Tag Archives: United States

Straight, No Chaser: Syphilis Prevention, Treatment and the Tuskegee Experience

Genital/Urinary, Medical Treatment, Obstetrics and Gynecology, Public Health, Health Prevention, , , , , , , , , , , , , , , ,

tuskegee syphilis4
Syphilis should be a word derived from something meaning horrible. In an earlier post, we reviewed the rather horrific progression of the symptoms of syphilis. An additionally horrible consideration is that treatment is so very easy once identified. Of course, that’s not the most horrific aspect of the disease. Read on.
Looking back retrospectively, advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. However, as discussed in the post discussing the symptoms of syphilis, remember that treating syphilis at any point can prevent the most severe complications that lead to death. Which brings us to Tuskegee – and keep in mind this is Straight, No Chaser.
In the early 1930s, the US Public Health Service working with the Tuskegee Institute in Alabama began a study to evaluate the effectiveness of current treatments for syphilis, which at the time, were thought to be at least as bad as the disease. The study was conducted on 600 Black men, who were convinced to participate in the study with the promise of free medical exams, meals and money for burial, ‘if’ it was necessary.
The study was initially meant to last 6 months, but at some point a governmental decision was made to continue the study and observe the natural progression of syphilis until all subjects died of the disease, with a commitment obtained from the subjects that they would be autopsied ‘if’ they died. There were several problems with this decision.

  • None of the patients participated under informed consent. They believed they were being treated as opposed to being observed and having medicine withheld while they were being allowed to die. In other words, the subjects were not aware of the purpose of the study.
  • Penicillin was established as a true, rapidly effective treatment for syphilis and the standard of care by 1947. The study continued 25 years beyond this treatment option being available.
  • Efforts by concerned individuals failed to end the study for 5 years prior to a whistleblower going to the press in 1972. The study was ended in a day.

The aftermath of the study includes the following:

  • Reparations averaging a mere $15,000 per individual were given ($9M total) as well as a formal apology, delivered by President Clinton. Yep, the victims received the equivalent of $15,000 per person on average for 40 years of carrying syphilis 25 years after there was a known cure, after infecting wives and unborn children in several documented cases.
  • Strict requirements for protocols for human study (i.e. Institutional Review Boards) were implemented for the first time.

It shouldn’t surprise anyone that many African-Americans remain distrustful of governmental public health efforts to this day; for many, this study continues to be the reason while vaccination isn’t optimally taken advantage of (e.g. HPV) and why organ donation rates are so relatively low in the African-American community. Even though this posture contributes to the adverse health outcomes that exist in the African-American community, it isn’t hard to see why the fear and distrust exists.
Let’s bring this full circle. When it comes to syphilis, prevention is best, and full treatment is available. At the very least, I certainly can say you’ve been warned. Folks have given their lives to make your warning possible. I welcome your questions and comments.
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Straight, No Chaser Editorial: The Future of Medicine – Nurses are Stepping Up to the Plate

Public Health, , , , , , , ,

Nursing1
I doubt you’ll hear this perspective anywhere else anytime soon, but there are some very interesting developments in health care underway. By way of introduction, a few decades ago, physicians abdicated the ownership and preeminent leadership role in healthcare, leaving the industry to the business minds of HMOs. During these early days, non-physician corporations actually owning medical practices and developing practice parameters were outlawed as to ensure that sufficient protections would remain in place for autonomous (and presumably honorable) medical practice. 
The combination of for profit hospitals and the advent of contract medical practice management groups (particularly in emergency medicine, hospitalist medicine and radiology) combined to erode away at the corporate practice of medicine laws to where even though the laws are still on the books, suits to enforce it are now routinely defeated. Today, in addition to emergency room physicians, radiologists, surgeons, hospitalists, and anesthesiologists are more likely to be employees than owners of a practice.
In recent times, health care costs have skyrocketed to 17% of our economy, while 50 million Americans went without insurance. Meanwhile, the combination of a shortage of primary care physicians and for-profit entities’ desire to cut costs has led to the development and proliferation of alternative, less costly methods of paying individuals to provide health care. Most notably, this has included the development of advance practice nurses (e.g. nurse practitioners and nurse anesthetists – instead of family doctors and anesthesiologists). Similar interest in cost savings has led to nurses assuming senior managerial positions in hospitals instead of MBA-type executives.
It is against this backdrop that the Patient Protection and Affordable Care Act (aka ‘Obamacare’) passed, seeking to infuse 30 million more paying patients into the primary care arena. With ongoing physician shortages unable to meet this demand, and with there being downward cost pressure on salaries due to the goals of the ACA and desires of corporations, it’s reasonable to predict that we will see a dramatic increase in primary care nurse practitioners (NPs) and physician assistants (PAs), which will lead to further abandonment of primary care as a physician specialty.
Meanwhile, nurses have stepped up to fill the void.  In addition to the ongoing advancement of Nurse Practitioners, nurses have successfully lobbied for and created a new provider entity: ‘The Doctorate in Nursing Practice’. It is important to note that NPs and PAs can successfully treat about 85% of the things physicians routinely see. Quality concerns aside, it is an important public health consideration that additional healthcare professionals and health options are being established to fill the need of care for tens of millions of individuals more likely to use the healthcare system.
Meanwhile, regarding your doctors, a conceivable end result is physicians are being marginalized in virtually every aspect of health care. It is easy to see a future in health care 25 years from now where cost concerns have been addressed by nurses having replaced physicians in more specialties than just primary care and anesthesia, and nurses have more control of the hospital apparatus than physicians. Physicians remain oblivious to what’s happening under their noses and an insufficient interest in contributing to healthcare solutions in the ways nurses have. The Straight, No Chaser perspective is given the large segments of society that continue not to have access to care (even with implementation of the Affordable Care Act, it is estimated that 20 million American still won’t have insurance), new innovative options to address these needs are welcome and have a place in the system. What’s next is for society to ensure that this transition occurs with appropriate quality controls and public education.
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Straight, No Chaser: The United States of Obesity – The Crossroads Between Health and Happiness

