All posts by Jeffrey Sterling, MD

Straight, No Chaser: Can You Hear Me Now? Checking Hearing Loss

Head/Eyes/Ears/Nose/Throat, Health Prevention, , , , , , ,

noise_thermometer
We live in a loud world. Take a listen around. You’re likely in the midst of multiple simultaneous noises, many of which (if you actually think about it) sound harsh and annoying. However, we’re pretty good at consciously ignoring background noise, even though the sounds are affecting our hearing apparatus. After years of traffic, screaming, loud music and other assorted sounds, our hearing invariably starts to suffer.
I’ll discuss the causes, mechanisms and prevention of hearing loss another day, but for now, I want to point you toward getting your hearing checked before you find yourself needing a hearing aid. Being cognizant of where your hearing stands may prompt you to make some early alterations that can save your hearing over the longer term.
Signs and symptoms of hearing loss may include the following:

  • Previously normal sounds, including speech, become muffled.
  • The ability to distinguish sounds in the midst of background noise becomes harder.
  • You need others to speak more slowly, clearly and loudly
  • You need to turn up the volume of the television, radio and other devices to which you’re listening.
  • You avoid socializing and find yourself withdrawing from conversations.

Our hearing anatomy is actually quite fascinating and complex, and there’s a lot that could be going on. It’s time to get an evaluation if you’re suffering from the above, or your daily activities are being interfered with by hearing difficulties. While you’re at it, check out the noise thermometer, and see how easy it is for a few common sounds to cause some real damage.

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: Steps for End-of-Life Planning

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

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

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

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

Straight, No Chaser: End of Life Decision Making

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

AdvanceDirective
Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.” I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. Please understand that at any age your life could be at risk, you could die, and you could need someone comply with decisions; as such, you need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.
Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and, subsequently, with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

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

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.

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: Depression Quick Tips – How to Avoid It, When to Get Help

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

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

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

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

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

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

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

I wish you and your loved ones all the best in avoiding and/or dealing with this disastrous condition.  I welcome any comments, thoughts or questions.

Straight, No Chaser: Are You Depressed and/or Suicidal?

Mental Health, Health Prevention, , , , , , ,

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

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

Now consider these most common precipitants for suicide:

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

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

Straight, No Chaser: Suicide Data – Understand the Threat

Mental Health, Public Health, , , , , , , , , , , ,

suicidemap
There are amazing, shocking and saddening facts about suicide.  It is equally amazing that we aren’t discussing this as an epidemic.  Consider the following information provided by the Centers for Disease Control and Prevention:
There were an average of 105 suicides a day in the U.S. (over 38,000 for 2010).
An estimated 8.3 million adults reported having suicidal thoughts in the past year.
Suicide is the third leading cause of death among those aged 15-24, the second among those aged 25-34, the fourth among those aged 35-54, and the eighth among persons aged 55-64.
For those committing suicide:

  • 33.3% tested positive for alcohol.
  • 23% tested positive for antidepressants.
  • 20.8% tested positive for opiates (such as heroin and prescription pain killers).
  • There is one suicide for every 25 attempts.

Females are more likely than males to have had suicidal thoughts, but suicide among males is four times higher than among females (in other words, females think about it and try more often, but males complete the act more often.).
Among Native Americans aged 15-34, suicide is the second leading cause of death, fully 2.5 times higher than the national average.
There are some topics that aren’t amenable to Blogs.  Depression and suicide are among them.  They can’t be done justice.  What I can try to do is break components of the conversation into bite size pieces and give you information to work with.  I’ll do this in three parts.  Above, I’ve shown you the magnitude of suicide.  In the next post, I will help you understand what clinical depression looks like, then finally, I’ll review some Quick Tips to help you prevent falling into the deepest levels of depression and to help you know when immediate attention is required.  Just remember: this isn’t the type of depression that involves having a bad day.  I’m talking about when your downward mood interferes with your activities of daily living.  I’m describing depression that introduces suicide and homicide as an option.  If you don’t read these for yourself, read them for knowledge.  Someone you know may be affected.
I welcome any questions, comments or thoughts.

