Tag Archives: There are 72 Hours in a Day

Straight, No Chaser: About That Vomiting and Diarrhea…

December 1, 2017General Health and Wellness, Infectious Disease, Health Prevention844-SMA-TALK, Behind the Curtain, Coronavirus, Diarrhea, Gastroenteritis, health, Influenza, Intestine, Norovirus, Oral rehydration therapy, Rotavirus, Sterling Medical Advice, SterlingMedicalAdvice.com, Stomach, Straight No Chaser, There are 72 Hours in a Day, VomitingJeffrey Sterling, MD

You’ve all been there and done that. It’s always a bad day when you get the so-called stomach flu… First of all ‘the flu’ is a respiratory disease (affects the lungs, not the stomach and intestines), and the influenza viruses don’t cause that syndrome of vomiting and watery diarrhea. So, what you’re actually getting is gastroenteritis (gastro = stomach, entero = intestines, and itis = inflammation), an inflammation of the stomach and intestines.
Gastroenteritis means inflammation of the stomach and small and large intestines. Most cases of gastroenteritis are infections caused by a variety of viruses that results in vomiting or diarrhea (other symptoms may include belly cramping, fever and headache from all that retching). There are other (bacterial) causes of vomiting and diarrhea, but the overwhelming number of cases is due to viruses. Your physician will know when the other considerations come into play. Here’s a few points you really want to know.
1. Is it serious?

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

2. Is it contagious?

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

3. How can I avoid gastroenteritis?
There are good options available to you.

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

4. How will it be treated?

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

It’s important to discuss some other treatment considerations.

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

In summary, you don’t always have to run to the ER when you get the runs. Stay hydrated, my friends.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: Here’s How You Complete End-of-Life Planning

November 30, 2017General Health and Wellness844-SMA-TALK, Behind the Curtain, Cardiopulmonary resuscitation, CPR, Decision making, Do not resuscitate, Family, Health care proxy, POA, Power of attorney, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), There are 72 Hours in a DayJeffrey Sterling, MD

Now that you’ve had a chance to wrap your mind around the concept of needing to make end of life decisions, let’s discuss some specific mechanisms by which you can ensure your wishes are honored.
Living Will: This document, also known as medical directives, addresses those scenarios where you are unable to communicate your near death choices. The key consideration is that a living will keeps the power and decision-making in your hands, even when you’re incapacitated or otherwise unable to state your preference. You’ll want to have a copy of this form with you or with your family.
Do Not Resuscitate (DNR): A DNR form takes the living will consideration straight to the end of life question and explicitly states your preference not to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if needed. Your physician will retain a copy of this document in your medical record as a way of alerting other medical providers (such as in the emergency room–if and when you show up there) of your desire.
Healthcare Power of Attorney (POA): The healthcare POA is your designee to carry out your medical wishes beyond what you have explicitly stated. A healthcare POA may serve more than one function.

If you haven’t made DNR or living will type decisions, a POA will make those decisions for you.
If you’ve made some decision and not others, the POA will fill in the gaps.
Making a POA designation is literally putting your life in someone else’s hands. Be very careful who you choose for this role. Some people will simply designate next-of-kin or a family member. Others will want someone objective with no other motives (e.g., financial) than fulfilling their wishes. Either choice is much better than no choice, which too often leaves family members with competing interests and potentially having to carry the burden of making decisions for you that you could have made in advance.
Your POA will not be able to overturn decisions you’ve designated on the DNR form or your living will.
Your POA will not be able to make any decisions for you while you’re still able to do so unless you ask him/her to do so.

It’s important to know that you can simultaneously have a living will, DNR declaration and a Healthcare POA. If you’re able, it may be wise to engage an attorney to sort through the various documents.
I hope for your sake and the comfort of any family you may leave behind that you take the time to engage in end-of-life planning for yourself and others in your family. I’ve seen all too often how messy it gets when issues aren’t addressed in advance. You really don’t want that happening to you at the end of your life.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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: End of Life Decision Making

November 29, 2017General Health and Wellness, Medical Treatment, Health Prevention844-SMA-TALK, Behind the Curtain, Blood flow, Brain, Death panel, DecisionMaking, Education, Futile medical care, health, health care provider, Health care proxy, Heart failure, Hypertension, Intubation, Patient Protection and Affordable Care Act, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Terminal illness, There are 72 Hours in a DayJeffrey Sterling, MD

Having this conversation when death is staring you or a loved one in the face is not the most ideal situation. Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.”
I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. It needs to sink in: at any age your life could be at risk, and at any age you could die. When your life is threatened, if you have specific desires, you’ll need someone comply with decisions. It could happen today. You need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.

Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and subsequently with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document, and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That scenario doesn’t have to happen.
Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
- If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering, or will you want to be allowed to die?
- Will you want the medical staff to feed you if you can’t feed yourself?
- Will you want to donate your organs?

