Tag Archives: There are 72 Hours in a Day

Straight, No Chaser: Straight Talk About Vasectomies

June 24, 2017Genital/Urinary844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Vas deferens, VasectomyJeffrey Sterling, MD

A couple’s conversation about having a vasectomy can either be a tense one or it can be a display of trust and cohesion. The decision by a man to have a vasectomy can be a soul-searching “moment of truth.” In this Straight, No Chaser, let’s look at seven of the issues surrounding vasectomies. At the end there’s an illustration of the procedure. Yes, it involves a clip.
A vasectomy is a surgical procedure that involves cutting the tube (the vas deferens) that carries sperm from the scrotum to the testes. The vasectomy prevents sperm from leaving the testes so that the man can’t impregnate a woman.

Issue 1: Why would you want it?
The answer to this is relatively straightforward. You’d want a vasectomy if you don’t want any, or any more, children. This is a form of sterilization.
Issue 2: When would it be a good option?
If you’re in a relationship and both partners agree that you’ve either had all the children you want or don’t want the risk of having any children, a vasectomy would be a reasonable option. Other considerations may include if you can’t use other forms of birth control, if pregnancy would be medically unsafe, or if the risk of genetic disease or a birth defect in your offspring is greater than you’re willing to accept.
Issue 3: When wouldn’t it be a good option?
This gets a little dicey and relates to levels of instability, either in your relationship or other personal situations. A decision to have a vasectomy to please your partner or salvage a relationship may not be the best choice. If you’re young or unmarried, you are subject to many life changes that may prompt reevaluating whether you really want a child. For example, if you marry/remarry, children may become more important than they currently are. A vasectomy is a surgical procedure with risks. A decision to have it done as a convenience (e.g., because you are unreliable or don’t want to use other forms of birth control) is irresponsible.
Issue 4: How successful is the procedure?
Vasectomies are very successful and have a failure rate of approximately 1 in 2,000. Comparatively speaking, the analogous procedure in females (tubal ligation) has a failure rate of 1 in 200-300. Typical failure rates are due to having sex too soon after the procedure. It takes time for existing sperm to be cleared from both ends of the vas deferens; that existing sperm can still impregnate a woman. This is a major reason why men should wait a week after the surgery and until the sperm count has been documented to be zero in the seminal fluid. To a much lesser extent, rare spontaneous reconnection of the clipped portions of the vas deferens may produce failures.
Issue 5: What complications exist?
Vasectomies are generally very safe, and the complications associated with it are those seen with any surgery. These include pain, swelling and infection. Remember, as we just discussed, the circumstances under which post-vasectomy pregnancies can occur.
Issue 6: What happens should I choose to have it reversed?
It is important for men considering a vasectomy to read and fully understand the next sentence. If you have a vasectomy, you should not consider it reversible. That said, you can spend a lot of money for a microsurgical reversal procedure that is successful about 50% of the time if done within 10 years of the vasectomy and approximately 25% of the time if done after 10 years. Be advised that such reversals are associated with a higher level of birth defects.
Issue 7: About what other considerations should I be concerned?

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

Most men are satisfied with vasectomies, because most men who have vasectomies do so in the context of a stable and healthy relationship. Men who are most likely to seek reversals do so in the context of unexpected life events (e.g., new partner/marriage with a desire for kids). Sometimes their reconsideration is in response to a tragedy. If you are considering a vasectomy, please only do so after a solemn view of the rest of your life. If you believe it to be stable, you will likely be satisfied with the outcome.
The following clip (click the link) is courtesy of the National Institutes of Health and demonstrates the logistics of the various approaches to the procedure. Feel free to leave any comments or ask any questions you may have.
Vasectomy
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 Treatment of Erectile Dysfunction

June 23, 2017Genital/Urinary, Medical Treatment72, 844-SMA-TALK, Austin Powers, Behind the Curtain, Blood, Erectile dysfunction, health, Limited liability company, Penis, Pharmaceutical drug, Physician, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Urology, ViagraJeffrey Sterling, MD

Well, here’s what many of you’ve been awaiting. Assuming the preventative efforts I mentioned didn’t work for you, there are several different treatment approaches. If there’s an underlying medical cause, then treatment of that cause is not only a good way to relieve erectile dysfunction (ED), but it’s a good way to get healthy and avoid other complications from the primary disease. Today, I’ll review different treatment strategies your primary care physician or urologist may discuss or recommend to you for treatment.
The medications
A first consideration is to be wary of (any) medications via mail order. The same level of testing, scrutiny and quality control just doesn’t exist to the same degree as do medications obtained through a pharmacy. Reports abound of people receiving expired or weak formulations of the pills, as well as fake or hazardous substitutes of the pills they thought they were receiving. Engage at your own risk.
Now, regarding those medications you know all too well by name and brand (e.g. Levitra, Cialis and Viagra), there’s no special ‘magic’ to them. They all are variations of the same theme, physiologically relaxing muscles in the penis, resulting in increased blood flow to it. Unfortunately, that’s not the entire story with these medications. ED medications all lower blood pressure throughout the body, and that increased blood to the penis is coming at the expense of decreased blood flow elsewhere (This is called a ‘steal syndrome’.). If you’re otherwise unhealthy, and your redirecting blood that was needed in the heart or brain, you could end up with a heart attack or stroke while taking these meds. Therefore, this leads to two very important cautions regarding ED meds. You shouldn’t start them without discussing with a physician first (to determine “…if you’re healthy enough to have sex”, as the commercials say), and secondly, don’t keep the fact that you’re taking them a secret (to your significant other, and especially to any physician you come across if you’re sick). These medications could be the cause of whatever medical issue has you in an emergency room. They could also be contributors to life-threatening adverse effects if you’re being treated for something else with a medication that interacts with the ED med you’re taking but didn’t bother to mention to the emergency physician. This is why ED medications generally aren’t given to men also on medications for high blood pressure, an enlarged prostate, blood thinners or certain other heart diseases (e.g. angina).
There are actually even more intricate medications used to treat ED. Taking testosterone injections is an increasing means of addressing low hormone levels. Additional injections directly into the penis or inserting a suppository into the penis itself are additional, effective treatment methods. You’d be given these options by your urologist if necessary.
The counseling
If your ED is due to anxiety, stress or other psychologically generated reasons, psychotherapy (possibly with your partner) may be of incredible assistance. If you pursue this option, you and your partner must be prepared to be patient and to work through a variety of issues and possible approaches.
Surgery and additional methods

If you’ve ever seen an Austin Powers movie, you’re familiar with (well at least the jokes about) penis pumps. These are real things, and involve placing a hollow tube over the penis and creating a vacuum to pull blood to the penis via a pump. A tension ring is placed about the base of the penis to maintain the erection during intercourse.
Actual vascular surgery to repair damaged arteries may be indicated in certain cases.
Penile implants are an additional option. Inflatable rods are placed into the sides of the penis. These rods are simply inflated when needed.

