Tag Archives: Behind the Curtain

Straight, No Chaser: This is How You Self-Assess For Breast Cancer

October 9, 2015Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast self-examination, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

When I started this series, my first thought was “Why reinvent the wheel? There is a massive amount of information available on the web about breast cancer, and surely it’s done much better than I could ever do it.” As true as that probably remains, it is also true that much of it is technical and filled with medical jargon. That’s why Straight, No Chaser exists; it’s an effort to break through those types of barriers to understanding. This series on breast cancer is really meant to be straightforward, more easily digestible facts to better empower you. With that in mind, today I’m going to address specific simple steps you should be taking to assess yourself for breast cancer.
First things first. There are a lot of breast cancer self-assessment tools on the internet that ask you questions and then give you a percentage probability that you’ll develop breast cancer. Maybe it’s just me, but that sounds like something that only would serve to increase stress. By my way of thinking, anything other than 0% or 100% is going to increase stress and uncertainty. What I’d like for you to do is to use the presence of the points and risk factors below to serve as talking points with your physician. In other words, seek to self assess with actions to reduce your risk instead of taking a test that spits out a percentage equating to the probability you’d develop the disease.

1. Reduce your risk factors

Discuss with your physician balancing the need for birth control with the use of oral contraceptives.
After you are pregnant, breast feed.
Exercise, and if you’re obese, lose weight.
Limit alcohol intake.
If you’re post-menopausal, discuss with your physician balancing the need for hormone use with your breast cancer risks.

2. Get screened

Learn your body better than anyone else; learn to do breast exams at and after age 20.
Have a clinical breast exam at least every three years starting at age 20, and every year starting at age 40.
Have a mammogram every year starting at age 40 unless your physician places you on a different schedule.

3. Know the signs of concern and prompts to see your health care provider

Lump, hard knot or change in consistency inside the breast or underarm area
Persistent pain, swelling, warmth, redness or discoloration of the breast
Change in the size or shape of the breast
Dimpling, puckering or pulling in of the skin, nipple or other parts of the breast
Itchy, scaly sore or rash on the nipple
Nipple discharge that starts suddenly

In the next Straight, No Chaser, we will go over the breast self-exam in detail.
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: Even More Myths Regarding Breast Cancer

October 7, 2015Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Continuing from the earlier post with additional myths, well because you have so many questions! In fact, I’m doubling up on what you received earlier in Part I of Breast Cancer Myths.
6. “Breast cancer is preventable.”

Unfortunately, this is not true. All of our efforts are geared toward lowering risks, early detection and effective treatment.

7. The risk of breast cancer isn’t affected by obesity.

Not true. The risk is particularly increased in post-menopausal women with weight gain.

8. African-American women have an increased risk due to hair straighteners and relaxers.

This myth was taken head on and debunked by the National Cancer Institute in a large 2007 study including women with significant use over a 20-year period.

9. Caffeine causes breast cancer.

Not according to the evidence. There’s even evidence suggesting a benefit, but the data on this is just as inconclusive as that suggesting a link to breast cancer.

10. Mammograms increase breast cancer risk due to the radiation load.

The risks of radiation are so relatively insignificant that they’re mentioned as an afterthought compared to the benefits received from early and frequent evaluation.

11. “Tight clothes and underwire bras will make me get breast cancer.”

Not true. Neither has any connection to breast cancer.

12. “I was told small breasts give me less of a chance of having cancer!”

Not true. Larger breasts are sometimes more difficult to evaluate, but that’s not the same as saying the risk of cancer is increased in women with larger breasts.

13. “These lumps I have are ok because I’m breastfeeding.”

The fact you can discover normal changes in your breast tissue doesn’t mean that all lumps discovered while breastfeeding are normal. Get evaluated.

14. “Deodorant and tanning cause breast cancer, don’t they?”

No. Cell phones don’t either. Tanning does increase the risk of skin cancer, but that’s a topic for another day.

15. “I heard having a baby when I’m older increases my risk of breast cancer.”

Well, not just any baby, but having one’s first baby later in life is a significant consideration. Women who give birth for the first time after age 35 are 40 percent more likely to get breast cancer than women who have their first child before age 20.

16. “Breast cancer is a death sentence.”

Most women survive breast cancer. Give yourself the best opportunity to do so by reducing your risks, learning the principles of early detection and getting prompt treatment if ever diagnosed. We’ll focus on these considerations in the next posts.

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 Myths Surrounding Breast Cancer

October 6, 2015Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, medical myths, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Before I get into the details of what you need to know about breast cancer, it’s important to clear the table of some of the persistent myths and fears that exist. The disease is tough enough as it is without the fear factor impeding our ability to fight back. Please be patient with me here. If you find these myths ridiculous, then good for you, as it indicates that you’re informed on the matter. Just understand that these are real questions that other physicians and I hear often. Remember, knowledge is power.

1. “If a family member of mine has breast cancer, that means I’ll get it too.”

It is only true to say that women who have a family history of breast cancer have a higher risk of developing it. Overall, only approximately 10% of women diagnosed with breast cancer have a family cancer, and most women with breast cancer have no family history. In other words, a family member with breast cancer isn’t a life sentence for you, and it shouldn’t stop your efforts to lower your other risks and focus on early detection and treatment.

2. “All lumps in my breast are breast cancer.”

There are two important points for you to remember. First, any persistent change in the breast or armpit (axilla) should not be ignored. Remember, I will be stressing the importance of early evaluation for the purposes of detection. That said, only a small percentage of breast changes represent cancer (about 80% of lumps are benign). The really good news is if you learn and perform consistent breast exams, you will detect these changes earlier than anyone else and very often early enough to make a difference.

3. “Men don’t get breast cancer.”

Unfortunately, I know this not to be the case within my family. Annually, there are over 400 breast cancer deaths among men from over 2000 new cases being diagnosed. Men should pay attention just as women do because unfortunately, in part due to the delayed detection, the death rate of breast cancer in men is higher than in women.

4. “I heard breast implants cause cancer.”

No. There’s no increased risk with breast implants and breast cancer. However, you can legitimately say implants sometimes obscure the view of possible cancer on a mammogram.

5. “The risk of breast cancer is always 1 in 8.”

Actually it’s 1 in 8 during a woman’s lifetime. The important distinction is the risk increases as one ages, from 1 in 233 in a woman’s 30s up to 1 in 8 across the board by age 85.

Straight, No Chaser: Domestic Violence – How to Get Out of an Abusive Situation

October 6, 2015Mental Health, Trauma844-SMA-TALK, Behind the Curtain, domestic violence, national domestic violence hotline, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Remember: You are not to blame, and you need not face domestic violence alone.