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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: Patient Rights and Responsibilities

November 28, 2017General Health and Wellness, Public Health844-SMA-TALK, Behind the Curtain, Patient Bill of Rights, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Even if you didn’t know it, you have rights as a patient. In 1998, the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry adopted a Consumer Bill of Rights and Responsibilities, which is summarized in this Straight, No Chaser. These rights apply universally to plans offered to federal employees and largely by health insurance plans and facilities.
Access to emergency services
If you have any health-related consideration that makes you believe your health is in danger, you have the right to be screened and stabilized using emergency services such as your local ER. You should be able to use these services whenever and wherever you need them, even if they’re out of your network, without needing to wait for authorization and without fear of any financial penalty from your insurance provider.
Choice of providers and plans
You have the right to choose healthcare providers who can give you high-quality health care when you need it.
Complaints and appeals
You have the right to a fair, fast and unbiased review of any complaint you have against your health plan, doctors, hospitals or other healthcare personnel. These complaints may include excessive waiting times, hours of operation, the actions of healthcare personnel, and/or the adequacy of health care facilities.
Confidentiality (privacy) of health information
You have the right to talk privately with healthcare providers and have your healthcare information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it’s not correct, relevant or complete.
Information for patients
You have the right to accurate and easy-to-understand information about your health plan, healthcare professionals, and healthcare facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be given so you can make informed healthcare decisions.
Respect and non-discrimination
You have a right to considerate, respectful care from your doctors, health plan representatives and other healthcare providers that does not discriminate against you based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information or source of payment.
Taking part in treatment decisions
You have the right to be informed about your treatment options and take part in decisions about your care. You have the right to ask about the pros and cons of any treatment, including no treatment at all. As long as you are able to make sound decisions, you have the right to refuse any test or treatment, even if it means you might have a bad health outcome as a result. You can also legally choose someone who can speak for you if you cannot make your own decisions.
Consumer responsibilities
In a healthcare system that protects consumers’ or patients’ rights, patients have certain responsibilities. For instance, patients must tell their healthcare providers about any drugs or supplements they are taking and about health conditions and medical or surgical problems in the past or present. Patients must ask questions or request further information from healthcare providers if they do not completely understand health information and/or instructions they’ve been given.
Patients must also take responsibility for their lifestyles to help improve their own health (for instance, following a treatment plan, exercising, and not using tobacco.) Having patients involved in their care increases the chance of the best possible outcomes and helps support a high quality, cost-conscious healthcare system.
Patients are also expected to do things like treat healthcare workers and other patients with respect, try to pay their medical bills, and follow the rules and benefits of their health plan coverage.

Knowing your rights is an important way to ensure you are receiving the best care possible. Take the time to learn these rights and use them to your advantage.

Straight, No Chaser: 25 Tips That WILL Increase Your Life Expectancy

November 27, 2017General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, life expectancy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

You may want to keep this post. I haven’t exactly found the Fountain of Youth, but I do know what activities lead to a longer life expectancy. In honor of Thanksgiving, and in the spirit of being thankful for life, here are 25 tips that you can incorporate into your daily life to help you live a younger life every day and a longer life.
1. Take a walk. Just give yourself a brisk 30-minute walk three times a week. Effect? Reverse your age by about 10 years.
2. Eat more fish. Doing so one to two times a week can reduce your heart attack risk by approximately one-third.
3. Lift weights. Yes, it gets tougher, but I’m not recommending a Schwarzenegger workout. Lifting reverses muscle and bone loss if you do it twice weekly. For those in their 50s or 60s, it can produce strength scores similar to those in their late 30s.
4. Get a pet. This is a pretty easy way to avoid depression and all that comes with it.
5. Hydrate. Your body is almost 70% water. Not soda, water. Learn to embrace clear fluids. When you’re not going clear, coffee and wine also have significant health benefits.

6. Equip your home. Everyone should have a functioning smoke alarm, carbon monoxide detector and fire extinguish, and everyone in your home should know where they are and how to use them.
7. Put a helmet on your head. 1,000 people die every year in the U.S. from motorcycle, bicycle, scooter or skydiving injuries related to not wearing protective helmet.
8. Engage in safe sex. Yes, people are still dying prematurely and living compromised lives because of the failure to wear condoms while others protect themselves.
9. Be optimistic. This keeps the negative effects of the body’s physiologic stress response from harming you.
10. Reduce your red meat intake. Even the daily intake of just one serving of red meat equivalent to the size of your fist decreases life expectancy by approximately 13 percent.

11. Spend time with friends. Healthy social networks have been shown to add as much to your life expectancy as healthy endeavors such as lowering high blood pressure and reducing high cholesterol levels.
12. Be generous. Studies consistently show that those who help others report better health than those who don’t. It may just be correlation, but being on the right side of this fence makes the world a better place.
13. Sleep. Seven hours a day gets done what your body needs to function optimally.
14. Discover blueberries. There’s been much talk about “superfoods.” Blueberries meet the criteria. Consuming approximately two cups a day has been shown to prevent chronic diseases, reduce depression and improve memory.
15. Enjoy sex and orgasms. There are a million jokes about the benefits of sex, but legitimate benefits include burning calories, reducing stress, inducing sleep and reducing pain.

16. Snack on nuts. Healthier nuts include almonds, cashews and pistachios. Eating them five days a week has been shown to add nearly three years to your life expectancy.
17. Get up! Sitting for more than three hours at a time independent of other activities can reduce your life expectancy. Take breaks, stretch and move around.
18. Maintain adequate intake of vitamins. You shouldn’t need supplemental vitamins if your diet is appropriate, buy if it’s not, here are the daily requirements that ensure optimal function. Vit C (1200 mg/day), Vit D (400-600 IU/day), Vit E (400 IU/day), Vit B6 (6 mg/day), calcium (1000-1200 mg/day) and folate (400 mcg/day).
19. Measure your blood pressure. Work to maintain your blood pressure at or below 115/75. This will help you function as much as approximately 25 years younger than someone of a blood pressure at or about 160/90.
20. Brush. Floss. Daily brushing and flossing can improve your functioning by approximately six years.