If you think some of this is a bit much, it may or may not be, depending on if you’re the one suffering. As I usually conclude, prevention would have been a much better course of action. Hopefully if that’s not the case, you’ve understood the information provided well enough to have an informed conversation with your physician. Good luck, and I welcome your comments and/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: Erectile Dysfunction, Part Two – Causes

June 22, 2017General Health and Wellness, Genital/UrinaryBehind the Curtain, Conditions and Diseases, Erectile dysfunction, health, Hypercholesterolemia, Men's Health, Substance abuse, There are 72 Hours in a Day, Western pattern dietJeffrey Sterling, MD

In my last post on erectile dysfunction (ED), I gave a simplistic way to understand and address it. However, the truth of the matter is the overwhelming majority of cases of ED are not related to stress or other psychological issues. First, some sense of ‘reasonable’, expected performance should be established, especially as one ages (as discussed here). Beyond that, you should know that approximately 90% of ED cases involve an underlying medical concern, including, but not limited to, the following:

Diabetes

High blood pressure

Changes/disease to your blood vessels

Low testosterone

Kidney disease

Smoking

Alcohol and Drug abuse

Obesity and High cholesterol

Effects of your medications

Therefore, today’s message is simple and brief, but I’d suggest it’s probably more important than you have previously thought. You should consult your physician if and when you or your partner’s sexual performance becomes an issue. You may actually discover something that will not only save his performance, but his life.
Finally, in the next post we will review the wide variety of treatment options for ED.
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: Erectile Dysfunction, Part One

June 21, 2017General Health and Wellness, Genital/UrinaryBehind the Curtain, Conditions and Diseases, Erectile dysfunction, Erection, health, Heart disease, Impotence, Men's Health, There are 72 Hours in a Day, Western pattern dietJeffrey Sterling, MD

It seems appropriate to follow-up a post on age-related changes in your genitourinary system with a discussion on erectile dysfunction (ED). The nature of the topic is such that I’m going to approach this in two different ways. Today, I’ll give you a functional, overly simplistic view of ED and tomorrow, I’ll look at it from more of a clinical orientation, because there really are nuances involved. So keep in mind the lead picture. There are many medical and psychological issues that can lead to problems having erections. I’ll get into that more tomorrow.
In many ways, your health is related to the quality of your blood flow, both in quantity (successful circulation to tissues) and quality (relative absence of toxins we ingest and deliver throughout). This is true for the brain (mental health, absence of strokes), the heart (stamina, absence of heart disease/attacks), and your penis (sexual function, lack of impotence), as well as every other organ.

Excluding truly medical considerations, the two surest ways I know to be a sexual stud (without implants or being of a certain age) are to have a legitimately healthy ego (psychologic health) and more importantly, to be in good physical shape and otherwise healthy. However, for now, given that an erection simply results from strong blood flow to the penis, your overall health better enables that process (the first time as well as if you want multiple contiguous encounters). Everything being equal, the best way for a guy to be able to have sex for whatever you define as a ‘sufficient’ period of time (besides being of a certain young age) is to maintain good cardiovascular health by spending that physician-recommended 20-30″ or more at a time on a treadmill, bike, running, etc.

Drugs like Viagra, Cialis, etc. are really nothing more than drugs that lower blood pressure (and resulting demands by other bodily organs on your blood), such that your penis’ call for an erection is otherwise unimpeded. Sounds good? The risk is varying forms of a ‘steal syndrome’, where that blood isn’t being distributed to your heart and brain, which could result in a heart attack or stroke. That’s why you must “ask your doctor if you’re healthy enough for sex” before using…
Bottom line: practice for good sex and stamina during sex by working out. It’s just another benefit to being healthy.
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 In the News – Testosterone Therapy Doubles the Risk of Heart Attacks

June 20, 2017Cardiology/Heart, Endocrine/Metabolic, Genital/Urinary844-SMA-TALK, andropause, Behind the Curtain, hypogonadism, Low testosterone, male menopause, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Over the last few days, Straight, No Chaser featured discussions of low testosterone and male menopause (which often includes low testosterone levels as a component of the syndrome). More importantly, you may recall our Straight, No Chaser post that discussed managing low testosterone without receiving testosterone therapy. Well as it seems, you may want to read that post again if you’re suffering from low testosterone (hypogonadism).

You should be aware of a study out of the University of California-Los Angeles, which notes two particularly disturbing findings about treatment of low testosterone:

The rate of developing a heart attack is nearly tripled in men less than 65 years old with a history of heart disease.
The rate of developing a heart attack doubled in men older than 65 years old with or without a history of heart disease.

The study, which was published in the journal PLOS One (Public Library of Science), followed a study with similar findings published in November 2013 in the Journal of the American Medical Association.

Today’s message is rather simple: if you’re one of those individuals that view medicines as “magic in a bottle,” or if you’re someone so impressed by those commercials that you take testosterone just for an “extra boost,” this serves as another reminder that health has no shortcuts. Medications have risks, and health has benefits.
Alternatively, if you have serious health concerns consistent with low testosterone or male menopause (andropause), please discuss your concerns with your physician. You certainly can discuss your concerns with your Sterling Medical Advice expert consultant at www.sterlingmedicaladvice.com or at 844-SMA-TALK. We’ll keep you informed of risks and benefits of medicines as well as how to appropriately address your medical concerns with and sometimes without medications. Your personal healthcare consultants are standing by.
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: Maintain Healthy Testosterone Levels Without Replacement Therapy

June 19, 2017Endocrine/Metabolic, Genital/UrinaryBehind the Curtain, hypogonadism, Low testosterone, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, testosterone, There are 72 Hours in a DayJeffrey Sterling, MD

Male virility is a fascinating topic medically. It is truly an example of how confidence and mental fortitude (or the absence thereof) can directly translate into physical performance. Thus, it doesn’t come as a surprise when TV ads seek to sow seeds of doubt into you. (“Don’t perform like you used to? Maybe it’s Low-T! Here’s a miracle pill!”)
As mentioned in the previous post, many factors control testosterone, most notably a natural drop associated with aging. In fact, your levels are considered normal until about age 30, then you lose approximately 1% per year until you reach a state by age 70 where you’re expected to be clinically below normal – and that’s just due to the age-related considerations. Factors you can control affect not only your sexual health but your physical and mental health, too. These include appropriately managing your diet, exercise, sleep and stress. Let’s look at the effect each has on maintenance of healthy testosterone levels.
Diet:

It will forever be true that what you place in your mouth either strengthens you or slowly poisons you. Here’s a quick list of foods that are specifically good for boosting your testosterone levels.