Cardiology/Heart, General Health and Wellness, , , , , , ,

obesity_trends_20092obesity4

Obesity in the United States places many at a crossroad between self-esteem and health.  Often, larger frames are celebrated as more desirable.  Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise.  Of course, our culture embraces and contributes to obesity.  Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport.  I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health.  If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed.  As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:
Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.
Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.
‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight No Chaser: The United States of Obesity – The Crossroads Between The Pursuit of Health and Happiness

Cardiology/Heart, General Health and Wellness, Health Prevention, , , , , , , , , , , ,

obesity_trends_20092obesity4

Obesity in the United States places many at a crossroad between self-esteem and health.  Often, larger frames are celebrated as more desirable.  Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise.  Of course, our culture embraces and contributes to obesity.  Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport.  I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health.  If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed.  As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:

Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.

Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.

‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Week In Review

Medical Treatment, Public Health, Health Prevention, , , , , , , , ,

WeekInReview_thumb2
Based on the response to this week’s posts, I’d say it was an informative week for you.  Remember to click the underlined topics to go to the mentioned post.  Let’s recap the week.
On Sunday, we reviewed night terrors and differentiated them from nightmares.  Remember, if your child develops these, it’s very important to protect them from harm during the episode, and try to identify the source of any increased stress.
On Monday, we reviewed the late Dr. Martin Luther King, Jr.’s comments on healthcare and its relevance today.  Injustice in healthcare is still shocking and inhuman, as health care disparities abound.  Monday also brought a review of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare.  As the time of implementation gets closer, I will revisit implementation of the ACA, particularly health care exchanges, what your options are, and what’s to be done with the 20 million Americans who will still be uninsured.  I will also be discussing how this blog and my national efforts will dovetail into these considerations.  Stay tuned.
On Tuesday, we began our series on toxins and detoxification.  The first post discussed the power our body naturally and normally has to detoxify and to defend us from harm.  The second post offered specific, natural Quick Tips to enhance your body’s capabilities.  Taken together, I strongly recommend you internalize this information (no put intended).  All the other exotic methods typically promoted are, at best, enhancements to what we already do unless disease limits us.  At worst, they can cause damage themselves.
On Wednesday, we looked at some of the environmentally toxic dangers to our bodies, focusing on various toxins affecting our lungs, skin, kidneys, liver and intestines.  If knowledge is power, your brain should be stuffed after reading that post.  Stop smoking (Yes, you.).  Wednesday also brought a review of detox diets.  My advice is simple.  Proceed with caution, and don’t expect any miracle cures.  In fact, the better course of action is to use any such efforts as a launch into a more modest long-term regimen of healthy diet and exercise.
On Thursday, we reviewed colon cleansing, looking at oral solutions and rectal colonics.  These were turbulent topics, to say the least.  Please consult your physician before starting any of these diets or cleansing programs.  They are not without risk and consequence in certain patients.  Thursday also brought a review and wrap-up of the toxin/detoxification series.  I enjoyed your questions, comments and thoughts.
On Friday, we reviewed insomnia.  Do you remember the difference between primary and secondary insomnia?  There are important treatment considerations attached to each, so consider reviewing.  I also gave you 10 Quick Tips to help your difficulty sleeping and answered your questions. 
On Saturday, we peeled back the brains of physicians and taught you how we decide if and when ankle x-rays are needed.  I really do want your feedback when you mention the Ottawa Ankle Rules to your physicians.  I’m sure you’ll have stories about hearing them muttering “Damn internet!” under their breath!  Saturday also brought a review of a normal calorie intake.  I think this is a pretty important topic for several reasons.  I hope you learned the different between sedentary, moderately active and active lifestyles.  Also, many of us have no idea how much we should be eating and how many calories we should have daily.  Also, this will serve as a nice launching pad for my review of obesity next week.
Speaking of the next two weeks, I will be focusing on revisiting some fundamental bread and butter topics (no pun intended).  I continue to hope you enjoy Straight, No Chaser and appreciate your supporting this blog, which has now reached readers in 60 countries around the world in every continent.  I’ll keep bringing the information, and you keep taking advantage of it.

Straight, No Chaser: How Many Calories Do You Need a Day?

