Tag Archives: There are 72 Hours in a Day

Straight, No Chaser: Rashes on Your Palms and Soles; It's Not Always Hand, Foot and Mouth Disease

August 4, 2017Pediatrics/Kids Health, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Coxsackie A virus, Hand foot and mouth disease, Kawasaki disease, Rocky Mountain Spotted Fever, secondary syphilis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), There are 72 Hours in a DayJeffrey Sterling, MD

In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles. However, there are a few of note, so here’s some Quick Tips to point you in the right direction. This doesn’t take long for you to learn, so commit this to memory, and you could save yourself a lot of drama down the road. Don’t forget to wear gloves and wash your hands!
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus. It’s rather benign.

If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii). If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.

If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease. This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.

Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.

And yes, secondary syphilis presents with rashes on the palms and soles. The real take home message is this. Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed. Trust me, you want to get treated before tertiary syphilis develops. Here’s what that rash looks like.

The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.
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: Eczema and Psoriasis

August 3, 2017Skin/Dermatology844-SMA-TALK, Atopic dermatitis, Eczema, Psoriasis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Rashes are very frustrating for patients. They itch, burn, get infected, aren’t pleasant to look at and never go away rapidly enough. Another problem is no one ever seems to know what they are at first, and that causes a big problem because you’re concerned immediately (as you should be) when the rash appears. Unfortunately, in the early stages, most rashes are indistinguishable. In many cases, in order to diagnose them, you’d have to let them evolve and bloom into whatever they’re trying to become, but who has time for that? I remember in medical school, the prevailing wisdom was “If it’s wet, dry it (powder), if it’s dry, wet it (creams, lotions and ointments), and give everybody steroids.” Well, don’t try that at home without your physician’s direction because it’s not universally true, but it sure does seem like hydrocortisone has a lot to do with treating rashes.
Today, I’d like to review two common chronic conditions defined by rashes, and later I’ll do the same with acute presentations of rashes. The thing about eczema and psoriasis is we should know it when we see it, and so should you. By the way, dermatitis is the general term for skin inflammations, and eczema and psoriasis both fall under this category. As such, they have a lot in common, including basic underlying mechanisms (irritation), treatment considerations and a knack at raising frustration levels.

Eczema (aka atopic dermatitis, which is the most common form of eczema) is a red, dry itchy rash that really is just an inflammatory reaction. If you let it linger, it can become cracked, infected and develop a leather-like consistency. It’s said that you’d develop eczema just by scratching or rubbing your skin long enough, because it’s the damage to the skin that causes the inflammatory reaction that defines eczema. This is why eczema is notoriously called “the itch that rashes”. You’re more likely to have it if you have asthma, have fever or tendencies toward food allergies (or other allergies), but you can get it with pretty much any significant skin irritation. It’s not contagious, but it does run in families.

Psoriasis is another chronic skin condition that is easily recognized. As noted above, that thick scaly, silvery skin (called plaques) results from an overgrowth of skin cells. As with eczema, this condition is a result of inflammation to the skin, in this instance caused by an overreaction of your immune system speeding up the production of skin cells. Psoriatic lesions are most often seen on the elbows, knees and scalp; it can also involve the back, hands and feet (including the nails). Psoriasis tends to flare-up then go into remission, but during those flare-ups, it is very uncomfortable and unsightly.
These are both ‘dry’ rashes, so treatment involves moisturizers, changing habits to include mild soaps, loose fitting clothing, moderate temperature showers (to avoid drying the skin), and when necessary, antihistamines (like Benadryl) and topical steroid creams (like hydrocortisone). Use any medications after consultation with your physician, who may prescribe more exotic treatments such as medications to calm or suppress the body’s immune response or ultraviolet light therapy. Your job is to identify and avoid the irritants that cause the inflammatory reaction (e.g. sweating, scratching, tight-fitting clothing and anything that dries you out). It’s important for you to get these addressed early before the appearance becomes too bothersome for you.
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: Reviewing (the Claims Made within) the Netflix Documentary "What The Health"

August 2, 2017Cardiology/Heart, Detoxification, Diet and Nutrition, Endocrine/Metabolic, Environmental, General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, Diabetes, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, What the HealthJeffrey Sterling, MD

Per your request, I’ve looked at the movie “What the Health,” which apparently is all the rage and significantly promoting conversion to a vegan diet. Now I really have little interest in reviewing movies, but in this instance, I am very interested in reviewing a few of the claims that were presented in it. In general, I found it an even more interesting exercise in filmmaking than a commentary about health, but the attempts are interesting enough to warrant a serious commentary in this space. Simply put, regarding the movie, it was all too obvious that it was agenda-based, and the movie is a horribly constructed attempt to draw linear relationships between considerations that are much more complex than presented. The movie’s bias and subsequent problems were clearly revealed within the first few moments of it…

You lost me at “I’m a recovering hypochondriac.”

However, in the spirit of “a blind squirrel occasionally finds a nut,” there are some principles that are very important to consider and try to understand.

We all would do well to follow a plant-based diet. However, following a plant-based diet is not the same as becoming a vegan or vegetarian. It should involve an understanding that the most fundamental way to health is through generous portions of fruits, vegetables and water, not through any meats and fluids that have been chemically manipulated in the way these things occur today.
The next time you’re looking for a “fad” or preferably healthy eating, think more about fiber and less about protein. Remember: most any actual diet will work if you stick with it.
Being comfortable about your appearance at a certain weight should not translate to your deceiving yourself into being oblivious about the health consequences of being overweight or obese.

To its credit, this movie illustrates many problems with the conversations that surround healthcare:

Physicians and others in academic medicine often are unable to clearly communicate with the patients and the lay population.
The lay population often completely misinterprets medical information and lacks the ability to critically analyze the body of medical research.
There is an extremely uncomfortable involvement of the pharmaceutical and food industries with the entities tasked with protecting our health interests.

Perhaps the greatest faux pas of the movie is the way it “mocks” moderation. Again, this clearly demonstrates an all-too-common problem medical professionals have in appreciating the role health has in people’s lives. I have long described health as a currency, not an absolute. Each of us chooses to “spend” our health on the items that are of value in our lives. Thus we occasional engage in habits that would be deemed “unhealthy” by an absolutist (e.g. eating desert, having an occasional drink or cigar). However, these types of actions are needed by many to maintain “quality of life,” regardless of the health consequences. The medical community would do well to respect the feelings of the general population along those lines and work with patients to customize care to promote both health and quality of life.
Another major mistake is the overstatement on the condition of our population’s general health. Although it is very accurate to suggest targeted efforts are needed in eradicating the health consequences for specific individuals and communities affected by the business practices of the food and pharmaceutical industries, and obesity and heart disease are ravaging the health of individuals, it demonstrates a lack of honesty to not also report that the life expectancy of the general population has dramatically improved over the last few generations and continues to improve. What this means for you as an individual is you do in fact have an opportunity to improve your individual condition and life expectancy by adhering to a plant-based diet that is high in fiber, but to present our collective circumstances as gloom and doom unless we all immediately eschew all meats is a bridge too far and ignores public health data.