Bananas – Banana are rich in B vitamins, which are needed to manufacture testosterone.
Brazil nuts – It’s the magnesium contained within that increases testosterone.
Chicken liver – It’s the zinc! Zinc increases testosterone levels.
Cruciferous vegetables – Broccoli, cabbage and cauliflower help eliminate the hormone estrogen from the body, which increases testosterone. Choosing these healthy foods also helps weight loss, which in turn increases testosterone production.
Eggs – It’s really about the vitamin D contained within eggs; vitamin D deficiency has been shown to correlate with higher estrogen levels and lower testosterone levels.
Garlic (as part of a high protein diet) – This combination increases testosterone production.
Oysters – It’s the zinc! Zinc increases testosterone.
Pineapples – It’s the magnesium contained within that increases testosterone.
Pumpkin seeds – It’s the zinc! Zinc increases testosterone.

Here’s the other dietary consideration for you: In general, most anything you eat that adds to your level of obesity will result in lowered testosterone levels. Number one on that list is processed sugar—think fructose, meaning soda/pop, fruit juices. The relationship between diet and testosterone is way more intricate than this, but if you incorporate the steps just mentioned, you will see a difference in your overall health and sexual health.
Exercise:

I will limit this part of the discussion to two manageable considerations.

If you’re overweight, you are more likely to have low testosterone levels. Globally losing weight will work to your advantage.
Intense strength training also boosts testosterone levels. When strength training to boost testosterone, you’ll want to increase the weight, lower your number of reps and slow down the motion on each rep. Also try to work a large number of muscles, as occurs with dead lifts or squats.

Stress Management:

When you’re under a significant stress, your body releases high levels of the stress hormone cortisol. Cortisol blocks the effects of testosterone. Over the longterm, stress chronically blocks the effects of testosterone, producing all of the undesired symptoms that accompany that state.
You know to how reduce your stress. Here are techniques shown to be effective in this setting.

Deep breathing
Laughter
Meditation
Positive visualization
Prayer
Yoga

Sleep:

Here’s something you likely didn’t know. Testosterone is only produced by your testes at night. Even more impressive production coincides at a specific point in the sleep cycle immediately before REM (rapid-eye movement) sleep. This production and replenishment is most complete in men getting at least eight hours of sleep/night. Conversely, testosterone levels are significantly lower in those receiving less than six hours of sleep/night. Note this is total sleep at night, not consecutive hours of sleep (assuming you are able to rapidly fall back asleep). Get your sleep!
These are very important considerations. As is the case with many conditions, your health is not going to be found in a medicine bottle. The fundamentals of taking care of yourself are your best course of action for longevity and health. This is especially important in the management of low testosterone, given that testosterone therapy has serious side effects and increases risks for certain conditions, including signaling the body to stop producing its own testosterone and the following:

Acne
Prostate enlargement
Prostate cancer
Reduction in sperm production
Sleep apnea
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: Men’s Health Week, Fathers Day and Health

June 18, 2017General Health and Wellness, Genital/Urinary, Geriatrics/Elderly Care844-SMA-TALK, Behind the Curtain, Father's Day, Men's Health Week, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

This year, Fathers’ Day falls right at the tail end of Men’s Health Week, but we don’t like that – and we’ll begin our own Men’s Health Week by starting with Fathers’ Day!

Take a moment to think through the variety of concerns of our fathers.

Many of our fathers are of advancing ages and have to address all the ramifications of that, including arthritis, coronary artery disease, peripheral vascular disease and cancer. With the likelihood of suffering from multiple diseases, it is probable that they are taking multiple medications, leaving them susceptible to medication side effects and drug interactions. Either of these concerns can result in falls, leading to trauma, fractures and head injuries. Additionally, many fathers have to deal with Alzheimer’s and/or dementia type issues.
Some of our fathers have been taken from us by gunshots or other forms of violence. Remember, public health concerns have caused more deaths than medical illness.
On a lighter note, a lot of fathers will only have to suffer the embarrassment of a minor burn over the grill this weekend.

All of this is meant to point out the need for health prevention in a group that utilizes health care much less than women and children. If you’re in the gift giving mood this Sunday, do better than that not-so-attractive tie. Think health. Get one of those health monitors that track steps, eating and sleeping habits. How about a treadmill? Try a safety helmet if he’s a motorcycle rider. Grab some manly mittens for the grill. Get him a back brace or a dolly to help with the duties he performs around the house. Make him an appointment to see his physician.

As a father, when I think of my health and what my loved ones can best do to contribute to it year-round, I think of happiness. Fathers are providers and protectors. If you’re lucky enough to still have your father around, take a moment, and let him know the ways he’s contributed to your happiness. That’s pretty simple and shouldn’t be that much to ask. Don’t discount the impact of happiness on health.

On Straight, No Chaser, we often discuss the intersection of health and happiness, and during Men’s Health Week and on a day like Father’s Day, that discussion becomes both important and meaningful. It is quite likely that on this day, fathers everywhere are reflecting on the meaning of life and realizing that fatherhood is our ultimate legacy. So while you’re rewarding your favorite guy (with healthy food, no doubt), lay the love sauce on a little thick. It’s needed and will be appreciated. Here’s an early Happy Fathers’ Day to all those deserving men out there.