21. Wear your seatbelt. The combination of seatbelt wearing and driving within five MPH of the posted speed limit can improve your life expectancy by approximately three and a half years.
22. Eat fiber. The number to know here is 25. If you get 25 grams of daily fiber in your diet, that improves your function by approximately two and a half years over consuming half that amount. Look for high fiber dietary options.
23. Learn to laugh. Laughter actually does have clinical benefits. It strengthens your immune system by decreasing the stress-induced release of certain hormones. Learn to take or tell a joke!
24. Love fruits and vegetables. The more fruits and vegetables you eat compared to red meat, the better your life expectancy becomes.
25. Consume medical care, information and advice. Being proactive about your health increases both your life expectancy and life functioning compared to someone a dozen years younger who does not. This includes getting recommended screenings and immunizations. Also, have you heard of www.sterlingmedicaladvice.com?
Here’s a bonus tip: Avoid getting hit by that truck.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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: Treatment of Acid Reflux (Gastroesophageal Reflux Disease)

November 26, 2017Gastrointestinal, Medical Treatment844-SMA-TALK, acid reflux, antacids, antihistamines, Behind the Curtain, Gastroesophageal reflux disease, GERD, histamine antagonists, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

If you experience heartburn two times a week or more, you may have gastroesophageal reflux disease (GERD). Because there are significant differences in the severity of GERD, you should know when varying forms of treatment may be necessary. This Straight, No Chaser focuses on treatment of mild symptoms. For discussion of more severe GERD, visit www.sterlingmedicaladvice.com or discuss the options listed below with your healthcare provider.

Mild symptoms As is the case for many diseases, simple dietary changes away from foods that increase acid producing and reflux symptoms often can be sufficient. As a reminder, such foods include alcohol, caffeine, chocolate, fatty foods and peppermint. With mild symptoms, over the counter medications such as antacids or antihistamines might be all that’s needed. Additional considerations such as the following have been shown to be helpful in some people with mild reflux and is worth the effort.

avoiding large meals
avoiding late meals
avoiding tight-fitting clothing
elevating the head of your bed six to eight inches
increasing the chewing of gum or use of oral lozenges (this is related to saliva production, which can neutralize acid)
quitting smoking (smoking actually reduces saliva production)
weight loss

If and when medicines are used for mild symptoms, there are two classes of medicines used.

Antacids — Antacids such as Maalox, Myalanta and Tums are commonly used for short-term relief of acid reflux. The frustration you may have experienced in taking them is related to the fact that these medicines only neutralize stomach acid very briefly after each dose.
Histamine antagonists (aka antihistamines) — These medicines, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac), reduce acid production in the stomach and are often helpful as a first line effort.

Moderate to severe symptoms — For patients with moderate, severe or refractory symptoms of acid reflux, or for those with complications of gastroesophageal reflux disease, different treatment options must be used.

Proton pump inhibitors (PPIs) — This class of prescription medicine is stronger and more effective than the histamine antagonists listed above. When these are necessary, it typically takes an eight-week course of treatment to optimize dosing and produce the best results that can be achieved.
Surgical treatment — When PPIs are ineffective, surgical options such as strengthening the lower esophageal sphincter and repairing any hiatus hernias (conditions in which the stomach partially slips through the diaphragm into the chest, facilitating more escape of acid into the esophagus) may be necessary.

There’s a lot you can do to avoid taking medicines and needing surgery. Make those better choices and live a healthier, happier life!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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: Acid Reflux (Gastroesophageal Reflux Disease)

November 25, 2017Gastrointestinal844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

I’m at the point in life where I rarely eat after 8 pm. That has defined health benefits, but it’s also protective from today’s Straight, No Chaser topic: gastroesophageal reflux, aka GERD, aka acid reflux, aka reflux. You should be surprised and feel fortunate if reflux don’t bother you at some point. Let’s tackle this spicy topic via a question and answer format:

What is reflux? Most simply put, acid reflux occurs whenever stomach contents back up into your food pipe (esophagus) and/or mouth.
Why does this occur? Your feeding tube (esophagus) has a connection to the stomach at its lower end. This connection is made via a circular ring of muscle called the lower esophageal sphincter (LES). The LES relaxes and contracts to allow food to enter and prevent it from forward back up into the esophagus. Unfortunately, there are a number of conditions that cause the sphincter to relax, such as episode overeating, lying flat and the presence of a hiatus hernia (more on that in the next blog).
Is this a disease? Some degree of acid reflux is actually normal, but it does rise to the level of a disease (gastroesophageal reflux disease, aka GERD) when symptoms create difficulties for the patient.

What are the symptoms? You know them, and you hate them! The most common symptoms include heartburn, difficulty with swallowing (including pain or food getting stuck; this is called dysphagia), regurgitation and vomiting. In fact, heartburn occurs in 10 million adults in the US every day. In severe cases, the acid can cause hoarseness due to the effects on the vocal cords or go back down the air tube (trachea) and into the lungs (this is called aspiration). Here are some additional symptoms you may experience.

Asthma “only” at night
Chronic cough
Chronic sinus infections
Non-burning chest pain
Painful swallowing
Persistent sore throat
Persistent laryngitis/hoarseness
Recurrent lung infections
Sense of a lump in your throat
Stomach (upper abdominal pain)
Waking up with a choking sensation
Worsening dental disease

Do foods cause heartburn or acid reflux? You already know they do! Here’s a quick list of common food that worsen or trigger symptoms:

Alcohol (think red wine)
Caffeinated drinks, including coffee, soda and tea
Chocolate
Citrus fruits and products, including oranges and orange juice
Peppermint
Spicy foods, such as black pepper, garlic, raw onions and tomatoes.

When should I seek help for reflux? Although you should feel free to contact your healthcare provider for any symptoms, you should be aware that the following signs and symptoms may indicate a more serious problem. The presence of any of these should prompt you to visit and emergency room or otherwise contact your physician immediately. Please do not assume because you’ve had these symptoms previously, that the symptoms represent the same thing they always have.

