Tag Archives: Behind the Curtain

Straight, No Chaser: Focus on Health, Happiness, Choices and Consequences

Space shuttle Atlantis lifts off from the launch pad 39A the Kennedy Space Center in Cape Canaveral, Florida May 14, 2010. Photo/SCOTT AUDETTE  (UNITED STATES)

It’s launch week for Behind the Curtain: A Peek at Life from within the ER, and thanks to the many of you that have already purchased the book, read it and provided wonderful feedback. It’s important to place the purpose of the book in context. The effort our team makes and the work we do is simply and entirely to provide a service and to promote healthy habits, awareness about health and medicine, and to advocate for public health issues that will create healthier communities.
New LogoIf you follow Straight, No Chaser regularly, you’ve heard this before: it isn’t a medical encyclopedia. Similarly, Behind the Curtain is much more than a collection of amazing stories about the human experience. These productions are tools to empower you to make choices that best suit your lifestyle and cautionary tales about the consequences of our poorer choices. Still, as educated consumers you get to incorporate this information into your life the way you see fit – into your personal intersection of health and happiness.
It is indeed interesting that our society doesn’t value health as it once did. Health seemingly must now be weighed alongside other life concerns. I hope yet fear that this has partially become the case because of the mindset that medicine has evolved such that you can be figuratively pulled from the fire when illness finally catches up with your habits or that there is now a “pill for everything.” Sometimes that is true. Other times you mourn when that isn’t the case.
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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.” That’s fine. Just realize that these are choices you’re making willingly, even if they seem more like unconscious decisions than not.
As our team travels around the country, we hope to see you out and to have meaningful conversations about your individual circumstances, the challenges of your communities and the solutions that can be shared and implemented. We hope that as you read Behind the Curtain, you not only enjoy the entertainment but notice the difference healthy habits make and notice the devastating consequences that occur from a lifetime of bad choices. Behind the Curtain is meant to be a mirror to the way we live our lives. Take from it what you will.
On Straight, No Chaser, we will continue to offer you tools be be your best self. Thanks to the more than 35,000 followers we have across various platforms for allowing us to play a role in your lives. Today, we leave you with this commonly cited part of the “health and happiness” equation:

STATE OF MIND = STATE OF BODY. 

Now remember this part:

STATE OF MIND + STATE OF BODY = STATE OF LIFE

Healthy-Mind-plus-Healthy-Body-equals-Happy-Life-from-Starling-Fitness
Choose wisely. Live healthily. See you tomorrow, LA!

Sterling_Cover_HighRes copy

If you’d like to read Behind the Curtain ahead of its national launch on Friday, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com! E-books and other means of obtaining the book will become available on Friday, June 24th.
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, follow us on Twitter at @asksterlingmd and at Instagram at @jsterlingmd.

Straight, No Chaser: Shingles – Return of the Chickenpox

shingles

It’s another interesting night in the ER.  My nurses are hounding me because there’s a patient with a rash, and they don’t know what it is.  They’re so good that they rarely get stumped, and they get excited when they are.  The patient had a pretty impressive cluster of little blisters called vesicles (see the picture above) under one eye with significant reddening of the skin under the cluster.  Unknown to them, their problem with this patient is she’s African-American.  Many healthcare professionals have difficulty identifying common rashes in dark-skinned individuals.

I wonder if any of you haven’t had chickenpox.  That’s a question that never would have been asked a few decades ago.  Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.).  Repeat infections or reactivation of the virus that went dormant inside of you causes shingles.  When I was younger, no one ever got shingles because no one got chickenpox twice.  Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it.  The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).

Then an odd thing happened.  A chickenpox vaccine came out.  Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age.  Then shingles started being seen more often.

shingles

The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes.  Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears.  The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks).  Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.

Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful.  If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half.  Please discuss this with your physician.  If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.

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Quick Tips:

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

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

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In the meantime, if you’d like to read Behind the Curtain ahead of its national launch, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com!
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: Expiration Dates on Food, Medicines and Cosmetics

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We’re all faced with the decision. When you’re sick, have you ever rummaged through the medicine cabinet and discovered an old prescription? Perhaps you wanted to wear your extra special makeup and discovered the expiration date has passed. Or perhaps you came back from out-of-town, and reached into the refrigerator to cook your favorite meat and discovered it’s a few days past the expiration date.
No lectures today. Let’s engage in some straight talk and answer the questions you have.