There are two final points that bear discussion, and I will do so in tandem and in summary. One scene that was meant to be especially damning in the movie was centered on the refusal of the Chief Medical Officer of the American Diabetes Association (ADA) to discuss the role of diet and diabetes, as if diabetes can be eliminated in two weeks by adhering to a plant-based diet (please don’t be that gullible). The point the filmmaker couldn’t seem to understand was actually rather clear: there is infinitely more data proving the treatment of disease (relative to diabetes and heart disease) than there is definitive data proving the specifics of a diet that will specifically and universally prevent diabetes and heart disease. The filmmaker’s effort to push a narrative of collusion between the food industries and groups like the ADA and the American Heart Association was quite transparent. To whatever extend that narrative may be true, the effectiveness of the point was minimized by the tactics of the filmmaker.
In fact, the key to life, health and the pursuit of happiness is recognizing in many examples, it is about moderation. With the exception of specific, immediate life-threatening toxins, most of the items in your diet aren’t all bad. For example, a certain amount of fat is needed within the body as a conduit to help absorb required vitamins. Similarly, carbohydrates are needed for energy.
If you’re looking for a takeaway from the movie or how to apply all that was thrown at you in the movie, keep it simple.

Appreciate that everything you place in your mouth either helps or hurts you. Make better food choices and make efforts to migrate toward a higher intake of plants and foods that increase fiber.
Drink water!
Don’t rely on medicines for your health. If your interest in your health begins at the point in which you’ve developed a disease, you’re too late.
If you focus on your health, yes you will begin to eliminate toxins and introduce incremental improvements regarding whatever is ailing you, but please don’t believe your lifelong ailments will magically disappear. The more important point is to get a plan, get focused, get started, and keep at it. You will see the difference.

It stands to reason that I should point out that Straight, No Chaser is no in any way supported or influenced by corporate sponsorship.
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: Understanding and Appropriately Stopping Thumbsucking

August 1, 2017Gastrointestinal, Dental844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, thumbsu, thumbsuckingJeffrey Sterling, MD

At first glance, you may be wondering what’s so significant about thumb-sucking that we need to discuss it. And then, I show you these two pictures.

In most instances, thumb-sucking is a benign activity. It appears to stem from the sucking reflexes babies have, which are useful in breastfeeding. It is understandable how babies can transfer the level of comfort and security they find in their maternal attachment. You would think that at some point that wouldn’t be necessary, and indeed that is the case in the overwhelming majority. In those instances when that is not the case, you need to have tools at your disposal to address the situation.
As a frame of reference, thumb-sucking tends to end during the toddler years for most. For most of the rest it ends when they are exposed to other children who may exert peer pressure.
As noted in the above picture, thumb-sucking becomes a physical problem when a child’s permanent teeth start to come in. Thumb sucking then can affect how teeth develop and how the roof of the mouth forms.
Regarding mental considerations, children (and adults) may revert to thumb-sucking behaviors when confronted with stress. In these instances the thumb-sucking can take them back to a more comforting time.
The two most common questions are “When should I do something about it?” and “What can I do about it?”
In general, the time to start working with your children to move past thumb-sucking is at about age four to five, if you notice dental problems or if you suspect that thumb-sucking is related to anxiety and stress.
Various strategies are used to facilitate cessation of thumb-sucking:

It appears that parental displays of anxiety are counterproductive. Children tend to respond more to positive reinforcement (rewarding good behaviors) than negative reinforcement (criticizing negative behaviors). Along those lines, experts generally recommend avoiding strategies such as placing bitter substances on the thumb.
Avoid rewarding the use of thumb-sucking as a means to obtain attention.
It’s easier and more productive to address any triggers (e.g., anxiety, stressors) that promote thumb-sucking than the activity itself. Substitution of the thumb with another release (e.g., a stuffed animal) may be effective.
If other efforts have been unsuccessful and the thumb-sucking is interfering with normal development of the teeth, your dentist might recommend a dental appliance (such as a mouth guard) or a thumb guard to prohibit sucking.

It is important to realize that in most instances thumb-sucking will go away. It is also important for you not to display so much stress that it adds to the child’s stress or reinforces any attention-seeking behavior.
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: When Fainting is Deadly

July 31, 2017Cardiology/Heart, Neurology844-SMA-TALK, anemia, arrhythmia, Behind the Curtain, Conditions and Diseases, fainting, Hypoglycemia, panic attacks, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vasovagal syncopeJeffrey Sterling, MD

1. So can faints be deadly?

Potentially. There are three separate sets of considerations. The brain can’t survive very long without adequate oxygen. Whatever caused that faint, if it continues to deny oxygen to the brain, can lead to seizures, strokes and death. The process that caused the faint could be deadly in and of itself. Such things would include heart attacks, strokes, seizures due to bleeding inside the brain. Significant injuries may occur after the faint. Someone who falls may subsequently suffer a head or neck injury, which could be deadly, independent of the cause of the faint. It’s worth mentioning that it’s an especially odd behavior that people seem to travel to the bathroom when they feel dizzy. All things considered, it’s better to faint in your soft bed or surrounding carpeted floor than on the hard tile of a typical bathroom with even harder sinks, toilets and tubs in close proximity.
2. My doctor always warns me about high blood sugars. You mentioned low blood sugars as a cause of faints. Am I putting myself in danger if I’m taking sugar and my sugar level is already high?
If you know all of that, yes. More often, you know none of that. Here’s the deal. Both a high and low glucose (blood sugar) count can cause altered mental status, fainting and coma. If your glucose level is especially high, say 900, and you drink some orange juice, it won’t make much of a difference. If your glucose level is 0, and you are given some orange juice, your life just got saved. In other words, it’s medically worth the risk if you don’t know what the glucose level is.
3. Can a loved one really take my breath away?
Yes. Overstimulation can lead to syncope in a variety of ways as mentioned previously.
4. What’s with the goats?
If you’re referring to Tennessee fainting goats, they exist. The goats don’t actually faint. When startled, they become stiff to the point of being unable to move their legs. Subsequently, the terrified goats can’t run and just topple over. Here you go.
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: You’re Way Too Comfortable With Fainting

July 30, 2017Cardiology/Heart, Neurology844-SMA-TALK, anemia, arrhythmia, Behind the Curtain, Conditions and Diseases, fainting, Hypoglycemia, panic attacks, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vasovagal syncopeJeffrey Sterling, MD

Don’t faints seem mysterious? It’s as if your computer crashed and had to reboot. Although we never seemingly figure out why computers are so crazy, fainting (syncope) is reducible to a common denominator: something causes a decrease in blood flow to your brain. Recall that oxygen and other needed nutrients are carried in blood, so even a temporary stoppage or shortage of blood flow shuts things down. Now extrapolate that to strokes and comas, which are often due to serious and prolonged causes of blockage to the blood vessels supplying the brain. This is a prime example of why good blood flow and good health are so important. The brain is a highly efficient, oxygen and energy-guzzling organ. Shut it down for even a few seconds, and bad things start to happen. Consider fainting a warning sign.