With the recent attention in the news on domestic violence and debates about responses and responsibility, I thought this post would refocus attention on where it needs to be: getting the abused individual safely out of harm’s way.
This is the third in a three-part series on domestic violence. The first post focused on the scope of domestic violence. The second post focused on risk factors and identifying whether your situation places you at risk.
When it comes to domestic violence, it is the immediate danger that can make it difficult for you to figure out the safest next move. Thus, it becomes important to know in advance the how and where of your escape plan.
Escaping the Crisis
If you are in a crisis situation, first make sure you and any other family members (e.g., children, parents) are safe. Leave the scene immediately, and find safe haven wherever it exists, such as an emergency shelter or the home of a friend or family member. You can find a shelter by calling (800) 799-SAFE. Call the police if you think you can’t leave home safely or if you want to bring charges against your abuser. If possible, take house keys, money and important papers with you. The staff members at emergency shelters can help you file for a court order of protection.
Be advised: Do not use drugs or alcohol at this time, because you need to be alert in a crisis. Even while you do what you feel you must do, be aware that use of weapons (even in a life-saving defense) will likely complicate and confuse matters.
If you can, just in case, plan your escape. Establish escape routes and a safe haven. Secure important documents.
Where Do I Go If I’m Mentally or Physically Hurt?
Talk to a physician or get to an emergency department. We are prepared to check you for any life-threatening consequences to your abuse, treat any medical issue, provide mental health support and make referrals. Should you find an emergency shelter, counseling and support groups are available for you and your children.

Dealing With Your Abuser
Your primary focus should be on finding help for yourself and escaping the danger.

First things first: Call the police if you believe that you are in danger.
Call the National Domestic Violence Hotline 1-800-799-SAFE (7233), your state domestic violence coalition and/or a local domestic violence agency. Seek out and speak with a family law advocate at your local crisis center. He or she can help you press charges against the perpetrator, file a temporary restraining order and advise you on how to seek a permanent restraining order.
Don’t keep your circumstances hidden. Discuss them with a physician, nurse, therapist, friend, family member or spiritual advisor when you first believe yourself to be in a dangerous environment. Be careful to avoid advice that attempts to place you back in harm’s way or to do anything that is not best for you or your family. Don’t let someone talk you into doing something that isn’t right for you.
Document any attempts at contact by the perpetrator. Save any new messages (especially threatening ones).
Keep photographs that show any injuries you received. You will need this should you pursue legal action (e.g., press charges or file a restraining order).
While it’s best to avoid the abuser completely, if you must meet to exchange documents or personal effects, do it in broad daylight where plenty of people are around, particularly those you know. It is preferable to have someone else make those exchanges, if possible.

After You’ve Escaped
You need to remain detached from your former situation as much as possible and implement changes in your life. Consider these following tips:

Establish a new routine. Someone looking for you will look for you in places you’ve frequented in the past.
Maintain an escape plan in your new location. It may seem counterintuitive, but avoid a route that takes you through areas with potential weapons – your attacker may end up with them instead of you.
Change your mobile or home phone number immediately after you’ve escaped the situation.

Being subjected to repeated domestic violence can extract a devastating psychological toll. Although many domestic violence survivors do not need mental health treatment, and many symptoms resolve once they and their children are safe and have support, for others, treatment is a major component of their plan for safety and recovery.
Again, the National Domestic Violence Hotline 1-800-799-SAFE (7233). You should definitely memorize it, but I hope you never have to use it. Unfortunately, the odds reveal that many of you will.
I hope you have found the information in this series helpful. Good luck. Feel free to contact your Sterling Medical Advice expert consultant with any questions you have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: October is Breast Cancer Awareness Month

October 5, 2015Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Breast cancer disturbs me deeply, and if it doesn’t affect you as well, you haven’t been paying attention. One in eight women will be diagnosed with breast cancer in their lifetime. It’s more likely than not that every single one of us has been affected by this, either directly or through a friend or family member.

Breast cancer is different. We’ve found the way to eradicate certain cancers and have made remarkable progress on others. Aside from the hereditary component, breast cancer seems so…random, so dehumanizing and so debilitating to so many. Unlike so many of the things I address as an emergency physician, breast cancer isn’t like trauma, STDs and many other conditions, where one is often directly suffering the consequences of their behavior. It is vital that you appreciate the need and value for early detection to give yourself the best possible chance for the best possible outcomes. I’ll be discussing all these considerations in detail throughout the week.

I appreciate the sentiment behind a National Breast Cancer Awareness Month, but if I could offer you anything on this, it would be a plea to be ‘aware’ every month, and use this month as a (re)commitment to take basic steps that will reduce your risk, a charge to maintain steps for early evaluation and a prod to point you toward prompt treatment if and when needed. In fact, those three areas will be the topics of my next few posts. In the meantime, please share this or other information about breast cancer with any and all females in your life. I also hope you choose to engage your family, friends and others in conversations geared to improving breast cancer awareness. Odds are many of them have been or will be affected by breast cancer.
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: Identifying Risks of Domestic Violence

October 2, 2015Mental Health, Trauma844-SMA-TALK, Behind the Curtain, domestic violence, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Today we point to knowledge as the key to preventing potential life-threatening episodes in the household. This is the second in a three-part series on domestic violence. The previous post focused on the scope of domestic violence. The next post will focus on actions to take if you find yourself in a relationship in which domestic violence occurs.
Certain environments or conditions may increase your risk of becoming a victim of domestic violence. Here are certain considerations that suggest you may be at risk:

Drugs and alcohol can exacerbate an already volatile situation.
Be aware that pregnancy is a particularly sensitive time emotionally, during which abuse may start or increase.
Women with fewer resources or greater perceived vulnerability—girls and those experiencing physical or psychiatric disabilities or living below the poverty line—are at even greater risk for domestic violence and lifetime abuse.

Children are also affected by domestic violence, even if they do not witness it directly. To protect them and yourself, evaluate your mate or others in a position to exert control over you. Abusers are masterful at isolating, manipulating, intimidating and controlling those they abuse. Abusers don’t always attack with a frontal assault. Abuse may begin slowly and progress. You may accommodate certain demands in an effort to “keep the peace” in your relationship and then find yourself beyond an easy retreat from a once generous and loving person who is now intimidating and threatening.
The insidious nature of abuse must be reemphasized. What may seem, at first, to be an isolated incident complicated by theoretically understandable factors may grow into a way of life with seemingly small events triggering abuse. Your abuser may change from an individual showing regret and remorse to someone who seems repulsed by your existence, blaming your every action (or inaction or anticipated action) for the abuse that follows.
The following conditions and circumstances have been associated with propensities for abuse. Don’t consider these as absolute predictors as much as risk factors about which you should be aware.

Whirlwind romance
Abnormal desire to be with you all the time
Tracking what you’re doing and who you’re with
Jealousy at any perceived attention to or from others
Attempting to isolate you in the guise of loving behavior, including going to lengths to convince you that your friends and family don’t adequately care for you (e.g., “You don’t need to work or go to school” or “We only need each other”)
Hypersensitivity to perceived slights
Quick to blame you or others for the abuse
Pressuring you into doing things you aren’t comfortable with (e.g., “If you really love me, you’ll do this for me”)

Are you at risk? Ask yourself these questions.