 Expiration_Date

1. Why do foods have an expiration date?
Expiration dates provide an assertion of a guarantee of freshness, assuming the absence of other considerations. In other words, expiration dates are meant to suggest “best quality.”
2. Why do some stores sell foods beyond their expiration date?
Because they can. The U.S. Food and Drug Administration (FDA) does not require the coordination of expiration dates with assertions of safety (or lack of safety).
3. So is it safe or not safe to eat foods beyond their expiration date?
This is where things get tricky. The problem with “bad food” is contamination to the extent where sufficient bacteria are present to cause an infection. An expiration date is only a rough measure of that. If you leave food unrefrigerated or exposed to heat, it will go bad well before the expiration date. Even after the expiration date, sufficient bacteria may or may not be present to cause problems, but it becomes more likely as time passes.
4. Are there different considerations for different foods?
Use this list as a quick reference.

  • Countertop food (e.g., bakery goods containing custards, meat, vegetables, or frostings made of cream cheese, whipped cream, or eggs) should be kept refrigerated. Others not containing these (e.g., breads, muffins) can be kept at room temperature for a few days, but watch for mold that will develop over time.
  • Unprocessed pantry foods (e.g., cereal, dry beans, grains, mixes, nuts and pastas) should be good up to a year if unopened. Once opened they must be stored in air-tight containers.
  • Processed pantry foods (e.g., canned foods, cake mixes, crackers, dried foods) are safe until opened. Discard cans that are cracked, bulging or squirt liquid when opened.
  • Refrigerated foods (e.g., milk, chicken) may have both sell-by and use-by dates. Although generally safe to eat after both dates, the risk of problems is higher, so check for odor, discoloration or a bad flavor.
  • Freezer foods, according to the FDA, are safe indefinitely as long as they haven’t partially thawed. In this example, the sell-by and use-by dates apply to quality and retained nutritional value. For best results, if you’re going to freeze, do so early.

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5. So cosmetics expire? I’ve never noticed an expiration date.
The FDA doesn’t require cosmetic manufacturers to print expiration dates on the labels of cosmetic products, but they do have the responsibility to determine shelf life for products, as part of their responsibility to substantiate product safety. The issue isn’t “expiration” as much as increasing risk for infections (of the eyes in particular).
6. For how long can I safely use cosmetics?
The better question is what increases the risk when using cosmetics. Here are some guidelines:

  • Manufacturers usually recommend discarding mascara two to six months after purchase.
  • If mascara becomes dry, discard it. Do not attempt to prolong its usefulness by adding water or saliva. Doing so will introduce bacteria into the product and onto your eyes when applied.
  • If you have an eye infection, stop using all eye-area cosmetics and discard those you were using when the infection occurred. Seek medical attention.
  • “All-natural” (i.e., plant-derived cosmetics) are more likely to have a shorter shelf life and to be conducive to bacterial growth with subsequent infection.
  • Poorly stored (e.g., exposed to high temperatures, previously opened) cosmetics may deteriorate before the expiration date. Conversely, those stored under optimal conditions may be acceptable long after the expiration date has been reached.
  • Sharing makeup increases the risk of contamination. A good example of this are the “testers” commonly found at department store cosmetic counters. If you feel you must test a cosmetic before purchasing it, apply it with a new, unused applicator, such as a fresh cotton swab.

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7. What happens after a medication expiration date?
When it comes to antibiotics, I hope you never find out. You should always take your medications as prescribed, which generally means until all pills are gone. The medication date actually is more of a “freshness” (actually, safety and potency) consideration than a danger warning. However, in the wrong patient, a medicine that has less than the 100% guarantee of its needed strength, as the expiration date represents, could have fatal results. The expiration date doesn’t really indicate a point at which the medication is no longer effective or has become unsafe to use, with significant exceptions (e.g., tetracycline, nitroglycerin, insulin, and liquid antibiotics).
Feel free to ask your SMA personal healthcare consultant any questions you have on this topic.
In the meantime, if you’d like to read Behind the Curtain ahead of its national launch, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com!
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 In The News: Birth Control Pills Without a Prescription and Expansion of Pharmacists’ Prescribing Authority

 

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In the news are updates from California and Oregon on new state laws allowing females to obtain oral contraceptive pills directly from a pharmacist without requiring a prescription from a physician. Let’s review the how and why of this.

