Tag Archives: Behind the Curtain

Straight, No Chaser: The Benefits of Exercise and Other Physical Activity

January 2, 2016General Health and Wellness, Personal Training844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

At Straight, No Chaser, we understand it’s the most optimistic time of the year. You’ve made many New Year’s resolutions, usually related to smoking cessation, eating better, lowering your levels of stress and starting an exercise routine. We’re here to help. The next several posts will feature our best advice to educate and motivate you as you pursue those goals.
As we begin the conversation on exercise, we will split the conversation into the “why” and the “how.” This post will remind you of why keeping your body moving is so important and why, no matter your age, sex, ethnicity, physical condition or presence of existing disease, you can improve from your current state.
Remember that your heart is a muscle, the purpose of which is to pump blood with its nutrients and oxygen around the body, supplying your organs. The more efficiently that muscle performs, the healthier you’ll be, because your vital organs will stay nourished. It’s important to restate that everything is relative, so starting with most any regular activity that’s more than your current baseline will improve your conditioning and eventually your health.
How, you might ask! Here are medically established ways that a routine of regular exercise provides physical and mental health benefits.

Exercise controls your weight by burning calories.
Exercise reduces your risk of cardiovascular disease by improving your heart’s function. It lowers the risk of both heart attacks and strokes.
Exercise reduces your risk for type 2 diabetes and combinations of high cholesterol, high blood pressure and high glucose levels (together known as metabolic syndrome).
Exercise specifically reduces your risk of colon and breast cancers, and it probably reduces your risk of endometrial and lung cancers.
Exercise improves the functioning of your immune system.
Exercise strengthens your bones and muscles, and it keeps your joints functioning well.
Exercise maintains your mobility and agility, it improves your ability to perform the activities of daily living and prevent falls as you age.
Exercise slows the development of arthritis.

Exercise improves your mental health and mood by stimulating pleasurable parts of your brain and improving blood flow to your brain.
Exercise reduces the rate of depression.
Exercise reduces the development of insomnia and other sleep disorders.

The sum total of these facts is that exercise increases your chances of living longer.
At Straight, No Chaser we talk a lot about healthy and unhealthy decisions and the impact these decisions have on the length and quality of your life. There aren’t many lifestyle decisions you can make that will more positively impact those than the decision to stay physically active. Furthermore, that decision doesn’t need to be followed by the fear that in order to improve your health you have to turn your body into that of a stereotypical teenager, body builder or model. Moderate activity will produce measurable health improvements. In a subsequent post, we will explore the “how” of physical activity to improve your health, but for now, don’t just sit there. Do something!

If you can sprint, do so.

If you can’t sprint, jog.

If you can’t jog, walk.

Even it you can’t walk, move what you can!

Feel free to ask your SMA expert consultant if you have any questions on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Five Frequently Asked Questions About Hangovers…

January 1, 2016Neurology, Toxicology/Drugs844-SMA-TALK, Alcohol, Behind the Curtain, hangover, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Happy New Year! If you’re reading this, you’ve either made it through the night or are looking for help! So… Let’s get this part of the conversation out-of-the-way. There is neither any way to tell you how much you have to drink to get a hangover, nor is there a magical hangover cure that will work for everyone or for anyone every time. Now, let’s delve into some FAQs about hangovers.

1. So what actually is a hangover? Well, you know it when you feel it, right? A hangover is that group of symptoms and physical signs you develop after overindulging in alcohol. The symptoms as just the results of the physiologic effects of alcohol on your body. Here are some examples:

Alcohol makes you urinate more and it irritates the lining of your stomach. These can result in nausea, vomiting, abdominal pain, dehydration and the resultant dizziness.
Alcohol expands your blood vessels. When this occurs in your scalp, this causes headaches.
Alcohol drops your blood sugar. With enough (read: too much) alcohol and enough of a drop in your blood sugar, dangerous symptoms such as weakness, fatigue, jitteriness, seizures and mood swings are likely to occur.
Alcohol is a toxin that produces a response from your immune system. These response can produce inability to concentrate or sleep, decreased memory, appetite and interest in routine activities.

2. So what can I expect if I’m having a hangover? In more of a list, symptoms and signs include headaches, nausea, vomiting, stomach pain, fatigue, dizziness with or without room spinning, weakness, fast heartbeats, poor sleep and concentration and moodiness.

3. Are hangovers ever suggestive of something life threatening? When should I see a physician? Here’s a quick non-exclusive list (use your own judgment; if you feel bad enough, just go to an emergency room):

Symptoms lasting over 24 hours.
Prolonged confusion, blackouts or inability to arouse
Nonstop vomiting
Seizures
Difficulty breathing or alterative in breathing pattern
Dramatic change in skin color or temperature

4. Does anything make a hangover more or less likely? Yes. You’re more likely to have a hangover if you drink on an empty stomach, don’t get enough sleep after drinking, combine alcohol with other drugs (even including cigarettes) or have a family history of alcoholism. Also, as a rule, darker liquors (such as brandy, whiskey, cognacs, red wine and dark beers) are more likely to produce hangovers than clearer liquors such as gin or vodka (tequila is a notable exception – no, it’s not because of the worm).
5. How do I treat a hangover? You don’t, and don’t fall for “hangover cures.” The best you can do is to avoid a hangover (meaning you prevent it), or you can chase symptoms by taking medicines for the headache or vomiting, or drinking water or eating to reverse the dizziness. Alcohol is removed from the body at a specific rate per hour, so once it’s in you (absorbed into your bloodstream), only time will heal you. Your best bet is to limit your intake. When someone tells you not to eat on an empty stomach, it’s because the sooner you get full, the less alcohol you’ll drink. That bread you’re eating isn’t absorbing anything!

Your best bet is to know your limits, don’t exceed your limits, and if you are otherwise safe, sleep it off. Happy New Year!
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Driving Under the Influence and New Year's Eve

December 31, 2015Toxicology/Drugs, Trauma, Health Prevention844-SMA-TALK, Behind the Curtain, drinking and driving, impaired driving, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Celebrating New Year’s Eve? As I am known to say: risks represent incidences of occurrences. Today of all days during the year, you must act to lower your risk of a fatal motor vehicle crash due to alcohol or drugs. Remember: it’s not just your behavior that places you at risk, but the others with whom you’ll be sharing the road. Please recall that alcohol is a central nervous system depressant that slows down brain function, including reaction time, information-processing skills and hand-eye coordination. This affects judgment, concentration, comprehension, sight and coordination, all of which means you’re much more likely to crash a car if you’ve been using any type of drug.

You’d do well to know a few FACTS about driving under the influence of alcohol or other drugs (Courtesy of National Council on Alcoholism and Drug Dependence).

FACT: Approximately 30 people a day die from motor vehicle crashes in which a driver was under the influence of alcohol. This is about one death every 51 minutes.
FACT: An estimated 32% of fatal car crashes involve an intoxicated driver or pedestrian.
FACT: Car crashes are the leading cause of death for teens, and about a quarter of those crashes involve an underage drinking driver.
FACT: 3,952 fatally injured drivers tested positive for drug involvement.
FACT: Over 1.2 million drivers are arrested annually for driving under the influence of alcohol or narcotics.
FACT: On average, two in three people will be involved in a drunk driving crash in their lifetime.

Tonight is not the night for debate; all of the above facts will become magnified tonight. Driving under the influence is a crime, and you know the police will be monitoring the roads. Avoid driving if you can. If you are driving, don’t drink, use marijuana, alcohol or any other drugs. The life you save may be your own. I hope to see you safe and healthy in the New Year.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Treatment of Food Poisoning

December 30, 2015Diet and Nutrition, Gastrointestinal, Infectious Disease844-SMA-TALK, Behind the Curtain, ceralyte, Conditions and Diseases, food poisoning, Gastroenteritis, Oral rehydration therapy, oralyte, pedialyte, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The vomiting, diarrhea, fever, abdominal cramps and all around bad feelings you may get with food poisoning is extremely unpleasant. We’ve previously discussed preventative measures you can take to minimize your risks, but you should also want to know what measures to take in the event you actually develop food poisoning. Of course, with over 250 different illnesses related to various forms of food poisoning, there’s a wide variety of treatment, some of which means to treat the specific disease (and its cause) and others that only treat the symptoms.
I always tell patients that although the vomiting and diarrhea are dramatic nuisance symptoms, the real concern is the risk of dehydration from these fluid losses. Given the body is approximately two-thirds water, altering that balance can lead to disturbances of many of the body’s functions and increase the risk of more serious infections. Thus the key to treatment is staying ahead of fluid and electrolyte losses that occur. Perhaps you’re wondering “How can I do that if I’m vomiting?” Here are five very important principles for you to remember.