Chest pain
Choking
Difficulty or pain with swallowing, or a sensation that your food gets stuck
Unexplained weight loss
Vomiting blood or have Bleeding (vomiting blood or dark-colored stools)

In the next Straight, No Chaser, we’ll review some complications, how GERD is diagnosed and treatment options.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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: Depression – How to Avoid It, When to Get Help

November 24, 2017Mental Health844-SMA-TALK, Behind the Curtain, Depression, National Suicide Prevention Lifeline, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicide, Suicide prevention, There are 72 Hours in a DayJeffrey Sterling, MD

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

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

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

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

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

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

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

I wish you and your loved ones all the best in avoiding and/or dealing with this disastrous condition. I welcome any comments, thoughts or questions.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: Tips to Deal with Depression and The Holiday Blues

November 23, 2017General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Depression, Disorders, health, Major depressive disorder, Mental disorder, Mental health professional, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

I don’t mean to bring anyone down during what is supposed to be the ‘most wonderful time of the year,’ but in reality there are many people hurting. For some, life’s tragedies happen this time of year the same as they might any other time. For others, this may have already happened, and this time of year is a permanent reminder of an unfortunate experience. For others still who struggle with depression, anxiety and mental illness all year, the holiday season can exacerbate these feelings and may make holidays especially long, depressing and potentially dangerous times.
Today’s Straight, No Chaser is not meant to drag you into the dumps but to empower you with tips to assist you in the event this is a difficult time for you. By the way, I’m extremely thankful that you’ve chosen to give me moments of your day and life. I take that gift seriously and hope you continue to find it a worthwhile use of your time.

Here’s five tips for your holiday mental health:

Remove yourself from stressful environments and avoid situations you know will create conflict, mental duress and/or danger. I can not emphasize this enough. If you put yourself in a bad situation, you can not be surprised when bad things happen.’
Find support. Specifically, have ‘go-to’ friends and family that provide you comforting support. There’s a time and place for tough love, but in the midst of depression or suicidal ideation, ‘buck up’ is not good advice. Know where your support lies and be sure (in advance) that it will be accessible if you need it.
Find success and happiness where it is. During the holidays, people tend to lament what isn’t. That’s not a formula for success. Yes, all of your family may not be around, but celebrating happy memories with the ones you can often fills the room with the joyous presence of loved ones not around. Enjoy the pleasures and successes you do have access to, whether big or small. Focusing on the positive keep you positive.
If you’re struggling, admit it. You already know you’re hurting. Often the first step to getting past it is acknowledging it. Once done, then you can put coping mechanisms in place to address your feelings.
Avoid holiday activities that will create post-holiday angst. This applies to eating, drinking, shopping and personal interactions. Some use the holiday as an excuse to overindulge as if the consequences won’t be there afterwards. Reread #1 above.

Know when you need professional help. If your support system doesn’t sufficiently address your needs, and you’re feeling severely depressed, can’t function or are suicidal or homicidal, find a physician or mental health professional ASAP. Of course, you can always contact your SterlingMedicalAdvice.com expert. If you type mental health, depression or other keywords into the search bar above, you can access many other Straight, No Chaser blogs on behavioral health concerns that may provide you the support you need. I wish you all the best today and throughout the year, and hopefully the picture above will reflect the only type of blues you’ll have to deal with this year.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: Are You Depressed and/or Suicidal?

November 22, 2017Mental Health844-SMA-TALK, Behind the Curtain, Depression, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicide, Suicide prevention, There are 72 Hours in a DayJeffrey Sterling, MD

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

I have a strong distaste for do-it-yourself websites that want to ‘screen’ you for depression. Folks, if you’re wondering whether you’re clinically depressed, you don’t need validation from some makeshift online questionnaire. That said, if you’d like to learn something, go ahead and find one. More importantly, seek assistance immediately from a qualified counselor or therapist. They do wonderful work and can get through to you before you get to yourself. Instead of a quiz, I will simply give you common signs and symptoms consistent with the diagnosis. Note the progression in the symptoms. The bottom line is: odds are, you already know if you need help. Yes, there are different depression syndromes; I’m not getting into that. You and a psychiatrist or therapist can sort that out. Don’t be reassured by a quiz when you already know better.

You may be depressed if…

You feel sad, hopeless, empty, or numb to the point where you wallow in these emotions, and they dominate your existence.
You have a loss of interest in your normal activities of daily living. It’s not just that you don’t enjoy things. You don’t even want to be bothered with them. You don’t want sex. You don’t enjoy your friends. You don’t want recreation. You can’t eat. You can’t sleep, or you can’t stop sleeping. You can’t breathe (because of your crippling anxiety). You might actually be depressed if you have these symptoms and didn’t get the ideas from listening to the lyrics of a Toni Braxton song.
You find yourself exceedingly irritable and/or anxious. These feelings are explosive and over the top. You’re waiting, ready and looking for a reason to embrace gloom, doom or anger.
You have difficulty moving forward and making decisions. This occurs for many reasons. Your attention may be shot. Your interests aren’t there. You’re overwhelmed. Stuck in a rut is not only where you are, it’s where you want to be.
You feel worthless and blame yourself for any and everything. Again, these feelings are explosive, dramatic and over the top.
You have thoughts of death and suicide. This is where things get beyond scary. You may simply have a passive wishing that things would end and a belief that your friends, family and the rest of the world would be ‘better off’ without you. You may have fleeting voices that aren’t your own suggesting or commanding suicide as an option. You may see visions of people telling you to harm yourself. You may have an active plan. When depression gets to this point, nothing good is going to happen without intervention. Never allow someone to make such comments and then pretend as if they were insincere.