Straight, No Chaser: Your Questions on When Fainting is Fatal

Neurology, , , , , , ,

fainting
1. So are faints deadly?

  • Potentially. There are three separate sets of considerations. The brain can’t survive very long without adequate oxygen. Whatever caused that faint, if it continues to deny oxygen to the brain, can lead to seizures, strokes and death.
  • The process that caused the faint could be deadly in and of itself. Such things would include heart attacks, strokes, seizures due to bleeding inside the brain.
  • Significant injuries may occur after the faint. Someone who falls may subsequently suffer a head or neck injury, which could be deadly, independent of the cause of the faint. It’s worth mentioning that it’s an especially odd behavior that people seem to travel to the bathroom when they feel dizzy. All things considered, it’s better to faint in your soft bed or surrounding carpeted floor than on the hard tile of a typical bathroom with even harder sinks, toilets and tubs in close proximity.

2. My doctor always warns me about high blood sugars. You mentioned low blood sugars as a cause of faints. Am I putting myself in danger if I’m taking sugar and my sugar level is already high?

  • If you know all of that, yes. More often, you know none of that. Here’s the deal. Both a high and low glucose (blood sugar) count can cause altered mental status, fainting and coma. If your glucose level is especially high, say 900, and you drink some orange juice, it won’t make much of a difference. If your glucose level is 0, and you are given some orange juice, your life just got saved. In other words, it’s medically worth the risk if you don’t know what the glucose level is.

3. Can a loved one really take my breath away?
Yes. Overstimulation can lead to syncope in a variety of ways as mentioned previously.
4. What’s with the goats?
If you’re referring to Tennessee fainting goats, they exist. The goats don’t actually faint. When startled, they become stiff to the point of being unable to move their legs. Subsequently, the terrified goats can’t run and just topple over. Here you go.
faintinggoats

Straight, No Chaser: This is Specifically For the Faint of Heart

Cardiology/Heart, Medical Treatment, Neurology, Health Prevention, , , , , , , , , , , , ,

faint
Don’t faints seem mysterious?  It’s as if your computer crashed and had to reboot.  Although we never seemingly figure out why computers are so crazy, fainting (syncope) is reducible to a common denominator: something causes a decrease in blood flow to your brain.  Recall that oxygen and other needed nutrients are carried in blood, so even a temporary stoppage or shortage of blood flow shuts things down.  Now extrapolate that to strokes and comas, which are often due to serious and prolonged causes of blockage to the blood vessels supplying the brain.  This is a prime example of why good blood flow and good health are so important.  The brain is a highly efficient, oxygen and energy-guzzling organ.  Shut it down for even a few seconds, and bad things start to happen.  Consider fainting a warning sign.
I’m going to start by offering some Quick Tips to help if you find yourself around someone who has fainted.  Then, I will get into the weeds of why these things happen for those interested.  I’m doing this so you can check these and determine where your risks may be.

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

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

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

Straight, No Chaser: When that Eye Problem Could Be an Eye Emergency

Head/Eyes/Ears/Nose/Throat, Ophthalmology/Eyes, Health Prevention, , , , , , ,

emergency-eye-injury
Now you may look at the topic and think, “Well, isn’t that obvious?” I’m here to tell you that as many people who come to the emergency room for seemingly minor things, there’s even more that delay coming because of a thought that things will get better. When it comes to your eyes, you only have two, and can’t afford to lose even one. If you have any of these signs or symptoms, come in while you still can see (if indeed you still can).
Sudden vision loss: The problem with sudden vision loss is that it didn’t happen by accident, and it’s not likely to get better without prompt relief. This could represent a stroke involving the eyes’ blood vessels (amaurosis fugax), a blockage of those blood vessels (central retinal artery occlusion), a retinal detachment and a few other critical considerations. The point to be made is that in most of these examples, you should assume that only a limited amount of time exists to repair the damage before the eye injury causes permanent damage.
Eye pain: Yes, there’s a lot of benign things that cause eye pain, but there are some serious considerations, including the following:

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

Something is in your eye: Whether a chemical splash, a piece of metal, a branch or other foreign body, there are several concerns you should have. In the example of the chemical splash, something may be burning through the layer of your eye, putting it at risk for rupture. One word – IRRIGATE! If some object is in there that you can remove by blinking, odds are it’s not going away. Don’t cause more damage than is already there by digging around in your eye. Get evaluated.
Visualization of flashing lights and floaters: The most concerning cause of this phenomenon is a retinal detachment, which is a serious eye-threatening emergency. Visualize (no pun intended) wallpaper peeling off a wall. Unfortunately in this analogy, the retina is like the film in your camera, capturing the images of the world you see. If your retina’s gone from its natural position, you’re not seeing anything.
I welcome any questions, comments or thoughts. Otherwise, I’ll see you tomorrow.

Straight, No Chaser: The Week in Review and Your Quick Tips

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

week-in-review-545x210
Another week of knowledge and good health has come and gone at Straight, No Chaser.  Here’s your Week in Review.  Click on any of the underlined topics for links to the original posts.
On Sunday, we started the week reviewing rashes found on the palms and soles.  The entire post was meant to raise awareness that secondary syphilis presents like this, which is an important consideration given how easily primary syphilis can be missed, how devastating tertiary syphilis is and how simple treatment is once diagnosed.  Get it checked, and get it treated.  Sunday also brought a tear jerker of a topic in reviewing the physical signs of child abuse.  We often say knowledge is power, but in this example, knowledge could mean continued life for a victim.  Review those patterns of symptoms, and commit to being involved when needed.
On Monday, we reviewed lactose intolerance, which we tend to think is funny in theory but never is if you’re the one affected.  Remember it’s not the dairy that’s important to your health but the calcium it provides.  There are alternatives.  We also provided Quick Tips for the newborn in your family.  It’s never a bad thing to have a newborn evaluated, but don’t be distraught if the answer to your questions involve a lot of reassurance.  Remember, lots of answers to your questions involve things that happen underneath the diaper.
On Tuesday, we reviewed rabies.  We all knew there was a reason we didn’t like bats, skunks and raccoons, but if you live in the wrong area, your household cat or dog could be just as deadly if they aren’t completely immunized against rabies.  We also looked at injuries that occur from playing golf.  Who’d have thought five hours of swinging a club 100 MPH could cause back problems?  It’s such a peaceful game!
On Wednesday, we discussed ulcers.  Amazingly, peptic ulcer disease is most commonly traceable to a bacterial infection.  This is another condition where smoking and drinking (and overuse of pain medications) will come back to haunt you.  Wednesday also brought a review of allergic reactions and the potential life-threatening nature of them.  Because of this fact, it’s just not a good idea to wait around for things to get better on their own.
On Thursday, we discussed antioxidants and free radicals, which surprised a lot of you.  Although you seemingly can’t go wrong with antioxidants you eat, taking all those expensive supplements has been shown not to provide the same level of benefit and may in fact be harmful.  We also reviewed grief and bereavement.  I hope many of you learned that your suffering and responses are not only normal, but they’re universal.
On Friday, we provided an update on CPR and gave you another reason to remember the BeeGees.  Layperson and bystander CPR has been made so easy that you just have to take the two minutes to learn what to do.  We also reviewed cocaine myths and truths, which is important because cocaine often leads to the need for CPR.  I think I scared some people off with the image of big needles to treat their cocaine erections… Oh well!
On Saturday, we discussed drowning.  Keep your infants at arm’s length, and remember to bring a few life-savers (preservers, ropes, etc.) when you plan on being especially adventurous in the water.  We wrapped the week up discussing bedwetting, which often resolves on its own but sometimes is a symptom of another medical condition.
Thanks for your support and continued feedback.  If you have topics you’d like to see discussed, please feel free to send me an email or comment.
Jeffrey E. Sterling, MD

Straight, No Chaser: Quick Tips on Bedwetting

Genital/Urinary, Neurology, Pediatrics/Kids Health, Health Prevention, , , , , , , , ,

bedwetting
Bedwetting (enuresis) is unintentional urination while asleep.  It could be part of normal bladder development or a cause for concern.  Most kids are toilet trained by 4 years old, and less than 5% of kids are still wetting the bed between ages 8-11.  Here’s some quick tips to help you figure out the difference.