  1. Why was there a need for this, you may ask?

Women’s health advocates have successfully made the case in these states that women should have similar opportunities as men to obtain birth control.

  1. Isn’t comparing condoms with hormonal pills like comparing apples and oranges? One’s much safer than the other, right?

It’s not a competition. Safe is safe. Oral contraceptives have been so widely studied for so long that the American College of Obstetricians and Gynecologists have recommended availability over the counter.

  1. What’s with California not having an age restriction?

There’s nothing especially odd about that once you understand laws known as “muture minor doctrines” regarding one’s body are already in place in various ways nationally. In fact, minors of any age may consent to family planning services when those services are funded in full or in part by Federal Title X monies. Under California state law (Cal. Family Code § 6925), a minor of any age may consent to medical care related to the prevention or treatment of pregnancy, including contraception.

  1. It can’t be that simple? What protections are in place?

Regulations differ between the two states, but here are examples of initial efforts to protect.

  • Pharmacists can only dispense oral contraceptives after providing a health screening, including a blood pressure check.
  • Women under 18 must show proof of prior birth control prescriptions from a physician.
  • Pharmacists are being required to undergo additional training.
  1. So pharmacists are taking on some of the responsibilities of physicians?

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Yes and by design. Part of the fall out from the Affordable Care Act appears to be the ongoing peeling away of responsibilities once exclusively held by physicians (depending on your point of view; this is often politically cited as “relieving the burden of physicians”). The biggest of these responsibilities appears to be prescriptive authority. There is an increasing number of circumstances in which pharmacists are now functioning beyond their prior role without physician consent needed, including the following:

  • administration of immunizations,
  • administration of medicines for smoking cessation
  • administration of narcotic overdose antidotes.
  • administration of the “morning-after pill”
  • administration of travel medicines

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In as much as the conversation is about women’s health and greater access to treatment, reform is a good thing. In the examples in which new health considerations are rushed through as part of a political agenda instead of as a measure of public health, the risk exists that equal measures of good and harm may be created. A serious and robust conversation needs to occur about how primary care physicians are to keep up with an increasing number of outlets for patients to receive medications. Such things matter, not only for routine health maintenance but particularly in managing side efforts and emergencies related to medication use. Not having access to complete and accurate medication lists can be the difference between life and death in an emergency. All in the public domain would do well to be aware and be involved in these conversations as new prescriptive authority measures migrate across the country. You have a stake in what the future of healthcare becomes.
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 ERat jeffreysterlingbooks.com.

Straight, No Chaser: Avoiding Sports Injuries

Rory-McIlroy

When the world’s #1 ranked golfer completely ruptures the major part of his ankle’s supportive structure casually playing soccer, it’s time to start wondering if us normal folk have to start walking on egg shells. Today’s Straight, No Chaser means to tell you that isn’t at all the case.
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Athletes are at risk for injuries for different reasons than weekend warriors. Although accidents happen to everyone, poor conditioning and training, propensities not to stretch or warm up, relatively poorer playing conditions, and use of inferior equipment (or lack of use of any at all) make your adventures a little more risky. Remember, it’s not that athletes are at greater risk; it’s that they are continually in the field of play, and this makes them have more opportunities to hurt themselves.
Straight, No Chaser has reviewed many common sports injuries. Links to some are listed below, and others you can read up on just by typing what you’re looking for into the search box on the right. The most common sports injuries include the following conditions.
sports-injuries soccer

Of course, the most common injuries aren’t all the rage. These days, everyone’s concerned about concussions. Here’s a Straight, No Chaser review of concussions.

Here are some tips to help you avoid sports injuries.

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  • Always warm up, regardless of the sport. It’s especially helpful to stretch the Achilles tendon, hamstring and quadriceps areas and hold the positions without a bouncing motion.
  • Avoid bending knees past 90 degrees.
  • Avoid twisting knees. This is best done by keeping your feet as flat as possible during stretches and running.
  • If you’re jumping, land with your knees bent.
  • Cool down following vigorous sports. You want your heart rate to come down gradually.
  • Wear properly fitting shoes. You can avoid stress fractures and sprains by wearing shoes that provide shock absorption and stability.
  • Avoid running on hard surfaces like asphalt and concrete. It’s preferable to run on softer, flat surfaces. Appreciate that running uphill may increase the stress on the Achilles tendon and the leg itself.
  • Know when to stop.