Are you ever afraid of your partner?
Has your partner ever hurt or threatened to hurt you physically or someone you care about?
Does your partner ever force you to engage in sexual activities that make you uncomfortable?
Do you constantly worry about your partner’s moods and change your behavior to deal with them?
Does your partner try to control where you go, what you do and who you see?
Does your partner constantly accuse you of having affairs?
Have you stopped seeing family or friends to avoid your partner’s jealousy or anger?
Does your partner control your finances?
Does he/she threaten to kill him/herself if you leave?
Does your partner claim his/her temper is out of control due to alcohol, drugs or because he/she had an abusive childhood?

If you answer yes to some or all of these questions, you could be at risk for or already suffering abuse.
In the next Straight, No Chaser, we’ll discuss actions you can take to protect yourself and remove yourself from an abusive environment.
It’s personal. We understand and we can help. Please … contact us if you’re in need of support. Our expert crisis counselors are here for you, 24/7. 1-844-SMA-TALK or www.SterlingMedicalAdvice.com. You don’t have to “endure with dignity.”

Straight, No Chaser: Focus on Domestic Violence

October 1, 2015Mental Health, Trauma844-SMA-TALK, Behind the Curtain, domestic violence, national domestic violence hotline, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

October is Domestic Violence Awareness Month, although it doesn’t take a break during other months. Are you concerned about domestic violence? You are not alone. Domestic violence occurs in every culture and society. It occurs in all age groups and in men and women. It occurs in all races, income levels and religions. It occurs in heterosexual and homosexual relationships. It is estimated that one in four women and one in nine men will be victims of domestic violence at some point in their lives. That’s right. Many (if not most) emergency rooms now screen every single woman for domestic violence. You need to know the signs of danger and what you can do to get help.
This is the first in a three-part series on domestic violence. This post will focus on the scope of domestic violence. The next post will focus on identifying risk factors. The third post will focus on actions to take if you find yourself in a relationship in which domestic violence occurs.
Domestic violence is the abuse that one person with control in a household inflicts on another. Perpetrators can include parents or other caregivers, siblings, spouses or intimate partners. Domestic violence reveals itself in several forms, including sexual (e.g., rape), physical (e.g., biting, hitting, kicking) and mental abuse (e.g., constant criticisms or threats, limiting ability to lead otherwise normal lives). These forms tend to center around abnormal control of an aspect of another’s life. The level of mental control is such that victims of domestic violence often internalize the activity as normal, assign fault to themselves and/or accept responsibility for the abuse.

Domestic violence is a crime in all 50 states of the U.S.

It is a crime.

Victims do not cause abuse and are not responsible for it.

Domestic violence has consistent adverse effects on mental health.

Children suffering from domestic violence often display developmental delays, aggressive behavior, difficulty performing in school and low self-esteem. They are at greater risk for being diagnosed with a psychiatric disorder.
Domestic violence increases the diagnoses of anxiety disorder, depression, panic attacks and post-traumatic stress disorder. It is associated with an increase in substance abuse.
Domestic violence increases the incidence of psychotic episodes, suicide attempts and homelessness. It’s presence slows recovery from those suffering from other mental illness.
Domestic violence increases the risk of retaliatory violence against the perpetrators.

Please … contact us if you’re in need of support. Our expert crisis counselors are here for you, 24/7. 1-844-SMA-TALK or www.SterlingMedicalAdvice.com. You don’t have to “endure with dignity.”
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser In the News: A Cure for Sickle Cell Disease

September 30, 2015Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

According to the National Heart, Lung and Blood Institute, stem cell transplantation (HSCT) is the only cure for sickle cell disease. You read that correctly. Yes, there is a cure for sickle cell disease. However, it hasn’t been an easy cure. Stem cells are precursors to fully formed cells, meaning that when infused into the body, they eventually grow into the desired cells. In this example, healthy, blood-forming stem cells are given to replace the diseased sickle cells. Treatment challenges have included the need to find a suitable donor and the need to undergo chemotherapy prior to the transplantation. Until recently, HSCT was only being performed at the National Institutes of Health in Maryland, where a success rate of 87% has been reported in the treatment of 30 patients. More recently, physicians at the University of Illinois have picked up the mantle. They have recently reported 12 cures in the treatment of 13 adult sickle cell patients, representing a 92% success rate.

The success of the University of Illinois is largely attributable to an alteration in the procedure that has eliminated the need to undergo chemotherapy. The significance of that last sentence is substantial. The illness itself often renders patients too ill to endure the risks of chemotherapy. These risks include killing off the patient’s own blood-forming cells and virtually freezing their immune systems as a means of avoiding rejection of the transplanted cells by the body’s active immune system. As a reminder, a major risk of immunosuppression is dangerous, life-threatening infection. Not having to address that risk will introduce the opportunity for a cure for tens of thousands of patients.
This is an important application of stem cell therapy. Treatment of sickle cell patients with HSCT produces enough healthy red blood cells to eliminate symptoms and even detection of sickle cells.

If you, someone in your family or a friend has sickle cell disease, please discuss this procedure with your physician. Having a cure for a disease is only as good as your awareness of it and ability to take advantage of it.
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. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: Sickle Cell Anemia

September 29, 2015Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, Behind the Curtain, Hemoglobin, Sickle Cell Anemia, Sickle Cell Disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

September represents Sickle Cell Anemia (SCA) Awareness Month. In the context of discussing diseases that present to the emergency department with pain, the Pain (Vasoocclusive) Crises of SCA stand out. In my experience, I can’t identify another physiologically understood disease in which patients are as commonly treated as if they are less than deserving of treatment. That certainly isn’t the case with patients needing pain control from diseases such as cancer and lupus. This is a quite good (and unfortunate) example of biases creeping into medical practice. Can you imagine an existence in which your blood cells are deformed to the extent to which they resemble pointy knives poking at you? That’s a grotesque oversimplification, but it does capture the essence of those suffering from a Pain Crisis.

What Is Sickle Cell Disease (SCD)?

Sickle cell disease is a group of disorders of the red blood cells (RBCs). The RBCs have abnormal hemoglobin (the protein responsible for carrying oxygen throughout your bodies to nourish various tissues).

How do I get Sickle Cell Disease?

The conditions defining SCD are inherited. It is not a disorder you can individually obtain from interacting with someone affected (i.e. it is not contagious). In order to inherit SCD, you must receive abnormal genes from both parents. Sickle cell anemia is more common in certain ethnic groups, including those of African descent, Hispanic Americans from Central and South America, and those of Middle Eastern, Asian, Indian, and Mediterranean descent. One in twelve African-Americans carries a sickle cell gene.

Is this the same as Sickle Cell Anemia?