First things first: if you have severe diarrhea, your favorite sports drink is not the cure. The composition of fluids and electrolytes in your stool is different from in your sweat, so these drinks don’t optimally replace your losses.

I want you to become familiar with oral rehydration therapy/solution (ORT). It’s how most of the rest of the world first treats fluid losses from vomiting and diarrhea. You may have heard of Ceralyte, Oralyte or Pedialyte, all of which are examples. ORT represents the best possible fluid for you to take and is readily available without a prescription at your local pharmacy or grocery store.
Here’s the deal with staying hydrated: you can’t hold a lot on your stomach. You need to dial back as much as possible so that you can tolerate something. That’s why you sip on chicken soup instead of steak when you’re sick. You’re likely to have more success keeping down teaspoons of fluid at a more frequent interval (say, every few minutes) than trying to chug a lot of fluid all at once.
Preparations of bismuth subsalicylate (Pepto-Bismol is a common example) can reduce the duration and severity of simple diarrhea.
If you have diarrhea and cramps with a fever or bloody stools, you should not take antidiarrheal medication without an evaluation by a physician. Even if they make you feel better, these medicines can make your food poisoning much worse.

Here’s one other point that you should understand as you’re going into your doctor’s office or the emergency room: don’t expect to receive an antibiotic to treat your vomiting and diarrhea. Most of these episodes are caused by viruses, which are self-limited and will resolve within two to three days. Furthermore, viruses don’t respond to antibiotics. In fact, efforts to use antibiotics in many of these cases only contribute to antibiotic resistance later on when you actually need them. Antibiotic resistance is discussed in detail in this Straight, No Chaser post.

Finally, here are symptoms that should prompt you to see your physician.

Bloody stools
Diarrhea lasting more than 3 days
High fever (oral temperature over 101.4 F)
Signs of dehydration, such as a decrease in urination, a dry mouth and throat, and dizziness with standing
Vomiting with inability to keep down liquids

Straight, No Chaser: Understanding Food Poisoning (Foodborne Illness)

December 29, 2015Detoxification, Diet and Nutrition844-SMA-TALK, Behind the Curtain, Campylobacter, Centers for Disease Control and Prevention, Conditions and Diseases, E. coli, Food and Drug Administration, food poisoning, foodborne illness, Staph, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vibrio, YersiniaJeffrey Sterling, MD

We make a decision with everything we place into our mouths. We also exhibit a large amount of trust that the food we eat is safe. Most of the time that’s true, but unfortunately sometimes it’s not. Here are some questions and answers to understanding the scope of food poisoning.
How frequent is food poisoning?
According to 2011 data from the U.S. Centers for Disease Control and Prevention (CDC), every year in the U.S. approximately 1 in 6 Americans (almost 50 million people) gets sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases.

What causes food poisoning?
Over 250 different foodborne diseases have been described, most of which are infections. The most common foodborne illnesses are caused by norovirus and by the bacteria Salmonella, Clostridium perfringens, and Campylobacter. Staph Aureus (yes, that Staph) is another prominent but less common cause of food poisoning. Poisonous chemicals or other harmful substances can cause foodborne diseases if present in food.
What are the most common symptoms of food poisoning?
Even though there are many different foodborne diseases, they share a commonality of entering your system through your gastrointestinal tract. As a result, the first symptoms are caused and expressed from there and typically include nausea, vomiting, diarrhea and abdominal cramps.

Why do foodborne diseases seem to occur in outbreaks?
Actually, the overwhelming majority of cases of food poisoning don’t occur in outbreaks, but of course you wouldn’t know that because having diarrhea is not something people typically will tell you… When outbreaks occur, it’s because a group of people happened to eat the same contaminated item. This would explain how instances of groups of friends or strangers could have been involved. Contaminations that occur closest to the food supply’s distribution result in the widest outbreaks. Look at the above picture. If contaminated food from the producer makes it all the way through the distribution chain, individuals in multiple states could end up with the same infection.

What foods are most associated with foodborne illness?

Foods that mingle the products of many individual animals: Raw milk, pooled raw eggs and ground beef have increased risk because contamination in any one of the multiple animals involved can contaminate the entire mixture.
Raw foods of animal origin: Foods such as meat, poultry, shellfish, eggs and unpasteurized milk are the most likely foods to be contaminated.
Raw fruits and vegetables: Washing reduces but doesn’t eliminate pre-existing contamination, such as that occurring from the fresh manure that fertilizes vegetables. Furthermore, water itself may be contaminated.
Shellfish: Because “filter-feeding” shellfish strain microorganisms from the sea over many months, they are particularly likely to be contaminated if there are any in the seawater.

An additional Straight, No Chaser will discuss treatment options. Refer to this post for preventative tips.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Food Contamination and Protecting Yourself From Foodborne Illness

December 28, 2015Diet and Nutrition, Infectious Disease844-SMA-TALK, Behind the Curtain, contamination, E. coli, food poisoning, Norovirus, pasteurization, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vibrioJeffrey Sterling, MD

Those of you who are regular readers of Straight, No Chaser may have heard me say that everything you place in your mouth either harms or helps you. Your mouth is the direct point of entry to your body. You should be concerned about the substances you ingest. Today’s post begins a Straight, No Chaser series that will discuss food safety, food poisoning, prevention and treatment of foodborne illnesses. Today we start with food safety.
Allow me to suggest that bacteria are as much (if not more) of a part of this world as humans, and it is to be expected that they would be present in our food supply. Our issues are when does present become contaminated, and when does contaminated become illness? Understanding these issues makes it easier to take appropriate preventative and treatment measures when needed.

Here are some examples of how our food becomes contaminated.

Microorganisms (e.g. bacterial, viruses) exist in the intestines of healthy animals, even those raised for human consumption. Even a small amount of spillage of intestinal contents during slaughter can lead to contamination.
Fruits and vegetables can be contaminated when washed or irrigated with contaminated water (which sometimes contains animal manure or human sewage).
Salmonella can infect a hen’s ovary (remember the ovaries produce eggs) so that the contents of a normal-appearing egg can be contaminated even before the shell is formed.
Vibrio bacteria are normally present in seawater. Oysters and other shellfish can develop concentrations of Vibrio high enough to cause infections.
Microorganisms such as norovirus can concentrate in human sewage that is dumped into the sea. This contaminates the water supply.
Infected food handlers and food conditions pass microorganisms on to customers. Examples of this include Shigella bacteria, hepatitis A virus and norovirus. Knives, other utensils and table surfaces also are methods of transferring disease when unclean.
When certain foods are left out (i.e. not refrigerated), minimal contamination can become highly infectious in a matter of hours due to rapid growth of microorganisms. Conversely, in most instances refrigeration or freezing prevents virtually all bacteria from growing. Certain other foods (e.g. salted meats, jams, pickled vegetables) require high salt, sugar or acid levels to prevent bacterial growth.
When certain foods are adequately cooked (the ideal internal temperature is 160 degrees Fahrenheit), most microorganisms will be killed.

Protecting yourself from foodborne illness
Professionals in public health, industry, governmental regulatory agencies, and academic research have roles to play in making the food supply less contaminated. So do you. I would like to advocate for one simple step for you to take as you shop for food that will promote food safety.

Buying pasteurized milk rather than raw unpasteurized milk prevents an enormous number of foodborne diseases every day and has done so for 100 years. Juice pasteurization has more recently proven to be important in preventing certain E. coli infections. Basically, you can lower your risk by purchasing pasteurized products.

Courtesy of the Centers for Disease Control and Prevention, here are some additional simple precautions to reduce the risk of foodborne diseases:
COOK: Cook your meat, poultry and eggs thoroughly.