Now consider these most common precipitants for suicide:

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

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

Straight, No Chaser: Cigar Smoking

November 21, 2017General Health and Wellness, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

It’s the latest, greatest, coolest past-time. Endorsed and practiced by celebrities the world over, cigar smoking has clearly and successfully marketed itself as a convenience of the successful. Even the notion that the ‘best’ cigars are forbidden fruit (i.e. come from Cuba) adds to the allure if and when you’re able to wrap your lips around one. I wasn’t surprised, but it’s worth noting that beyond the success stories received from those of you who have successfully stopped cigarette smoking, the next set of questions involved whether cigar smoking is a safe alternative.
Since you have little old me taking on an $8 billion a year industry and the wrath of the very passionate, I have no recourse but to arm myself with some data – cold, hard facts.

49% of all cigars sold are large cigars. A single large cigar contains as much tobacco as an entire pack of cigarettes.
Cigar use is on the rise, with over 13 million people identifying as current users.
15% of male students in grades 9-12 are current users.
African-Americans have the highest rate of cigar smoking (among ethnicities/races), with a 7.7% user rate.

You want to know the effects of cigar smoking? Let’s cut to the chase.

Here are the five “SURGEON GENERAL WARNING” text-only labels, one of which must be displayed on all cigar packaging and advertisements. This is done on a rotating basis.

Cigar Smoking Can Cause Cancers Of The Mouth and Throat, Even if You Do Not Inhale.
Cigar Smoking Can Cause Lung Cancer and Heart Disease.
Tobacco Use Increases the Risk of Infertility, Stillbirth and Low Birth Weight.
Cigars Are Not A Safe Alternative To Cigarettes.
Tobacco Smoke Increases The Risk of Lung Cancer And Heart Disease, Even In Nonsmokers.

Beyond what the Surgeon General requires, here are some additional facts:

All tobacco smoke contains more than 60 chemicals that can cause cancer, and cigar smoke is no exception.
Regular cigar smoking increases your risk for the following cancers: lung, esophagus, larynx (your voice box), and oral cavity (lips, tongue, mouth and throat).
Cigar smoking is linked to gum disease and tooth decay and loss.
In addition to lung cancer, heavy cigar smoking increases the risk for emphysema and chronic bronchitis.

The bottom line?
Cigar smoking is not a safe alternative to cigarette smoking.
There is no level of cigar smoking that does not pose health risks.
As always, it’s not my chore to convince you to do or not to do; freedom of choice is a beautiful thing. That said, be advised that if you read this blog, you will be an informed consumer.
Feel free to ask your SMA expert consultant any questions you may have on this topic.Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: The Frustration of Acute Bronchitis

November 20, 2017Respiratory/Lungs844-SMA-TALK, Acute bronchitis, Behind the Curtain, Bronchitis, Chronic bronchitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey 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 breathe 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. Your 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. 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).

From the Health Library of SterlingMedicalAdvice.com: “If I stop smoking, what does this do to my risk for heart disease and stroke?”

November 19, 2017Cardiology/Heart, General Health and Wellness844-SMA-TALK, Behind the Curtain, cigarette smoking, coronary heart disease, heart attack, Heart disease, smoking, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, There are 72 Hours in a DayJeffrey Sterling, MD

There are immediate and long term benefits to smoking cessation that extend beyond just lowering your risk for lung cancer. I challenge you to consider the following regarding lowering your risk for heart disease and stroke, and I’d bet you’d make the change to make yourself healthier.

Within 1 year of smoking cessation, your excess risk of coronary heart disease, heart attack, and stroke has dropped to less than half that of a smoker.
Within 5–15 years after stopping, your risk of stroke has declined to that of a non-smoker.
At 15 years after stopping, your risk of coronary heart disease is that of a person who has never smoked.

You can do it. There are many great reasons to do so. You likely call some of these reasons family and friends.

Straight, No Chaser: COPD

November 18, 2017Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Chronic bronchitis, COPD, emphysema, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

November is COPD Awareness Month. You already know a lot about COPD without realizing it or even having to think about it. You’ve seen patients walking around with the oxygen tanks or tubes in their noses. However, that’s just the extreme. COPD is the third or fourth leading cause of death in the US depending on the source, with millions of individuals diagnosed. You also know COPD and cancers are why your doctors always warn you against smoking in any form. You know smoking is the leading cause of this. This Straight, No Chaser provides a brief overview of COPD and answers some key questions.

What Is COPD?
Chronic obstructive pulmonary disease is a lung disease that makes it hard to breathe and advances in severity over time.
Appreciate that air goes from your mouth or nose through the windpipe (trachea) through several branches of airways, eventually connecting to blood vessels meant to carry oxygen to the organs of your body. These same blood vessels drop off waste gas known as carbon dioxide, which we exhale with each breath out. In COPD, less air flows in and out of the airways because of one or more of the following:

The airways and air sacs lose their elasticity. Elasticity is the stretchiness your lungs need to fill up with and push out air. In COPD, these sacs act less like a balloon and more like a lead pipe.
The airways make more mucus than usual, which clog them and make breathing more difficult. The inflammation caused by smoke and other irritants produce mucus. It’s not a good thing when instead of breathing air, you’re attempting to breathe a smoke-filled swamp of snot-like material.
The walls of the airways become thick and inflamed. Over time, inflammation can cause permanent changes in the walls of the airways to compensate for the environment you’ve created.
The walls between many of the air sacs are destroyed. Ongoing inflammation overwhelms the body’s ability to repair itself, and eventually sheets of tissue in your airways are destroyed beyond repair, providing you with less tissue to exchange oxygen from the lungs to the blood vessels that carry oxygen through the body.