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: Low Testosterone

June 17, 2017Endocrine/Metabolic, General Health and Wellness, Genital/Urinary844-SMA-TALK, andropause, Behind the Curtain, Low testosterone, Menopause, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Are you someone who had never heard of Low-T until recent commercials starting telling you that you weren’t normal? Let’s review what all the fuss is about.
As most people know, testosterone is the most important male sex hormone that in many ways and for many defines “manhood,” contributing to the following:

Changes of puberty, including deepening of your voice
Production of pubic, facial and body hair
Production of sperm
Facilitation of sex drive
Maintenance of bone health, which assists growth

In case you were wondering, this is what “male menopause” looks like.
Certain parts of the brain (hypothalamus and pituitary gland) signal how much testosterone needs to be produced. Most production occurs in the testes.
The symptoms of low testosterone are predictable. Symptoms include a reduction in sex drive, erections and sperm count. Men may also see an enlargement of their breasts. Additional symptoms (over the long-term) may include smaller testes, less energy, mood changes, loss of muscle size and strength, and weakened bones.

The aging process normally reduces sex drive, sperm count and frequency of erections. Aging also reduces testosterone such that clinically low testosterone levels invariably occur by age 70. The presence of these two independent facts can make it confusing to know if these symptoms are simply part of the aging process or might be attributable to a disease in the areas that either produce or regulate testosterone. In other words, although a natural age-related reduction in testosterone level is normal, it may or may not be the cause of lower sex drive.

Low testosterone in the absence of aging really is thought to be more of a sign of disease than a disease unto itself. The primary goal is to ensure than none of the more serious causes of low testosterone are present. Some of the more serious causes and considerations leading to low testosterone include injury, infection or cancer to the testes, radiation therapy or chemotherapy, hormonal disorders such as pituitary gland tumors or diseases, liver and kidney disease, diabetes, HIV/AIDS, obesity, certain genetic disorders and use of opiates (pain-killers).
Based on the cause and your health status, you may be prescribed testosterone replacement therapy. Testosterone replacement may occur via periodic injections, skin patches/gels, skin pellets or tablets that stick to the gums.
Testosterone replacement is not like taking a pill for an erection. These are hormones and come with long-term risks, the most notable being prostate cancer. Therefore, those males with prostate or breast cancer aren’t candidates for testosterone replacement therapy. Other side effects of testosterone replacement therapy include acne, breast enlargement, fluid buildup in the legs, ankles and feet, increased red blood cell count, prostate enlargement and sleep apnea.
Here are groups with significant enough risks from testosterone replacement therapy that they require monitoring if treated this way:

African-American men
Men over 40 years of age who have close relatives with prostate cancer
All men over 50 years of age

So what should you do with this information?

Understand that certain age-related changes occur naturally and don’t represent disease.
Understand that the premature presence of these symptoms could represent disease and need to be evaluated.
Understand that a desire to avoid the symptoms associated with low testosterone is best done with routine health measures (diet and exercise) that help the body function and maintain healthy levels of testosterone naturally.
Understand that a decision to seek treatment for these symptoms isn’t as simple as getting a pill or a patch. Hormonal treatment has real and serious associated side effects and risks and should only be done with the consultation and consent of your physician and endocrinologist (hormone specialist).

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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Straight, No Chaser: Male Menopause (aka Andropause)

June 16, 2017Endocrine/Metabolic, General Health and Wellness, Genital/Urinary844-SMA-TALK, andropause, Behind the Curtain, Low testosterone, Menopause, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Manopause? Male Menopause? Yes, andropause is a thing (at least according to many medical authorities). Most of us are roughly familiar with menopause. You may or may not be surprised to discover that men suffer through similar age-related changes called andropause.
With both sexes, changes are related to diminishing sex hormones. In the example of women, it’s estrogen and progesterone. With men, it’s testosterone. One big difference between the male and female experiences is lower testosterone levels don’t prevent men from still being able to have kids. Men can have kids into their 90s.

So the logical question to ask would be is this just the same as low testosterone? Well, not exactly. It’s the confluence of several problems men face with aging, including low testosterone, obesity, diabetes and depression (in those with these conditions). In particular, obesity, high blood pressure and diabetes seem to be particular risk factors. The fortunate news is this complex doesn’t occur universally and can be delayed with certain actions.
So what are you to do? For starters, know the symptoms and know when to ask for help. Here are symptoms commonly associated with andropause.

Depression
Difficulty sleeping
Increased body fat, particularly in the midsection
Irritability
Less desire for physical activity
Less energy
Less erections or less strong erections
Less mental sharpness and quickness
Loss of armpit or genital hair
Loss of confidence
Loss of interest in regular activities
Loss of libido
Night sweats
Reduced muscle mass
Social withdrawal
Swollen breasts

It’s important to get evaluated for these issues because even if these aren’t attributable to andropause, other causes can be even more serious. Examples of conditions that can cause these same symptoms include depression, drug and alcohol abuse, infections, heart disease, poor nutrition, stress and thyroid disease.
When you begin to develop these symptoms, you may discover that diet, exercise and weight control are important in relieving symptoms and slowing the progression of symptoms. Your physician likely will advise the same. In many cases, treating low testosterone is another important component of management. The next few Straight, No Chaser posts will discuss these additional considerations.

Straight, No Chaser: Travelers’ Diarrhea

June 15, 2017Gastrointestinal, General Health and Wellness, Infectious Disease, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, Diarrhea, Gastroenteritis, Montezuma's revenge, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, travelers diarrheaJeffrey Sterling, MD

This is the time of year in the U.S. when you wished you were somewhere else. (Hawaii, Africa, Australia or Mexico for a Valentine’s Day cruise, anyone?) Unfortunately, sometimes when you travel, you get more than you hoped.
“Montezuma’s Revenge” is often the punchline of a joke in the U.S., but travelers’ diarrhea (TD) is a serious concern. It is the most common illness contracted by travelers, affecting approximately 10 million people per year. Individuals visiting the U.S. can suffer from it as well. That’s a clue as to what’s actually occurring with TD.
TD is typically a response to an infection by a strain of bacteria known as E. coli, specifically, a strain that produces a toxin that affects the intestines. This is the case approximately 80% of the time. Parasites sometimes figure prominently in the illness. The risk and primary source of this infection is food or water that is contaminated with feces. Note that most any disturbance in the bacterial balance of the intestines can cause disruptions in the digestive system, leading to diarrhea.

Although anyone can contract TD, destinations and personal characteristics can markedly increase that risk.

Higher risk destinations include developing countries in Africa, Asia, Latin America and the Middle East.
Those individuals at higher risk include the immunocompromised, diabetics, young adults, those with inflammatory bowel disease and those taking antacids or medicines known as H-2 blockers.