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

soda1
Let’s put this post (at least the end of it) under the category of things you do but really don’t think about.
How many calories should you take in per day to function (meaning produce the energy you need for your activities of daily living)?  It actually depends on your gender, your age and your level of activity.  Let me start by defining the types of lifestyles, according to the Institute of Medicine.  If you are in the third category (active), I doubt that you’re worried.
Sedentary means a lifestyle that includes only the light physical activity associated with day-to-day living.
Moderately active means a level of physical activity equivalent to walking about 1.5-3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
Active means a level of physical equivalent to walking more than 3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
That breaks down as follows:

  • For women between 14-50, the number is right about 2000 kcal/day (calories) if you’re moderately active and 1800 if you’re sedentary.
  • For men between 14-50, there’s some greater variance, but the 2500 kcal/day works if you’re moderately active and 2200 if you’re sedentary.

In short, that averages to about 600-800 calories per meal, with the low end being for sedentary females and the high end being for moderately active males.
Now consider, 16% of the calories in the average American diet come from refined sugars.  Fully 50% of that total comes from beverages with added sugar.

Every 12 ounces of non-diet of pop/soda you drink contains about 150 calories.  

Your average dessert ranges from 300-500 calories.  

The most popular one, only one cup of ice cream, contains 270 calories.

I’ll let you take the math forward from there.  However, the take home point is obvious.  Suffice it to say, the link between pop, deserts and obesity has been well established.  Here’s three Quick Tips for you.

  • Try finding a drink with fewer calories if you want to lose calories (and weight).  It’s water, not Coke, that adds life.
  • Try eating your favorite fruits as dessert.
  • Also, consider just walking 3-4 miles a day.  It’s not that hard, if you just do it.

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Straight No Chaser: Top Seven Facts You Should Know About the Affordable Care Act (Obamacare)



Public Health, , , , , , , ,

Affordable-care-act
In general, the Patient Protection and Affordable Care Act (ACA) attempts a nifty set of tricks: it aims to add over 30 million currently uncovered Americans to insurance rolls while slowing the rate of growth of health care costs, then ultimately reduce the costs of care. This simultaneously makes insurance providers huge winners and slight losers (30 million new customers but less profit per customer), as well as hospitals, physicians and pharmaceutical companies, who are meant to make a little more money while working a lot harder for it. The basic premise is there’s already plenty of money in the system (America spends over 17% of the gross domestic product – over $2 trillion annually on health care; no other country spends more than about 11% of GDP on health care) to provide what we need. 

The ACA was truly a Republican initiative at birth, for those keeping score. It was born out of the Heritage Foundation (a conservative think-tank) and is more or less a combination of plans proposed by Bob Dole and executed by Mitt Romney in Massachusetts. It does not provide universal coverage or even “Medicare for all” (those would have been current Democratic ideas, although Richard Nixon proposed the same) or allow a governmental takeover of hospitals, insurance companies or physician practices (those would be socialized medicine). At it’s simplest, it’s a capitalist give to insurance companies of 30 million new patients with enhanced governmental oversight.
Here’s those 7 positive facts:
1)    The 80/20 rule: The law requires insurers to spend at least 80% of premiums on direct medical care. This nearly doubles historical trends. This is meant to expand care greatly in certain areas such as prevention and mental health. If and when this doesn’t happen, you’ll get a rebate check.
2)    Preventative care is being emphasized: you likely won’t have to pay a co-payment, co-insurance or deductible to receive services such as screenings, vaccinations and counseling.
3)    Preexisting conditions: Health plans can’t limit or deny benefits or coverage to anyone under age 19 because of the existence of pre-existing conditions. These protections will be extended to all ages beginning in 2014.
4)    Choice and ER access: You choose your own doctor. You don’t need a referral from your primary care doctor to see an Ob-Gyn doctor. You don’t need pre-approval to seek ER services outside of your plan’s network (e.g. when you’re out of town). This means those ridiculous out of network charges should go away.
5)    Young Adult Coverage: If your plan covers children, you can add or keep your kids on your policy until they turn 26, even if they’re married, don’t live with you or are otherwise eligible to have their own plan.
6)    Consumer Assistance Program: This strengthens your ability to appeal and fight decisions made by your insurance provider and guarantees your right to appeal denials of payment.
7)     End on Annual and Lifetime Limits on Coverage for all new health insurance plans by 2014.
The bottom line is 30 million American are being formally brought under the umbrella of the health care instead of relying on emergency departments or going without care.  Despite not being a perfect solution, if we were to list societal priorities, closing this gap to this extent is high enough on the list that the downstream consequences are less important as considerations.  As a public health initiative, this act will accomplish many things, including putting in motion changes in health care disparities due to the lack of access to care.  I would challenge all the critics of the ACA to answer one question whenever they have an argument about why they continue to oppose implementation of the ACA: “Is your concern worth leaving 30 million Americans without structured healthcare?”
I welcome your comments and questions.
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Straight, No Chaser: A Dream of Equal Access to Health Care

Public Health, , , , , , , ,

MLKMOW
This weekend marked the celebrations of the 50th anniversary of the famous March on Washington. During this weekend’s remembrances, I couldn’t help but reflect back on Dr. Martin Luther King, Jr.’s most famous comments on health care in America.