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We’ve discussed the RICE method of treating strains and sprains in the past. Make a habit of this for even minor ankle, knee, wrist, elbow and shoulder sprains. It helps with pain and swelling, and it also speeds recovery.
The weekend warrior is too often engaged in a testosterone fest and doesn’t listen to his or her body. If you get hurt, stop. If you don’t listen to your body, someone more serious could be on the verge of happening. Whether you’re a pro or just a weekend warrior, it’s good to know what you’re looking to avoid. Don’t let a sports injury sneak up behind you.

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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: Health Promotion – Introducing "Invisible Health"

healthy-habits

Good habits are just as addictive as bad habits, but they’re much more positively rewarding.

Good health is a journey, not a destination. Stop acting like what you are is what you will be now and forever. Look, the easiest way to change your life is to change your life. But how? When it comes to health, sometimes it can seem like work. For many, the idea of exercise is a big to do. You have to pack. You have to drive. You have to shower. Who has time for all of that? Dieting is just as bad, it seems. Do I need to go find a special store? It always takes time to cook a special meal. It seems like work to count calories! I don’t like the taste of this or that…
Well, at Straight, No Chaser, we want to introduce you to Invisible Health. Today, we offer you a series of ten simple tips (and one admittedly not so easy one) that will promote your health without all the fuss (although we fully endorse the fuss and know that over time, it’s not a fuss). Feel free to expand the list. More importantly, implement the list. You’ll be amazed how just a few minor modifications in regular activities can produce large improvements in your health. Everything is relative. Don’t just sit there. Do something!

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One thing you’ll notice about these tips is you’re producing health benefits without the active grind of “working out ” or “dieting.” We just want you to develop some new habits or increase the frequency of some things you may already be doing.

  • Take a walk. You’re exercising and didn’t know it. Walk the stairs. Take a walk in the park with your loved one. Walk while you talk with your kid. Regular walkers have less heart attacks and strokes, better sex lives and less stress. Walking improves your immune system and reduces all manners of unhealthy cravings. It’s easy. Just do it.
  • Learn to like to dance. Hear your favorite song? Go for it. Have a child? Teach them and dance with them! I’ll bet while you’re having fun, you’re breaking a sweat, losing calories and getting your heart pumping without the worry of reps or time spent.
  • Are you hungry and about to shove something unhealthy in your mouth? Drink a glass of water. Your body needs it. The majority of you don’t drink nearly enough water. Learn to appreciate water. Have you heard that you need eight glasses of water a day? You’ll never get there by sipping on a hot beverage. It’s refreshing and replenishing, plus it makes your body function optimally. Besides, if you’re drinking water, you’re not drinking high calorie, sugar-laden soft drinks. Speaking of which…
  • Stop. Drinking. Sodas. Today. I’d bet the easiest “diet” many of you could go on would be just eliminating soda. Even without doing anything else you’d lower your risk of diabetes and high blood pressure, and you would start losing weight. One can delivers 150 calories. Any amount of water is zero calories.
  • Still hungry and still looking at that donut? Go brush your teeth. You probably don’t brush enough anyway, and brushing and flossing intermittently throughout the day provide numerous health benefits as well as serve as suppressing your appetite in a simple way.
  • Wack some weeds. Getting in your yard and doing most any kind of cleaning is going to be beneficial to your health. Stop riding your lawnmower. Walk! Pull some weeds (with both hands), rake some leaves, plant some flowers or sod some grass. You’re burning several hundred calories an hour!
  • Stand for something. If you think about it, you spend a lot of time sitting during the day. Could you perform a lot of what you’re doing standing or moving? Give it a try. Just develop the habit of getting up and moving around intermittently. For example, learn to pace while you’re on the phone. It’s activity, and you probably need more of it.