What causes COPD?
Cigarette smoking is far and away the leading cause of COPD. Most of those with COPD are current or former smokers. Heredity, childhood respiratory infections, and long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust may contribute to or cause COPD.

I’ve been told I have bronchitis. Is that the same thing?
There’s acute bronchitis, and there’s chronic bronchitis. In the US, COPD refers to two separate but similar conditions, emphysema and chronic bronchitis; most with COPD have both conditions. Now if you have acute bronchitis, it means something (like and likely cigarette smoke) is currently inflaming your airways. Over time this can permanently damage the airways and produce an ongoing state of inflammation – chronic bronchitis – with airway wall thickening and increased mucus production within the lungs. Let the smoker beware.
How is this different from emphysema?
In emphysema, the walls between many of the air sacs are damaged, losing their shape and elasticity. This damage also can destroy the walls of the air sacs, leading to fewer, larger and less efficient air sacs instead of many more efficient tiny ones. If this happens, the amount of gas exchange in the lungs is reduced, meaning you’re not getting enough oxygen in you and enough carbon dioxide out of you.

What are some symptoms of COPD?
COPD can cause coughing with mucus production, wheezing, shortness of breath, chest tightness, decreased ability to exert yourself and walk around. Even more symptoms may develop as a result of inadequate oxygen supply and inadequate carbon dioxide disposal.
How can I know if I have COPD?
One big problem with COPD is many have the disease and don’t know it until it starts becoming quite advanced. It’s safe to assume that if you’re a smoker and have difficulty breathing, you’re experiencing changes to your airways that aren’t in your best interest. You are advised to get evaluated. You are best advised to remove yourself from the source of the inflammation (in other words, stop smoking).
How does COPD affect my life?
For starters, it shortens it. It also markedly increases your cancer risk. At some point all the damage and changes to your lungs is going to cause some abnormality. Given this is the area you use to breathe, deliver oxygen to your organs and eliminate toxins from your body, all manners of things can go wrong, and they often do. COPD is a chronic, progressive disease. You may or may not pick up on the slow creep of diminishing ability to perform routine activities, or maybe you’ll just attribute them to aging (COPD occurs most often in middle-aged to elderly individuals). Once severe enough, COPD may prevent you from doing even basic activities like walking, breathing without difficulty, or taking care of yourself.
What’s the cure for this?
Here’s the frightening part: we’re talking about irreversible lung tissue change and destruction. Once layers of your airways have been ripped out (figuratively), they aren’t coming back. The damage is done. Prevention is your best defense.

So how is it treated?
There is no real treatment without removing the trigger feeding the ongoing inflammation. In other words, you’ll have to stop smoking to attempt to arrest the progression. Additional measures involve support.

Supplemental oxygen may be needed to deliver enough oxygen to the tissues as an effort to combat the destruction and inflammation of tissue meant to facilitate oxygen exchange.
Medicines to reduce the inflammation and mucus may be prescribed.
Medicines to better open the airways past the clogging caused by inflammation and mucus may be prescribed.

Your physician will discuss these and other options. The truth is COPD has no cure. Once you’re discovered to have COPD, efforts switch to slowing the progression and implementing measures to improve the quality of your life within the parameters defined by the advancement of your disease.

Here is a short video from the National Institutes of Health.

[youtube https://www.youtube.com/watch?v=BIdHQQEXPDk?version=3&rel=1&fs=1&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent]

Straight, No Chaser: Lung Health – Know The Signs of Danger

November 17, 2017Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

I would suggest you should be in complete awe of your lungs. Did you know you take over 20,000 breaths a day? Your lungs bring air into your body and eliminates waste (carbon dioxide) when you exhale. The lungs transfer oxygen into the bloodstream and launches it throughout body’s cells as life-sustaining fuel. This Straight, No Chaser skips ahead in the process of lung function to discuss the relevance of everyday symptoms you experience as signals of danger.

If you have any of these warning signs or symptoms, discuss them with your physician as soon as possible.

Chronic Cough – In this definition, chronic means the cough has been present for at least a month. This is an important early symptom and should not be ignored – smokers, that means you.

Shortness of Breath – To be clear: you expect to be short of breath after you exercise or otherwise exert yourself. The shortness of breath that should be particularly concerning doesn’t go away after exercising or occurs after little or no exertion. The feeling that it is hard to breathe in or out is also a warning sign and is also indicative of respiratory illness.

Chronic Mucus Production – Mucus (aka sputum or phlegm) is produced by the airways as a defense response to infections or irritants. Ongoing production for more than a month could indicate lung disease.

Wheezing – Wheezing is often described as noisy or musical breathing and is a sign that something blocking your lungs’ airways or making them too narrow, such as a physical obstruction, inflammation or increased mucus production.

Coughing up Blood – If you are coughing up blood, the blood may be coming from your lungs or higher up in your respiratory tract. It is a sign of a health problem.

Chronic Chest Pain – Chest pain lasting more than a month should be taken as a warning sign. Lung involvement is more likely if it is associated with worsening while breathing or coughing.

Straight, No Chaser: Great American Smokeout – Quick Tips to START Smoking Cessation

November 16, 2017General Health and Wellness, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, smoking, Smoking cessation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

The Great American Smokeout is a great time to get serious about smoking cessation. Don’t wait to make it a New Year’s resolution. Do it now. Can’t do it now? Do it Monday. In fact, do it every Monday. It’s a fight. If you fall down, start it back up again. It’s the fight of your life (or should I say for your life)!
Try all of these tips to help you:

If you decide to quit after your current (last) pack, throw away one cigarette for every one you smoke.
Count (figuratively or literally) all the money you’re saving by not smoking.
Throw away (not give away) all cigarettes, cigars, matches, lighters, humidors, cigar cutters and anything else you associate with smoking. You’ll realize how sad it is if and when you find yourself rummaging through the garbage to get a fix.
Tell everyone (loudly) that you’ve quit. Empower them to help and hold you accountable. Enlist another smoker friend to go through the journey with you.
If you do fall off the wagon, smoke a different cigarette brand. Odds are you won’t like it as much, and that will help combat the natural ease you have with smoking.
Contact your physician and ask for help.