Using a food thermometer to measure the internal temperature of meat is a good way to be sure that it is cooked sufficiently to kill bacteria. Remember, the internal temperature of meat should be above 160 degrees Fahrenheit.
Eggs should be cooked until the yolk is firm.

SEPARATE: Don’t cross-contaminate one food with another.

Avoid cross-contaminating foods by washing hands, utensils and cutting boards after they have been in contact with raw meat or poultry and before they touch another food.
Put cooked meat on a clean platter, rather back on one that held the pre-cooked, raw meat.

CHILL: Refrigerate leftovers promptly.

Bacteria can grow quickly at room temperature, so refrigerate leftover foods if they are not going to be eaten within 4 hours.
Large volumes of food will cool more quickly if they are divided into several shallow containers for refrigeration.

CLEAN: Wash produce.

Rinse fresh fruits and vegetables in running tap water to remove visible dirt and grime.
Remove and discard the outermost leaves of a head of lettuce or cabbage.
Because bacteria can grow well on the cut surface of fruit or vegetable, be careful not to contaminate these foods while slicing them up on the cutting board, and avoid leaving cut produce at room temperature for many hours.
Wash your hands with soap and water before preparing food and before touching others.
Avoid preparing food for others if you yourself have a diarrheal illness.
Changing a baby’s diaper while preparing food is a bad idea that can easily spread illness.

REPORT: Report suspected foodborne illnesses to your local health department.

Calls from concerned citizens are often how outbreaks are first detected. Play your part.
If a public health official contacts you to find out more about an illness you had, your cooperation is important. In public health investigations, it can be as important to talk to healthy people as to ill people.

Straight, No Chaser: The Intersection of Health and Happiness, aka Merry Christmas!

December 25, 2015General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Merry Christmas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Straight, No Chaser isn’t a medical encyclopedia. It’s a tool to empower you to make choices that best suit your lifestyle – the intersection between health and happiness. Even though today is Christmas, remember we offer you the gift of knowledge every day.
After more than 20 years as a physician, I still am fascinated at the health trade-offs people make for their pleasure – or “quality of life.” We have previously discussed your habits and how some of them negatively impact your health. Click here for that discussion. The literature on negative energy and health is well documented and robust. In short, avoid negativity and those that bring it to you! That said, we’re following our own advice and going positive today. To that end, here’s the other half of the “health and happiness” equation:

STATE OF MIND = STATE OF BODY.

Research from the Harvard School of Public Health (Go, Crimson!) led by Laura Kubzansky, Associate Profession of Society, Human Development and Health, identified personal attributes that actually do translate into better health. Specifically these personality traits have been shown to help avoid or healthfully manage depression, diabetes, heart attacks, strokes and other diseases.
Her landmark 2007 study followed over 6,000 men and women for over 20 years, discovering that a sense of enthusiasm, hopefulness, engagement in life and the ability to face life’s stresses with emotional balance appears to reduce the risk of coronary heart disease. Her studies have also demonstrated that children with a positive outlook and ability to focus on a task at age seven are in better health with fewer illnesses 30 years later. An additional finding of hers is that optimism cuts the risk of coronary heart disease in half.
This isn’t that hard. It just requires a rewiring of some of our outlook on life. Make a change today. Become a more positive person, and you’ll become a healthier person! Incorporate these mental lifestyle changes and reap the benefits.

Emotional vitality: a sense of enthusiasm, hopefulness, engagement
Optimism: the perspective that good things will happen and that one’s actions account for the good things that occur in life
Supportive networks of family and friends
Good “self-regulation,” i.e., bouncing back from stressful challenges and knowing that things will eventually look up again
Healthy behaviors such as physical activity and eating well
Avoidance of risky behaviors such as unsafe sex, drinking alcohol to excess, and regular overeating

Speaking of Christmas, the Straight, No Chaser team greatly appreciates your readership, support and feedback. Over 36,000 of you both follow us and like us on Facebook and WordPress. We’ve had readers in approximately 200 countries around the world with approximately 300,000 page clicks. Most of all you’ve helped us successfully launch www.SterlingMedicalAdvice.com (SMA), 844-SMA-TALK (www.docadviceline.com) and Dr. Sterling’s acclaimed first book, Behind the Curtain. We’ll continue to give you information to make a difference in your lives. Please continue to share your stories. It is very fulfilling and fascinating to hear how these efforts have made a difference in your lives. Feel free to continue to send us topic requests. We generally find a way to work them into the schedule.

Thank you so much, Merry Christmas, Happy Hanukkah, Happy Kwanzaa, peace and blessings throughout the holiday season.

Straight, No Chaser In The News: Corporate Medical Schools?

December 24, 2015General Health and Wellness, Public Health844-SMA-TALK, Behind the Curtain, Kaiser Permanente, Manipal Education Americas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Sometimes news is simple and straightforward, and other times, it’s an amazing sign of the times. In the news is an announcement by different for-profit entities looking to open and operate medical schools in the United States. One is Kaiser Permanente, a healthcare corporation that operates hospitals and an HMO in eight states and the District of Columbia, serving over 10 million members. This megacorporation will be opening the Kaiser Permanente School of Medicine, perhaps as early as 2019. Another is a for-profit firm called Manipal Education Americas, that runs schools in India, Malaysia, Nepal and Antigua. The proposed Montana College of Osteopathic Medicine would enroll its first students in 2017 or 2018.
Pause.

It is true that more than one thing can be true at a time. On the one hand…

There is a profound shortage of physicians in the U.S., and any new medical school offering provides additional access to communities in need. By 2025, the shortage of physicians nationwide is estimated to hit at least 80,000, and possibly 120,000, mostly in the area of primary care. In the example of Manipal seeking to place a medical school in Montana, the state ranks third-lowest in the U.S. with respect to the number of physicians per capita, and its physician population is among the nation’s oldest. Montana does not currently have a medical school.
There is a sea change occurring in healthcare, and innovative approaches to providing care are needed, particularly incorporating the increasing reliance on emerging technologies. It is conceivable that corporations would want to have a role in this change, particularly in collaboration with the medical education industry.

However….

There is an inherent conflict in a corporation establishing a medical school on its own, particularly as a for-profit entity (it is fair to note that as proposed, the Manipal school will be a for-profit entity, and the Kaiser school will run through a foundation; its “benefits” would be received by the nature of the physicians produced and altering the nature of healthcare education). Can you imagine physicians being trained in a manner less consistent with traditions and standards in medicine and more in line with corporate guidelines? It was only recently that “corporate practice of medicine” statutes began to be ignored, and now we’re supposed to be ok with a corporation not only “owning” physicians and their practices, but also educating and training them along corporate values?

Perhaps it is an accurate reflection of the times, or maybe the good produced will outweigh the concerns generated by this paradigm shift. In any event and in case you weren’t aware, this is another opportunity to point out that the overwhelming majority of physicians are now employees and don’t have the control over your healthcare that once existed. Frankly, regardless of what you may be told, if your physician (read corporate employee) is following corporate guidelines instead of practicing evidence and outcomes-based medicine, there will be conflicts, and just as is the case with any employee, a real danger exists that compromises will necessarily be made – often for the benefit of the employer (i.e. making profits) instead of the consumer (protecting health). After all, if you control someone’s medical education, you will largely control their medical practice.
All of this requires you to be a more conspicuous consumer of your medical information, advice and care. Let the patient beware; forewarned is forearmed.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Prevention and Treatment of Lead Poisoning

December 23, 2015Detoxification, Environmental, Toxicology/Drugs844-SMA-TALK, Behind the Curtain, Conditions and Diseases, lead poisoning, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

What you need to know about protecting yourself from lead poisoning and its effects is reducible to awareness, baseline testing, prevention and treatment.
We covered what you needed for awareness in the previous Straight, No Chaser.
However your goal really should be prevention via avoidance, as much as is possible. However, to prevent, you must have a level of awareness. Think about these things:

Do you have a child in your house between ages 6 months and 3 years old? If so, be reminded that children wander around putting things in their mouths.
Do you live in an old house or have old plumbing?
Do you live near a busy road or near bridges?