I’m going to start by offering some Quick Tips to help if you find yourself around someone who has fainted. Then, I will get into the weeds of why these things happen for those interested. I’m doing this so you can check these and determine where your risks may be.

Call 911. Make sure the person is still breathing and has a pulse. If not, start CPR.
Loosen clothing, especially around the neck.
Elevate the legs above the level of the chest.
If the fainter vomited, turn him/her to the side to help avoid choking and food going down the airway (aspiration).
A diabetic may have been given instructions to eat or drink something if s/he feels as if s/he is going to faint. If you know this, a faint would be a good time to administer any glucose gel or supplies advised by a physician. Prompt treatment of low blood sugar reactions is a life-saver. Discuss and coordinate how you can perform this effort on behalf of your friends and family with their physicians.
If it’s possible that the faint is part of some heat emergency (heat exhaustion or heat stroke).

Actually, faints are caused by all kinds of medical problems. I list a few notable causes below, but whether the front end difficulty is with the heart pumping, the nerves conducting, or the content of oxygen or energy being delivered, the end result is the same.

Decreased nerve tone (vasovagal syncope): This is the most common cause of faints, and contrary to what you might think, it happens more often in kids and young adults than in the elderly. Understand that your nerves actually regulate blood flow (analogous to a train conductor telling the heart to speed up or pump harder or not). Changes in nerve tone can result in errant signals being sent, transiently resulting in low flow.
Diseases and conditions that affect the nervous system and/or ability to regulate blood pressure: Alcoholism, dehydration, diabetes and malnutrition are conditions that may depress the nervous system. Alternatively, coughing, having a bowel movement (especially if straining) and urination may abnormally stimulate the system. In the elderly and those bedridden, simply standing can cause fainting due to difficulty regulating blood pressure. In this case, standing causes a sharp drop in blood pressure.
Anemia: A deficiency in blood cells can lead to a deficiency in oxygen delivery to the brain.
Arrhythmias (irregular heart beats): Inefficiency in your heartbeat leads to unstable delivery of blood to the brain.
Low blood sugar (hypoglycemia): Low energy states can deplete the body of what it needs to operate effectively, leading to low blood flow.
Medications (especially those treating high blood pressure): anything that lowers the heart’s ability to vigorously pump blood around the body can leave the brain inadequately supplied, leading to a blackout. Let’s include illicit drugs and alcohol in this category.
Panic attacks: Hyperventilation caused by anxiety and panic upset the balance between oxygen and carbon dioxide in the brain, which can lead to fainting spells.
Seizures: Here’s a chicken and egg scenario. A prolonged faint can lead to a seizure, and seizures lead to periods of unconsciousness, during and after the seizure. The lack of oxygen is a common denominator.

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: Sealed with a (Wrong Type of) Kiss – Zoonotic Diseases

July 29, 2017General Health and Wellness, Infectious Disease, Public Health, Health Prevention844-SMA-TALK, anthrax, Behind the Curtain, Conditions and Diseases, dengue, E. coli, ebola, lyme disease, malaria, plague, Rabies, Rocky Mountain Spotted Fever, salmonela, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, toxoplasmosis, west nile virus, zoonosisJeffrey Sterling, MD

It’s interesting how we take animals for granted. Many of us touch and handle them, play with them. Some people keep their pets in their faces, allowing them to kiss and lick them. Do you ever think about where they’ve been and whether they are ill and contagious? Would you be surprised if I told you that approximately 60% of the bacteria, viruses and other microorganisms that cause human disease originates from animals?

That’s right. There are many diseases that animals have that can be transmitted to humans. These groups of diseases are called zoonoses. It’s at least worth giving it some thought; many of these diseases don’t even require direct contact with the affected animal. Even more concerning is the fact that about 75% of newly emergent infectious diseases affecting humans are of animal origin.
We spend a lot of time in places where infected animals and insects may exist. Besides exposures in relatively exotic areas such as farms, woods, nature parks and petting zoos, simpler environments such as pet stores, fairs, schools and childcare facilities may also prove to be risky.

Many different types of animals pose these risks, including rodents, amphibians, live poultry, reptiles, insects and an assortment of domestic and wild animals. Here are a few examples (but not an exhaustive list) of how disease may spread that have been particularly common in the news of late.

Many animals carry rabies, including bats, raccoons, foxes, skunks, wolves, coyotes, cattle, monkeys, mongooses and dogs.
Reptiles such as turtles, iguanas and snakes can transmit Salmonella, a prominent cause of food poisoning.
Handling your cat’s kitty litter (or otherwise handling stool) can transmit toxoplasmosis, an infection that can be deadly to those with weakened immune systems or to unborn children.
West Nile has been in the news every year this millennium, causing over 1.5 million infections in humans since 1999.
Deer and deer mice carry ticks that can lead to Lyme disease, a bacterial infection involving a rash, fever, chills, body aches and possible arthritis, neurological and cardiac disorders.
Other common infections caused by these exposures include anthrax, dengue, Ebola hemorrhagic fever, E. coli infection, malaria, Plague and Rocky Mountain spotted fever.

If you’re a good pet owner (and otherwise healthy), you shouldn’t have to worry about this much. Simple steps such as keeping your pets’ shots up to date, keeping their play areas clean, avoiding direct contact with wildlife and maintaining basic hygiene measures such as hand washing after contact sufficiently lowers your risk. Here are a few additional tips:

Keep tabs on your kids to ensure they wash their hands properly and avoid thumb-sucking, eating and pacifier use after animal contact and before cleaning up.
Use insect repellents that contain 20% or more DEET on the exposed skin and be generous with it when in risky areas.
Use products that contain repellents (such as permethrin) on your clothing and gear, such as boots, pants, socks and tents.
Look for and remove ticks from your and your children’s bodies.
Limit mosquito breeding grounds around your home by getting rid of items that hold still water.