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  • Snack healthy. Find a favorite fruit. Eat a handful of nuts. A handful of carrots or almonds, a few slices of an apple or a bowl of grapes is an infinitely better approach to those cravings. Lose the potato chips and the empty calories. This is both addition by subtraction and addition by addition!
  • Play! Have a kid of any age? Throw the football around. Shag fly balls with each other. Shoot some hoops. You’ll love the benefits to your heart and lungs. Plus, it’ll keep your brain sharp.
  • Find a healthy friend. Having a companion with whom you share your health aspirations gives you a much better chance of success across the board, as opposed to that friend of yours that you just get together with to eat or drink. It’s true in health as well. You’re probably the average of the five people you most hang around!
  • Stop smoking. You didn’t really think I would leave smoking off the list, did you? Speaking of invisible health, the more invisible smoking is, the better. I don’t care how you do it, just do it. Every cigarette is costing you about seven minutes of your life. In one fell swoop, eliminating cigarettes from your life will produce as many benefits as most anything else you’ll do.

Healthy-Lifestyle

Give it a try. See how many of these 10 tips you can incorporate into your life.

In the meantime, if you’d like to read Behind the Curtain ahead of its national launch, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com!
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: Kids Summer Fun Gone Wrong

Young Girl Jumping in a trampoline
So I’m back in the emergency room with a little girl who looks like her forearm is going to fall off the rest of her upper extremity.
People love trampolines. Yet somehow the only time I seem to hear the word trampoline is when someone’s been hurt. I’m not the only one who’d vaporize them on site. The American Academy of Pediatrics recommends that trampolines never be used at home or in outdoor playgrounds, because associated injuries include head and neck contusions, fractures, strains and sprains, among other injuries.

So my patient had a (posteriorly) dislocated elbow, meaning she fell off the trampoline, landing on the back of the extended upper arm, pushing the upper arm bone (the humerus) in front of the elbow and forearm. This is how that looks (yes, the ball is supposed to fit into the socket).

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So for the joy of bouncing on a trampoline, the child had to be put asleep so the elbow could be replaced into the appropriate position. This procedure is fraught with potential for complications, including a broken bone on the way back, as well as damage to the local nerves and arteries (brachial artery, median and ulnar nerves), which can become entrapped during the effort to relocate the bone into the elbow joint. Some limitation in fully bending the arm up and down (flexion and extension) is common after a dislocation, especially without prompt orthopedic and physical therapy follow-up. This really is a high price to pay for the privilege of bouncing up and down.
So if you’re going to allow your kids to play on a trampoline, here are three tips shown to reduce injuries:
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  • Find one of those nets that encloses the trampoline to prevent a child from being thrown from the trampoline.
  • Make sure the frame and hooks are completely covered with padding to prevent a child from getting impaled or scratched.
  • Keep the trampoline away from anything else, including trees and rocks. This works even better if the trampoline is enclosed as previously mentioned.

Think back to the little girl I had to care for and consider whether this predictable event (complete with the mental stress of being in a loud emergency room in pain, getting an IV needle and being put to sleep) was worth the effort. As per routine, an ounce of prevention…

Straight, No Chaser: Addressing Hearing Loss and the Use of Hearing Aids

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Again joining the conversation is my friend and colleague Greg Keeney, audiologist and owner of Affordable Hearing Aids in Texas.

Addressing hearing loss is a humbling experience in that it forces you to face your mortality. The irony is that your feeling immortal is what leads to hearing loss in many instances (e.g., gunshots, explosions, scuba diving, noise exposures at concerts and sporting events, etc.).

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Prevention and protecting your hearing is easy; the decision to do so seems not to be so easy. Remembering this hearing thermometer is a good way to know what activities hurt your hearing.
When it gets to the point that you’re having acute difficulty hearing, assuming you’re a victim of trauma, you may be inclined to flush wax out of your ear or use wax softeners. If you go this route, be careful. Remember that old Q-Tip commercial with the tag line, “You should never place anything in your ear smaller than your elbow.” Unless it’s ridiculous easy, you should have a health provider remove anything from your ear. Importantly, you should never place anything sharp in your ear (e.g., bobby pins, tweezers, etc.).
There are many procedures and surgeries that can help with hearing loss, including the following:

  • Placing tubes in the eardrum (aka T-tubes, tympanostomy tubes) to remove fluid
  • Repairing the eardrum or the bones in the middle ear that assist in sound transmission
  • Wearing heading aids, though only one of five individuals who could benefit from a hearing aid uses one
  • Using cochlear implants, a final option for those whose hearing impairment is so severe that various types of hearing aids aren’t effective or a viable option (Learn about cochlear implants at www.sterlingmedicaladvice.com.)