If you are in a high-risk situation, your ideal level of awareness should include preventive considerations such as getting your home tested and your blood lead level checked. If anyone in the home has been found to have high lead levels, the entire household should be checked.
Whatever your level of exposure, you want to engage in preventive strategies to prevent further exposure that could lead to disease. Here are a few quick tips to do so:

Avoid dust in your home, because you just never know!
Wash everyone’s hands prior to eating.
Throw away old painted toys, unless you’re sure lead based paint was not used.
Use filters for your water, switch to bottled water for drinking and cooking, and/or let any tap water run for approximately one minute prior to drinking or cooking with it.
Avoid storing wines in lead crystal decanters for long periods of time.

Treatment:
If you have been found to have any significant levels of lead in your blood, you have a role in your treatment. If your levels and symptoms are significant enough to be hospitalized, that will occur and you’ll receive medicine that facilitates the removal of lead from the body, called chelating agents. However, in the absence of that, your job likely will be to maintain a healthy diet that includes calcium, iron and Vitamin C, all of which help decrease lead absorption within the body.

Prognosis:
As mentioned, you want to avoid lead poisoning. Each year in the United States, 310,000 kids aged 1-5 years old are found to have unsafe levels of lead in their blood. In these children, even mild lead poisoning can have a permanent impact on attention and IQ. Remember, the developing brain is more susceptible to the toxic effects of lead. Those with higher lead levels have a greater risk of long-lasting health problems and must be closely followed because of the potential damage to the brain, nervous system, muscles and other systems. Adults who have had mildly high lead levels often recover without problems, but in general, a complete recovery from chronic lead poisoning may take months to years.
If you suspect you may have lead paint in your house, get advice on safe removal from the U.S. Department of Housing and Urban Development (HUD) at 800-RID-LEAD, or the National Information Center at 800-LEAD-FYI. Another excellent source of information is the National Lead Information Center at (800) 424-5323.
If you suspect you or someone in your family is suffering from the effects of lead, call 911 immediately and/or call 1-800-222-1222 to speak with a local poison control center for further instructions while you await the paramedics to arrive.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser In the News: Lead Poisoning

December 22, 2015General Health and Wellness, Mental Health, Neurology, Pediatrics/Kids Health, Public Health, Skin/Dermatology, Toxicology/Drugs, Health Prevention, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Flint, lead poisoning, Michigan, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

In the news is the story of dozens of cases of lead poisoning in Flint, Michigan, resulting from elevated levels of lead in the city’s drinking water supply. This followed inadequate preventive treatment of the water supply, a necessary step in the provision of public health. It appears that the water had become contaminated from aging pipes in the Flint river, which became relevant after the city switched its water supply from Detroit sources in 2014. The number of poisonings has been so high the city has declared a state of emergency. In case you’re wondering, yes this could happen to you, but if you read on, we’ll tell you how to minimize your exposure.
What is lead poisoning? Why is it dangerous?
Lead is a chemical element (“mineral”) that is quite poisonous in humans. Swallowing or breathing lead dust can cause major health problems, both immediately (with a very high exposure), or more commonly, over time with ongoing exposures to low levels. The particular concern is in exposure to children. As is the case with head injuries or most any other type of insult to a developing child’s brain and nervous system, a significant risk to one’s mental development occurs. The younger the child, the more dangerous the exposure is; the highest risks are in the unborn.

How does one get poisoned? What are the risk factors?
Lead used to be very common in gasoline and house paint in the U.S., but lead based paint was banned in 1978. It is estimated that approximately 4 million Americans are still significantly exposed to potentially toxic levels of lead, because lead basically is everywhere, including old house paint, new toys, dust, dirt and gasoline. Children living in cities with older houses are more likely to have high levels of lead.
Here’s a quick list of lead exposures (there are many other potential exposures):

Homes, toys and furniture painted in the US before 1978 and any toys made outside the US (no, the paint doesn’t have to be peeling);
Plumbing, pipes, faucets and the water flowing through them;
Soil contaminated by car exhaust (think near expressways or busy streets) or house paint scrapings (think old abandoned buildings); and
Storage batteries

Take these exposures seriously, because lead exposure comes from swallowing, touching and/or breathing objects containing lead particles. Once in the body and bloodstream, it spread, causing damage throughout. Two notable areas of concern are the effects of lead on blood cells (causing anemia) and on bones (preventing healthy, strong teeth and bone function due to reducing the absorption of calcium.

How does lead poisoning get identified? What are the signs and symptoms?
Lead poisoning can affect many different parts of the body, and symptoms can range from nothing obvious to dramatic mental impairment. Symptoms are more prominent as blood lead levels get higher.
Lead is much more harmful to children than adults because it can affect children’s developing nerves and brains. The younger the child, the more harmful lead can be. Unborn children are the most vulnerable.
It’s important to reiterate that many with lead poisoning won’t have signs of illness early on. If you believe your environment poses a risk, you should ask to be checked. Symptoms are often nonspecific, but if you can remember groupings of symptoms, you’d be on the right track. Consider the following:

Behavioral problems may exist such as irritability, difficulty concentrating, sluggishness or fatigue.
Digestive tract problems may exist, such as loss of appetite, a metallic taste in one’s mouth, weight loss, nausea, vomiting, constipation and/or abdominal pain.
Neurologic problems may exist, such as headaches, muscle and joint weakness or pain, seizures.
Pale skin from anemia is also often a prominent finding.

Over the longer term, health problems include the following:

damage to the nervous system (such as poor muscle coordination, speech and language problems), kidneys, and/or hearing
decreased bone and muscle growth
developmental delay

The next Straight, No Chaser will address prevention and treatment strategies.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at www.jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: The Holiday Heart Syndrome

December 21, 2015Cardiology/Heart, General Health and Wellness844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There’s something about the holiday season and flickering. We’re all aware that Christmas lights are meant to do so, but did you know that your heart is more inclined to flicker and flutter this time of year (sorry, but I’m not talking about mistletoe)? In a previous Straight, No Chaser, we discussed a mental consideration concerning the holiday season: the increased rate and risks of depression, known as The Holiday Blues. Unfortunately, health issues associated with the holidays don’t stop there. There are defined physical risks associated with the holidays as well. The disturbing aspect of today’s topic is you’re not immune to this even if you’re otherwise healthy.

Holiday heart syndrome is a real condition and has been described as such since the 1970s. It’s the result of eating and drinking alcohol too much (with or without excessive caffeine intake and a lack of sleep), which is exactly what we’re inclined to do this time of year. The combination of these indulgences places an undue level of strain on the heart, which causes the heart to develop an abnormal rhythm, most commonly atrial fibrillation. Interestingly, certain foods, alcohol and caffeine all have direct effects on the heart, and indirectly they can also affect the heart through increase of certain hormones (such as epinephrine) that stimulate the heart.
Curiously, holiday heart syndrome is notable for its occurrence in those without existent heart disease but can be especially concerning in uncovering existing disease or exacerbating disease in those having it. For example, someone with underlying cardiovascular disease featuring microclots can have such clots dislodge during an episode of atrial fibrillation, causing a stroke.
Fortunately, by far the common course of holiday heart syndrome is benign. The abnormal heart rates will slowly resolve as the levels and effects of alcohol and/or other substances decline. That said, the risk is such that you don’t just want to sleep off an occurrence.
The symptoms you’d have are pretty obvious, given that you’d have been eating and drinking to excess. You’d also note that your heart was racing and perhaps pounding, as if it was attempting to jump out of your chest. Heart rates in the 120s are pretty typical for holiday heart syndrome (a normal heart rate is between 70-100 beats per minute). This tidbit is important to know; if your heart rate is higher than this, something more serious could be occurring. Under either circumstance, you need to be evaluated and treated in the emergency room setting with hydration and observation of the heart rhythm and rate.

The lessons here are pretty straightforward:

Holiday heart syndrome suggests that indulgences that occur during the holidays can cause symptoms. By no means does it suggest that these symptoms are restricted to the holidays. Overindulgence in food and drink can cause abnormal heart rhythms at any time, including weekends, spring break, birthday or other celebrations, as well as holidays.
You’d be particularly interested in knowing that the combination of vodka and the energy drink Red Bull have been shown to make these symptoms more likely to occur.

