Tag Archives: Twitter

Straight, No Chaser: Your Questions About Taking a Daily Aspirin

aspirin-for-heart-disease-and-prevention-of-cancer1-500x375

Thanks for your enthusiastic response to yesterday’s post on taking an aspirin.  Today, I’ll follow up with some of your questions.
So you’ve been told to take a daily aspirin to reduce your risk of a heart attack because you likely fell into one a high-risk category. Here are some logistical considerations about what to do.
1) Is there a better time of day to take an aspirin?
Recent data suggests that most heart attacks occur early in the morning. The best time to take an aspirin is relatively soon before you have that heart attack. However, since your heart doesn’t give you a heart attack alarm clock (and many of us aren’t especially mindful of heart attack recognition), the best move would seem to be to take an aspirin before going to bed, and recent research supports that an aspirin taken before going to bed offers the most protection from a heart attack. There are limitations to doing this (e.g. taking aspirin on an empty stomach if you have a history of ulcers may not prove to be the most pleasant thing), and you should discuss such timing with your physician.
2) Is there a better dose of aspirin to take?
That’s a question your physician will answer and is dependent on your personal situation. That said, doses as low as 75-81 mg have been shown to be effective. You may be placed on any dose up to 325 mg/day. It really is important to take an aspirin dose recommended by your physician for this consideration.
3) Is it better to chew or swallow an aspirin?
Chewing an aspirin is the quickest way to achieve effective blood levels. In case you were thinking about taking an alka-seltzer (which contains aspirin), that’s also good – but it’s just not as good as chewing an aspirin.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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Should I Take a Daily Aspirin?

asaheart

So… I’m stuck on a desert island, and I’m allowed to take two medications. I’m pretty sure aspirin is going to be one of them. This begs the question “Who should take a daily aspirin?”
The answer is actually easy: anyone and only anyone whose physician recommends it. The better question is when will your physician recommend it?
The benefits of aspirin in reducing heart attack risk have been known and well described for quite a while now, and you should check this list to see if you’d benefit from taking a daily aspirin. Truth be told, it’s of such importance that if you’re of a certain age, you should have this conversation with your physician at your next physical exam. Here’s a partial list that will get you a daily aspirin or very strongly considered for one.

  • If you’ve previously had a heart attack
  • If you’ve had a coronary artery stent or surgery
  • If you’ve previously had a stroke (caused by a blood clot) or TIA (transient ischemia attack, aka ‘mini-stroke’).
  • You’re a male over 50.
  • You’re a female over 60.
  • You have a bad risk factor profile (i.e. You smoke, have diabetes, high blood pressure or high cholesterol levels, are overweight, don’t exercise or have a personal or family history of heart disease)

The above list actually isn’t exhaustive but is sufficient for most individuals’  ability to remember to start a conversation with their physician.  These considerations will be measured against others that would suggest you shouldn’t be taking a daily aspirin (e.g. allergy, bleeding ulcers, a bleeding disorder or if you’re taking certain other medications).
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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From the Health Library of SterlingMedicalAdvice.com: "When should I be worried about a vaginal discharge?"

VagDCchart

With the incidence of bacterial vaginosis and sexually transmitted infections, one would think the easy answer would be “always”, but it’s not quite that simple.
Some females normally have a discharge, and part of ‘being worried’ or not is knowing what’s normal for you. Discharges that are foul-smelling, colored, bloody, or accompanying genital rashes or sores should definitely be evaluated. Certainly, new discharges should be evaluated in an effort to help you understand if this is something physiologic or abnormal.
For the full blog on this topic, visit us at SterlingMedicalAdvice.com. Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

 

From the Health Library of SterlingMedicalAdvice.com: "What are psychosocial disorders?"