TD is straightforward. Symptoms include watery diarrhea and cramps. A mild fever may or may not be present.
So, what are you supposed to do to prevent TD? This stuff is miserable! Here are a few tips and pointers for you:

Avoid street vendors.
Avoid raw or undercooked foods (especially meats and seafood).
Avoid raw fruits and vegetables (unless you peel them).
Wash your hands!
Taking antibiotics in advance (prophylactically) is not recommended, because they can increase your susceptibility to resistant organisms and side effects.
Bismuth subsalicylate (two ounces or two tablespoons four times daily) reduces the incidence of TD. Speak to your physician or SMA expert consultant about the risks and indication of taking bismuth subsalicylate. By the way, you know bismuth subsalicylate as pepto-bismol or kaopectate.

And now, a few words about treatment. Here are a few considerations about which you should be aware.

TD is usually mild and will run its course without medication. In other words, you’re likely to be just fine.
The most important consideration is to ensure adequate hydration. Clear fluids are key.
You may need antibiotics if symptoms progress to include fever, bloody stools, nausea, vomiting and severe cramps. Drugs typically include ciprofloxacin and norfloxacin. Previously used drugs such as trimethoprim-sulfamethoxazole and doxycycline aren’t recommended anymore because of the high resistance rate.
Bismuth subsalicylate may also be used as treatment (in addition to its role in prevention).
A special word about anti-motility (anti-diarrhea) medications: There are some benefits to using these agents, but there are also significant risks. You should not take these medications without understanding the risks and how they may affect you based on your existing health profile. This topic is discussed in greater detail at www.sterlingmedicaladvice.com, and you certainly can discuss this further with your SMA personal healthcare consultant.

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.

Straight, No Chaser: Spotlight on Health Concerns When Traveling – Vaccines and Illnesses

June 14, 2017General Health and Wellness, Health Prevention844-SMA-TALK, Chronic obstructive pulmonary disease, Deep vein thrombosis, health, Limited liability company, Lung, Pulmonary embolism, Sterling Medical Advice, Sterling Medical Wellness, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, ThrombusJeffrey Sterling, MD

Traveling is exciting, but it presents multiple challenges to your health. To best meet these challenges, preparation is everything.

Before you travel and every time you travel, your surest means of protecting yourself is to confirm you are current on routine vaccines.

Your basic vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine and influenza.
Most international travelers will need immunizations to protect you from hepatitis A, polio, and typhoid.
Depending on where you’re international travels take you and the duration of your trip, you may need immunizations to protect you from hepatitis B, malaria, rabies and/or yellow fever.

The plane trip itself can be hazardous to your health. I encourage you to review the risks of flying.

Diseases have different patterns in how they spread and their resistance to medications in different countries. It is important to be aware of prominent diseases affecting the countries you plan to visit, because some may be uncommon in your home country. For Americans traveling abroad, such diseases include the following:

HIV/AIDS
Malaria: an infectious disease caused by a parasite, which invades the blood cells. It is notable for the presence of high fever, shaking chills, low blood count and a flu-like set of symptoms.
Pandemic/avian flu (aka as the bird flu): an infectious disease in birds caused by a virus that can spread to humans
Travelers’ diarrhea – the most common disease acquired by travelers.
Tuberculosis: an infectious disease involving the lungs, able to spread throughout the body

I strongly recommend that you develop a habit of checking the CDC travel site every time you prepare to travel internationally, including those of you coming from abroad into the United States. Detailed information on these diseases is available clicking the links, checking the search engine and at www.sterlingmedicaladvice.com.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Life, Death and Grief

June 13, 2017Mental Health, Public Health844-SMA-TALK, Acceptance, Anger, Bargaining, Behind the Curtain, Death, Delayed grief, Denial, Depression, Emotion, Grief, Grief Loss and Bereavement, Kübler-Ross model, mental-health, Mourning, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

It’s never easy discussing death. Bereavement is the state of mourning and sadness we endure after the death of a loved one. Grief is that process we endure, either in anticipation of death or in bereavement. Humans have been shown to systematically show grief in a predictable way. This Kubler-Ross model famously describes the response of those dying.

Denial, accompanied with simultaneous emotional numbness
Anger over the loss
Bargaining, as if the possibility of staying alive exists
Depression and intense mourning
Acceptance

The real point of bringing up the grieving process is to point out that the loss of a loved one is an extremely dangerous time for those left behind. In fact, the death of a spouse is the single highest risk factor for one’s own death. I’m sure many of us can think back to an elderly couple who died months apart.
The period of bereavement is a time when people need to come together, provide support and take care of each other. It’s very important that you and your loved ones know that the emotions you will experience are universal and normal. Try to keep that in mind when the time comes. Be reminded that normal grief can last over a year. Don’t feel abnormal because of the difficulties you may be having moving on. It’s healthy to work through your pain.
Common psychological thought describe four trajectories we take in bereavement.

Resilience – the attempt to ‘stay strong’ through it all
Recovery – evolution toward a healthy honoring and appreciation of the life of the lost
Chronic dysfunction – the unfortunate circumstance of being stuck in the mourning process such that it cripples your existence
Delayed grief or trauma – the subsequent release and expression of those suppressed emotions

Grief is to be considered a necessary and healthy part of a recovery process that we should learn to embrace. Here’s hoping you find the path to celebrating the lives of your loved ones when they’ve made the final transition.
I welcome any questions you may have.
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: When Your Jaw Pain Could Be a Heart Attack

June 12, 2017Cardiology/Heart, Head/Eyes/Ears/Nose/Throat, Dental844-SMA-TALK, Acute coronary syndrome, Conditions and Diseases, heart attack, jaw pain, Myocardial infarction, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, temporomandibular joint syndrome, There are 72 Hours in a Day, TMJJeffrey Sterling, MD

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

If exertion exacerbates the pain, this makes the heart more likely as a cause.
If rest does not relieve the discomfort, this makes the heart more likely as a cause.
Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain.

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
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: Reacting to Broken or Dislocated Jaws

June 11, 2017Head/Eyes/Ears/Nose/Throat, Trauma844-SMA-TALK, jaw dislocation, Jaw fracture, mandibular fracture, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, temporomandibular joint syndrome, There are 72 Hours in a Day, TMJ syndromeJeffrey Sterling, MD

Should you ever suffer the misfortune of getting hit or falling onto your jaw, would you know what to do?
Trauma to the jaw is more dangerous than you might imagine. The risk for bleeding or subsequent breathing difficulties is such that immediate medical attention is a must in the presence of either.