Following alcohol-related abnormal heart rhythms, it is advisable for patients to avoid significant exertion because the excessive stimulation that raises epinephrine levels can precipitate recurrent and possibly more serious episodes. Most patients without underlying heart disease should be able to gradually resume full physical activity over the next few days. Once everything is back to normal, most patients do not require further therapy if they refrain from alcohol use. Patients with underlying heart disease, heart disease that’s discovered during evaluation, or those with severe symptoms on presentation (e.g., blackouts or simultaneous low blood pressure) may be candidates to receive certain heart medications.

At the end of the day, Holiday Heart Syndrome is yet another example of the virtue of enjoying life in moderation. Failure to do so can turn the holidays into the most dangerous time of the year. Cheers!
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at www.jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Preventing and Treating Urinary Tract Infections (UTIs)

December 18, 2015Genital/Urinary, Infectious Disease844-SMA-TALK, Behind the Curtain, Conditions and Diseases, cystitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Urinary tract infection, UTIJeffrey Sterling, MD

At some point, you’ve got to be on board with the notion that you need to prevent some of the things that ail you. All men who have UTIs are at higher risk for having another one. About one of every five women who have a UTI will have another one. Many women have three or more UTIs a year. This Straight, No Chaser will address preventative and treatment considerations for urinary tract infections. Check back to this Straight, No Chaser for a discussion of the how and why you get UTIs.
Some individuals have unfortunate anatomy, and others have increased risk factors due to diseases (e.g. diabetes) or a lowered immune system. Even in these individuals, improving daily habits and lifestyle choices may help you prevent repeat UTIs. There actually is a fair amount of controversy regarding methods of preventing and treating UTIs. The information I am providing represents the latest consensus information from the U.S. Department of Health and Human Services.

Fluids
Drinking lots of fluid (preferably water) can help flush bacteria from your system. Unless you have kidney or heart failure, you should try to drink six to eight, 8-ounce glasses a day.
Regarding cranberries and cranberry juice, the jury is still out. This is what we do know: there is a substance in cranberries that assist in preventing bacteria from sticking to the walls of your urinary tract. The ability to attach to the walls of your urinary tract keeps bacteria from being flushed out and allows them to grow and multiply. It seems that the amount of this substance in the typical glass of cranberry juice you’re drinking or serving of cranberries you’re eating is sufficient to completely prevent or treat UTIs. It is more likely that the benefit you’re receiving simply comes from drinking fluids. The bottom line? Drinking cranberry juice isn’t hurting you and may be helpful.
Bathroom Habits
It’s just a good idea to urinate often. Whenever you feel the urge, and it’s convenient, eliminate the waste. Also, make a habit of urinating after sex, as soon as it’s convenient. These steps prevent bacteria from staying in your bladder longer than necessary, preventing the growth that can become a UTI.
It’s true: always wipe from front-to-back after using the toilet. A back-to-front wipe can deliver bacteria straying from the rectum (and inclined to cause a UTI) close enough to your urethral opening to get things started.

Birth Control
Using a diaphragm or spermicide increases bacteria growth and can lead to UTIs. If you’re not having an issue with this, that’s fine, but if you are, you may want to consider a different form of birth control. Furthermore, unlubricated or spermicidal condoms increase irritation of the vaginal walls, which may help bacteria grow and may lead to transport up the urinary tract. This is yet another reason why lubricated condoms without spermicide or a nonspermicidal lubricant are better options for safe sex.

Clothing
Does wearing cotton underwear and loose-fitting clothes prevent UTIs? Probably not. Does doing so keep the area around the urethra dry? Yes. Nylon underwear and tight-fitting jeans can trap moisture and help bacteria grow. Use this information to your advantage. This is another example of how altering your habits may help and won’t hurt the cause.

Instrumentation
Whether you’re a patient using a catheter to assist yourself with emptying your bladder, or if you’re placing objects into your genital orifices for other purposes (e.g. sexual stimulation), you should appreciate the risks found in not exercising good hygiene with these objects. The immediate proximity of these objects to your urinary tract certainly increases the risks of UTIs.
Treatment
Treatment is usually straightforward and based on the eliminating the organisms most likely to be causing the infection. Treatment regimens range from 3 days to more than a week depending on certain considerations such as severity, resistance patterns in your area, whether you get frequent UTIs and whether you have certain risks or anatomical abnormalities in your urinary tract. Men should receive a longer course of treatment as a rule due to the involvement of the prostate.
Other treatment considerations involve pain control and plenty of fluids.
If your frequency or severity of UTIs requires as much, you may be referred to a urologist for specialized treatment considerations. However, for most people, this isn’t necessary because treatment is sufficient – and prevention is even easier.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at www.jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Urinary Tract Infections (UTIs)

December 17, 2015Genital/Urinary, Infectious Disease844-SMA-TALK, Behind the Curtain, Conditions and Diseases, cystogram, cystography, E. coli, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, ultrasound, urinary tract infections, UTIsJeffrey Sterling, MD

Ladies, have you ever been told that you get “bladder infections” because you didn’t wipe front to back instead of back to front? Men, have you ever been told that this could be a sign that your prostate needs to be examined? This Straight, No Chaser answers simple questions on urinary tract infections (UTIs). With over 8 millions cases and 100,000 hospitalizations a year due to these, it’s information you should know.

What is a urinary tract infection (UTI)? Is it the same as a bladder infection?
What these questions really ask is “What is the urinary tract?” The body’s drainage system serves to remove excess fluid and bodily waste. It includes the following organs:

The kidneys serve to filter blood and produce approximately 1-2 quarts of urine per day as a result of this process.
The ureters are tubes extending from the kidneys to the bladder, carrying filtered urine within them.
The bladder is the pouch within which you store urine until you’re ready to release it.
The urethra is a tube at the bottom of the bladder through which urine gets expelled.

A UTI is an infection anywhere along this path. Infections at different parts of the urinary tract can display different symptoms and have different complications.
What causes a UTI?
Bacteria are the most common cause of UTIs, particularly those that live in the bowel (such as E. coli) and are within or in close proximity to the vagina. Under most circumstances the body is very effective at removing bacteria and other microorganisms from the urinary tract (urinating just washes them out!), but some of us are at increased risk due to diminished defenses or other circumstances in which these microorganisms can grow.

Why do women get UTIs, and it seems like men don’t?
It is true that women get UTIs about four times more frequently than men, but anyone of any age or sex can be infected. Here are some reasons why.

Women have a shorter urethra, which makes it easier for bacteria to reach the bladder.
Also, the opening of a woman’s urethra is near the vagina and anus, where bacteria live.
Women who use a diaphragm are also more likely to get UTIs than women who use other forms of birth control.
The male prostate produces secretions that slow bacterial growth.

Are there other risk factors for UTIs?
Yes. Others at higher risk for UTIs include the following.

those having diabetes or have lowered immune systems
those habitually needing a tube to drain their bladder
those with urinary tract abnormalities that block the flow of urine
those with spinal cord injuries or other nerve damage

Additionally, once a man has a UTI, it’s more likely he’ll have the problem again because the bacteria are extremely difficult to reach once they set up shop in the male prostate.
Are UTIs serious?
Unless you describe the annoying symptoms as serious, most UTIs are not serious. However, UTIs can lead to severe complications if left untreated, including the following:

Long lasting or recurrent kidney infections can cause permanent damage and scarring to the kidneys, which can create insufficient kidney function and produce high blood pressure and other problems.
Kidney infections can enter the blood stream and become life threatening.