  1. If your child is bedwetting below age 7, and no external cause is in play, you will most likely be reassured if you see a healthcare professional.  Specific treatments for bedwetting aren’t started until at or after age 7.
  2. If bedwetting occurs in conjunction with foul-smelling urine, pain or other discomfort with urine, urinary frequency or enhanced urge to go during the day, your child could have a bladder (urinary tract) infection.  Symptoms may be resolved with antibiotics.
  3. If bedwetting occurs in conjunction with a change in urinary color, this could be a medical issue.  Changes could include urine becoming pink, cloudy, bloody or clear.
  4. Many children who wet the bed also have constipation.  Resolving constipation has been shown to resolve bedwetting in up to 60% of children.  Be on the lookout for this.
  5. Is the bedwetting occurring with snoring?  This could be a sign of sleep apnea.
  6. It is very important for parents to appreciate the behavioral components in play.  Stress can be a significant contributor to bedwetting.  If you reinforce positive behaviors, resolution of bedwetting may occur sooner than otherwise.  If you are relatively unsupportive and critical, symptoms may linger and become more profound.  Techniques such as gold stars and other rewards have proven to be effective.

Despite the topic, this post was intentionally dry.  Good luck.

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: Cocaine Myth Busters – Facts and Fiction

Medical Treatment, Toxicology/Drugs, Health Prevention, , , , , , , ,

cocaine whitney-houstonbias

Whitney was right. Crack is whack, and coke’s no joke.

There has to be a better way to chase The Glamorous Life.

Debunking myths about cocaine use

1.    “Cocaine isn’t addictive.”

  • This is just wrong.  Cocaine produces an incredibly powerful psychological dependency, and people will chase the experience of that first high to their deathbeds.  As tolerance to the previous doses develops, it takes increasingly high doses to get similar effects as before, and the risk of overdosing becomes incrementally higher.  Let me be clear.  No set number of cocaine doses accurately determines the development of either a physical or psychological addiction.  That first dose could be the one.

2.    “Cocaine is safe if I only use it once or only use it from time to time.”

  • What you’re discounting is that cocaine use is very much a game of Russian Roulette.  A single dose can cause death in many ways, including heart attacks, abnormal heart rhythms and rupture, strokes, sudden kidney failure, and rupture of your nasal passages.  A bad cocaine high could be the last thing you ever do.  Learn the story of Len Bias, pictured above, just to name one example.

3.    “As long as I’m not using crack cocaine, it’s clean and safe.”

  • If you are looking at the relative merits of smoking, inhaling or injecting drugs, you’ve already missed the point.  That said, people tend to confuse ‘clean drug’ with the ‘upscale’ nature of those who snort cocaine, as opposed to the more negative ‘dirty’ stereotypes of the individuals using crack cocaine.  It’s the same drug, folks.  In fact, snorting cocaine leaves you just as sweaty, irritable and prone to hallucinations as crack users.  The subsequent addiction and pursuit of an even higher high will lead to many a rich, ‘clean’ individual eventually resembling the most stereotypically downtrodden crack user.  There’s nothing ‘clean’ about someone walking around with ulcerated, bleeding or perforated nasal passages.

4.    “Cocaine doesn’t produce a hangover or residual effects.”

  • This is frankly ridiculous.  Cocaine acts by producing a massive release of internal substances that rev you up and produce a powerful euphoria.  When you’ve depleted your body of all these hormones, there’s nowhere else to go but down.  Where do you think the term crash came from?  Fatigue, depression and some degree of mental instability, including suicidal tendencies, are not only common but should be expected.  Other residual effects include insomnia, weight loss, paranoia, anxiety, and aggressive behavior.  The downward spiral of a cocaine user is all too predictable.  The lifestyle changes and risky behavior pattern of cocaine users, including enhanced exposure to HIV, hepatitis and other easily transmittable deadly disease must be included as residual effects of cocaine use.