Straight, No Chaser: Extracting Ticks and Preventing Tick Bites

July 28, 2017General Health and Wellness844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, tick borne diseasesJeffrey Sterling, MD

Springtime is the beginning of the outdoor season for many. Whether you’re camping, hunting, playing paintball, hiking or engaged in other activities in the woods or tall grass, you need to be alert to the presence of pesky mosquitoes and ticks.
This Straight, No Chaser will discuss prevention and removal of ticks. An additional post will discuss tick-borne diseases.
Tick-borne diseases are seen more often between April and September, because people are more inclined to be outdoors during the warmer months. Preventative activities are necessary whenever you’re outdoors.

Try the following preventative measures:

In general, ticks are found in areas with high grass and in leafy mounds. Avoid these areas, and stay on trails that are well outlined when possible.
Wear clothing that covers as much of your body as practical.
Wear clothing that is pre-treated for tick control. These products contain permethrin. Protect your pants, boots and socks. Also treat your tent if you are camping.
If you’re using repellent (which you should), use 20-30% DEET. Apply repellent generously and avoid getting it in the eyes, mouth and hands.

Prevention also includes steps you take once you’re literally out of the woods.

As soon are you arrive home, bathe and/or shower.
View (or have someone else view) your body for ticks. Be sure to check the hair and in body crevices, such as under your arms, within the belly button, armpits and the backs of the knees, the front of the elbows, around the waist and groin, and around the ears.
Once you’ve cared for yourself, check your gear and any pets that accompanied you. Ticks can attach to your pets or other items taken on the retreat, then get on you later. Take the time to look everything over.
Furthermore, once washing your clothes, tumble them in a dryer set on high heat for an hour. This will kill any remaining ticks.

The simplest way to remove a tick that is attached to you is to use tweezers, which should be part of what you take with you when headed to the woods.

Grasp the tick as close to your skin as possible.
Pull upward with steady, even pressure, and do not twist, bend or jerk the tick.
If you break off the tick’s mouth and leave it in the skin, go back and take out the individual parts with tweezers. If you are unsuccessful, do not dig into the skin. Do the best you can to clean the area; the skin will heal.
After removing whichever part of the tick you can, use soap and water, alcohol or and iodine scrub to clean the area of the tick bite.

Avoid and ignore folk tales that involve doing anything to the tick other than extracting it. Without going into details, using paint or fire doesn’t help and can make matters worse.
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: Avoiding Mosquito-Bourne Diseases

July 27, 2017Infectious Disease, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, dengue fever, japanese b encephalitis, malaria, mosquito, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, west nile virus, yellow feverJeffrey Sterling, MD

Sometimes things occur so frequently that you become sensitized to the real danger they present. This thought occurred to me when I saw Bill Gates talking about efforts to eliminate the various threats posed by mosquitoes. Yes, mosquitoes.

Including the damage humans inflict on each other during times of war, mosquitoes are responsible for more human suffering than any other organism on earth. Well over one million humans die every year from diseases transmitted by mosquitoes, and with worldwide travel having increased as it has, the risk is greater than ever. Even if you don’t know the diseases caused by mosquitos, you may have heard of them.

Malaria

West Nile virus

Dengue fever

Yellow fever

Japanese B encephalitis

Getting into the specifics of these various diseases is beyond the scope of this particular post. What I’d like for you to appreciate is this list comprises various diseases with deadly consequences.
Furthermore, you’re not defenseless. There are steps you can take to lessen your risks. In the interest in making this manageable, I’m going to focus on the “Ds of mosquito prevention”, because as is the case with most things, prevention is more effective than attempting to cure a disease once it is obtained.

Dusk and Dawn: Try to steer your activity away from the times when mosquitoes are most active.
Drain: Get rid of standing water around your home. This is where mosquitoes will lay eggs.
Dress: During those times when mosquitoes are most active, wear clothing that covers as much of your skin as practical.
DEET: Use mosquito repellent. Repellents containing up to 30% DEET are effective. Additionally, picaridin, oil of lemon eucalyptus and IR3535 are effective, according to the Center for Disease Control and Prevention (CDC).

Here are a few other simple tips.

Cover doors and windows with screens to keep mosquitoes from entering your home.
Keep infants indoors or use mosquito netting over carriers.
If you have a water garden, stock it with mosquito-eating fish, such as gambusia, goldfish, guppies or minnows.
If you’re traveling, be aware of peak exposure times and places, and schedule around these times if possible. Avoid outbreaks.

Being just a bit more sensitive to the risks mosquitoes pose could be an important component of your overall health strategy. Be smart, and be healthy.

Straight, No Chaser: Emergency Room Adventures – The Risk of Rabies

July 26, 2017Infectious Disease, Neurology, Public Health844-SMA-TALK, Behind the Curtain, Rabies, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Depending on the circumstances of your life, sometimes risks are theoretical, and other times risks become occurrences…
You can’t make this stuff up. It’s another busy night in the ER, and back-to-back patients come in, not related but dealing with the same issue. One’s a child bitten over the eye by a family dog with no shots. The next is a teenager attacked by a possum, which he decided to kick in the mouth, and of course he ends up being bitten. Both of these situations hold a certain risk of rabies exposure.
Rabies is a viral disease transmitted to humans through the bite (or scratch) of an infected animal. It infects the central nervous system, initially producing a multitude of symptoms that resemble the flu (fatigue, headaches, fever, malaise) and then progressing to exotic symptoms (including fear of water, increase in saliva, hallucinations, confusion and partial paralysis) culminating in death within days.
There is no cure for rabies once symptoms appear, so prevention is critical.
Animals that are especially likely to transmit rabies include bats (the most common culprit in the U.S.), foxes, raccoons, skunks and most other carnivores.

Bites from these animals are regarded as rabid unless proven otherwise by lab tests.

These animals must be killed and tested as soon as possible.

Animals that have been reported to transmit rabies also include dogs, cats and ferrets.

If bitten from one of these animals, and it appears rabid, treatment must begin immediately.
If the biting animal appears healthy and can be observed for 10 days, then do so, but the animal must be euthanized at the first sign of rabies.

Others bites in which rabies should be considered include those from rodents (woodchucks, beavers and smaller rodents), rabbits and hares; these almost never require post-exposure prophylaxis unless the area is a high rabies exposure area. In these instances decisions will be made in consultation with local public health officials.

So what should you do if bitten?