“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”

Why would he say such a thing? Injustice in health care has taken many forms and resulted in predictably poor outcomes for those affected. I will be frequently reviewing these considerations and addressing health care disparities in this blog. Today, I will address the inequity in insurance coverage that formed the premise for the Affordable Care Act (aka Obamacare).
According to the Kaiser Family Foundation, in 2009-2010, 41% of low-income adults were uninsured, and 45% of poor adults were uninsured. Contrast this with the fact that only 6% of those who make four or more times the poverty rate were uninsured. This pretty clearly makes the case that health care is a desirable asset for Americans who can afford it, and a choice that too often can’t be afforded for others. Now consider that 14% percent of white Americans were uninsured, while 22% of African-Americans were uninsured, and 32% of Hispanic Americans were uninsured. Whether you believe this is just a correlation, coincidence or reflection of something more damning, it is a situation that screaming to be addressed and improved.
Even more recently, the Centers for Disease Control and Prevention released a survey showing that more than 45 million U.S. residents didn’t have health insurance during the first nine months of last year. Still even more people, 57.5 million, were uninsured for at least part of the 12 months before being polled (Be reminded that the total U.S. population is just over 311 million.).
Please take a moment and ponder the enormity of the numbers just presented. It begs the question “How can such be allowed to exist?” Dr. King’s comment begged the same question. The answer of course lies in the fact that the American health care system isn’t built on producing equality of access or outcomes. You’ve heard me say before that the American health care system remains the only system among all the major industrialized nations on earth that doesn’t ensure access for all its citizens. The American health care system is a business enterprise that has captured over $2 trillion annually, representing over 1/6 (17%) of the gross domestic product, and all the while leaving more than 45 million Americans uninsured. We are number one in money spent on health care by a large margin; in fact, the U.S. spends more on people aged over 65 than any other other country spends on its entire population. The business of medicine in America is business first. It is largely expected that good health care outcomes will result from good business in the same way that good cars, computers, smartphones, etc. are produced (theoretically). It’s important to note that according to the World Health Organization (the monitor of such things), the U.S. health care system was ranked #38 in the last WHO ranking based on standard health outcomes produced.
President Barack Obama’s health care reform law aims to extend health insurance coverage to a large portion of the uninsured. According to the Congressional Budget Office, health care reform will reduce the number of uninsured people by 27 million between 2014 and 2023. The Affordable Care Act (ACA) targets its assistance to the poor and near-poor who are least likely to have health care coverage. The ACA will provide Medicaid coverage to those with incomes up to 133 percent of the poverty level ($15,282 for a single person this year) — unless their home state opts out of the Medicaid expansion. People who earn between the poverty level and four times that amount will be eligible for tax credits for private health insurance.
Access to health care is the beginning of the process by which health care disparities can be erased. As long as failure to have equal access exists to the extent that it does, the types of disparities in life expectancy, disease rates and disease survival will remain predictably dismal for certain populations. This afternoon I will revisit the Affordable Care Act and it’s efforts to improve the current system. I welcome any questions or comments.
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Straight, No Chaser: Quick Tips – Learn the ABCDEs of Hiccups

Medical Treatment, Neurology, , , , , , ,

hiccup-460_1215860c

Three question sets on hiccups of all things

Why do I get hiccups?
You get hiccups because everyone gets them.  You get them because basically you’ve agitated your main breathing muscle (You have one on both sides, between the chest and abdominal cavities.).  Something’s caused it to spasm, which produces a reflex vocal cord closure.  That sound you hear is the reflex air going down your windpipe.  Here’s some of those ‘somethings’…
You smoke too much.
You’re overstressed.
You’re agitating your stomach.

  • You eat too much too quickly.
  • You drink too much.
  • You swallow too much air.
  • You alternative between hot and cold foods too quickly.

Are hiccups ever serious?
Absolutely.  In fact, hiccups can go on for more than 48 hours.  In these instances, you need to get evaluated.  Several things can cause this, but I’ll be particularly worried about your nerves and nervous system.
What about all those hiccup cures?
Some things never hurt to try.  What you’re actually trying to accomplish through multiple variations of the same theme is to increase your carbon dioxide level (the gas you exhale in breathing), which tends to stop the hiccups.  Here’s a few oldies but goodies – think ABCDE.

  • Achoo!  Sneeze even if you don’t need to.  It may additionally stimulate the diaphragm out of hiccupping.
  • Breathe into a paper bag for 30-60 seconds.
  • Count to 10 while holding your breath.
  • Drink a cold glass of water – fast (Notice you’re holding your breath while doing this, and no, you don’t need a pencil in your mouth.).
  • Eat a teaspoon of sugar or honey.

Straight, No Chaser: Quick Tips – You Snore Too Much

Neurology, Sleep, Health Prevention, , , , , , ,

snoring
You snore too much.  What this means is your breathing is intermittently partially obstructed while you’re sleeping.  Snoring is the sound of air moving past that obstruction.  Whether serious or not, first you should know it’s common, occurring in about 50% of adults.    It could be serious or just positional.  Here are some Quick Tips for you.

  • Sleep on your side.  This should remove the tongue as a cause of a partial obstruction.
  • Avoid sedatives if possible.  Sedatives cause significant enough relaxation to the tissues in your throat to cause that partial obstruction.
  • Limit alcohol before sleeping (by about two hours).  Alcohol is a sedative.
  • Elevate the head of your bed or prop your head up by about 4-6 inches.  This should manually move partially obstructing tissue out of the way.
  • Fix what ails your nose.  If you have chronic problems with nasal obstruction or a deviated nasal septum, you’re more inclined to breathe through your mouth.  This will increase the chances that you snore.  Similarly, those nasal strips you may have seen work (when they do) by increase the area in the nose through which they can breathe.
  • Finally, losing weight (if you have it to lose) works by reducing the tissues in and around your throat that cause snoring.