$jawfracture$

Once you get past bruises, there are two main considerations to jaw injuries: fractures and dislocations. Jaw fractures are simply broken jaws. A dislocated jaw is one in which the lower portion of the jaw bone (the mandible) has moved from its normal position (i.e., out of the joint connecting it to the skull). It’s not likely that you’ll know which has occurred, which is another big reason why you should be sure to get medical attention instead of attempting to do much yourself. There are significant differences in the medical management of the two conditions.
There are two main considerations I want you to learn from this post: what to do (and not to do) in the case of a jaw injury and what can happen if you don’t.

Things for you to do

While traveling to the emergency room, you should hold the jaw and any other injured portion of the face gently in place.
If you have access to a bandage, loosely wrap it over the top of your head and under your jaw. It needs to be rather loose in the event you need to remove it so you can vomit, which is likely after a head injury.

What you should not do

Do not attempt to move, relocate or otherwise manipulate the jaw after an injury. Your doing so without knowing the extent of the injuries could have devastating consequences.

What can happen if you don’t get the situation addressed

Bleeding from a facial fracture is a pretty big deal. Blood can go into the lungs and block your airway at different levels. Similarly any food that might have been in your mouth (e.g., during a car crash) can have the same outcome.
Displacement of a broken or dislocated jaw can cause difficulty eating or speaking and can cause problems aligning the teeth over the long-term.
Depending on the mechanism, the jaw and/or other parts of the face can become infected. With the facial structures being packed so tightly in a relatively small space, many different types of complications can occur.
Anyone with TMJ syndrome (temporomandibular joint) appreciates the pain this condition can bring. Untreated or mistreated injuries to the jaw and/or jaw joint can produce chronic pain in these areas.

Of course it shouldn’t have to be said that the better course of action is to avoid such injuries, but some of us refuse to wear helmets during sporting events, and some of us find ourselves in bar fights and motor vehicle crashes. If you can’t avoid these situations, then the next best course of action is to respond appropriately. Take care not to ruin your beautiful faces and smiles.
I welcome any questions you may have.
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: TMJ (Temporomandibular Joint) Syndrome

June 10, 2017Head/Eyes/Ears/Nose/Throat, Trauma844-SMA-TALK, fracture, jaw dislocation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, temporomandibular joint syndrome, There are 72 Hours in a Day, TMJ syndromeJeffrey Sterling, MD

TMJ. Those of you have TMJ syndrome are likely already shaking your head in understanding. Those of you who don’t, be thankful. Take the advice of those who do and read this post to appreciate steps you can take to avoid developing it.
TMJ (temporomandibular joint) syndrome/disorders refer to symptoms developed in the chewing muscles and joints connecting your lower jaw to your skull. In other words, you’re having problems with your jaw joint. Given that the TMJ closes your mouth, and you’re using it all day to talk and chew, having this poses a lot of problems.
To understand various causes of TMJ, start by appreciating that most anything affecting all the various structures connecting the joint can contribute to the disorder. This includes problems with the joint itself or to its surrounding muscles, tendons and bones. Therefore, there isn’t just one cause. Many things you do or have done can contribute to difficulties with the joint. Here are some examples:

Arthritis (degenerative joint disease)
Having a bad (poorly aligned) bite
Having to wear braces
Lack of sleep (insufficient rest and recuperation for overworked muscles)
Poor diet
Poor posture (e.g., holding the head forward while looking at a computer all day, straining the muscles of the face and neck)
Stress and grinding your teeth
Trauma to the jaw resulting in fractures or dislocations

Knowing this makes prevention easy.

Limit or avoid hard foods and excessively chewing gum. Although you don’t think about it much, you can wear out the joints in your mouth just as you can a hip or a knee.
Learn to reduce your overall levels of stress and muscle tension.
Practice and maintain good posture of your head and neck.
Use protective measures when engaged in activities that can produce jaw fractures and dislocations.

It’s pretty easy to figure out the symptoms you may have if there is a problem with your jaw or TMJ.

Aching facial pain
Clicking, popping or grating of the mouth when opening or closing it
Difficulty opening and/or closing the mouth
Difficulty/pain biting or chewing
Earache
Headache
Jaw pain or tenderness
Locking of the jaw

Treatment strategies vary widely based on severity and cause of the joint issues. Many patients get by with over the counter medications, relaxation techniques, heat or ice to the face and prevention of additional damage. More complicated measures may include use of prescription pain medicines, muscle relaxants, corticosteroids or antidepressants. Bite guards (aka splints, mouth guards/appliances) may be recommended if you have problems with teeth grinding. Your physician will make appropriate recommendations based on your individual circumstances.
The good news is for many patients symptoms come and go, and they are reasonably well treated with minor interventions. The bad news is if you go unidentified or untreated, you may suffer chronic facial pain and/or headache, and this is not a pleasant experience. Therefore, if you discover yourself having difficulty opening and closing your mouth or eating, please address it early and see your doctor or dentist right away. You really don’t want to deal with the consequences of inaction.
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: Broken Noses (Nasal Fractures)

June 9, 2017Head/Eyes/Ears/Nose/Throat, Trauma844-SMA-TALK, Conditions and Diseases, nasal fracture, rhinoplasty, saddlenose deformity, septal hematoma, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, TraumaJeffrey Sterling, MD

It’s curious how many patients with broken noses come into the emergency room smiling. Usually they’re kids whose parents “just want to be sure.” In these cases not much happens. The kids love to see the pictures of their x-rayed faces, and, as long as nothing more serious has also occurred, they come back for a follow-up after the swelling has gone down.
At the other end of the spectrum, a broken nose may be part of a devastating facial injury. In that case it’s very unlikely that anyone is smiling, and there are other symptoms accompanying the nose injury.

A broken nose (aka nose fracture or nasal fracture) is the most common facial fracture, and it describes one or a combination of the following:

There’s either a break in the cartilage or bone over the bridge of the nose.
There’s a break in the structure that divides the nostrils, called the septum.
There’s a break in the sidewall of the nose.

Signs and symptoms typically include a bloodied nose, difficulty breathing through the nose, deformed nose, pain, swelling and/or bruising around the eyes.

$nasalfractureclots$

There are serious concerns that either may result from or appear together with a broken nose.