In sickle cell disease, a form of hemoglobin known as hemoglobin S is formed through inheritance from one parent. If the genes passed down from both parents create hemoglobin S (a designated known as hemoglobin SS), the resulting condition is known as sickle cell anemia (SCA). SCA is the most common and severe form of SCD. It should be noted that other forms of sickle cell disease exist, representing other combinations of hemoglobin and relatively different amounts of hemoglobin S. These include the following:

Hemoglobin SS
Hemoglobin SC
Hemoglobin Sβ0 thalassemia
Hemoglobin Sβ+ thalassemia
Hemoglobin SD
Hemoglobin SE

What does it mean if I have Sickle Cell Disease?

The problem is simple and relatively easily understood. Red blood cells (RBCs) carry oxygen from your lungs to tissues around the body. Normally hemoglobin is disc-shaped and quite able to deform in ways allowing it to maneuver throughout the body in its quest to deliver oxygen. If the hemoglobin is deformed, it is less able or unable to carry oxygen. If you can’t carry oxygen, it’s not getting delivered to your organs and tissues. If it’s not getting delivered, there are consequences.

Why do I get symptoms? What symptoms would I get if I had SCD?

It’s all about the lack of oxygen. The pain results from the equivalent of your body screaming from its absence. These pain crises are sudden, severe and often unrelenting, requiring ER visits and dramatic doses of medicine to reverse symptoms. These crises can occur anywhere such as the brain or lungs, but are typically seen in joints.
Symptoms may result from the rupture of these deformed cells (hemolysis). Sickle cells only last 10-20 days, compared to a normal lifespan of 90-120 days for normal cells. The lack of effective RBCs in your body is what’s known as anemia. Those of you who bleed monthly or otherwise have conditions affecting red blood cells recognize all too well the fatigue and energy loss associated with low RBC levels. Furthermore, the abnormally shaped cells themselves (in combination with the relative lack of oxygen delivery) can damage organs, most notably including the spleen but also including the brain, eyes, lungs, liver, heart, kidneys, penis, joints, bones, or skin.

How is SCD treated?

On a relative scale, there’s much better news than existed a generation or two ago. In the US, back in 1973 the average lifespan of a patient with SCD was only 14 years old; today it is approximately 40-60 years. SCD produces a life-long illness. Today, stem cell transplantation of those cells producing normal red blood cells (called hematopoietic stem cell transplantation or HSCT) represents a cure for those that can obtain it. The rate limiting consideration for many is most sicklers are either too old or don’t have an appropriate healthy genetic match to receive a successful transplant.
In the absence of a cure, for most patients, management involves regular healthy measures and regular medical care to prevent complications Special attention is given to maintaining hydration, appropriate blood cell counts and pain management when needed.

A truly unfortunate part of the disease is the relative lack of compassion offered to sufferers. As previously mentioned, these patients live a life of pain and go through life treated as drug-seekers in a way we rarely, if ever, see others treated. Most have had surgery before they reached age 10. Patients with sickle cell anemia suffer from a decreased life expectancy. If you’ve made it to this point in the post, consider yourself aware. I hope you care enough to lend a hand when needed.

There are good and important organizations that are dedicated to the study and treatment of SCA, including the Sickle Cell Disease Association www.sicklecelldisease.org and the Foundation for Sickle Cell Research www.fscdr.org.
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. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: Your Questions About Chronic Pain and Management

September 28, 2015General Health and Wellness844-SMA-TALK, Behind the Curtain, chronic pain syndrome, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Chronic pain and its management are complicated topics, both for sufferers and those who care for them. Thank you for your feedback on the previous post and appreciating the spirit in which the information was provided. There were many interesting questions presented, and I’d like to address two topics raised in some detail.
You don’t have to be a drug seeker to be drug addicted.

Here’s a point many chronic pain patients don’t think about that emergency room (ER) staffs have to. Even if you’re not a drug seeker, you can still be physiologically addicted to drugs. Of course your ER physician cares about your mental intent, but s/he has to be cognizant of the possibility or reality that your body might be addicted. One reason this is especially relevant is the development of tolerance, which is an important sign of addiction.
Specifically, tolerance is the phenomenon by which those physiologically addicted to a substance don’t get the same effect by giving what had previously been an effective dose. So what? This means over time you will require increasing amounts to get an effective amount of relief (i.e. equivalent to previous effects).
So… as a patient suffering from pain, you’re focusing on the fact that you’re not relieved of your pain. Your ER staff is focused on the reality that increasing amounts of certain pain medications (i.e. narcotics) come with increasing amounts of side effects, more notably respiratory depression, meaning a high enough dose can knock out your ability to breath and will kill you. This is a major reason why there are limits as to the amounts and frequency of what will be given to you in an ER setting. Once you’ve been given a certain amount, many physicians will simple stop giving additional amounts regardless as to how you feel – unless we are able to specifically discuss your cases with your primary or pain management physician, who may explain your circumstance and help decide if additionally amounts are needed. This also explains why you’re more likely to get “better” treatment during regular business hours than in the middle of the night; those conversations with other members of the team are important.
The allergy vs. adverse drug reaction question:

In a previous post, I commented on patients equating preference or side effects with allergies, and several readers have asked for clarification (e.g. “Why isn’t that side effect the same as an allergy?). An example that relates to pain is some patients’ preference of various narcotics. For some, morphine routinely makes many people itch. This is an expected side effect and is not the same as an allergic reaction. Morphine also makes some patients feel “bleh,” especially when compared with such medicinal options as Dilaudid or Demerol which are more “happy drugs.”
Even so, these drugs have different effects that would make a physician choose one over the other. For example, morphine is actually a drug of choice for pain exacerbations associated with sickle cell anemia due to its effects at the cellular level, so in many cases, physician will prefer to use morphine despite patient preference. In any event, your job is simply to have the conversation with your physician. Don’t claim an allergy if one doesn’t exist; simply discuss the reasons why one medication seems to work better than the other. You likely will find a much more receptive audience taking this approach.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Getting Your Pain Treated at the Emergency Room

September 25, 2015General Health and Wellness844-SMA-TALK, American Chronic Pain Association, American College of Emergency Physicians, Behind the Curtain, chronic pain, narcotics, Sterling Medical Advice, Straight No ChaserJeffrey Sterling, MD

Both the American College of Emergency Physicians and the American Chronic Pain Association have worked diligently to offer information and recommendations to protect patient interests and prevent inappropriate emergency room utilization while respecting the needs of chronic pain patients experiencing acute exacerbations.
In a word, it’s about expectations. Learning to understand what’s reasonable and not so much in an emergency room setting is important in helping patients to avoid disappointment.
Here are some tips to help your emergency room team help you.
If you don’t prepare for an emergency room visit, you’re the one who’s going to end up disappointed.