psychosocial

 
Our latest reader submission strikes at the heart of the age-old concern about the relationship between our environment and our mind. It is important to appreciate that mental illness is often influenced by external factors, such as environmental stimulants. When we describe psychosocial disorders, we’re talking about mental illness precipitated by these factors. These factors include everything from family, religion, friends and cultural considerations. Yes, the situations you place yourself in can be hazardous to your health!
For the full blog on this topic, visit us at SterlingMedicalAdvice.com. Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
 

From the Health Library of SterlingMedicalAdvice.com: "Why do I get those big tender knots in my neck?"

cervical lymph-node swelling from a posterior lateral squamouscell head_lymphnodes2

First of all, thank you for the continued reader submissions.
Cervical (that is, neck) lymph nodes (small oval organs located in various parts of the body that help the body fight infections; aka ‘swollen glands’) are the topic of the day.  Cervical adenopathy (aka lymphadenopathy) is the presence of swollen, tender lymph nodes in the neck.  They can represent the following:

  • The body’s response to a primary infection in the neck;
  • The body’s response to a local infection around the neck (such as the ears or throat); and/or
  • The body’s response to diseases widespread throughout the body (such as with mononucleosis, tuberculosis, and other diseases, such as HIV).

Just remember that infections are by far the most common cause of tender lymph nodes in the neck and get them checked if your other symptoms are concerning enough to you.  Of course, you could always contact your personalized health consultant at www.SterlingMedicalAdvice.com as well, and we’ll help you work through your concerns.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

From the Health Library of SterlingMedicalAdvice.com: "What is a spinal tap, and why is it done?"

LP

A lumbar puncture (spinal tap) is performed to obtain cerebrospinal fluid (CSF – the naturally occurring fluid that bathes the spinal cord) from the spinal column, usually to evaluate for the presence of infection (as in meningitis), but it can also detect other conditions such as multiple sclerosis, Guillain-Barre syndrome or cancer involving the spinal cord. In some instances, a lumbar puncture is a treatment; medicines and anesthetics can be placed in the cerebrospinal fluid via lumbar puncture, or it can be used to lower the pressure in the brain caused when too much fluid is present.
Here’s a video that would be helpful to view before you or a family member has a lumbar puncture. It is provided courtesy of Cure Search for Children’s Cancer.

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

From the Health Library of SterlingMedicalAdvice.com: "Why would my doctor tell me not to take a decongestant?"

decon

Thanks for all the reader submissions on Blog and FAQ ideas. Here’s my first response.
Based on how ubiquitous cold and flu remedies are, you would think they were the safest medications known to man. That’s actually not the case and in some instances can be quite far from the truth. The reason for this is simple. Decongestants work by manipulating blood vessels. Specifically, they narrow nasal blood vessels, creating more room for air flow and mucous drainage while reducing swelling and other effects of inflammation. This is a major part of how you treat upper respiratory viral infections like colds and the flu; antibiotics don’t work against viruses.
Unfortunately, if you have certain medical issues, you should not take decongestants. Here’s a list situations that can make it dangerous to take decongestants:

  • Allergies to pseudo-ephedrine
  • Children under age 4
  • Diabetes
  • Glaucoma
  • High blood pressure
  • Heart disease
  • Kidney disease
  • Prostate disease
  • Pregnant
  • Breast feeding women
  • Thyroid disease

So … even if it’s an over the counter preparation, if you’re not sure, head over to the pharmacist before you make that purchase at the store. Of course, you can always connect with your SterlingMedicalAdvice.com consultant as well.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

From the Health Library of SterlingMedicalAdvice.com: "My tooth hurts. Is it dry socket?"

dry socket(1)Dry_socket2

Ok.  Some of you are thinking “What is dry socket?”. Anyone who has ever suffered from it knows it all to well.  This as well as so many other dental conditions are best dealt with by appropriate hygiene (brushing and flossing) so it never gets to this point. But when it does…
‘Dry socket’ is another name for alveolar osteitis.  This is an extremely painful condition of the mouth that usually occurs within a week (say 2-5 days most frequently) after you’ve had a tooth extracted. Normally a small clot forms to protect the exposed bone.  Anything you do to cause the loss of this protective clot can lead to inflammation and sometimes infection of that bone.
Treatment involves mostly addressing the pain. Your dentist will likely rinse the socket to eliminate any offending particles and apply a medicated dressing. Prescription pain medications often are given. These measures pretty promptly bring relief, so if your pain after having had an extraction seems especially severe, get in for an evaluation promptly.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