What are the signs and symptoms of a UTI?
You should see your physician if you develop any of the following signs or symptoms:

A burning sensation with urination
Bloody, cloudy, dark or otherwise discolored urine
Fever or chills
Foul-smelling urine
Frequent or urgent need to urinate, regardless of the amount actually expressed
Pain in your back or side below the ribs

How are UTIs diagnosed?
UTIs are diagnosed based both on symptoms and a lab test. Many of you have experienced your urine being sent to a lab from the emergency room or your doctor’s office. Based on a combination of symptoms, the presence of bacteria and white blood cells that have accumulated to fight the infection, the diagnosis will be made. If you have frequent infections, infections that don’t respond well to treatment, atypical presentations or are sick enough to be hospitalized, your urine may be cultured in an effort to grow the bacteria causing your symptoms. This allows more precise treatment regimens to be given. In other circumstances, tests may be done to check the normalcy of your urinary tract, including an ultrasound or CT scan. Further details on when and why this would be done is available on www.sterlingmedicaladvice.com.
An additional Straight, No Chaser will discuss prevention and treatment options for UTIs.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at www.jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Text Neck and Other Smart Phone/Computer Related Difficulties

December 16, 2015General Health and Wellness, Health Prevention, Musculoskeletal System844-SMA-TALK, Behind the Curtain, carpal tunnel syndrome, Disorders, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Text NeckJeffrey Sterling, MD

It shouldn’t be too much of a chore to be mindful of your future as you unwrap your new technologic gadget this holiday season. You really should think more about your quality of life during your golden years. Arthritis (aka degenerative joint disease) is inevitable if you live longer enough, but that doesn’t mean you need to accelerate the process. Live your life with longevity in mind. There is no reason you can’t maintain a high level of function for years to come. In general the way you’re built represents a position of comfort. Your body best accommodates movements that maintains these positions. With that in mind, this Straight, No Chaser will discuss some simple ergonomic considerations to keep you just a bit safer over the long-term.
Computer use

This is simple. Take ten minutes to set up your workstation so it isn’t damaging your spine.

Place your computer monitor so it is directly in front of you as you type.
Place your monitor at eye level to prevent having to hunch over.
Place your keyboard at elbow level; this aligns your arms and shoulder.
Placing padding in front of your keyboard aligns your wrist and helps prevent carpal tunnel syndrome.
Find an adjustable chair as a means of providing low back support.
Find a footrest to further stabilize your lower back.

An additional consideration for computer use is remembering to take breaks. Your eyes are able to accommodate computer use, but the constant glare causes eyestrain and dryness, which can be irritating and reduce productivity.

Take a break after 45 minutes of computer use. During your break, make a point of staring at something far off in the distance to relax your eye muscles.
If your eyes get easily irritated, consider using clear tears to keep them lubricated.
If you’re a heavy computer user and wear glasses, you can compound your problem if you aren’t getting frequent checks to make sure your prescription is accurate.

Smartphone/Cell phone use
There’s been a lot of chatter lately about “text neck,” which basically points to the dangers of leaning your neck forward over a prolonged period of time. The way your head, neck and shoulders are constructed means you create less stress and strain when your head is centered and your eyes are pointed forward. Consider the following:

When your spine is in a neutral position, the head weighs about 10-12 pounds.
When you lean your head just 15 degrees forward, the neck feels the strain of 27 pounds.
When you lean your head 45 degrees forward, the neck feels the strain of 49 pounds.
When you lean your head 60 degrees forward, the neck feels the strain of 60 pounds.

This level of stress on your neck for hours at a time every day plant the seeds for chronic neck pain, muscle spasms, numbness and tingling in your hands and even misalignment and/or herniated discs.
It’s not just your neck that’s at risk. Have you ever wondered why you have two thumbs and eight fingers? Your thumbs are stabilizers, and really aren’t built for the type of massive work that your smart phones impose on them. Over time such use can cause tendonitis.
The good news is smartphones are accommodating these considerations, but you need to be smart and take advantage of them.

Use earphones and avoid holding the phone up by lodging it between your ear and shoulder.
Use the option that allows you to send texts by speaking instead of typing.
Try to text using your fingers instead of your thumbs.
Use the predictive text functions, which suggest words for you as you type on your phone.
Don’t forget that you could just pick up the phone, and make a call…

So here is a pretty simple consideration for you that works whether you’re on the computer or using a smart phone. Whenever you can, increase the space between your chin and your chest. This action alone optimizes the position of your neck and shoulders, and it avoids any pinching of the nerves in your neck. Additionally, if you find yourself uncomfortable, take a break and stretch. Get a message. Don’t forget to stay hydrated because your bones bathe in fluid.
Remember, technology is meant to work for you, not against you. Use these tips, and enjoy the advantages your technology is offering. Type you later.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Influenza Prevention

December 15, 2015Infectious Disease844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

It’s time to get your flu shots! Of course, many people choose not to get the influenza vaccine (the “flu shot”) for various reasons, some more reasonable than others (including an allergy to eggs). This Straight, No Chaser reviews some of the better options left for you should you choose not to get vaccinated.

The best way to avoid the flu is prevention. Consider adopting these healthy habits before you ever get exposed:

Wash your hands frequently with warm soapy water. You know when they’re dirty. Most certainly wash your hands before you use them to eat or put anything else in your mouth.
If you can’t wash your hands, use an alcohol-based hand sanitizer.
If your hands are dirty and neither soap nor sanitizer is available, still rinse and dry your hands with warm water if you can.
Use disinfectant to clean surfaces.
Avoid unnecessarily touching your eyes, nose, or mouth.
Politely limit close contact with people who are ill, coughing and sneezing.
When coughing or sneezing use the bend of your elbow or a facial tissue to help cover your nose and mouth. Learn to avoid coughing or sneezing into your hands.
When you become sick, stay home. It’s the proper thing to do to avoid spreading your infection to others.

Vitamin C, echinacea and zinc have long been touted to prevent colds and influenza. There are no studies confirming or refuting this claim. Despite assurances that these and other herbal medicines are safe alternatives because they’re “natural”, the active ingredients in them are the same as found in certain prescription medicines. Thus they too may interact with other medications and worsen certain medical conditions. Given this, you should discuss your use of supplements with your physician or pharmacist prior to use.

Another level of defense for you involves use of certain antiviral prescription medications. If you are exposed to someone (e.g. a family member) with influenza, and especially if you begin having flu-like symptoms, immediately contact your physician to discuss taking medicines to prevent catching the flu. Such medications include Tamiflu® (generic name: oseltamivir), Relenza® (generic name: zanamivir), Flumadine® (generic name: rimantadine) and Symmetrel® (generic name: amantadine). If you make the request more than 24-48 hours after the onset of symptoms, you likely won’t be given the medication, since it isn’t likely to be effective outside of this timeframe.

Straight, No Chaser: Flu Myths and Questions

December 14, 2015General Health and WellnessBehind the Curtain, CDC, Center For Disease Control and Prevention, Centers for Disease Control and Prevention, Disease, health, Influenza, Influenza vaccine, Influenza-like illness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Vaccination, Vaccine, WordPressJeffrey Sterling, MD

Every year 36,000 people die and over 200,000 are hospitalized each year due to the flu—in the U.S. alone. If you’re not getting a vaccine every year, you are subjecting yourself to a significantly higher risk and allowing fears and myths to get the better of you. Knowledge is power. Learn the facts.
Does the flu shot give you the flu?
No, no, no. The influenza vaccine cannot cause flu illness. There are vaccines that involve the delivery of live virus, including mumps, measles, rubella, chicken pox and polio. Influenza is not in that category. Flu shots are made either with ‘inactivated’ vaccine viruses that are not infectious or they contain no flu vaccine viruses at all (and instead have recombinant particles that serve to stimulate your immune system).
The most common side effects from the influenza shot are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. These symptoms are among the same symptoms you see with influenza, so it’s easy to confuse them as flu symptoms. They are not.
Controlled medical studies have been performed on humans in which some people received flu shots and others received shots containing salt water. There were no differences in symptoms other than increased redness and soreness at the injection site for those receiving influenza vaccine. The flu shot does not give you the flu.

I swear I’ve gotten the flu right after getting the flu shot! How is that possible if I can’t get the flu from the flu shot?
I always remind people that the flu vaccine does an even better job of preventing you from dying from the flu than it does in preventing you from catching the flu (and it does that at a 70–90% rate). It primes your immune system to better fight off the influenza virus when you’re exposed to it.
There are several reasons why someone still might get a flu-like illness after being vaccinated against the flu:

Influenza is just one group of respiratory viruses. There are many other viruses that cause similar symptoms including the common cold, which is also most commonly seen during “flu season.” The flu vaccine only protects against influenza, so any other infection timed correctly can give you similar symptoms.
When you get immunized against influenza, it takes the body up to two weeks to obtain the desired level of protection. There is nothing preventing you from having been infected before or during the period immediately before immunity sets in. Such an occurrence will result in your obtaining the flu despite being vaccinated.
An additional reason why some people may experience flu-like symptoms despite getting vaccinated is that they may have been exposed to a strain of influenza that is different from the viruses against which the vaccine is designed to protect. The ability of a flu vaccine to protect a person depends largely on the match between the viruses selected to make the vaccine and those causing illness among the population that same year.
It is also the case that the flu vaccine doesn’t always provide adequate protection against the flu. This is more likely to occur among people who have weakened immune systems or people age 65 and older. Even if the vaccine is 90% effect, some individuals will contact the flu despite having been vaccinated.