Remember, there will be no immediate symptoms, so you can’t trust that you’re ok just because you’re feeling ok.
Make every effort to secure the animal.
Even if the animal isn’t available, go to the nearest emergency room as soon as possible after contact with a suspect animal.

What can you expect?

Vigorous wound cleaning
Assessment for and possible administration of two different types of vaccinations. These regimens can prevent the onset of rabies in virtually 100% of cases, one of which needs to be administered in five separate doses over a month’s time.
Additional vaccination for tetanus, if appropriate
Antibiotics if appropriate.

Remember, rabies is a fatal disease. It is meant to be avoided, but if you can’t avoid it, you need to get assessed as rapidly as possible. I hope this information helps you make correct decisions if you’re ever confronted with a rabies prone animal, and for goodness’ sake, please get any house pets all appropriate vaccines.
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: Stop, The Life You Save May Be Your Own – Snake Bites

July 25, 2017General Health and Wellness844-SMA-TALK, Antivenom, Behind the Curtain, Conditions and Diseases, health, health care provider, postaday, Rattlesnake, Snake, snake bit, snake bites, Snakebite, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, triangular heads, Venomous snake, Wound, wound cleaningJeffrey Sterling, MD

So you’ve been snake bitten. What will you do next?
First things first. Stay calm. Call 911. Realize that most snake bites are non-venomous (A really quick tip regarding the likelihood of a venomous snake: most have triangular heads.). Here’s 10 additional steps to take while waiting for your help to arrive.
5 Things To Do

Protect yourself. Get out of the snake’s striking distance. It should be trying to get away from you as well.
Lie down. Keep the wound below the level of the heart.
Be still. Activity simply facilitates spreading of any venom present.
Cover the wound with a loose, clean dressing. Immobilize the extremity if possible.
Remove all restrictive clothing and jewelry from the area, because the area will swell.

5 Things Not to Do

Try to suck out venom.
Try to cut out the area bitten.
Apply any constrictive dressings.
Apply any cold or ice packs to the wound site.
Run to help.

If you’re lucky enough to have a snake bite kit, you’ll simply follow those instructions, which are a modified version of the instructions I’ve just given.
You will need to be seen by a health care provider for consideration of the following:

Anti-venom may be needed.
Tetanus immunization may be needed.
Appropriate wound cleaning will be needed.
Antibiotics for skin infection may be needed.

Straight, No Chaser: Animal Bites

July 24, 2017Infectious Disease, Skin/Dermatology844-SMA-TALK, animal bites, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

We love our pets, and animals in general. Is there one about which a movie hasn’t been made? In most cases they are sources of entertainment, if not love. Unfortunately, they are still animals, and on occasions instincts kick in. When this occurs, we find ourselves in danger. Today’s post reviews the dangers of various animal bites.

Bow-Wow Ows
Dogs bite almost five million people yearly, resulting in 800,000 visits to a healthcare provider. Injuries are highest for kids between ages five and nine.
Most dog bites are to the upper extremities. (Imagine yourself reaching out, petting or slapping a dog.) However, in kids most injuries are to the head and neck. (They’re smaller.) Here are some tips to avoid getting bitten.

If you’re considering bringing a dog into your family, remember that dogs or dog breeds with histories of aggression are inappropriate in households with children. (I’m talking to you, pit bull owner.) Also, spend time with a dog before committing. If your kids are afraid of any individual dog, hold off. That fear may create cues the dog will pick up on and create a self-fulfilling prophecy. Spaying/neutering a dog actually reduces aggressive tenderness (no puns necessary).
Once you’ve acquired a pet dog, please never leave infants or young children alone with the dog.
Train your dogs, focusing on submissive behaviors. Do not wrestle or otherwise become overly aggressive with your dog. If your dog develops aggressive tendencies, either get better training or remove the pet from the household before it’s too late.
Don’t disturb your pet if sleeping, eating or caring for puppies. Also, avoid staring down your or any dog.
Do not approach an unfamiliar dog.
Regarding dogs you don’t know, don’t pet any new dog without allowing it to see your hand and smell you beforehand. Do not run away screaming from a dog; in fact, if you’re approached by an unfamiliar dog, your best move is to remain motionless. If you trip or fall over, roll into a ball and lie still.

Mee-Ow Ows
In general, cat bites and scratches are much worse than dog bites. Cat bites and scratches are more of the puncture wound variety, seeding and walling off very infectious bacteria deep inside of you, which then grow and cause infections. (Dog bites are more of the ripping, tearing variety, which poses different problems, but they aren’t as dangerous from an infectious disease standpoint.) Cat bites cause skin and blood infections. You’ll know this by warmth, redness, pain and pus from the wound site. Below is a depiction of an infected cat bite wound.

Fever may also be present if the infection is severe enough, and yes, cat bites can be fatal if untreated. You may have heard of “cat-scratch fever.” It’s a real phenomenon. Forget the lead picture; here’s a real picture of cat-scratch fever.

All bite wounds should immediately be washed under high pressure running water, but you want to avoid any scrubbing. Applying pressure to bleeding wounds is important. Time is also important. Both cat and dog bites need to get evaluated. Expect to receive antibiotics in the vast majority of cases. Some bites will require stitches; others will not. That’s a decision for the medical professionals. Treatment may include tetanus and rabies vaccines. Get in and be seen, especially with cat bites/scratches, which can cause loss of life and limb if not dealt with rapidly and effectively.

By the way, since this is my blog, I’ll just say stop it with letting your dogs lick you and kiss you in the mouth. That’s just nasty (and that’s medically speaking). Don’t you know where their mouths have been?

The Big Yow Wow! Ow
Shark bites are the things of legends, thanks to movies like Jaws and The Deep Blue Sea, which gives the impression that sharks are serial human killers. In fact, there are about 100 shark attacks worldwide yearly, with about 15-20% of attacks being fatal. I doubt that most Straight, No Chaser readers will be shark bait anytime soon, but the first thing I will mention that’s important to know is unlike other attacks by potential predators, playing possum doesn’t work with sharks. Fight back and fight dirty, attacking the eyes and gills. Apparently, sharks like easy food. In case you’ve ever wondered, sharks aren’t biting you because they’re hungry but because they’re curious. They don’t encounter humans often and similar to how a baby puts about anything in its mouth, sharks will take an “exploratory bite.” The typical human who swims frequently enough to be in shark infested waters isn’t obese enough to keep sharks’ interest and be a focus of their diets, particularly with so many other options. The other curiosity about sharks is after that first nibble, they tend to back off and wait for prey to die before returning for the kill. They don’t seem to like fighting wounded and aggressive victims. Rather lazy, I’d say.
The real danger in shark bites is the amputation. Single bites of arms and leg can cause enough blood loss and subsequent infection to kill you, just like any other amputation. Obviously a bite to your skull, chest or abdomen can kill instantly. Treatment primarily involves aggressive fluid resuscitation and other life-supportive measures, along with assessment of infection risk with antibiotics as necessary.