From the Health Library of SterlingMedicalAdvice.com: "What is Roid Rage?"

roidrageroid rage1

Excessive anabolic (muscle-building) steroid use has many well-known side effects, but one of particular interest is the development of behavioral changes.  ‘Roid rage’ (short for steroid rage) is often an early symptom of heavy anabolic steroid use.  Symptoms start off with hyperactivity and excitability (mania) that is followed by recklessness and aggressiveness.  Users also discover a diminished need for sleep.  Curiously, for some (e.g. athletes), this ‘side effect’ is a desired effect.  It gives some users the extra motivation needed to work out harder and perform more aggressively during competition.

Unfortunately, roid rage is followed by a downer phase.  The depths of the depression experienced sometimes leads to suicidal behavior.  Forewarned is forearmed.  There’s a better way.

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

Straight, No Chaser: Why Those Hairs Go Gray

gray-hair

This is a lot simpler than people make it.  Gray hair is a happenstance of life.  At the end of the day, genetic, racial and chemical considerations determine when you go gray.  Let’s briefly look at each and dispel a myth or two along the way.
Chemical: Your hair consists of two parts, a shaft (the visible part above the skin line) and the root (the portion located below the surface). The root contains hair follicles, which contain color-producing cells called melanin (yes, the same melanin that contributes to skin color). Any disruption in melanin production or damage to the hair follicles, such as folliculitis and especially the normal effects of aging, can cause graying. This graying may be physiologic and timely, or it can be premature. An addition consideration to graying can be the physiologic build up of hydrogen peroxide. This naturally occurring chemical actually bleaches the hair.
Racial: Bet you didn’t know different racial and ethnic groups go gray at different rates on average. Whites start graying in their mid-30s. Asians begin graying in their late 30s. African-Americans seem to begin graying in their mid to late 40s. Most people will have noticeable and significant graying by age 50.
Genetic: Simply put, graying is predetermined based on your genetic composition. You should already have a good idea if and when you’re going gray by looking at your parents and grandparents.

And now… two questions rolled into one.

Doesn’t stress make you gray?  Isn’t that why Presidents go gray while in office?

  • Presidents go gray in office because they’re at the age when people go gray while in office.
  • The stress you’re thinking of (‘freaking out’) isn’t the same as physiologic stress, which is a disruption of the body’s normal functions. Such biological stresses can cause disruption of any bodily function. This is why so much confusion exists around ‘stress’. When scientists or your physicians are describing the effects of stress, it’s much deeper than your anxiety attack, which isn’t going to turn you gray overnight.

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

From the Health Library of SterlingMedicalAdvice.com: "What’s a PSA test, and why is it important?"

GU

Prostate-specific antigen (PSA) is a protein that is secreted from the prostate gland. It is important marker of disease. The higher the PSA level, the more likely it is that prostate cancer is present (this is not the same as saying that if your PSA level is high, you have or will have prostate cancer). It is useful and important as a screening tool and a monitor for prostate cancer recurrence after treatment or response to treatment.
According to the American Cancer Society, the following groups of men should consider having a PSA test.