You should be able to tell the staff the name of the condition from which you suffer.
You should know the name and the contact information of your primary physician and any pain management specialist you see.
You should know the names of your medications, including over the counter and herbal preparations.
You should know any medical allergies you have. (A word about this. There is a difference between a medical allergy and an adverse reaction to a medication. Just because a medicine upsets you stomach or isn’t as effective as another doesn’t mean you’re allergic to it. It’s insulting to your physician to insist that you have an allergy when you don’t. You can assume that taking this posture starts the relationship off poorly because the physician will often know better and in many cases can check or test you for true allergies. It’s ok to be honest about your concerns, including medications that seem to work better than others. Your physicians will work with you and will do so more willingly when you are completely honest.)

At the ER
If you’re dealing with chronic pain, you’re going to end up in an emergency room at some point. The experience doesn’t have to be unpleasant. Emergency physicians are quite aware that pain is woefully under-treated and really do want to address it when it exists. That said, it’s important to be aware that physicians’ first charge is to “Do No Harm,” and if the situation is such that it could lead to inappropriate treatment, other and possible greater concerns than your immediate pain may take priority in the mind of the physician. It’s not that this applies to you, but this is what we have to protect against:

Here are other things to appreciate when you come to visit:

Your presence doesn’t change the reality that life-threatening conditions may be present at the same time in the emergency room. Be patient. You’re not being ignored.
Your physicians are going to treat your pain, but they’re even more interested in finding and treating any disease that exists. Be patient.
Your physicians are going to attempt to coordinate your care with your primary physicians and/or your pain management physicians.
You can’t just come to the emergency room and start demanding narcotics, even if it’s what is eventually going to happen. I shouldn’t have to explain that.

You can’t come to the emergency room and claim medical allergies to every medication except for a specific pain cocktail. Your physician understands that your body doesn’t work that way.
You shouldn’t expect an emergency physician to immediately be able to make a diagnosis of your condition that has eluded other physicians who have been evaluating you for months or years.
You shouldn’t expect an emergency physician to provide you with more than a few days of pain medication (or any without a discussion with one of your physicians).
You should expect to receive a thorough evaluation of your condition and to be treated with respect.
You should expect to receive treatment based on the evaluation performed in the emergency room.

You have a role to play in the treatment of your pain in an emergency room. The more prepared you are and better able you are to discuss your current situation in the context of your long-term care, the more likely you are to have a successful interaction and treatment experience. Although you never know when pain will strike, taking the time to organize the information described above will work to your advantage.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Pain Awareness Month and Your Chronic Pain

September 24, 2015General Health and Wellness844-SMA-TALK, acupuncture, Behind the Curtain, brain stimulation therapy, chronic fatigue syndrome, chronic pain, Cognitive behavioral therapy, endometriosis, fibromyalgia, Inflammatory bowel disease, Interstitial cystitis, local electrical stimulation, occupational therapy, osteopathic manipulation therapy, pain awareness month, psychotherapy, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temporomandibular joint dysfunction, TMJ syndrome, VulvodyniaJeffrey Sterling, MD

The notion of a pain awareness month is an odd thing; probably even more so to those suffering from chronic pain. Typically the idea with these periods of recognizing diseases and conditions is to create sensitivity among the general public toward one’s condition. In this and the next Straight, No Chaser, we will not only do that but will build upon that and provide those sufferers of chronic pain some better tools to make those emergency room visits more productive.

I’d begin by asking you to get more in touch with your “you sensitivity” and learn to differentiate between different types of pain. It’s important for you to know the difference.

Clearly there’s acute pain from injury. You break a jaw or twist an ankle, you’re going to hurt.
There’s acute exacerbations of pain from disease. You have sickle cell anemia? Cancer? Lupus? Sciatica or other low back pain? Arthritis? Migraines? You will have acute flare ups.

Then there’s chronic pain. Remember, sometimes pain happens without injury or disease. Pain is simply a signal communicated from your body to you through your brain. Acute pain is normal and is meant to alert you to somehow protect yourself or get help. Chronic pain is different. Those signals coming from your nervous system can be sporadic or haphazard, and they may be more reflective of dysfunction within the nervous system than a disease or injury. It can even be psychogenic (due to matters of your mind). Regardless of the cause, chronic pain is well, a pain.
There are many established conditions that cause chronic pain, such as the following:

Chronic fatigue syndrome
Endometriosis
Fibromyalgia
Inflammatory bowel disease
Interstitial cystitis
Temporomandibular joint dysfunction (TMJ syndrome)
Vulvodynia

Maybe the point of this post isn’t to tell those of you who suffer from chronic pain things you don’t already know as much as it is to organize your thoughts and approach to your pain. After all, it’s not like there are cures for chronic pain besides eliminating the underlying condition (which reminds me to remind you not to fall for the many medical scams promising instant and permanent relief to these medical conditions). The first step really is to help you appreciate the need for becoming better sensitized to your condition. Many patients with chronic pain suffer horrible outcomes because they become desensitized to pain, learn to ignore it, and misinterpret a new, unrelated pain condition (maybe with a few similarities), failing to get evaluated before it is too late.
If you suffer from chronic pain, it’s key to know the things you can do to improve your quality of life. Strengthening your mind to reduce stress and avoid fixating on your medical condition is very important. Learning to relax actually is treatment; your body has pain-reducing chemicals, including those that directly treat pain and promote healing, and others that prevent release of internal pain producers. Find someone with whom you can discuss relaxation and stress reduction.

Engage the fight to get better within your physical limitations.

Exercise remains key. Depending on your situation, walking, running, biking and/or swimming can dramatically improve your situation. Be advised that the extremes (not exercising at all or doing so too much) can actually worsen the situation.
Stretching and strengthening similarly produce benefits to those with chronic pain. This should sound like a good reason to become involved with a personal trainer or have a physical therapist.
Regular sleep and avoidance of nicotine (stop smoking!) will also help.

Your physician may discuss multiple other possible treatment modalities, such as the following:

Acupuncture
Behavioral therapy can reduce your pain and decrease your stress through methods that help you relax, such as meditation, tai chi, and yoga. Give it a try. It works for many people.
Brain stimulation therapy
Local electrical stimulation
Occupational therapy teaches you how to perform routine activities of daily living in a way that reduces your pain and/or avoids reinjuring yourself.
Osteopathic manipulation therapy (OMT)
Psychotherapy

Regarding medication, for many people use of medication (especially narcotics) becomes a crutch and a slippery slope. Over the counter medications such as acetaminophen and ibuprofen are quite effective for many causes of pain. Use of narcotics should be measured and part of an overall plan, not a tool for a quick fix or to get you out of your doctor’s face. It is part of reality that even if you are not a drug-seeking patient, with enough exposure to narcotics you will develop tolerance (less effectiveness at the same dose) and become addicted. You should want to avoid this fate.
The pain, mental duress and reduction in quality of life associated with chronic pain can be lessened with you learning how to approach and understand your pain, taking appropriate steps to reduce things you do to exacerbate the pain, increasing the things you do to lessen the pain, and working with your health care team to provide you with appropriate support and treatment.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Prostate Cancer Screening

September 23, 2015Genital/Urinary844-SMA-TALK, American Cancer Society, Behind the Curtain, digital rectal exam, Prostate cancer, prostate cancer screening, Prostate-specific antigen, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Every so often, controversies regarding medical treatment recommendations get in the news and seemingly only serve to confuse the public. Every blog, article or research paper is a single entity that may or may not adjust the body and weight of evidence on a given topic. Even most well-done research articles do not completely change the standard of care for medical practice. Prostate cancer screening is a great example. At the end of it all, controversies aren’t as important as the consensus recommendations that emerge from medical and public health professionals tasked with reviewing such information.
In this Straight, No Chaser, we will review the 2015 recommendations from the American Cancer Society (ACS) for early detection of prostate cancer. Remember, when you hear dissenting views, consider the source and balance that against the formal recommendations of ACS.
In an earlier Straight, No Chaser, several questions regarding prostate cancer were addressed. However, there is one additional question that is important to review.
Does Everyone With Prostate Cancer Get Treated?