It’s time to see your physician if you find yourself awakening from sleep choking, gasping or otherwise short of breath.  This could be an indicator of a serious condition, including sleep apnea.  Additionally, you may want to seek care if your sleeping causes functional problems (e.g. you or your partner have difficulty sleeping as a result of your snoring).
This is a significant enough issue that I will revisit it in the future.  In the meantime, sleep well.

Straight, No Chaser: Circumcision – To Do or Not to Do?

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

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

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

Here are criticisms of the decision to have circumcision.

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

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

Straight, No Chaser: About That Vomiting and Diarrhea…

Medical Treatment, Health Prevention, , , , , , , , , , ,

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

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

2. Is it contagious?

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

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

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

4. How will it be treated?

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

It’s important to discuss some other treatment considerations.

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

In summary, you don’t always have to run to the ER when you get the runs. Stay hydrated, my friends.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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.
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Straight, No Chaser: When (Not) to Visit the ER

Public Health, , , , , , ,
copay I’ve spent a lot of time discussing the life threats that should prompt you to rush to the Emergency Room.  Today, I’m going to give you some factual information that could save you some time and a lot of money and keep you out of the ER.  There are so many misconceptions about the appropriate use of an ER.  Let’s address five points you should consider before you come to see me or my colleagues.  The message is not meant to be disrespectful to you and your families, but it’s just straight talk, and remember, the most important consideration is if you ever feel yourself (or your family) to be in harm’s way, don’t even think about it, get to the ER, and we’ll sort it out for you. 1)   Your expectations are sometimes completely unrealistic about the appropriate use of the ER.  One of the most expensive and inefficient healthcare laws on the books is the Prudent Layperson, which places in the hands of the public the right to go to an ER if one ‘believes’ an emergency exists.  Of course, the result of this is 80% of ER presentations represent things that could have been seen elsewhere for a fraction of the cost (mostly strains and sprains, bumps and bruises, sniffles and coughs – none of which usually requires an ER visit).  Admit it.  Your family sometimes uses the ER as a convenience because we’ll see you quicker than your doctor and can do certain tests quicker.  That doesn’t make it right and certainly doesn’t make it cheap.  But it sure makes for good business. 2)   The ER is not a clinic or a take out restaurant, regardless of what you think or need.  The ER’s notoriety as the ‘facility of last resort’ doesn’t mean we’re a substitute for seeing your doctor.  We rule out life-threats.  We’re not necessarily trying to diagnose the issues you’ve had for 3 years.  We don’t have the equipment or inclination to diagnose chronic disease.  It’s called an emergency department and is a specialty just as much as Surgery, Obstetrics or anything else.  We understand if you leave with some degree of dissatisfaction when we don’t address the reasons you came that were not life-threatening and/or emergent, and your complaining doesn’t impose a different standard of care onto us.   All to which you are entitled on an ER visit (as spelled out in the EMTALA law) is a medical screening exam, which is still going to be expensive.  All this accomplishes is the ER doc determining that you really aren’t trying to die at this moment.  Just because you think you need an x-ray doesn’t mean we’re going to order one.  We’re practicing medicine, not taking orders.  I’m not doing a spinal tap on your child because you saw a news report on encephalitis when you don’t have the symptoms (and as a rule, that analogy fits whenever you say the words “Can you do…xxx…just to be sure?” to an ER physician).  We do care.  We will go the extra mile for you and accommodate you – within reason. 3)   The ER is the most expensive portal of entry into the healthcare system by design.  Controlled for the same typical presentations, the average cost for an ER visit is $1020, and the average cost for the same in an office setting is $140.  The government sets prices, not hospitals or physicians.  Hospitals are able to charge more for any presentation because the infrastructure and operating costs of hospitals are massive compared with your doctor’s office.  In fact, hospitals charge a facility fee of several hundred dollars just for you walking through the door, in addition to everything else.  Insurance companies also attempt to discourage this by charging you higher co-pays for your ‘bad behavior’ ($50-150 upfront) to be seen in the ER instead of your doctor’s office, and in some instances, they require pre-authorization. 4)   The ER, hospital and the medical care system in general in this country is not about charity (or health care for that matter).  The US system is capitalistic by design, and has been very successful at that, capturing 1/6th of the US Gross Domestic Product.  We spend $2 trillion a year on medical care, fully one out of every six dollars spent in this country.  It’s probably the very best place to conduct business in this country.  Your occasionally irrational fears are costing you money.  And this is how hospital bills have been the #1 cause of personal bankruptcy in the US.  Just because you’re not paying upfront doesn’t mean the hospital won’t be tenaciously coming after you for payment. 5)   About 80% of disease takes care of itself if you’re patient.  The body is able to fight off most disease.  Nearly all of your creature comfort symptoms can be addressed by over the counter preparations.  Stop letting your fears be played upon.  Use the internet and other resources available to you, and smartly (i.e. selectively) decide when you need to come to the ER.   And please call your primary physician first. Doctors, nurses and pharmacists are still the best advocates you have left in the system, and we love taking care of you.  Virtually every survey this century shows that the aforementioned medical professionals are the most trusted in the United States, with teachers occasionally in the mix.  The ethics of healthcare providers offer a nice cover for the sometimes questionable (but legally permissible) behavior of insurance companies, pharmaceutical companies and for-profit hospitals, who all too often are all about the profit margin.  The business of American medicine in the 21st century is business first and medical care second.  I’ve told you time and again that diet, exercise, moderation and ounces of prevention preclude all manners of disease.  Take care of yourself, lest you’ll become one of the many for whom medical care expenses destroy personal finances. If you have any questions, comments or financial horror stories to share, I’m all ears.