Here’s a marvelous best-practices schemata of appropriate interplay between a physician and a patient trying to stop smoking.

If your physician and you decide to place you on a patch or otherwise medicate you, follow instructions carefully and precisely.

More tips:

Practice deep breathing. Part of the euphoria of smoking is nothing more than the physiologic sensations produced by deep inhalations.
Keep other things in your mouth. Mints and chewing gum (low-calorie) are great. Brushing your teeth also serves many purposes. Drinking water when you want to smoke will often remove the urge.
Make it past the first day. Then make it past the first week.

I personally love the START method, which includes several of the above methods. Let me know if it works for any of you.
S: Set a quit date.
T: Tell your friends, family and associates that you’re quitting, and enlist their help.
A: Anticipate and act on the plan you’ve set and challenges you’ll meet.
R: Remove (trash) cigarettes, cigar and other paraphernalia from your environment.
T: Talk with your physician about options and additional support.
For those of you affected (either first or second-hand), this is huge and important. I really wish you all the best. I welcome any comments or questions.

Straight, No Chaser: Does Cuba Hold the Key to Lung Cancer Treatment and Prevention?

November 15, 2017Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs, Health Prevention844-SMA-TALK, Behind the Curtain, Cimavax, Lung cancer, oat cell cancer, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

For many, some of the first things that come to mind when you think of Cuba are smoking and cigars. For many others, the one of first things that come to mind when you think of cigars is cancer. As such, lung cancer is the fourth-leading cause of death in Cuba. Given that necessity is often the mother of invention (and given Cuba’s outstanding public health system), it stands to reason that Cuba might be at the forefront when it comes to advancing the search for a cure for cancer.
In the medical news (and in the category of important stuff that’s actually going on but you aren’t paying attention to), is a Cuban-developed lung cancer vaccine called CimaVax. Imagine if you will: a potential powerful deterrent to the most common form of lung cancer may have existed 90 miles off the shores of the US for 25 years but has been unavailable to citizens due to the US-Cuban trade embargo. Sounds like a good enough reason to normalize relations all by itself, you think?

Here’s what we know about CimaVax at this point:

It’s been researched for 25 years in Cuba and Europe.
It’s been available to Cubans since 2011.
It’s been used to treat 5,000 worldwide.
Research, including that published in the US (Journal of Clinical Oncology), has shown CimaVax to be safe, with no significant side effects.
Research has shown it to especially increase survival in study participants younger than 60 years old.

To be clear, CimaVax is not a cure for cancer; what it’s doing is blocking a hormone that causes lung cancer growth. It is thought that this strategy will also prove beneficial in the fight against breast, colorectal, head/neck, ovarian and prostate cancers, so in the field of oncology (study of cancer), this is a really big deal.

What’s next is applying the full scrutiny of the scientific method here in the U.S. What’s possible is within a few years, we may have access to what would unquestionably be one of the biggest tools in the fight against cancer this side of prevention. Here hoping. Sometimes good politics actually do make for great public health.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: Eye Pain

November 14, 2017General Health and Wellness844-SMA-TALK, amaurosis fugax, Conjunctivitis, floaters, Glaucoma, keratitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, uveitisJeffrey Sterling, MD

Look at the picture. What would you do if that was your eye? Would you try to remove the object or be too afraid, fearing that you could permanently damage it? Does the amount of pain you’re in make a difference? Eye pain is a good example of how people use the ER in general. For as many people who come to the emergency room for seemingly minor things, there’s even more that delay coming because of a thought that things will get better. When it comes to your eyes, you only have two and can’t afford to lose even one. This Straight, No Chaser focuses on eye pain that likely represents a true emergency and for which waiting should not be an option. If you have any of these signs or symptoms, come in while you still can see (if indeed you still can).

Sudden vision loss: The problem with sudden vision loss is that it didn’t happen by accident, and it’s not likely to get better without prompt relief. This could represent a stroke involving the eyes’ blood vessels (amaurosis fugax), a blockage of those blood vessels (central retinal artery occlusion), a retinal detachment and a few other critical considerations. The point to be made is that in most of these examples, you should assume that only a limited amount of time exists to repair the damage before the eye injury causes permanent damage.

Eye pain: Yes, there’s a lot of benign things that cause eye pain, but there are some serious considerations, including the following:

Burns (seen very commonly in welders and those using chemicals)
Conjunctivitis (yep, even this can be serious when caused by gonorrhea or a herpes virus – wash your hands!)
Glaucoma
Inflammation of various components of the eye (uveitis, keratitis)
Migraines
Scratches and ulcers to the eye surface (the cornea – do not sleep in your contacts unless this has been approved by your eye doctor; it just sets you up for bad things to happen)
Trauma
Tumors

Something is in your eye: Whether a chemical splash, a piece of metal, a branch or other foreign body, there are several concerns you should have. In the example of the chemical splash, something may be burning through the layer of your eye, putting it at risk for rupture. One word – IRRIGATE! If some object is in there that you cannot remove by blinking, odds are it’s not going away. Don’t cause more damage than is already there by digging around in your eye. Get evaluated.