This is the source of controversies regarding screening of prostate cancer. Most men diagnosed with prostate cancer do not die from the disease. I mentioned previously that 30,000 men with prostate cancer die of the disease every year. However, over 2.5 million men in the U.S. are currently living with a diagnosis of prostate cancer. Based on these statistics, the question then becomes…

Why Do All Men Need to Be Screened For Prostate Cancer?
A certain stream of logic asks why screening is necessary if most of those who are diagnosed don’t die. Many treatments (e.g. surgery, medications, radiation) have additional risks that could be avoided if interventions were avoided. Similarly, some have taken to asking if any screening program is necessary. The view here is information is empowering. It’s always better to have information regarding the state of your health. Working with your medical team and family, the correct decisions about next steps can be made. This option is only available if you know what’s happening with your health.
How Does Screening Occur?

There are two tests commonly used to screen for prostate cancer.

A digital rectal exam (DRE) is when a doctor inserts a gloved, lubricated finger into the rectum and estimates the size of the prostate and assesses it for lumps or other abnormalities.
The prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate, and PSA blood levels can be higher in men who have prostate cancer. Unfortunately the PSA level isn’t specific for prostate cancer, as it can be elevated in other conditions that affect the prostate such as age, race, certain medications or medical procedures, prostate enlargement or infection.

So What Are The Current Recommendations for screening?

The American Cancer Society (ACS) recommends that men get to decide if they want to be screened, based on a recommendation from their physician and having received information about the risks, benefits and uncertainties surrounding screening. In other words, we don’t even talk about screening anymore; now it’s “Who should have a conversation with their physician about getting screened?”

If you’re age 50 and have an average risk of prostate cancer and are expected to live at least 10 more years. Because prostate cancer grows slowly, if your life expectancy is less than 10 years, you wouldn’t benefit from screening or treatment for prostate cancer.
If you’re age 45 for men and are at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
If you’re age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Among these groups, when the decision is made to screen, those men will be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
Assuming no prostate cancer is found as a result of screening, the need for future screenings depends on the results of the PSA blood test:

Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences. Please at least have the conversation with your physician.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Prostate Cancer

September 22, 2015Genital/Urinary, Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, Behind the Curtain, Prostate cancer, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Men (and those who care for men – meaning everyone) should be knowledgeable about prostate cancer. I don’t mean physician-level knowledgeable, but there are just a few facts that you should know that are meaningful. We’ll cover those in this Straight, No Chaser.
Aside from skin cancer, prostate cancer is the most common cancer among men in the U.S. It is also one of the leading causes of cancer death among men of all races. In 2011, well over 200,000 men in the U.S. were diagnosed with prostate cancer with almost 30,000 deaths. Approximately one in six men will be diagnosed with prostate cancer. Here are some prostate cancer basics.

What’s the prostate exactly?
The location and function of the prostate was covered in this previous post.
Who’s at risk for prostate cancer?

Age: This is simple. The older you are, the greater your risk of developing prostate cancer.
Race: Prostate cancer is more common in certain racial and ethnic groups.
Genetics: Your risk is increased, which is not the same as saying you’ll develop it if a family member has. This risk is twice to three times more likely if you have a father, brother or son who has had prostate cancer.

What are the symptoms of prostate cancer?
It is of interest that a wide variety of presentations exists in those later diagnosed with prostate cancer. Some men don’t have symptoms (meaning it’s discovered on screening examinations), and other men present with several symptoms, which may include the following.

Blood in the urine or semen
Difficulty completely emptying the bladder
Difficulty starting urination
Frequent urination (especially at night)
Pain in the back, hips, or pelvis that doesn’t go away
Pain or burning during urination
Painful ejaculation
Weak or interrupted flow of urine

How Is Prostate Cancer Treated?
See the above chart for more detailed information. Optimally, treatment for prostate cancer should take into account

Your age and expected life span with and without treatment
Other health conditions you have
The severity (i.e. stage and grade) of your cancer
Your feelings (and your physician’s medical opinion) about the need to treat the cancer
The likelihood that treatment will cure your cancer or provide some other measure of benefit
Possible side effects from treatment

Different types of established treatments are available for prostate cancer, including the following:

Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) and digital rectal exam (DRE) tests regularly, and treating the cancer only if it grows or causes symptoms. This is known as active surveillance.
Surgery to remove the prostate and or surrounding tissue. This surgery is called a prostatectomy.
Radiation therapy with high-energy rays to kill the cancer..
Hormone therapy perhaps could be named “hormone blocking therapy,” because these medicines blocks cancer cells from getting the hormones they need to grow.

The next Straight, No Chaser will provide an update on prostate cancer screening recommendations.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Prostate Awareness

September 21, 2015Genital/Urinary844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is Prostate Cancer Awareness month, and as such, this Straight, No Chaser explores the prostate (no pun intended). Prostate cancer and screening will be addressed in an additional post. There are generally five questions people ask about the prostate, so let’s take the time to address them. These topics are individually discussed in detail at www.sterlingmedicaladvice.com.

1. What is the prostate?

The prostate is a male-only organ located in front of the rectum and under the bladder. It surrounds the urethra, which is the tube through which urine flows on its way out of the penis. Understanding this anatomy helps one understand the nature of problems that arise related to the prostate. Importantly, the prostate is part of the male reproductive system. It’s a gland that contributes to the fluid (seminal fluid) that carries sperm out of the body (i.e., semen).
2. Doesn’t it get infected?

Prostatitis is either inflammation or infection of the prostate gland. It has many different causes. When an infection with bacteria causes prostatitis, it is called bacterial prostatitis. Bacterial prostatitis can be a particularly long-lasting infection, requiring antibiotics to treat.

Acute bacterial prostatitis is an infection that produces signs and symptoms rapidly.
Chronic bacterial prostatitis is an infection that lasts for at least three months.