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Orders are now being filled (without shipping delays!) at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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Feel free to #asksterlingmd any questions you may have on this topic. Take the #72HoursChallenge, and join the community. As a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Receive introductory pricing with orders!Thanks for liking and following Straight, No Chaser! This public service provides a sample what you can get from http://www.docadviceline.com. Please share our page with your friends on WordPress! Like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.Copyright © 2020 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Quick Tips for the Drowning Victim

Medical Treatment, Trauma, Health Prevention, , , , , , ,

Drowning_safety_children_CPSC

  1. If the victim is still conscious, attempt to hand him something that can be used to pull him from the water. If you’re out of handing distance, throw either a floatable object or something he can hold onto and with which he can be pulled to safety.
  2. If the victim has fallen into solid ice, and you have enough individuals, consider forming a human rope, with each individual interconnected and at least two individuals safely connected back on firm land.
  3. The victim should be removed from the water at the earliest opportunity. Forego inclination to perform chest compressions or rescue breathing in the water.
  4. If possible, remove the victim from the water as flat (horizontal) as possible. You want to make every effort to avoid damage to the neck throughout this entire process (This actually would be additional injury to the neck; there’s a fair chance such an injury has already occurred.).
  5. Once victims are out of the water, NEVER assume death unless you’re a qualified medical professional. Begin CPR, as described in yesterday’s post (Click here to review.).
  6. If the victim has an altered mental status, check the airway for foreign material and vomitus. Use your fingers to sweep away any material visible between the mouth and throat.
  7. The Heimlich maneuver (abdominal thrusting) is not effective in removing swallowed water. Don’t waste valuable time with it.
  8. If you’ve successfully saved a drowning victim, don’t bother taking off wet clothes. It’s not worth the possible agitation to the neck, and recent medical thought suggests that cooling after certain likely types of cardiac arrest is especially beneficial in reducing brain injury and death. This consideration is much more important than any benefit to be gained from warming the patient. Sounds weird, but it’s the truth.

Regarding the lead picture, yes it’s true that one can drown in inches of water. Infant safety means keeping them at arm’s length while they’re in the water.

Straight, No Chaser: Staying Alive – A New, Ridiculously Simple Approach to CPR

Cardiology/Heart, General Health and Wellness, Medical Treatment, , , , , , , , , ,

cpr
Hopefully, this video is the hokiest thing I’ll ever post, but modern understanding of CPR is such that every single one of you should know exactly how to respond in the event someone collapses near you. Simply put, this is how you save lives. I would think every one who reads this would do well to forward or post this message within your networks.
http://www.heart.org/HEARTORG/CPRAndECC/HandsOnlyCPR/Hands-Only-CPR_UCM_440559_SubHomePage.jsp
In case the video doesn’t launch for you, here’s your two steps.
1) Have someone call 911.
2) Interlock your hands and fingers (one on top of the other), and use them to apply compressions to the center of the affected person’s chest, right between the nipples. Push fast and hard; and yes, the correct rate (200 reps/minute) can be approximated by pump to the beat of The BeeGee’s hit ‘Staying Alive’. Forgive me, but this is important enough to go there.
You may have noticed the deemphasis of rescue breathing. That makes this process even easier. Combine this with my past comments regarding an AED (automated external defibrillator – click here for details), and you are really giving someone the best opportunity to have a successful outcome.
Don’t worry, in a future post, I’ll address how to get that song out of your head.