Sign language can complement these other methods or aural based communication when other methods don’t work.
Let’s focus on some frequently asked questions about hearing aids.

 hearingaidtypes

How do hearing aids work?
Hearing aids consist of a microphone, an amplifier and a speaker. These components convert sound waves to signals you can hear through the speaker. It’s really that simple.
How do experts determine that I need a hearing aid?
When the time comes, a physician who specializes in ear, nose and throat disorders (otolaryngologist) will evaluate possible causes of hearing impairment. An audiologist, a hearing health professional, may also identify and quantify the degree of loss. The results of these evaluations will determine your needs.
What are the different types of hearing aids?
Hearing aids differ in style, placement and means of amplifying sound. You can place them behind the ear, in the ear canal or within the middle ear for this effect. Analog hearing aids convert sound waves into electrical signals, which are amplified. Digital hearing aids convert sound waves into numerical codes, similar to the binary code of a computer, before amplifying them. The digital method allows more customization of various frequencies. These simple but important distinctions comprise how hearing aids are individualized.
What questions should I ask when getting a hearing aid?
The most important consideration is your mastery of the device you’ll be taking home with you. You shouldn’t be satisfied with a “plug and play” device. You should be prepared to know how to respond if your voice seems too loud or if you’re getting feedback, buzzing or background noise. You should be aware of cleaning and maintenance needs, as well as repair and service benefits that come with your device.

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Information and innovation are available for you. Don’t put it off.
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: Let's Discuss Hearing Loss

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As I muse, I wonder why we don’t take better care of our eyes and ears. Those cotton swabs and other things we place in our ears really are reckless acts. Then there’s the noise. If you think about it, it shouldn’t surprise you to hear that hearing loss is the third most common ailment. In fact, “pump up the volume” could be the motto for a period of our lives lasting about 20 years. Let’s review causes, how you might know you’re suffering from hearing loss and what you can do about it. Joining the conversation is my friend and colleague Greg Keeney, audiologist and owner of Affordable Hearing Aids in Texas.
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There are two main types of hearing loss. The first is called conductive hearing loss. There’s a problem transmitting sound because something is preventing the ear bones from relaying sound or the eardrum from vibrating in response. This can be due to several considerations.

  • An ear infection can produce fluid in the ear, interfering with the process.
  • An ear infections can scar the eardrum.
  • Wax buildup or a foreign body in the ear can block sound transmission.
  • Infections, cotton swabs, increased pressure from scuba diving or other items can rupture the eardrum.

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Another type of hearing loss (and by far the most common type) is called sensorineural hearing loss. It is due to damage to the nerves that detect sound, and it is more likely to be irreversible. There are multiple causes of this condition as well.

  • Age
  • The loud noise we are exposed to at work and play (concerts, sporting events, fireworks, gun shots, etc.)
  • Medications (certain diuretics, chemotherapy regimens, antibiotic classes known as aminoglycosides and large doses of aspirin)
  • Infections (measles, meningitis, mumps, scarlet fever)
  • Medical conditions (e.g., acoustic neuroma, Meniere’s disease)

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Unfortunately, hearing deficits can also be present at birth due to genetic conditions, birth defects, and infections transmitted from mother to baby (such as herpes, rubella and toxoplasmosis).
Symptoms are pretty straightforward. You’ll know it when you don’t hear it. There are some additional considerations that suggest may be developing hearing loss.

  • In those instances when your nerves are damaged and conducting sound erratically, certain sounds may seem excessively loud.
  • Your relative inability to hear will result in difficulty following conversations or distinguishing sounds when in noisy areas or if background noise is present.
  • Voices may sounds slurred, muffled or mumbled, and women’s voices will be harder to understand than men’s.
  • An interesting thing about your ears is that they aren’t just for hearing; they’re also your balance centers. It is common to see those suffering from ear damage also suffering from disturbances in balance.