Please don’t get the wrong message from this section. These explanations are the exceptions, not the rule. In the overwhelming number of cases, the influenza vaccine does an excellent job of protecting against and prevent disease from the influenza virus.
Is it better to get the flu than the flu vaccine?
No. Influenza causes tens of thousands of deaths every year. If you have asthma, diabetes, heart disease or are especially young or old, you are placing yourself at significant risk by not getting vaccinated. Even if you aren’t in one of the above categories and are otherwise healthy, a flu infection can cause serious complications, including hospitalization or death.

Why do I need a flu vaccine every year?
The Center for Disease Control and Prevention (CDC) recommends a yearly flu vaccine for just about everyone six months and older. Once vaccinated, your immune protection decreases over time. These boosters are scheduled and dosed to help you maintain the best level of protection against influenza. Additionally, the virus mutates (changes) every year, so what you were covered for this year may not apply next year.
You can make a decision not to get vaccinated, but frankly, that’s accepts a risk that you flies in the face of a reasonable risk/benefit analysis, and you would be doing so in the face of the solid consensus of medical evidence and research. You should seriously question the motives or knowledge of someone who suggests that you should not get vaccinate for influenza, particularly if they profess to be involved in healthcare. Get vaccinated.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Lactose Intolerance – It’s Explosive!

December 11, 2015General Health and WellnessBehind the Curtain, Calcium, Dairy, Dairy product, Hispanic, Lactose, Lactose intolerance, Milk, Native Americans, Pinto beans, Small intestine, Soy milk, Turnip greensJeffrey Sterling, MD

So I’m at dinner with a group of friends, and somehow the topic gets to lactose intolerance. For 15 minutes. They were really into it. At dinner! You know what it is. Everyone seemingly knows someone who has it, even if (hopefully) you aren’t reminded of it too often. Lactose intolerance is a state where you simply have difficulty digesting lactose (one of the sugars we consume, most notably in milk and other dairy products) because of a deficiency in the enzyme that breaks it down, called lactase. Lactose intolerance occurs more often in Black, Asian, Hispanic and Native Americans, but that doesn’t mean your body read that book.
So by now you may be thinking “What is there to discuss besides the odoriferous emanations produced?” (In case you didn’t get the reference that’s from an old Right Guard commercial featuring Charles Barkley.) Well, the biggest concern from a health standpoint is to ensure you’re still getting enough calcium to keep your bones strong and enough Vitamin D. Here are 3 sets of practical facts to help you get through it all.

1. If you’re lactose intolerant, that doesn’t mean you’re allergic to dairy products.

This is an important distinction. There’s nothing immediately life-threatening about the ingestion of dairy products if you’re lactose intolerant, as there might be if you were allergic. Just be aware of the cramping, bloating, flatulence, nausea, vomiting, diarrhea and gas that may ensue.

2. If you’re lactose intolerant, that doesn’t mean you can’t necessarily have any dairy or won’t ever be able to have dairy.

Lactose intolerance occurs in many shades of grey. Some people get worse with age; others get better as they learn to work around it. Some develop lactose intolerance at birth, others later in life, and others develop it after injury or surgery to the small intestine (which is where lactase is normally produced). Some can ingest small amounts of certain products without symptoms. In the privacy of your own surroundings, you should discover for yourself if you’re affected every time you have daily or whether or not only large amounts of certain products cause symptoms (e.g. Try not to eat the entire gallon of ice cream.). You should also gauge your response to daily after taking various lactase-containing supplements.

3. If you’re lactose intolerant, you still can get adequate calcium. Here’s a few suggestions.

Soy and rice products have exploded (in a different way) on the market. Consider soy milk, soybeans and tofu.
Many juice, bread and cereal makers have taken to providing calcium.
Some fruits and veggies are great sources. Consider broccoli, collard and turnip greens, kale, okra, pinto beans, rhubarb, and spinach. Oranges are a good source of calcium.
Other great foods include almonds, salmon, sardines and tuna.

If you have any questions or comments (I’m sure you’re busting at the gut to discuss this topic), let ’em rip…
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight No Chaser: Gluten, Wheat and Celiac Disease

December 10, 2015Diet and Nutrition, Gastrointestinal, General Health and Wellness844-SMA-TALK, Behind the Curtain, celiac disease, Diet, exercise, gluten, healthy eating plate, nutrition, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

One of the reasons I enjoy writing this blog is it brings me closer to understanding you. As you respond to posts or query me, I get to better appreciate the breadth of your concerns. I realize that much of what physicians do in clinical practice is talk AT you. Sometimes physicians assume that you know better because we do. Your issues often involves uncertainty about the nature of your symptoms, and, in real-time, you tend not to appreciate that symptoms are incredibly non-specific, meaning the same set of symptoms show up in multiple diseases and conditions (as you’ll noted from the picture below featuring possible symptoms of celiac disease). Many times, you’ll be researching a topic on the Internet, see symptoms you have and say, “That sounds like me! That must be what I have.” The relationship of symptoms to disease really isn’t anywhere near that linear.
Weight loss is an example of something patients think about differently than physicians. When a patient wants to lose weight, s/he may think of everything under the sun from the latest diet craze, surgery or other potential “quick-fixes.” On the other hand, a physician will parrot something about calorie control, healthy eating and exercise, assuming you know better than to entertain miscellaneous information aimed to strike fear into your hearts or give you false expectations. (If you need a refresher on that consideration, check here.) In many of these instances, physicians may never even address your questions, because we’re so busy promoting the standard of care.
This month, we’ve been discussing nutrition with probably a dozen different blogs posted on various topics. Do you think the most common questions I’ve received have involved application of the healthy eating plate or simple tips to healthier eating? Nope. They’ve been more along the lines of esoteric concerns – or at least concerns that only affect rare segments of the population – so much so that physicians typically wouldn’t even think to discuss them with patients.
Two such discussions involve the consumption of gluten and wheat. Let’s answer those questions and clear up any confusion you may have. Thank you for your willingness to engage in straight talk. Indeed, your concerns are real, and our mission at Straight, No Chaser and www.sterlingmedicaladvice.com is to get you the information and advice you need.
What is gluten?
Gluten an important protein found in all forms of wheat, barley and rye. It is also found in other foods such as deli meats, soy sauce, vitamins, some chocolate, some toothpaste and imitation crab. For the purpose of this blog, let’s relegate your wheat concerns to gluten.

Why do I care about gluten?
You probably don’t and probably shouldn’t, unless you have a specific disease called celiac disease, which is related to the adverse effects of an extreme sensitivity to gluten. Some humans (only some and not many at all) have difficulty digesting gluten. In fact, the ingestion of gluten in those with celiac disease can cause damage to the intestinal lining, causing chronic (ongoing, continuous) diarrhea and abdominal pain. This can result in potentially life-threatening concerns, but it only occurs in less than 1% of the population.
The other reason you may have heard about gluten is the existence of a diet craze based on avoiding gluten (having to do partially with limiting carbohydrates).
Why is this an issue?
As societies have moved to diets with higher consumption of refined wheat flour, the sensitivity to gluten has expressed itself more often. As is often the case, when you over consume or are overexposed to substances, danger ensues. That is not the same as saying you need to avoid any and everything on earth that could potentially cause you harm.

Do I need to give up wheat and gluten completely?
Absolutely not, unless you have celiac disease or demonstrated allergies to these substances. This is simply another example of your needing to understand the issue. As with most overstated concerns, solutions are to be found in the same principles of healthy eating described throughout Straight, No Chaser. (Feel free to research our many topics by typing your topic of interest into the search engine over on the right side of the page.)
In this instance and others, what happens all too often is folks create new problems running from other, perceived ones. Substituting high-calorie, high-fat products for wheat and other products containing gluten is not a healthy decision and has been shown to increase weight gain and the risk of diabetes. The principles of any successful efforts to diet remain the same. Your best bet is to learn principles of healthy eating and incorporate calorie control and exercise into your regimen. Embrace moderation across the board, and enjoy learning to make healthy eating an adventure by adding variety to your meals.
One final caveat: There’s nothing wrong with, and potentially much to gain from, asking your physician about your individual risks for celiac disease. Just understand that unless you have the symptoms (e.g., diarrhea, abdominal pain, bloating, fatigue, headaches and joint pains to name a few), you likely will cause your physician to scratch her or his head.