  • Those at age 50 if they are at average risk of prostate cancer
  • Those at age 45 if they are at high risk
  • Those at age 40 if they are at very high risk (those with first-degree relatives who had prostate cancer at an early age)

Please discuss the value of prostate cancer screening with your physician. There is a fair amount of controversy about the test, which is why having the test done is a ‘consideration’ instead of a must. The specifics of this can be discussed with your physician or personal healthcare consultant at SterlingMedicalAdvice.com.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

From the Health Library of SterlingMedicalAdvice.com: "Is skin glue as good for stitches for laceration repair?"

laceration_chindermabond_chinlac0

So your child has been cut.  S/he is writhing in pain and anxiety and lives in deathly fear of needles.  The doctor tells you that you have options.  Your child can be strapped down, sedated or… the laceration can be repaired with some variety of ‘medical glue’?  Let’s briefly look at what it means to use a skin adhesive for laceration repair.

  • The main advantage to skin glue is that it is quickly applied and virtually painless to use if applied correctly.  Occasionally a small amount of burning will be felt after application.
  • There are no needles, papooses, or putting the child to sleep.
  • The main disadvantage to skin glue is that sometimes the cosmetic result may not be as good as with stitches, especially if the laceration is in an area of high skin tension or if it’s in an area where the child can pick the wound apart.  It is very important to understand that if you can’t control your child to the extent to if s/he picks at the wound, you can’t come back and get stitches later.
  • In short, in most instances it’s as good of an option as stitches.

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

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

Stop Smoking

There are immediate and longterm benefits to smoking cessation that extend beyond just lowering your risk for lung cancer.  Consider the following regarding lowering your risk for heart disease and stroke, and make the change to make yourself healthier.

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

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

Straight, No Chaser: Bell's Palsy

bellspalsy

Bell’s palsy is a paralysis of the facial nerve, caused by inflammation or other irritation to the nerve.  This paralysis causes muscle weakness in one side of the face.
Patients often find themselves unable to close one of the eyelids or wrinkle one side of the forehead/face.  The eyes may become dry due to inability to blink.  One side of the mouth may drool and droop.  The sense of taste may change.  Sounds may become louder, and headache may develop.

Bell’s palsy is treated with steroids and artificial tears.

The prognosis for individuals with Bell’s palsy is generally very good.  The extent of nerve damage determines the extent of recovery.  Improvement is gradual and recovery times vary.  With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of symptoms and most recover completely, returning to normal inside of 3-6 months.  For some, the symptoms may last longer, and in a few cases, the symptoms may never completely disappear.
By the way, in case you’re wondering about the picture, the right side of the picture (the left side of the patient’s face) is the side affected.  He can neither wrinkle his forehead nor close his eye, both of which are functions of the cranial nerve.  And no, this is not a stroke.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

From the Health Library of SterlingMedicalAdvice.com: "What are the different types of burns?"

MrBurns

Well, yes, he’s a Burns, but I don’t think that’s what we’re addressing today.  Let’s look at some burns of the traumatic variety.

burn-classification

What’s a first degree burn?
A first-degree burn (superficial thickness) only involves the first (outer) layer of skin, and that layer is still intact.  Symptoms include pain, redness, and swelling.
What’s a second degree burn?
A second-degree burn (partial thickness) involves not only the first layer of skin (which has been completely burned through) but the second layer (the dermis) as well.  Symptoms include severe pain, redness, swelling, and blistering.
What’s a third degree burn?
A third-degree burn (full thickness) involves all skin layers and may also involve fat, muscle, bone, and nerves. The skin may appear charred or leathery, or it may appear dry and white.  These burns are severe enough that complications involving the lungs–from smoke inhalation–may require breathing support. These burns tend not to be as immediately painful due to destruction of nerves. Third degree burns cause permanent tissue damage.
How are burns treated?
Depending on the severity and degree of the injury, burns are often treated with tetanus infection immunization, topical antibiotics to prevent infection, vigorous fluid replacement, and sometimes skin grafting.
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Straight, No Chaser: Your Questions About Gunshot and Stab Wounds