3. Why does the prostate get large?

A condition known as benign prostatic hypertrophy (BPH) occurs in men as they age. As a general rule, 50% of men have it by age 50, and 80% have it by age 80. The prostate normally is only the size of a walnut. When BPH occurs, the prostate has enlarged to a point where it may press upon the urethra, disrupting the normal flow of urine, preventing normal emptying. It is important to understand that the growth seen in BPH is not cancer.
4. What’s the relationship between the prostate and sex?
When people ask me this question, they have one of two concerns.

Some medical studies have drawn a relationship between a higher frequency of ejaculations and a lower risk of prostate cancer. This trend is not currently considered definitive; to be clear there is no conclusive evidence that the risk of prostate cancer is reduced by frequent ejaculation.
The male equivalent of a “G-spot” is described as being near the prostate.

5. Is prostate cancer deadly?

Prostate cancer is usually slow growing, but may occasionally be aggressive. Cancerous prostate cells may break off and spread to other parts of the body, particularly the bones and lymph nodes. Prostate cancer usually is seen in men after 50 and even when discovered often doesn’t require especially aggressive management.
Your bottom line? You especially need a prostate exam and other considerations yearly after age 50.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Questions About Memory Loss and Forgetfulness

September 18, 2015Mental Health, Neurology844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Are you the type that has a bad memory? Is your memory good when you “want it to be?” Do you just have problems paying attention? Are you concerned about elderly family members suffering from dementia or Alzheimer’s disease? This Straight, No Chaser may have some answers to your common questions. Feel free to ask any others you may have.
Am I forgetful, absent-minded or do I have a serious memory problem?
You tell me. It’s not memory loss if you never paid attention to begin with (there’s a joke about husbands and sporting events in here somewhere). It’s certainly the case that the more you focus on remembering whatever it is, the more likely it is that you will.
Ok then, what’s the difference between normal forgetfulness and serious memory loss?
To understand this distinction, think about functionality. We all forget things. It is a clear concern when the things being forgotten involve items needed for activities of daily living (your name, your address, your birthday, etc.).
Why do we forget?
This is a very complicated question and the cause is often multifactorial, include one or several of aging, medical and emotional considerations.

So what about health-related causes of memory loss?
If this refers to non-aging causes, there are several. There a phenomenon called state-dependent learning that’s pretty fascinating. For example, if you learn something while intoxicated, you may not remember it while sober, and you may remember it again once intoxicated again. Alcoholism itself causes conditions (e.g. Wernicke’s encephalopathy and Korsakoff’s psychosis – these aren’t esoteric; these are out there) in which memory loss is a component. Chronic alcohol use and other conditions that involve vitamin deficiencies (e.g. Vit D, Vit B12) also produce memory loss and deficiencies.
Is it true that stress can cause memory loss?
Yes, both stress and depression can cause memory loss, both emotionally and physiologically.

Should I worry about Alzheimer’s?
No. Alzheimer’s happens whether you “worry” about it or not. What you should do is be concerned about memory loss and trying to prevent premature dementia. First, take steps to protect and build your memory. Second, if you are experiencing memory loss, discuss it with your physician. He or she will know what to do from there.
Ok, then how do I work on my memory?
An active brain is a healthy brain. Of course diet and exercise will keep all of you healthy, including your brain. There are untold numbers of memory games and problem-solving exercises you can perform to train and keep your brain sharp. Learn a new skill or dabble in a new language. In general, socializing and engaging your mind in activities is most of what you need. Alternatively, you can also protect against your bad memory (or inattentiveness). Make a habit of placing your keys, purse/wallet and other needed items in the same place, so when something’s lost, instead of remembering what you did, you can ask yourself “what was I supposed to do?” And yes, guys you can pay better attention to your wives.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser In the News: The Republican Presidential Debate and Vaccines

September 17, 2015General Health and Wellness, Pediatrics/Kids Health, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

View this debate segment. We’re about to have a Straight, No Chaser moment.

If you are of the view that vaccines cause autism and have typically received your news (and views) from non-medical (read illegitimate) sources, this portion of the Republican Presidential Debate from last evening likely gave you pause. There are two issues here to address and clarify.

Not only is there no established medical link between vaccinations and autism, failure to get vaccinated increases exposure to diseases that are deadly. That’s why vaccines were created for certain specific diseases in the first place. The notion that vaccines exist to support a large governmental apparatus or to exert control on individuals is a dangerous level of ignorance to certain medical realities that can easily be rejected by having a simple understanding what diseases like smallpox, measles, tetanus and others do to children when they occur in those not protected.

You can protest if you like, but the societal construct suggests that in some instances, your responsibilities to society are greater than your individual rights. Vaccinations work because and only if enough individuals get vaccinated to provide blanket coverage of everyone. This concept of herd immunity is critical to certain individuals with legitimate inability to get vaccinated because of a lowered immune status or the existence of true allergies to vaccine components, for example. The only protection from disease and death these individuals have is the collective protection received by nearly eradicating the disease. Vaccines are Exhibit A in the old adage “an ounce of prevention is worth a pound of cure.”

Ill-informed opinions do not equate to medical facts and increasingly have consequences. Medical practices all over the country are beginning to refuse to accept patients whose parents refuse immunizations. Schools have long mandated immunizations as a means of protecting the large numbers of children present. Instead of just being a denier, be an informed consumer. Take the time to actually learn the facts involved. Thankfully, it appears many politicians are starting to do just that.

Finally, an interesting concept is being thrown around regarding spacing out immunizations. This similarly raises two issues.

There is no link between giving multiple doses of immunizations in batches and the presence of worse outcomes. Think about your family’s experiences with vaccines. Your kids get their shots; experience some pain, and maybe develop a fever for a day after this. Are you really wanting this to occur on say, three times as many occasions for the “benefit” of spacing out vaccine administration? Exactly what are those benefits? I’ll say it again: there is no link between giving multiple doses of immunizations in batches and the subsequent development of worse outcomes.
The bundling of immunizations isn’t being done without good reason. Potentially fatal childhood diseases occur during childhood. The greatest benefit from getting immunized is during the time in which the probability of contracting disease is at its highest and the consequences are potentially greatest. Increasing the time beyond well-studied, worldwide-accepted recommendations is to unnecessarily increase the risk for disease. Of course, if moderation in vaccine administration can occur, it will be studied, and recommendations will be adjusted. However, this won’t occur because of strictly political considerations, if these considerations run counter to medical science and if they actually dilute the benefit of giving vaccines.

It’s good that the topic of immunizations came up in the debate. It’s even better that all involved finally chose to acknowledge what is clear in the medical science: immunizations are among the most important tools in public health, they have been proven to be dramatically safe, they provide much more benefit than they impose any potential danger, and their administration should be vigorously supported.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Gynecological Cancer Awareness

September 16, 2015Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology844-SMA-TALK, Behind the Curtain, Cervical cancer, gynecological cancer, ovarian cancer, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, uterine cancerJeffrey Sterling, MD

September is Gynecological Cancer Awareness month, and the challenge is to become empowered through knowledge in an effort to avoid becoming a victim. Consider this post your “essentials” for awareness and prevention. The group of gynecologic cancers include cervical, ovarian, uterine, vaginal and vulvar. This Straight, No Chaser will provide a quick overview on the three most common types (uterine, cervical and ovarian cancers) and will be followed by posts on each.