Straight, No Chaser: When Allergies Strike

Medical Treatment, Skin/Dermatology, Health Prevention, , , , , , , , , , ,

allergy
Bee stings.  Medication reactions.  Food allergies.  Latex.  Animals.  Dust.  Cosmetics.  What do these things have in common?  You get allergic to them, and in differing degrees, they make you come to me huffing and puffing and puffy and thinking about not breathing anymore.
The basis of allergies is that your body is trying to defend you from infections.  Sometimes our defense mechanisms are ‘inaccurate’, and the body overreacts to what normally might be harmless substances by producing a system wide reaction (antibodies) to certain triggers (allergens).  This overreaction leads to our bodies fighting a war that isn’t meant to be fought.  That manifests itself clinically by some subset of itchy rashes (wheals, urticaria or angioedema), shortness of breath, nausea, vomiting and other systemic systems.  Again, it’s important to note that this can be both a systemic overreaction or just a local reaction.
One question I commonly get asked is “Why I am allergic to this now?”  In other words, sometimes allergies occur after the initial exposure to seafood or peanuts, or maybe you had been stung by a bee in the past.  That occurs because the first allergic exposure doesn’t always cause a visible reaction.  However, it will sensitize the body such that you’re mobilized for subsequent exposures and will be prepared to ‘unload both barrels’ if it’s needed.  Unfortunately, this reaction can be itself life-threatening.  This life-threatening response is called anaphylaxis, and you’ll know it because more than one organ system of your body (heart palpations, breathing difficulties, gastric upset, itchy skin rashes, dizziness as your body goes into shock, etc.).
Although allergic reactions are more likely to occur in those with conditions like asthma, eczema, allergic rhinitis, seasonal allergies, and sleep apnea, to be clear, the acute allergic reaction is a different animal than seasonal allergies.  If you have any sensation that you’re short of breath, your throat feels like it’s closing, you have any dizziness or altered mental status, palpitations, or if the rash is diffuse and spreading, please get to your closest emergency room.  I wouldn’t be upset if you took the recommended dose of Benadryl along the way.
Final tip: Those of you who’ve suffered any type of allergic reaction to medication, food, animals, etc. should ask your physician about the utility of carrying an epipen, benadryl or steroids in the event of an emergency.  If your risk profile warrants it, any or all of these could prove life saving.  However, these medicines aren’t without risk, so you shouldn’t take any of them unless recommended by your physician.

Straight, No Chaser: Can You Get Chicken Pox Twice? Emergency Room Adventures: Introducing Shingles

Medical Treatment, Health Prevention, , , , , , , , , , , , ,

shingles
It’s another interesting night in the ER.  My nurses are hounding me because there’s a patient with a rash, and they don’t know what it is.  They’re so good that they rarely get stumped, and they get excited when they are.  The patient had a pretty impressive cluster of little blisters called vesicles (see the picture above) under one eye with significant reddening of the skin under the cluster.  Unknown to them, their problem with this patient is she’s African-American.  Many healthcare professionals have difficulty identifying common rashes in dark-skinned individuals.
I wonder if any of you haven’t had chickenpox.  That’s a question that never would have been asked a few decades ago.  Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.).  Repeat infections or reactivation of the virus that went dormant inside of you causes shingles.  When I was younger, no one ever got shingles because no one got chickenpox twice.  Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it.  The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).
Then an odd thing happened.  A chickenpox vaccine came out.  Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age.  Then shingles started being seen more often.
The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes.  Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears.  The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks).  Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.
Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful.  If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half.  Please discuss this with your physician.  If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.
Quick Tips:

  • If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from blisters in both conditions is contagious and can cause chickenpox in these groups.
  • If you have shingles, avoid close contact with people until after the rash blisters heal.
  • Certain people are at heightened risk from chickenpox and shingles, including anyone pregnant, elderly, ill or with a diminished immune system.

I welcome your questions, comments or stories.  For the sports fans out there, this pictorial trivia question shouldn’t be hard to answer?  Who’s this famous manager pictured here with shingles?
larussashingles

Straight, No Chaser: Spider Bites – Emergency Room Adventures, Part I

Medical Treatment, Health Prevention, , , , , , ,

volcanolesion

And I thought I was done with stuff biting you for a while… Everything’s bigger in Texas, they say. I recall the first time I saw a banana spider. The thing seemed to be as big as my fist. The only thing more surprising than that was discovering that wasps actually kill and eat spiders. I thought it was supposed to be the other way around… Anyway, I’m typing this immediately after seeing a patient who’s working around the house (or farm or barn as the case is around here), and he put his hand in the woodshed and got bit by a big spider with a red hourglass appearance. Of course, the mother’s excited and wants to know if he’s going to die. The father’s not too concerned because he was just in Missouri a month ago and was bitten by a spider that looked like it had a violin on its back (You can’t make this stuff up!).

Not a day goes by when I don’t see several patients bitten or stung by various insects, including fire ants, mosquitos, bees, wasps, ticks, scorpions and spiders. Usually everyone’s worried about a Staph infection. It’s important to note that only four American species of spiders are known to be dangerous to humans. However, there are only two types of spiders that are worth mentioning as a cause of significant disease.

blackwidow

Black widow spider bites are even more interesting when they’re not eating their mates after procreation (fun fact: North American black widow spiders don’t usually do that; it’s actually the Australian brand that does). They prefer to avoid humans, hanging out in outhouses, garages and the like. They become aggressive when disturbed (particularly if there’s an egg sac around), and if you’ve been bitten, it was by a female. You’ll know it was a black widow because of its red hourglass underside.

The black widow spider injects a powerful nerve toxin into humans. Once bitten, you’ll feel pain, but the real symptoms are likely to start about 20” later. Among other things, this venom produces symptoms that mimic appendicitis. Patients can develop abdominal pain and rigidity, tremor, weakness, chest pain, shortness of breath, dizziness and fainting. People at the extremes of age are more at risk for serious complications. Otherwise, reactions are rarely life threatening.

brownrecluse

The brown recluse spider is native to the Midwest and Southeastern U.S. You’ll recognize this one by its distinctive violin pattern on its back near where its legs attach. As the name suggests, they’re not at all aggressive and tend to bite only when it’s pressed against its victim’s skin. These spiders like warm and dry environments (think attics, closets, basements, porches, barns and woodpiles).