The Most Dangerous Animal of Them All
Yesterday’s blog on human bites is important; it’s that frequent and important. For now, understanding that the human mouth is especially dirty and dangerous should hold you over. (Yes, it gets a lot worse than the above picture.) In the meantime, pay attention to your household pets and use the tips mentioned to avoid infection.
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: Your Questions About Human Bites

July 23, 2017Infectious Disease, Medical Treatment, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bite marks, Bites and Stings, Boxer's fracture, cat bite, Conditions and Diseases, Dracula, health, human bite, Infection, laceration repair, metacarpal bone, pinky finger, puncture wound, Snake bite, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Wound, Wounds and InjuriesJeffrey Sterling, MD

A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5^th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.

3) Is a human’s mouth really dirtier than a goat’s mouth?

It’s correct to say the bacteria in a human’s mouth cause more disease.

4) Is a bite the same as a puncture wound

The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).

5) I received a bite and didn’t get stitched up. Why?

This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.

6) Why didn’t Dracula ever get Hepatitis or HIV?

Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for a while in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.

Straight, No Chaser: Human Bites

July 22, 2017Infectious Disease, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bites and Stings, Biting, Cellulitis, Conditions and Diseases, Hangnails, health, human bite, Infection, Mike Tyson, Open wound, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Tetanus shot, There are 72 Hours in a Day, Wound, Wounds and InjuriesJeffrey Sterling, MD

I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious. However, as an emergency physician, knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first quick tip is to do the same.

Maybe it’s where I’m located, but I tend to see way more “fight bites” than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who “won” the fight being the one who has to come in for medical treatment. He cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize, the structures in the hand (tendons, blood vessels, muscles, and bones) are highly concentrated. He also doesn’t know that they are confined to a very limited space and seeding an infection in that tight space makes things really bad really quick. This guy is very dangerous because he tends to deny ever getting into the fight, ascribing the injury to something else (like punching a tree)—at least until I ask him why a tooth is inside his hand.

Then there’s the “Yes, he bit me” variety, where the teeth were the aggressor that engaged the victim instead of the fist engaging the tooth. Think of the Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears, and other unmentionables)! Children, as another example, sometimes bite and need to learn to stop that behavior. Biting is sometimes seen in sexual assault, physical abuse, self-mutilation, or with mentally handicapped individuals.

A third type is the ‘We love too much!’ variety of bites. These may include hickeys that actually break the skin. Other examples of “friendly” bites are folks biting off their hangnails, fingernails, and toenails and create skin infections. Yes, it happens more than you’d think, and no, you don’t have to be a vampire.
The commonality to all of these scenarios is saliva that found its way through the skin. Because of the virulence of the bacteria contained within the saliva, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness, fever, and possible pus from the wound develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, get evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop. In fact, these bites require immunization for tetanus.
Bottom line: There’s no reason not to get evaluated if you develop those signs of infection, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.

So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies like peroxide, alcohol, and anything else that burns. Those agents make things worse by damaging the skin more than they “clean” the area.
2) Apply ice—never directly to the wound—but in a towel. Use for 15 minutes on and then 15 minutes off.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
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: Don’t Let the Bedbugs Bite!

July 21, 2017Infectious Disease844-SMA-TALK, bed bugs, Behind the Curtain, Benadryl, diphenhydramine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

There’s nothing pleasant in talking about bedbugs, but’s it is even worse to have to deal with them, so let’s get you some information to help you prevent and address these bug bites.

Bedbugs are everything you don’t want them to be. They’re parasites found all over the world, living only to feed on the blood of humans and other animals while you sleep. They’re excellent at hiding, and they do so all day. They only come out every week or so to feed, and when that doesn’t work, they don’t mind so much. They can go over a year between meals. Here’s a not-so-pleasant fact. If you have them, they live within eight feet of where you sleep, but they are willing to travel over 100 feet to get to you.
Let’s discuss your major concerns about bed bugs.

How do I prevent having them?

Keep a tidy environment so there are fewer places for bedbugs to hide.
Routinely check your furniture, drapes and curtains.
Use a protective cover for your mattress, box springs and pillows, and frequently check it for holes.
When on the road, don’t place your luggage on the floor (use a luggage rack if available). Inspect your mattress, looking for bugs, blood stains or droppings.
When returning from a trip, unpack directly into the washing machine. Learn to check your travel bags.

If bitten, what type of symptoms will I have?

You’ll itch, and you’ll discover bite marks (These may not appear for a week or two after the bite. Why you might ask? The bite actually injects an anesthetic into you that prevents you from immediately realizing you were bitten.). Symptoms vary pretty widely between individuals, from some having no reaction to others having severe allergic reactions.

Do bedbugs spread disease?

At least it can be said that bedbugs don’t transmit other diseases.

What treatment do I need for bedbug bites?

Treatment is symptomatic and involves controlling the itching. Diphenhydramine (branded as Benadryl®) is usually effective for this, as are over the counter topic corticosteroids. You should be careful about scratching your skin, as you can cause infections. If you develop redness, swelling, pain, ongoing itching or develop pus from the bite site, you should seek medical attention.

How do I get rid of bed bugs?

Once you discover you are exposed to bedbugs, you will need to wash and dry your clothes and bed sheets at very high temperatures.
If you aren’t using protective covers for your mattress, box springs and pillows, you will need to do so.
Insecticide spraying is effective in treating infestations.

Keep in mind that bed bugs are often an acquired habit. When you’re at a hotel or a guest in someone’s home, be mindful to check everything you bring back home!
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: Lou Gehrig’s Disease (aka Amyotrophic Lateral Sclerosis)

July 20, 2017Neurology844-SMA-TALK, ALS, amyotrophic lateral sclerosis, Behind the Curtain, lou gehrig's disease, motor neurons, riluzole, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

There’s no longer an ice bucket challenge, but the disease known as Lou Gehrig’s disease still is around. However, I have to ask… Do you have any idea what the disease is? In the overwhelming likelihood that you do not, this Straight, No Chaser is going to provide you with a few facts about ALS, so you can at least know why you were getting all wet. ALS is actually a very complicated disease for the layperson to understand (and it’s even worse for the 12,000 or so Americans with definitive diagnosis), so I’ll break it down in five questions.