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SW

Your Top Five Questions:
1. Why don’t we remove the bullets every time? 
Removing bullets may cause more damage than leaving them in the body. Sometimes it’s not worth the effort.
2. What’s with the tubes that go in the chest?
Chest tubes are used to treat a pneumothorax (a collapsed lung). The problem is there’s air in the space between the lung and the chest wall. This can interfere with normal breathing and may be life threatening. The tubes go through the chest wall to release the air from that space, thus allowing re-expansion of the lungs.
3. Why would doctors ever need to slit someone’s throat to save his or her life?
That describes either a cricothyrotomy or a tracheostomy, and it’s not “slitting” the throat as much as it is creating an opening in the airway to permit airflow. This is usually necessary because of some airway obstruction at the upper throat (foreign body in the throat, etc.) with an inability to clear it. This procedure is only done to save a life.
4. Why would you die from a wound to the thigh?
Fractures of certain bones and laceration of certain blood vessels might cause so much blood loss that you could bleed to death. Infection and blood clots are additional considerations that could be life-threatening.
5. What about gunshot or stab wounds to someone pregnant?
Penetrating trauma to the abdomen is typically less fatal to the mother than to a fetus because the fetus is literally acting as a shield. In the event any wound has placed the mother’s life at risk or the mother has died from the wound, under certain extreme circumstances, an emergency C-section may be performed to save the baby.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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From the Health Library of SterlingMedicalAdvice.com: Does drug use cause kidney damage?

cocaine-kills-1

Kidney_–_acute_cortical_necrosis

Each kidney filters about 1700 liters of blood per day and concentrates fluid and waste products into about one liter of urine per day. Because of this, the kidneys receive more exposure to toxic substances in the body than almost any other organ. Therefore, they are highly susceptible to injury from toxic substances.
Inflammation from immune response to drugs may injure the structures of the kidney, usually causing various types of glomerulonephritis or acute tubular necrosis (tissue death). Injury to the kidney may result in short-term damage with minimal or no symptoms. It may also be life threatening from bleeding and associated shock, or it may result in acute renal failure or chronic renal failure.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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About SterlingMedicalAdvice.com: What's Next?

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SterlingMedicalAdvice.com is creating a virtual healthcare universe.  You can look forward to the following offerings.

Nov. 1: The launching of www.SterlingMedicalAdvice.com, including the Sterling Advice plan and the Sterling Advice Plus plan.  The Sterling Advice plan offers you personalized, immediate 24-hour advice and information from physicians and other medical specialists covering all medical specialties. The Sterling Advice Plus plan incorporates the offerings of the Sterling Advice plan and expands it to include pharmacy, mental health, dentistry, nutrition and personal training.

Dec. 1: The launching of SterlingMedicalAdvice.com’s Wellness and Smoking Cessation Programs. These modules will allow you to follow a best-practice program to improve your health over the long-term. This is a perfect addition to your employee benefits program. Employers, take note!

Jan. 1: The launching of SterlingMedicalAdvice.com’s Spanish language platform. All of the offerings of www.SterlingMedicalAdvice.com will be available in multiple languages for multiple audience.
Hablamos español!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

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About SterlingMedicalAdvice.com: "How do I sign up?"

Anytime starting noon EDT (and 11 am CDT) on Nov. 1st, you may go to www.sterlingmedicaladvice.com to join. It’s very easy to do. Give yourself about 15″. Have your personal health information, including medications and past medical history available. You will only have to provide this information once, and it will be invaluable in allowing our expert consultants to give you the very best information and advice.

Remember, if you sign up for a year’s plan, you get 13 months for the price of 12!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

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From the Health Library of SterlingMedicalAdvice.com: "Can I use antibiotics if I forgot to refrigerate them?"

antibiotics_050106

I left my son’s liquid antibiotic sitting on the kitchen counter all day instead of putting it back in the refrigerator. Is the medicine still OK?
Depending on the medication, including liquid antibiotics, it may no longer be effective due to improper storage. Certain medications will break down and lose their potency if not stored in the refrigerator. If you are unsure if the medication is still effective, consult your doctor or pharmacist.
Always be sure to read all the labels on the medication container for directions for use and storage.
 
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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