5.    “Cocaine is a great sex drug.”

  • I hold disdain for educational efforts that aren’t truthful, and in this case, too often such efforts make suggestions that any cocaine user knows not to be true.  A large part of the mystique of cocaine is to be found in the fact that users find it an exotic enhancer of sexual activity.  Cocaine opens blood vessels, which in the case of the penis, facilitates the blood flow that produces and sustains an erection.  Recall, however, that I mentioned that cocaine use is playing Russian Roulette.  One big (no pun intended) problem with using cocaine to stimulate erections is you may not be able to finish what you start.  In other words, that “contact your doctor if you have an erection that lasts more than 4 hours” disclaimer should have originated with cocaine, except for the fact that its use is illegal.  And if you ever do get this side effect, when you arrive to see me or my colleagues, we’ll be there with very large needles needing to be inserted into your penis to manually extract the blood.  That’s not a good day for you.

The answer to the naiveté about cocaine is the same.  It is an extremely powerful and dangerous drug with physical and psychological effects that can linger long past the high. If anyone’s reading this that’s a cocaine user, and you’ve never had any of these problems, learn the medical meaning of physiological tolerance.  As you become acclimated to the effects of cocaine, and the propensity to use more drug to get the same effects rise, the more likely these phenomena will happen to you.  Also recall that a single dose, even in the absence of any past such reaction, can produce any of the adverse effects I’ve described.
If you know someone on cocaine, be as aggressive as you can to get them off of it before it’s too late.  Counseling works.

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: The Grief of it All

Mental Health, Public Health, , , , , , , , , , , ,

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

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

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

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

Grief is to be considered a necessary and healthy part of a recovery process that we should learn to embrace.

Straight, No Chaser: The Battle of Antioxidants and Free Radicals

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

Antioxidants
We engage in a lot of fads and off the wall activity to pursue health instead of following tried and true principles of basic science. One thing that I wish didn’t fit that trend is use of supplemental antioxidants. Before talking about using antioxidants, allow me to discuss why they’re necessary.
Free radicals are like the Tasmanian Devil. These molecules are byproducts of many activities that create cell damage. Think about cigarette smoke, trauma (even vigorous exercise), excessive heat and sunlight (and its radiation), to name a few examples. The process of creating and releasing these molecules is called oxidation. The key point is free radicals are unstable and too many of them lead to a process called oxidative stress. This process is implicated in the development of many illnesses, including Alzheimer’s disease, cancer, cataracts and other eye diseases, cardiovascular diseases, diabetes and Parkinson’s disease.
Antioxidants are substances that prevent or delay cell damage caused by free radicals. Antioxidants may be natural or artificial (e.g. man-made). The healthy diets we’re always asking you to eat (e.g. those high in fruits and vegetables) contain lots of antioxidants; in fact this has a lot to do with why we believe they’re good for us. Of course, now you can get many forms of antioxidants in pills. That’s where things get a little less certain.
Logically, you’d think that if some antioxidants are good, a lot would be better, and they would really be effective against free radicals. Furthermore, you’d think a convenient and efficient way of doing this would be putting a lot of antioxidants in a pill. Unfortunately, medical science (including over 100,000 people studied) has shown this not to be as simplistic as our logic would have us believe. I can’t say this any simpler. Antioxidant supplements have not been shown to be helpful in preventing disease. In fact, high-dose supplementation has been shown to have harmful effects, including increasing the risks of lung and prostate cancer. In short, our body doesn’t function in as linear a manner as we would like to think.
Here’s your take home message: We have yet proven that we’re able to cheat Mother Nature. You will not find your health in a bottle. Diet and exercise remain the champions of the battle of pursuing good health. Get your antioxidants the old fashioned way – in your fruits and veggies. Here’s a nice chart for your reference.
Top-Antioxidants

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.

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