What is ALS?
The medical description of ALS is a progressive neurodegenerative disease that affects those nerve cells in the brain and in the spinal cord that control voluntary muscle movement and power. Decomposing that medical jargon, this disease
1) creates a dysfunction of certain areas of the brain and nervous system and the associated nerves and muscles controlled by them,
2) worsens over time, and
3) it often culminates in irreversible deterioration and loss of function in the affected organs or tissues.

So what’s the dysfunction?
Remember that the brain controls the activities of the rest of the body. If nerve cells in the brain and spinal cord are dying, your functions associated with those cells go away. In ALS, based on the type of cells affected (motor neurons), what is affected results in a loss of the ability of the brain to initiate and control muscle movement.
Does ALS involve all muscles?
No. There are organs and tissues of the body (most notably the heart and digestive system) that aren’t under voluntary control. These areas are spared from the effects of ALS.

What are the symptoms?
Since the brain can’t control those muscles under your voluntary control, symptoms are somewhat predictable and include the following.

Early symptoms often include increasing and widespread muscle weakness. This can include the arms and legs and also those muscles allowing you to speak, swallow and breath.
Additional symptoms include thinning of the arms and legs resulting from lack of muscle use.
Eventually, paralysis can occur. Paralysis of muscles involved with swallowing and breathing can lead to a rapid death.

What’s the treatment for ALS?
There is no cure for ALS. There is also no treatment that halts or reverses progression. However, there is a drug named riluzole that modestly slows the progress of ALS. The remainder of treatment efforts involves providing episodic relief of symptoms.
This is why your contributions are of value. There is ongoing research that is promising. Even if you didn’t take the ice bucket challenge, you can still make a difference. Go to www.alsa.org to learn more.

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: Questions About Memory Loss and Forgetfulness

July 19, 2017General Health and Wellness, Geriatrics/Elderly Care, Mental Health, Neurology844-SMA-TALK, Alzheimer's disease, Behind the Curtain, dementia, memory loss, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Are you the type that has a bad memory? Is your memory good when you “want it to be?” Do you just have problems paying attention? Are you concerned about elderly family members suffering from dementia or Alzheimer’s disease? This Straight, No Chaser may have some answers to your common questions. Feel free to ask any others you may have.
Am I forgetful, absent-minded or do I have a serious memory problem?
You tell me. It’s not memory loss if you never paid attention to begin with (there’s a joke about husbands and sporting events in here somewhere). It’s certainly the case that the more you focus on remembering whatever it is, the more likely it is that you will.
Ok then, what’s the difference between normal forgetfulness and serious memory loss?
To understand this distinction, think about functionality. We all forget things. It is a clear concern when the things being forgotten involve items needed for activities of daily living (your name, your address, your birthday, etc.).
Why do we forget?
This is a very complicated question and the cause is often multifactorial, include one or several of aging, medical and emotional considerations.

So what about health-related causes of memory loss?
If this refers to non-aging causes, there are several. There a phenomenon called state-dependent learning that’s pretty fascinating. For example, if you learn something while intoxicated, you may not remember it while sober, and you may remember it again once intoxicated again. Alcoholism itself causes conditions (e.g. Wernicke’s encephalopathy and Korsakoff’s psychosis – these aren’t esoteric; these are out there) in which memory loss is a component. Chronic alcohol use and other conditions that involve vitamin deficiencies (e.g. Vit D, Vit B12) also produce memory loss and deficiencies.
Is it true that stress can cause memory loss?
Yes, both stress and depression can cause memory loss, both emotionally and physiologically.

Should I worry about Alzheimer’s?
No. Alzheimer’s happens whether you “worry” about it or not. What you should do is be concerned about memory loss and trying to prevent premature dementia. First, take steps to protect and build your memory. Second, if you are experiencing memory loss, discuss it with your physician. He or she will know what to do from there.
Ok, then how do I work on my memory?
An active brain is a healthy brain. Of course diet and exercise will keep all of you healthy, including your brain. There are untold numbers of memory games and problem-solving exercises you can perform to train and keep your brain sharp. Learn a new skill or dabble in a new language. In general, socializing and engaging your mind in activities is most of what you need. Alternatively, you can also protect against your bad memory (or inattentiveness). Make a habit of placing your keys, purse/wallet and other needed items in the same place, so when something’s lost, instead of remembering what you did, you can ask yourself “what was I supposed to do?” And yes, guys you can pay better attention to your wives.
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!
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Police and PTSD Production in Communities

July 18, 2017Mental Health, Public Health844-SMA-TALK, Behind the Curtain, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post reviews the effect of police and PTSD production in communities.

Just a month ago, Straight, No Chaser discussed Mass Trauma, Community Stress and Post-Traumatic Stress Disorder. Have you been following the news? It may have occurred to you that recent events involving shooting of civilians and police officers could either be the result of or the precipitant of individual and community stress. This stress potentially rises to the level of post-traumatic stress disorder (PTSD). As a reminder, episodes that some might be able to handle when taken in isolation can have dramatically different psychological effects on others.

An Expanded Scope of PTSD

When entire communities are affected by a mass trauma such as a natural disaster, a terrorist attack, the effects of war or a seemingly senseless death within the community, many within the community can subsequently develop signs of post-traumatic stress disorder (PTSD). Although it is most correct to note that symptoms tend to develop in the first few weeks after the episode, victims are likely to be hyperreesponsive to subsequent stimuli long into the future. New stimuli can then trigger abnormal responses. In many ways, what is happening now is a normal, expected and shared community response to serious trauma.

Now with all due respect to our veterans, PSTD is not limited to those who have participated in wars (although it is of note that those involved in the execution of police officers both had military backgrounds). Would it be easier to accept, understand and empathize with those involved if these events had happened immediately after having served in the arena of war? Why hasn’t there been a discussion of these issues through this prism? More importantly, why hasn’t support and solutions been fashioned for involved communities accordingly?

Take a breath, and conceptualize the cumulative effect on a community of slavery, Jim Crow, all the various forms of oppression and institutional racism that have come with that and now the ongoing senseless, avoidable and largely unpunished loss of life at the hands of those meant to “Serve and Protect?” One could argue that remarkable restraint has been shown, all things considered.

Do You Have Doubts?

How can anyone question the multitude of stimuli that have been present of late, poised to affect someone affected by PTSD? How can we be blind to the notion that communities (most notably the African-American community) and the “fraternity” of police officers are both (not to be confused with equally) addressing an abnormal level of stress and fear?

That’s right. Now the police are involved. Whether or not the recipients of the initial affronts, or whether or not you believe it to be reasonable, when a community (of police officers) begin being besieged by random killings of officers, they will respond a certain way. However, the involvement of the police comes with a different consideration. They are empowered to strike back. Officers can shoot to kill if confronted with subsequent dangerous situations in which they believe their lives are in danger. Has there been sufficient discussion about the inherent danger of leaving in place such power to individuals under this level of stress without specific, additional cultural sensitivity training and counseling on PTSD?