Sometimes a collection of blood forms inside the nose. Failure to identify this can lead to further destruction of nasal cartilage, an abscess developing within the nose or the development of a permanent deformity causing breathing difficulty.
The nose structure itself can collapse if not repaired, particularly in the presence of retained blood.
Due to the nature of the force involved, neck injuries are often present with nose injuries.

If you have a broken nose, none of the above serious concerns should be a surprise. You should have symptoms that suggest the possibility of dangerous complications. Thus, it becomes important for you to know how to respond in the presence of a potentially broken nose.

Breathe through your mouth.
Lean forward to keep blood from going down the back of your throat.
Apply ice packs or other cold compresses to your nose without applying excessive pressure. This will reduce swelling.
Use acetaminophen (Tylenol) for pain. Other over the counter remedies may contribute to further bleeding.
Don’t manipulate or try to straighten your nose. Doing so could dislodge blood or spinal fluid being kept in check.
If a potentially serious injury has occurred, or if the injury involved a lot of force, avoid movement. A neck injury could be worsened with additional movement.

Here are some clues that you should make your way to an emergency room after a potentially broken nose injury:

Clear fluid is draining from the nose.
You have difficulty breathing.
Neck pain is present or a large amount of force was delivered to the face.
There is significant facial or nasal deformity.
You have uncontrollable bleeding.
You see a bulge inside either nostril.

Given that noses are a prominent part of our faces, be mindful to take simple protective measures when engaged in activities that could lead to broken noses. These are simple. Use protective headgear, seat belts and car seats, and avoid bar fights (or any other type of fight for that matter). That is a small price to pay for protecting your appearance!
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: Open Fractures

June 8, 2017Orthopedics/Bones844-SMA-TALK, Open fractures, ORIF, physical therapy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

I don’t think you need especially gory illustrations for this. I think you get the picture.

In a previous Straight, No Chaser, we discussed broken fingers. If you get a “fight bite” (i.e. punch someone and cut your finger on their tooth), or punch through a glass, strike a brick wall or engage in any other number of ill-advised activities, you can receive what’s called an open fracture. An open fracture is a broken bone in which the break of the bone is accompanied by a break in the skin. It certainly isn’t restricted to the hand, as anyone who has fallen from a tree or off a roof can attest. We’re simply focusing on the hand because of its importance to our activities of daily living.

Open fractures present an ever higher level of risk and danger to you. Theoretically, the injury has communicated from the skin all the way down to the bone, which presents opportunities for damage to additional structures besides the bone and skin, such as tendons, ligaments, muscles, nerves and blood vessels. Never, ever assume that a “fight bite” or any other type of open wound is or will be ok without medical attention. The risk for delayed healing, deformity and other complications is very high with this type of injury.
One particular area of focus regarding open wounds is the propensity for infection. Have you ever heard that a human’s mouth is dirtier than a goat’s? For purposes of causing infections, you should be so lucky as to have buffalo’s breath. An open wound provides free passage into the deep structures in your body. With the hand in particular, including so many structures in close approximation, this is especially dangerous. (Side note: please stop lying to your physician about the nature of your injuries; we’re not the police. We can only help you as much as you provide us with accurate information.)
Open fractures aren’t just regular wounds. They really only result from vicious injuries. This means there is approximately a 40-70% rate of additional injury somewhere else in the body. This can include additional injuries at the site, away from the site and/or contamination of the open wound. Foreign objects may have been placed somewhere within the wound.
Remember: you need to come clean – figuratively and literally. These injuries can lead to amputations of your limbs due to contamination of the bone with subsequent infection.
Treatment of open fractures is discussed in a separate Straight, No Chaser, but you should know the goals of treatment are to prevent infection, heal the bones, and maintain/restore function of the body part involved. Healing and a return to normalcy is up to you as much as it is dependent on the skilled hands of the orthopedic surgeon who will oversee your care. You will need to exercise, and you will need to exercise through the pain. This will provide you with the best opportunity to obtain normal flexibility, motion and strength. You may have a self guided exercise plan, or it may occur via physical therapy.
Ultimately, your recovery will be based on the type and severity of injury sustained. Many patients give up in the face of ongoing weakness, stiffness and ongoing pain. This doesn’t have to be the case. If this even occurs to you, careful following of instructions will lead to how you lead the rest 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.
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Straight, No Chaser: Broken Fingers

June 7, 2017Orthopedics/Bones, Trauma844-SMA-TALK, angulation, comminuted fracture, dislocation, impacted fracture, Open fracture, rotational deformity, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Don’t the tips of your fingers drive you nuts? Our leading edges cause so much drama for us. We’ve previously discussed injuries to nails and nail beds, but many of you who work with your hands know all too well that lacerations and broken bones may be a consequence of a crush injury, a fall, a power saw or some other means of injury. Interestingly (at least medically), finger fractures have a multitude of appearances. Simple-appearing injuries may disguise complicated underlying injuries, and complicated-appearing cuts may reveal the full extent of the injury. For your purposes, you should always get significant injuries (and certainly any injuries potentially complicated by a fracture) evaluated. Healing in this area can be very difficult given its remote location from the body, and given all the various functions of your fingers (ranging from touching, scratching, eating, typing, tying your shoes), appropriate evaluation, diagnosis and treatment are a must.
Your clues are pretty obvious. Look for pain when touching the finger (especially deep bony pain), swelling, difficulty bending (which is different than pain when bending) and/or deformity to the finger. Our clues are pretty obvious, too. That’s why we obtain x-rays!
It bears repeating. Your fingers are your body’s “stalking horses” and serve the purpose of interacting with our environment. A broken finger that goes unaddressed or gets mismanaged can lead to a life-long deformity and inability to perform many of the activities of daily living. As such, here are the types of considerations your emergency physician is looking for when determining whether or not your finger is broken.

Is a joint involved? Your joints allow for movement of different parts of your finger, as these are the areas where different bones meet. A fracture involving the joints is more likely to produce deformity unless addressed.
Is the fracture so “smashed up” that it is defined as “unstable?” An unstable fracture requires emergency orthopedic intervention to reapproximate the structure and positioning of the bone that allow for adequate function. Otherwise, the bones may further shift out of position, leading to additional loss of function.
Is the finger deformed? We look for abnormalities such as rotation, angulation and shortening of the broken finger fragments. These deformities may produce functional losses and sometimes require surgery to repair.
A special consideration that will be discussed in a separate Straight, No Chaser is the fracture that is accompanied by a laceration or other loss of skin tissue. This is called an open fracture.