General considerations:

All women are at risk for gynecologic cancers.
Generally, risk increases with age.
Treatment is most effective after early detection.

Cervical cancer:

How you get it – It is thought to be caused by a virus named the Human Papilloma Virus.
How you address it – It is preventable if you get vaccinated before you become sexually active, and risk is lowered by not smoking. Detection occurs by Pap smears as recommended by your gynecologist or family doctor.
What to look for – There are usually no early symptoms, although you should be alarmed by the presence of bleeding after intercourse or between menstrual periods, or by the presence of excessive and persistent vaginal discharge.

Uterine/Endometrial Cancer (the most common gynecological cancer)

How you get it – Family histories of endometrial or colon cancers are important contributors to subsequent development of uterine cancer. Additional risk factors are the use of estrogen alone or use of the drug tamoxifen. Uterine cancer usually occurs around menopause.
How you address it – Your best bet is to reduce your risk by managing your weight and keeping blood pressure and blood sugar under control. You must be diligent here; routine Pap tests do not detect uterine cancer.
What to look for – Vaginal bleeding after menopause or the presence of irregular or very heavy bleeding in younger women could be signs.

Ovarian Cancer

How you get it – Risk factors notably include increasing age and obesity. Protective considerations include early use of birth control pills and carrying a pregnancy to term delivery by age 26.
How you address it – You really must have a conversation with your physician about ovarian cancer. There is no screening exam or test for it. Your best protection is to learn and reduce the risks, and you should promptly seek evaluation in the presence of symptoms.
What to look for – Symptoms can be easily attributed to other problems. If symptoms persist for more than a few weeks, don’t delay getting evaluated. Such symptoms include bloating, abdominal or pelvic pain, difficulty eating or quick sensations of feeling full and urinary frequency or urgency.

Although these are topics that you likely would prefer not to think about, they represent disease that you really don’t want to endure, so learn the risks, lower them through prevention and keep your regularly scheduled appointments. If you develop one of these cancers and get detected early, you’ll be very glad you took these simple steps.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Traumatic Brain Injuries (Concussion), Part II

September 15, 2015Neurology, Trauma844-SMA-TALK, Behind the Curtain, CDC, Centers for Disease Control and Prevention, Concussion, Post-concussion syndrome, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Traumatic brain injuryJeffrey Sterling, MD

Your son is a star in Friday Night Lights (actually football, not the TV show) and has been concussed. Amazingly, the most common question I get asked is not “Will he be ok?”, but “When will he be able to get back on the field?” My answer, coming out the ER, is never going to be less than two weeks, and I won’t be the one who provides medical clearance. It’ll either be your family doctor or preferably, a neurologist. Don’t just take my word for it. Consider the following Quick Tips from the Center for Disease Control and Preventions.
CDC’s Discharge Instructions

You may experience a range of symptoms over the next few days, such as difficulty concentrating, dizziness or trouble falling asleep. These symptoms can be part of the normal healing process, and most go away over time without any treatment.
Return immediately to the ED if you have worsening or severe headache, lose consciousness, increased vomiting, increasing confusion, seizures, numbness or any symptom that concerns you, your family, or friends.
Tell a family member or friend about your head injury and ask them to help monitor you for more serious symptoms. Get plenty of rest and sleep, and return gradually and slowly to your usually routines. Don’t drink alcohol. Avoid activities that are physically demanding or require a lot of concentration.
If you don’t feel better after a week, see a doctor who has experience treating brain injuries.
Don’t return to sports before talking to your doctor. A repeat blow to your head-before your brain has time to heal-can be very dangerous and may slow recovery or increase the chance for long-term problems.

Finally, there are two particularly impactful consequences about which you should be aware.

The ‘second impact syndrome’ is irreversible brain injury triggered by a fairly routine second head impact after a prior concussion. You must take the time off needed for the brain to heal. I care more about your child’s mental future than the upcoming playoff game.
The ‘post-concussive syndrome’ represents long-term neurologic and psychologic consequences of the head injury. It includes such symptoms as inability to sleep, irritability, inability to concentrate, headache, dizziness and anxiety.

There are no definitive treatments for concussions other than prevention of an additional injury, and that fact should be chilling to you. Be mindful of the risks involved in choosing to engage in activities putting the brain at risk.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Concussions – Traumatic Brain Injuries, Part I

September 14, 2015Neurology, Trauma844-SMA-TALK, Behind the Curtain, Concussions, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Traumatic brain injuryJeffrey Sterling, MD

It’s probably not a coincidence that National Traumatic Brain Injury Awareness Month occurs at the same time as the onset of the NFL season in the U.S. However, it’s also important to appreciate that traumatic brain injuries (TBIs) don’t only occur in the setting of professional sports. Regarding sports, the really interesting thing about concussions these days is many individuals seem to have convinced themselves that the risk of a concussion or even continuing in football, wrestling, boxing, or MMA type activities after having had concussions won’t deter them from pursuing the glory, fame, and fortune to be obtained in putting themselves at risk. That’s a fascinating but very flawed concept, as evidenced by the increasing suicide rate among concussed former athletes.

A traumatic brain injury (TBI) is caused by a blunt or penetrating head blow that disrupts some aspect of normal brain function. TBIs may produce changes, ranging from brief alterations in mental status or consciousness to an extended period of unconsciousness or amnesia. (It’s important to note that not all blows to the head result in a TBI.) For the purposes of this discussion, the majority of TBIs that occur each year are concussions. In terms of societal impact, TBIs contribute to a remarkable number of deaths and permanent disability. Every year, at least 1.7 million TBIs occur in the US.

Healthcare professionals may describe a concussion as a “mild” brain injury because concussions are usually not life threatening. Even so, their effects can be serious. Concussive symptoms usually fall in one of four categories:

Thinking/remembering
Physical
Emotional/mood
Sleep

Red Flags
Here’s what you need to know today. Get to the ER right away if you have any of the following danger signs after any type of head injury, no matter how minor it may seem:

Any difficulty waking
Any loss of consciousness, confusion, or significant agitation
One pupil (the black part in the middle of the eye) larger than the other
Loss of ability to identify people, places, the date, or self
Loss of motion or sensation, weakness, numbness or loss of coordination
Persistent, worsening headache
Repeated vomiting
Slurred speech or difficulty with expression
Seizures
Kids will not stop crying and cannot be consoled
Kids will not nurse or eat

We’ll continue the conversation about concussions in the next Straight, No Chaser.
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.
Copyright, Sterling Initiatives, LLC. 2013-2015

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