Traditionally, when communities suffer mass trauma, resources are more likely to become readily available, which allows many to experience a lessening of symptoms over time.
In the immediate timeframe of the event, vital measures for physical and mental wellbeing should include the following.

Getting medically evaluated and to a safe place
Reinforcing contacts with loved ones or friends
Learning what is being done to help and either provide or receive help as needed

Long Term Consequences

Unfortunately, some individuals just do not get better on their own. Although most people tend to improve with time after a community disaster, it is not uncommon for some to become more distressed and to exhibit more symptoms of PTSD, depression, and other mental health conditions. There are so many variables in play based on the type of disaster that occurred. Some people are effective at rebuilding their lives if the available resources are appropriate for the type of effect it had on them personally, but others may experience ongoing stress from loss of jobs and schools, trouble paying bills, finding housing, and getting healthcare. These types of stressors compound the effects of the disaster and may delay recovery in those affected by PTSD.

Many in the public health communities are embracing a comprehensive version of mass trauma “psychological first aid.” This complement to medical and financial resources is meant to fill existing voids in post-community disaster care delivery. Otherwise treatment approaches are generally similar to treatment of other forms of PTSD.

It is time to add these considerations to the current conversation. Fear, retaliation and conversation isn’t enough and will only contribute to a never-ending spiral of death. Our leadership needs to begin implementation of services and support to address the broad factors in play.

There’s More!

Interested in other Straight, No Chaser posts on Post-Traumatic Stress Disorder (PTSD)? They are listed below.

Read an introduction to PTSD, including signs, symptoms and those at risk. click here .
For a discussion of the diagnosis and treatment of PTSD, click here.
Read a discussion of the effects of PTSD in children. click here.

Follow us!

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

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Straight, No Chaser: Dementia – When Brain Health Goes Bad

July 17, 2017General Health and Wellness, Mental Health, Neurology844-SMA-TALK, Alzheimer's disease, Behind the Curtain, dementia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

In case you didn’t pick up on it, the posts regarding brain health served two purposes. The first is to ensure you give yourself the best opportunity to live a healthy, happy mental life. The second is to stave off the point in your life when you develop dementia. In this and the next post on brain health, we focus on dementia, which occurs when the brain becomes a certain type of unhealthy. Alzheimer’s disease is the most common cause of dementia, accounting for approximately 60-80% of cases.
Look at the below chart for a stunning illustration of the scope of dementia.

As opposed to being a single disease, dementia describes a range of symptoms associated with a decline in memory or other mental skills. As such, it’s more helpful to describe functions lost instead of symptoms you may experience. Dementia is associated with a reduced ability to perform routine activities of daily living. It can be associated with significant impairment of other mental functions, including the following:

Memory
Communication and language.
Ability to focus and pay attention
Reasoning and judgment
Visual perception

Practically this could range from problems with remembering appointments or names, engaging in unnecessarily dangerous activities for no reason, or keeping track of items.

Dementia is caused by damage to brain cells. It’s the type of damage that could occur from a poor diet, age-related or other causes of poor blood circulation to the brain (e.g. a stroke). Depending on the involved area of the brain, various levels of loss of function may be seen. Based on the most common patterns and sites of brain damage, the mental deficits described above are those most likely to be seen. It is of note that the center of memory and learning (the hippocampus) is often the first area damaged, which corresponds to those deficits that define early dementia/Alzheimer’s.
My messages to you regarding dementia are pretty simple.

You don’t want it. Dementia is the end of the beginning and the beginning of the end. It is progressive. The symptoms will be more and more pronounced with time.
You need to address it. If you haven’t been forward thinking enough to engage in brain health, know the early signs, and get checked out as soon as possible. The good news is all dementia isn’t Alzheimer’s and could represent a treatable cause. Even when it doesn’t, steps to temporarily improve symptoms can be instituted.

Straight, No Chaser: Self-Assessment for Signs of Early Dementia or Alzheimer’s

July 16, 2017Geriatrics/Elderly Care, Mental Health, Neurology844-SMA-TALK, Alzheimer's disease, Behind the Curtain, dementia, mental-health, Neurology, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Each of us has elderly family members for whom we may be concerned about their memory or other possible signs of dementia. You don’t have to stand by powerless and let them dwindle away. Early detection of dementia gives the best chance for a higher quality during the rest of one’s life. Isn’t that how we’d all want our loved ones to spend their golden days? This Straight, No Chaser post adapts information provided by the Alzheimer’s Association. Any positive responses can suggest an issue warranting further investigation. The goal here is straightforward. If any concerns arises after completing this, you should print out the sheet, and take it to your physician, requesting an evaluation.

_____ 1. Memory loss that disrupts daily life. One of the most common signs of Alzheimer’s, especially in the early stages, is forgetting recently learned information. Other signs include forgetting important dates or events; asking for the same information over and over; relying on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. Typical age-related changes involve sometimes forget names or appointments, especially if you remember them later.
_____ 2. Challenges in planning or solving problems. Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. Typical age-related changes include making an occasional error when balancing a checkbook.
_____ 3. Difficulty completing familiar tasks at home, at work or at leisure.People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. Typical age-related changes include occasionally needing help to use the settings on a microwave or to record a television show.
_____ 4. Confusion with time or place. People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. Typical age-related changes include occasionally getting confused about the day of the week, especially if s/he figures it out later.
_____ 5. Trouble understanding visual images and spatial relationships. For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not recognize their own reflection. Typical age-related changes of vision changes are related to cataracts and do not indicate Alzheimer’s.
_____ 6. New problems with words in speaking or writing. People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a watch a “hand clock”). Typical age-related changes involve sometimes having trouble finding the right word.
_____ 7. Misplacing things and losing the ability to retrace steps. A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. It’s more typical to displace things from time to time, such as a pair of glasses or the remote control.
_____ 8. Decreased or poor judgment. People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. It’s less concerning for anyone of any age to make a bad decision once in a while.
_____ 9. Withdrawal from work or social activities. A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. It’s more typical for anyone of any age to sometimes feel weary of work, family and social obligations.
_____ 10. Changes in mood and personality. The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. It’s more typical for people as they age to develop very specific ways of doing things and to become irritable when a routine is disrupted.
It is worth restating: early diagnosis provides the best opportunities for treatment, support and future planning. For more information, call the Alzheimer’s Association at 800.272.3900 or your SterlingMedicalAdvice.comexpert consultants.

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