The Brown recluse also injects a powerful venom – more so than a rattlesnake – who’s lethality is only limited because it’s such a small creature. Its venom rapidly destroys the cells it’s injected into, causing necrosis and tissue death (This is decreased as having a ‘volcano-like’ appearance at the bite site. The lead picture is a demonstration of this.). This destruction has secondary effects in humans, including kidney damage and failure, red blood cell and platelet (your clotting cells) destruction, formation of blood clots, coma and death (rarely). Deaths have only been reported in children less than age seven by the brown recluse.

Here’s your Quick Tip do’s and no’s for Spider Bites:

Do’s

  • Get to the ER. Not your Doctor’s office. Not the Urgent Care.
  • Elevate the area above your heart.
  • Wash with soap and cool water.
  • Tylenol for pain.
  • Apply ice.

No’s

  • No waiting to see if it gets better.
  • No heat.
  • No suction.
  • No cutting away tissue.
  • No tourniquets.

Straight, No Chaser: Back Pain to The Future

Neurology, Orthopedics/Bones, , , , , , ,

lower-back-pain-causes-2
Over 40 million Americans suffer from various forms of chronic low back pain. We must work really hard.
Lower back pain is a tricky subject for an emergency physician. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.
Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

  • Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
  • Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:

  • Direct blow to your back
  • Fever and new onset back pain
  • Loss of control of your bowel movements or bladder function
  • New onset back pain after age 65
  • Numbness and tingling in both of your legs
  • Nighttime back pain
  • Sudden sexual dysfunction
  • Weakness and/or loss of motion or sensation in your legs
  • Weight loss and new onset back pain
  • Work related back injuries

What can you do to prevent or reduce the pain at home?

  • Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

CaptainMorgan

  • Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
  • Wear low-heeled shoes whenever you can, ladies!
  • Learn how to stretch your back.

LBP exercises

  • Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
  • Sleep on your side. Try a pillow between your knees.
  • Walk. Did you know walking is the best (and easiest) exercise for your back?

I’ll be back later (no pun intended) with your questions and more.

Straight, No Chaser: Do You Drink Too Much?

Health Prevention, , , , , , , , , ,

drinks
It’s one of those Straight, No Chaser (literally) days.  I haven’t addressed substance abuse much yet (and you know I will), but the problems with most intoxicating substances revolve around the same consideration.  You had the most incredible time and got the most incredible high the first time, and you spend the rest of your life chasing the joy of that first buzz, which for most drugs you’ll never get.  The difference with alcohol abuse is that alcohol is legal and comparatively inexpensive, so you get to keep trying without much fuss (or at least initially).
Let’s set the stage by standardizing some terms:

  • Alcohol intoxication: You’re drunk and under the influence of alcohol.
  • Alcohol abuse: Your drinking habits are unhealthy, resulting in bad consequences (e.g. at work, in your relationships, with the law).
  • Alcohol dependency: You’re physically and/or mentally addicted to alcohol.  You crave liquor and seemingly can’t do without it.  Dependency involves withdrawal symptoms when alcohol is not in your system.  These symptoms may include anxiety, nausea, sweating, jitteriness, shakes and even withdrawal seizures.

Alcoholism is a chronic disease.  Unfortunately, some of us start with a predisposition based on genes and strong influences based on family and cultural considerations.  It is so much more than either a lack of willpower or an inability to quit.  This disease has a predictable course and defined effects on various parts of the body, leading to specific means of death if unaddressed.  Because I’m Straight, No Chaser, I’m not going to deal with the subjective thoughts you offer about whether or not you can ‘handle your liquor’ or whether you believe ‘you can stop anytime you want’.  I’m going to give you some medical data that defines when you’re doing damage to your body.  It’s actually pretty simple.
Are you this guy or gal (keep in mind a standard drink is defined as one 12 ounce can of beer, 1 glass of wine or 1 mixed drink)?

  • Women having more than 3 drinks at one time or more than 7 drinks a week.
  • Men having more than 4 drinks at one time or more than 14 drinks a week.

If so, you’re causing damage.  We’ll get into the specifics at another time.
That’s damage.  Let’s discuss dependency.  Consider the possibility that you may be dependent on alcohol if you have any of these problems over the course of a year:

  • While you’re drinking, you can’t quit or control how much you drink.
  • You have tried to quit drinking or to cut back the amount you drink but can’t.
  • You need to drink more to get a previous effect (This is called ‘tolerance’.).
  • You have withdrawal symptoms (discussed earlier) when you stop.
  • You spend a lot of your time either drinking, recovering from drinking, or giving up other activities so you can drink.
  • You continue to drink even though it harms your relationships and causes physical problems.

So What?
No one is giving up alcohol by reading this, I’m sure.  I haven’t even touched to the harsh realities of alcoholism (yet).  Alcohol is part of the American social fabric.  We live, celebrate and commemorate milestones with it.  It’s glamorized throughout society.  It’s constitutionally approved.  I appreciate that.  In moderation, it’s a good time.  Just understand that it’s not a free ride.  The danger is in the insidious nature of this disease, meaning issues may creep up on you before you ever know what’s about to hit you.  Then we’re having a completely different conversation.
I look forward to any questions or thoughts on the topic.
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