You’ve probably seen variations of treatments, ranging from the metal finger splints and the “buddy taping,” in which the broken finger is wrapped to the adjacent finger (as noted above). These procedures are adequate for simple fractures without any of the above considerations. More complicated fractures may require placement of surgical pins, plates or screws to hold the bones in place while healing occurs. Your bottom line is to remember how important your fingers are. If and when they get injured, get them evaluated so you can keep functioning as your normal self.

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Straight, No Chaser Reader Submission: Does Joint Cracking Cause Arthritis?

June 6, 2017Orthopedics/Bones844-SMA-TALK, Arthritis, Behind the Curtain, bursitis, knuckles, Osteoarthritis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, tendonitis, There are 72 Hours in a DayJeffrey Sterling, MD

I actually understand the question. You would think all that snap, knuckle and pop would represent bad things happening to your bones, and over time, it could cause damage to the joints. Fortunately this isn’t what is happening.
Basically manipulation of the joint space when you’re attempting to crack your knuckles or other joints creates a vacuum within the (synovial) fluid that bathes the joint. The air within that vacuum can result in the characteristic popping sounds you hear when further manipulation occurs, disrupting that air pocket. In other instances, popping sounds from the joints can be the result of the snapping of tendons. This latter consideration is more likely as you age, with narrowing of joint spaces and stiffening of tendons that already occur.

Here’s what you need to be concern about: pain when your knuckles pop. Generally, the absence of pain suggests that you’re not harming anything of note. Conversely, the presence of pain suggests a problem potentially exists that requires evaluation. These problems could represent the following:

Arthritis
Bursitis: inflammation of the small, fluid-filled sac that cushions bone as they move across other moving body parts, such as muscles, skin or tendons
Tendonitis: inflammation of the tissue that connects muscle to bone

So regarding the question of does cracking your knuckles cause arthritis, it’s a pretty simple “no.” With any luck, you’ll just have to wait to age for that to happen!

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: The Cancer Prevention Workbook

June 5, 2017Detoxification, General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer, Health Prevention844-SMA-TALK, Behind the Curtain, Cancer, cancer prevention, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

We continue with simple principles to avoid various forms of cancer, but in today’s Straight, No Chaser, we add some detail about the what’s and whys of the conversation. The areas bolded represent summary actions for your benefit.

Take Charge of Your Intake

1. Eat a healthy diet
A healthy diet is a nutritious approach to reducing your cancer risks. Adopt these principles.

Eat plenty of fruits and vegetables. Base your diet on fruits, vegetables and other foods from plant sources — such as whole grains and beans. No, there is not evidence that cancer supplements reduce cancer risks.
Avoid obesity. Avoid high calorie foods such as refined sugars and fat from animal sources.
Limit red meats (beef, pork, lamb) and avoid processed meats. Embrace chicken, seafood and legumes instead.
If you choose to drink alcohol, do so only in moderation. Alcohol intake is associated with multiple forms of cancer, including breast, colon, kidney, liver and lung. Your risk increases with regular intake, the duration of intake and the amount you drink. Practice moderation in general and limit yourself to two drinks a day (if your male; women should limit themselves to one a day) in most settings to obtain a variety of health benefits, including cancer risk reduction.

2. Don’t use tobacco
It is one of the oddest human behaviors to purposely infuse smoke into the area of your body meant to deliver air to the rest of your body, and this is true for cigarettes and cigars. Smoking nearly screams cancer risk; it is linked to cancers of the bladder, cervix, kidney, larynx, lung, mouth, pancreas and throat. Even secondhand smoke exposure is linked to an increased link with lung cancer. Chewing tobacco is associated with cancers of the oral cavity and pancreas. Tobacco is your true “just say no” drug. This is simple. If you don’t smoke, avoid it. If you do smoke, stop.

Take Charge of Your Actions

3. Maintain a healthy weight and stay physically active
A healthy weight is defined by your heart, not your appearance. Being physically active and maintaining a healthy weight might lower the risk of cancers of the breast, colon, kidney, lung and prostate. If you want an amount of activity to use as a target, as a general goal, include at least 30 minutes of physical activity in your day. At least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic physical activity is ideal.
4. Protect yourself from the sun
Skin cancer is one of the most common and preventable forms of cancer. Just be smart about your exposure. Avoid tanning beds, sunlamps, and midday sun. Seek out shade, cover yourself, wear bright or dark colors to reflect the suns rays away and use sunscreen.
5. Avoid risky behaviors
We’ll let rock and roll off the hook, but sex and drugs have direct links to cancer.

Practice safe sex. If you’re not practicing safe sex (by using condoms, abstinence or at least limiting your number of sexual partners), you are more likely to contract HPV and/or HIV. The links of HPV and cancer are noted above; the links of HIV include a higher risk of cancer of the anus, lung and liver.
Don’t share needles. Anyone injecting themselves with needles for illicit drug use should be considered a high risk for HIV and/or hepatitis. Sharing needles with an infected drug user can lead to those diseases. Hepatitis from IV drug use carries an increased risk of liver cancer.

Take Charge of Your Health Maintenance

6. Get immunized
There are two specific immunizations that have definite benefit in cancer prevention.

Immunize against Hepatitis B. Hepatitis B can increase the risk of developing liver cancer. If you are sexually polygamous, have a sexually transmitted infection, are an IV drug user, a healthcare, public safety or other worker who might be exposed to blood or body fluids or are a male who has sex with other men, you are a strong candidate for immunization.
Immunize against HPV (Human papillomavirus). HPV is a sexually transmitted virus that can lead to cervical and other genital cancers as well as cancers of the head and neck. The HPV vaccine is recommended for girls and boys ages 11 and 12. It is also available to both men and women age 26 or younger who didn’t have the vaccine as adolescents. Universal application of the HPV virus would virtually eliminate cervical cancer.

7. Get regular medical care
Learn to screen. Learn to self-exam yourself. Commit to regular evaluations. Even if you don’t prevent cancer, early detection gives you the very best chance of recovery after treatment.
Your health is your choice. Balance your life decisions in a way that allows you to enjoy yourself to the fullest while lowering your risks for cancer. Implementation of these tips will get you there. All things considered, this isn’t very much for you to commit to doing, particularly when you consider the benefits of doing so.

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