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Check tomorrow’s post for tips on how to prevent and treat hearing loss as well as a discussion of hearing aid options.
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: Fireworks Safety

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For many, the Fourth of July is a time of celebration, happiness and creation of good family memories. In the emergency room it’s one of the two worst days to have to work (excluding any Friday the 13ths that occur during a full moon…). I’d bet it’s even worse for firefighters, as over 50,000 fires are caused each year as a result of using fireworks. The presence of fireworks, grills, alcohol, driving and other hazardous activities make for an eventful day filled with many different types of trauma and drama, including the following:

  • Burns
  • Eye injuries
  • Finger/hand lacerations and amputations
  • Motor vehicle collisions

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That said, this isn’t about us; it’s about you. Let’s take advantage of this opportunity to provide you with some safety tips to prevent injuries and enjoy your holiday. Yes, some of these may sound simplistic, but failure to follow these tips are the reasons people end up in emergency rooms.
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  • Tip #1 is to leave the fireworks to the professionals. If you want to enjoy a fireworks celebration, attend a public display. Your biggest risk here will be getting stuck in traffic.
  • If you like fireworks, get the legal kind. You can always identify legal fireworks by their being labeled with the manufacturer’s name and address. Also don’t try to make your own fireworks. Doesn’t that just sound like a formula for disaster?
  • Speaking of disasters, if you are going to use fireworks, don’t drink alcohol until everything’s done. Think about it. Alcohol + fire + explosives by design aren’t meant to have a happy ending.
  • Store your animals. They will become spooked by the fireworks and can have their hearing damaged by the blasts or otherwise hurt themselves escaping.

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  • If you allow fireworks in the home, don’t allow use by kids – or do so at your own risk. Did you know that sparklers, which many parents allow as a “safer” alternative to firecrackers, can get as hot as 1,800 degrees Fahrenheit?
  • Keep any fireworks outdoors, and keep a water supply nearby. These things cause fires.
  • Here’s a common mistake: do not light fireworks while holding. This is how your hands get burned or fingers get blown off.
  • Wear eye shields when using fireworks. Folks have lost vision and eyes playing with fireworks.
  • Do not keep fireworks in your pocket, as the friction can ignite them.
  • Never point fireworks at anything other than the sky or an open space. Buildings can catch on fire, and individuals will be injured.
  • Do not light fireworks in glass or metal containers. They explode and end up stuck in people.
  • Only attempt to light one firework at a time.
  • Never attempt to relight a dud. If it ends up not being a dud, it can fire unpredictably. If you have a dud, soak it in water for twenty minutes before attempting to discard it.
  • In fact, soak all fireworks in water prior to trashing them.
  • Do not allow kids to pick up fireworks after an event. You and they don’t know if any are still active.
  • Finally, remember that fireworks are not legal everywhere. You’re rather check and be safe then be fined or arrested if your activity is discovered.

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To be complete, here are some tips in the unfortunate event that an injury occurs as a result of fireworks.

  • Go to the closest major medical center immediately. This is an example of “time is tissue.” Don’t dally at home, and I’d recommend not even stopping at the closest emergency room. In the example when your eye or limb is at risk, you’re going to want to be at a trauma and/or burn center.
  • If an eye injury occurs as a result of fireworks, don’t rub or otherwise touch it. You’re more likely to cause additional damage than do anything constructive. Along the same line, don’t spend the time attempting to flush your eyes. Grab a shield or anything that can be used to protect the eye, and get to the emergency room. If you have sustained this injury, your eye is at risk.
  • If a minor burn occurs as a result of fireworks, remove clothing, and avoid ice. If you have access to water while waiting for an ambulance, run cool (not cold) water over the burn.

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Happy Fourth of July, and I hope you feel that way at day’s end.
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 In the News: Enacting Laws to Enforce Childhood Immunization

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In the news is vaccination. Again. A decision by the State of California now bars parents from citing religious and other “personal-belief exemptions” for opting out of childhood immunizations. Although the decision was a response to recent outbreaks of measles and other preventable diseases gaining foothold due to reduced immunization rates throughout the state, the implications reach beyond these considerations. (You may recall an outbreak of measles starting at Disneyland in December 2014 that affected 150 people.)
Of course, at the center of the debate is the notion by some that immunizations are dangerous and may be a frequent cause of autism (condolences to those families that actually have suffered). At this time, the medical science remains unequivocal that this is not the case. However, in this day and age when many people are driven by fear and opinions at least as much as by facts and science, the science is being drowned out by the high-profile platforms of celebrities and Internet anecdotes.
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A second (and rather fascinating) component to the debate is the result of seeking the balance between parental rights and presumed liberty to raise their children as they see fit versus our shared obligations as a society. This concern represents an interesting intersection between public health, individual rights and law.
To that end, the following comments aren’t statements of health care law as much as constructs of public health policy.

