietary habits also increase the risk by lessening muscle strength.

Don’t let this happen to you! I welcome any questions.  Hold the comments!
hernia
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Straight, No Chaser: Appendicitis – A Whole Lot over Quite a Little…

Gastrointestinal, Medical Treatment, , , , , , ,

appendicitis
There’s not much that causes as much legitimate angst in parents as a child with appendicitis. In case you don’t know what the fuss is all about, the appendix is a 3 1/2 inch pouch on the edge of the large intestine near the right lower part of your abdomen. It’s actually like a long, skinny skin tag that (as best as we know) has no purpose other than to seemingly get inflamed, rupture and require surgery. The problem with it is that it’s a pouch (Pouches are bad things in the body. They always seem to twist or otherwise get blocked, leading to problems. This happens with aneurysms and hemorrhoids; twisting otherwise occurs with torsion of ovarian cysts or the testes. These stories don’t end well.). This particular pouch has the misfortune of being filled with stool, so if it gets sufficiently blocked or inflamed to the point where it ruptures, your abdomen will contain loose stool, which as you can imagine will cause a nasty infection rapidly (This is called peritonitis.). Appendicitis is a surgical emergency, because left untreated, the peritonitis caused by rupture will lead to septic shock.
Appendicitis is very common, occurring in one of fifteen individuals, usually between ages 10-30. It is more dangerous in the young and old, because they are both less able to describe symptoms and more likely to have abnormal presentations. Both of these scenarios lead to delayed diagnosis and treatment, which as you might imagine, doesn’t give patients the best opportunity for good outcomes.
Symptoms classically involve abdominal pain, followed by nausea, vomiting and fever, although other symptoms involving the digestive and urinary systems may be present. Often, the pain begins near the umbilicus (belly button) and seemingly migrates to the right lower portion of the abdomen. The pain may lead to a ‘board-like’ feel of the abdomen. This is a bad sign when it happens.
Treatment involves surgery (an appendectomy) in the overwhelming majority of cases. Your job is to maintain a high level of suspicion and remember a few very important pearls of wisdom. First is seek medical attention without delay. Also, don’t eat, drink or take any medicine if you think this is what’s going on. Surgery requires an empty stomach, and certain medicines may mask the pain (leading to diagnostic difficulties) or facilitate early rupture of the appendix. In case you were wondering, there’s no definitive way to prevent appendicitis, but it is less frequent in those on high fiber diets. Score another point for fruits and vegetables.
I welcome any questions or comments you may have.
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Straight, No Chaser: Circumcision – To Do or Not to Do?

Genital/Urinary, Medical Treatment, Pediatrics/Kids Health, Public Health, , , , , , , , ,

screamingbaby
As a medical professional, circumcision has long been one of those things that’s made me go hmmm…. If your religious beliefs include this as a ritual or ceremony, fine.  I get it, and I have no criticism at all.  No disrespect is intended.  Otherwise, circumcision is largely a procedure looking for an indication.  Quick, tell me what other elective surgical procedure or harmful activity of any type is allowed on children, much less newborns?  While I’m waiting for you to think about an answer that doesn’t exist, let’s recap the procedure and the medical logic behind it.
As you know (and men are painfully aware – pun intended), circumcision is the surgical removal of the skin over the glans (tip) of the penis.  Over the last 30 years, the rate of males receiving the procedure has dropped from 64.5% to 58.3%, according to the National Center for Health Statistics.  Worldwide about 30% of males are circumcised, and of those receiving it, the religious influence is largely present. 69% of those being circumcised are Muslim and 1% are Jewish (Circumcision is part of religious rituals in both religions.).
Let’s cut to the chase (no pun intended): Here are the best arguments for circumcision.

  • It helps prevent certain infections (e.g. yeast and UTIs – which most males aren’t especially prone to anyway).
  • The cells of the inner surface of the foreskin may provide an optimal target for the HIV virus (This is theoretical and not conclusively decided in the medical literature.  In any event, this is NOT the same as saying uncircumcised males do or are more likely to contract HIV.).
  • Circumcised males have a lower rate of penile cancer (which is very low under any circumstances).
  • Now, there are emergency indications for circumcision; the one I’ve had to address (once in twenty years) is an inability to readjust a foreskin that too tightly adhered to the shaft of the penis (paraphimosis).  Obviously, that’s a medical emergency and not something frequently seen enough to justify universal circumcision any more than a much higher rate of appendicitis would warrant universal and elective removal of everyone’s appendix.

Here are criticisms of the decision to have circumcision.

  • Any surgical procedure has complications, and that should be taken seriously.  That said, the complication rate for circumcision is very small and includes bleeding infection and pain.
  • Circumcision is a violation of a child’s body and is unnecessary and disfiguring.  The foreskin might not be cut the appropriate length, might not heal properly and may require addition surgery because the remaining foreskin incorrectly attaches to the end of the penile shaft.

Honestly, both the risks and benefits are quite overstated.  Circumcision doesn’t appear to be a medically necessary procedure, but it isn’t an especially dangerous one.  Interestingly, the American Academy of Pediatrics’ latest comment on circumcision is that the benefits of circumcision outweigh the risks, which stops short of recommending routine circumcision for all.  Even that equivocal smacks of conflict of interest, given who’s performing the procedure at a significant cost to the consumer.  Again, this appears to be a procedure looking for an indication…
If I was having this conversation in Africa, where the sexually transmitted infection rate is substantially higher and can be significantly reduced by circumcision, we’d be having a different conversation.  If my Jewish or Muslim friends and colleagues were asking my medical advice on the safety of getting the procedure done as part of their religious ceremonies, we’d be having a different conversation.  However, we’re not, and for the population in general, it’s safe to say that – various preferences (for various reasons) aside – there’s no compelling reason to recommend circumcision on all newborn males.  Make your judgment based on facts, not a whim.  And that’s medical straight talk.  Oh, and guys – sorry about the picture.  That wasn’t a good day.