Visualization of flashing lights and floaters: The most concerning cause of this phenomenon is a retinal detachment, which is a serious eye-threatening emergency. Visualize (no pun intended) wallpaper peeling off a wall. Unfortunately in this analogy, the retina is like the film in your camera, capturing the images of the world you see. If your retina’s gone from its natural position, you’re not seeing anything.
Eye hope you’ve found this post illuminating.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: LASIK Surgery

November 13, 2017Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, LASIK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

So you’re 40-ish, and your eyes are starting to act up on you. Or perhaps you’re younger and/or too vain to wear glasses. Or you have a phobia about having anything in your eyes, so contacts just aren’t an option. There are many different scenarios that lead one to consider Lasik surgery, but what do you really know about it? It is worth the considerable cost (and risks)?

What is LASIK? What is it trying to accomplish?
LASIK (Laser-Assisted In Situ Keratomileusis; you’re supposed to ignore the order of the letters) is a surgical procedure that permanently changes the shape of the outer covering of the eye (the cornea) in an effort to reduce one’s dependency on glasses or contact lens. It does this by positioning your eye apparatus to bend light rays so they focus better on your retina, producing vision that is clearer and sharper. I’ll defer the details of the procedure to the attached video.
How will I know if I’m a candidate?
The testing is pretty involved but in general, it is worth getting evaluated if you have one of the following conditions. The shape of your eyes (i.e., longer, shorter, flatter) may prevent light rays from hitting the retina optimally. When this is the case, your vision (focus) will be off one way or another.

Nearsightedness (myopia) is having more clear vision for objects that are closer compared to those further away.
Farsightedness (hyperopia) is having more clear vision for objects that are further compared to those closer.
Astigmatism is a disruption of both near and distant vision due to unevenness in the cornea.

So should I consider it a medical procedure or cosmetic surgery?
You’d do well to have a healthy fear of any surgery, especially on your eyes. Your ophthalmologist (eye doctor) should explore non-invasive options before offering surgery. However, when you choose or need it, the result can be pleasing when a skilled and experience surgeon does it.

So what are the risks?
As with any surgery, LASIK eye surgery carries risks:

Undercorrections and overcorrections. Optimal results require removal of a rather exact amount of tissue. If not done, your vision won’t be quite clear. If too little tissue (undercorrection) was done, an enhancement surgery may help.
Vision returning to pre-surgery vision. Over time, your eyes may worsen and even go back to the level of vision you had before surgery.
Visual loss or changes. Surgical complications can lead to worsening or loss of vision.
Astigmatism. Astigmatism is a result of unevenness in the cornea. It can be produced by uneven tissue removal during surgery.
Glare, halos, double vision and difficulty seeing at night.
Dry eyes. LASIK causes a temporary decrease in tear production. The resulting dryness in your eyes can negatively affect your vision.
Flap problems. The process of folding or removing the flap in the front of your eye during surgery can lead to infections, inflammation and excess tears.

Your eye doctor will discuss your risks and the potential benefits of LASIK surgery. It’s estimated that more than eight of 10 who undergo the procedure are able to forego contacts or glasses – for the majority of their activities. I welcome your questions or comments. Enjoy the following video, courtesy of the U.S. Food and Drug Administration.

LASIK

Straight, No Chaser: Important Things to Know About Your Contact Lenses

November 12, 2017Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, Contact Lenses, Corneal abrasion, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Subconjunctival hemorrhage, There are 72 Hours in a DayJeffrey Sterling, MD

You’d likely be surprised to know how often patients are seen in emergency rooms for complications related to use of contact lenses. If you or a loved one are using contact lenses, they’re quite safe, but you must be diligent. Failure to do so can lead to some pretty significant complications.
Question: Which is better: disposable or regular contact lenses?
The development of disposable contact lenses has lessened the risk of various eye problems. This isn’t the same as saying regular lenses aren’t good or even just as good. Daily use (i.e. disposable) contacts don’t require cleaning solutions, which were commonly used for contacts in the past to increase the longevity of them. When you’re next ready for lenses, ask about silicon hydrogel lens. Evidence suggests they are even better for comfort and lower risk for eye problems.
Question: Can I wear my contact lenses when I go swimming?
You can, but you shouldn’t, according to the FDA (Food and Drug Administration). Swimming can cause absorption of chemicals (including chlorine) and bacteria from the water, leading to an eye infection. Additionally, contacts can adhere to the eye after swimming. This can lead to ulceration of parts of the eye (e.g. cornea).

Question: Can I wear my contact lenses while I sleep?
You can use extended wear contacts while you sleep if this has been approved in advance by your optometrist or ophthalmologist; they can be used for up to seven days if recommended as such. Daily wear contacts must be removed prior to sleep – even a nap.
Question: What steps help prevent fungal infections caused by contact lenses?
First, you should understand your risks, which include prior eye damage or a diminished immune system. Fungal infections are a particular concern for those wearing soft contact lens with risk factors. To reduce your risk, be sure to thoroughly wash your hands with soap and water. Be especially careful to avoid lint on your hands before handling your contacts. Avoid extending the use of your contact lens beyond the recommendations of your eye provider. Be sure to keep your lens case clean, and replace the case every 3-6 months. In the unlikely event you’re still using Bausch & Lomb ReNu ® with MoistureLoc® Multi-Purpose Solution, discard it. It’s been recalled due to an increase rate of eye fungal infections.

Question: How do I know if my contact lenses have caused an eye infection?
Be on the lookout for redness, swelling, tearing and/or eye discharge, light sensitivity, blurred vision and pain that doesn’t improve after removal of the contacts. If you have symptoms like this, remove the contacts and get medical assistance.
Remember to pause before inserting anything in your eyes. The consequences of bad decisions can be devastating and irreversible.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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

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