Straight, No Chaser: Genetically Engineered Foods (GMOs) – Frankenfoods or Public Health Innovation?

December 9, 2015Diet and Nutrition, Public Health844-SMA-TALK, Behind the Curtain, bioengineered foods, Food and Dr, genetically modified organism, GMO, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Have you ever bred an animal, say a dog? Have you ever taken a vitamin or supplement? Of course you have, so let’s start the conversation there. Imagine you live in a world with shortages of food or fresh water, a diminished food supply, an inability to maintain the freshness of food, or have local conditions that require an abundant need for use of pesticides? What if your food supply could become a vehicle for delivery of vaccines or other medications? These are the arguments used to support the use of genetically engineered foods (aka bioengineered foods, aka GMOs), because all of these conditions exist in large parts of the world.

Even if you didn’t previously understand the logic for the use of genetically engineered foods, you’ve been using them for a long period of time if you live in the U.S. Upwards of 70% of processed foods on US grocery store shelves contain a genetically modified ingredient. If you’re eating corn (or anything with high-fructose corn syrup, such as cereals, sodas or snacks), potatoes, soybeans, squash or tomatoes, you’re likely eating food that has been genetically altered.

Let’s review frequently asked questions.

What are GMOs?
The actual question should be “What are genetically engineered foods?” These foods have genes from other organisms (plants, animals or microorganisms) inserted into their genetic codes, introducing new traits to the affected foods once grown. GMO is short for genetically modified organisms.
Why would anyone want to do this?
There are many great reasons to want to do this. In fact, we have a long history of breeding. Dogs came from wolves. Long-stemmed roses are a result of breeding. Unfortunately, natural processes of doing this can take thousands of years. Science has evolved to the point that genetically desirable traits can be extracted from one source and placed into another.

So what would the benefits of doing this be?
Since you’re selecting (i.e. genetically engineering) what you want your food to be, you can create many different benefits. Here’s a list of some of those.

Ability to use food as medicine or vaccines
Faster growing (plants and animals)
Increased food supply
Increased shelf life
Less need for water, fertilizer and pesticides
More desirable traits (e.g. less fat absorbent even when fried)
More drought tolerant
More nutritious
More resistant to pests and diseases
More tasty

What are the potential risks?
Let’s start by pointing out that the risks are theoretical. Perhaps “concerns” would be a better descriptor. The nature of concerns generally revolves around the notion that scientists may prove unable to control the science, and some genetic changes can end up different than planned and harmful. In some conceived scenarios, modified organisms could produce extinction of naturally occurring organisms, with resultant adverse effects on the environment (that requires a certain existing balance). Other risks could include cross-communication of allergies and antibiotic resistance (e.g. you could exhibit a peanut allergy while eating a tomato).
Is this why many speak out against it?
It’s hard to say. There are several reasons cited against GMOs, some of which are political, others of that are scientific and still others that could be ethical or religious.

You may be aware that the 28 countries of the European Union (EU) have banned GMOs. Why, you might ask? The official line is organically produced food is healthier and closer to nature, so it has to be better!
You should also be aware that the US dominates the world bioengineered food market. As such, if GMOs become the natural order of things, there is a certain reality other countries would have to accept when it comes to trade.
A different theoretical concern is a public health concern that we can’t afford the risk of creating any potential adverse effects to the environment, our food supply or to our health.
Still other fears center around the thought that farmers could be rendered irrelevant with these mass produced foods.

Are they safe?
I’m mentioned “theoretical” on a few occasions. To be fair, there currently have been no adverse effects (to a medical or scientific certainty) demonstrated from using genetically engineered foods. To this point, GMOs have avoided significant regulation from the Food and Drug Administration (FDA), largely because the ice cream looks and tastes the same, and despite the craze toward organic foods, doesn’t appear to cause any harm. That said, no one is suggesting that either sufficient research has been done or that the long-term effects have been determined.

Another question is why consumers aren’t simply informed as to whether the products they purchase are GMO products. Labeling would address that issue, but to this point the FDA hasn’t felt the need to do so and views a requirement to do so as punitive without cause. This lack of transparency is causing quite of a bit of concern, but I’d remind you that you don’t know (and usually don’t want to know) how most of your food supply is created (something about not wanting to know how the sausage is made comes to mind).
The bottom line is, at this point genetically engineered foods are regarded as safe. There are no reports of illness or injury due to consumption of these foods. You can rest assured that more research on the matter will be forthcoming. You’ve already been using them and would find it extremely difficult to avoid them in the US, even if you tried. The decision to avoid them at this point is either based on fear, politics or dissatisfaction with the level of scientific evidence supporting what is being seen in real time. The issue of labeling genetically modified foods as such is still an ongoing battle.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Prevention and Treatment of Food Allergies

December 8, 2015Diet and Nutrition, Environmental, Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, Behind the Curtain, food allergies, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Whether or not you personally have a food allergy, it is likely you will find yourself in a situation with someone who does. Food allergies affect approximately 15 million Americans. Given that this could be a life-threatening event, it’s important for you to know some basics about addressing allergic reactions to food as they occur.
Tips to Prevent
Let’s start with some tips for you to better prevent allergic reactions, because once you become aware that you have a food allergy, avoidance means everything. Remember from this post that allergic reactions can occur without you eating the food; simple exposures such as touching or breathing the food can prompt a reaction.

Develop a habit of carefully checking the ingredient labels of food products. You don’t get to live life casually. You must be diligent and make sure you’re not exposing yourself.
Learn other names for the food or foods that you and your doctor think it best to avoid. Especially when you’re eating out, you should present these names on a list to your kitchen staff to ensure your safety. Have the waiters check with the cook or chef. Depending on the severity of your condition, you may wish to do this before entering restaurants, as vapors may be enough to trigger reactions in some.
Have your physician provide you a list of symptoms and instructions in case of an allergic reaction. Keep it within easy reach, and share it when out and about eating. Yes, you need to be this diligent.

Tips to deal with emergencies

The first consideration is you need a plan. Your life probably isn’t as simple as the movies, where you get to stab yourself with some epinephrine and go about your business five minutes later. Rummaging through a pharmacy looking for Benadryl while your throat is closing isn’t your best course of action.
Wearing a medical alert bracelet can be life saving in the event you pass out. It can be the only tip available to a medical professional trying to save you.

If you’ve been instructed by your physician on how to self-administer epinephrine (adrenaline), go for it under the correct circumstances.
In the absence of that, or while you’re following your physician’s instructions, calling 9-1-1 (i.e., emergency services, an ambulance) is your best bet. They will have the medicine needed to rescue you and the equipment needed to help you if things go wrong. Because you might not have much time, getting help can be more important that attempting to treat yourself.
You should be aware that once in the emergency room, treatment focuses on blunting the immune response with steroids and various medicines called antihistamines (histamines are substances that are released by the body in response to perceived threats; inappropriate histamine release causes many of the symptoms of an allergic reaction).

Advances in Food Allergy Treatment

There is no cure for food allergy. Researchers in food allergy treatments are focusing on new methods of treatment, some of which your primary care physician or allergist may consider.

Oral and sublingual immunotherapy: This involves providing small amounts of the allergic substance either by mouth or under the tongue, and treating reactions as they occur. The idea here is to allow you to better tolerate increasing exposures to the allergen.
Chinese herbal medicine: An herbal remedy known as FAHF-2 is being studied to assess effectiveness against those serious, life threatening allergic reactions (anaphylaxis).
Anti-IgE therapy: IgE is the molecule our bodies use to fight off allergic threats. Anti-IgE molecules bind to IgE in an effort to curb that response and provide possible short-term relief treatment from food allergies.

While these treatments are still in ongoing studies to determine safety and long-term effectiveness, these potential advances represent the best source of optimism in food allergy research in recent memory. If you have any additional questions, certainly contact your Sterling Medical Advice expert consultant or your physician.

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