  • Despite what you think and what opinions you may have, the greater good (as a public health consideration) has long deemed it necessary to guard against your ability to impose your beliefs in a way that produces harm to your children. Child protection laws have followed this premise.
  • Despite what you desire, your obligation toward contributing to a safer society is greater than your rights to have personal beliefs that specifically endanger the rest of society. In this example, it remains important for citizens to understand the concept of herd immunity. As it applies here, the consideration speaks to broad societal protection from diseases as long as a critical mass of community members opt into getting immunized. This entire debate has become necessary because more than an medically tolerable number of people have decided to benefit from the efforts of others instead of contributing to the protective pool formed by mass immunization.

Medical exceptions in California will now be restricted to children with physician-certified allergies and deficiencies of the immune system. Additionally, parents who participate in various forms of home schooling may be granted waivers.

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Obviously, there’s more to follow. California is only the third state to take this step, and there are twenty states still allowing personal belief exemptions. Also, the enforcement process itself will be a source of angst. I’m sure many pediatricians will have trepidation about providing immunizations against parents’ will under the watchful eye of some form of law enforcement. Of course there will be lawsuits that will ultimately answer the questions.
In the meantime, just think about this. Your physicians have every incentive to protect your children and no incentive to harm them. If there actually was a risk from immunizations, don’t you think your doctors would be the ones most loudly sounding the horn? Don’t you think the absence of virtually any physicians doing so tells you what you need to know?
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 Vlog: Stroke – How to Save a Life

As part of the launch of http://www.jeffreysterlingbooks.com and Behind the Curtain: A Peek at Life from within the ER, the Straight, No Chaser vlog (video blog) series presents “health care basics” to keep you safe, healthy and out of the emergency room. Today’s topic is stroke, take 60 seconds to learn how to save a life. It may be your own.
In the meantime, if you’d like to read Behind the Curtain ahead of its national launch, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com!
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 Reader Request: Why You Get Grey Hair

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

And now… two questions rolled into one.

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

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

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) 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: Dehydration – When You're Too Dry to Cry

Illustration depicting a sign with a dehydration concept.
Dehydration is one of those topics that illustrates the adage “a little knowledge is a dangerous thing”— except I would adjust that to suggest a little of the wrong type of knowledge is dangerous. In this Straight, No Chaser, we’ll provide you with enough information to recognize and act on dehydration when it becomes significant or severe, because the first thing you should know is dehydration can be a life-threatening emergency. In fact dehydration due to diarrheal diseases remains the one of the topic five causes of death in the world.
Simply put, you’re dehydrated when your body is lacking in the amount of fluids it needs. This can occur from losing fluid (as occurs with excessive vomiting, diarrhea, sweating, urination or other losses), from insufficient fluid intake (as occurs with nausea, a loss of appetite, eating disorders, etc.) or from a combination of both.
Let’s approach the rest of the conversation simply by answering seven commonly asked questions.
1.  Who’s at risk/what places me at risk?
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Infants, children, the elderly and the ill are at particular risk for dehydration (and add yourself if you work outdoors during hot summer months). Children simply have lower fluid amounts than adults, and fluid losses is kids proportionately cause greater effects. All the above risk groups share the habit of a more rapid utilization and/or turnover of fluids, requiring higher fluid intake.
2.  How can I prevent dehydration?
This is relatively easy. Drink plenty of fluids every day and even more when exercising or losing fluids (e.g., menstruating, sweating on hot days, exercising or if you’re suffering from vomiting or diarrhea).
3.  How can I recognize when I’m dehydrated?
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You will do a good job of preventing dehydration if you learn the early signs, including those less severe items listed in the above picture. You will do an even better job if you don’t wait until signs develop to begin rehydration. Specifically, sipping fluids is generally recommended for anyone with vomiting, diarrhea or a febrile illness.
4.  When should I treat possible dehydration?
Here are a few scenarios that should prompt treatment.

  • There is less frequent wetting of diapers in children and urination in those older.
  • There is a relative absence/reduction of saliva and/or tears.
  • In infants, the eyes or the soft spot on the top of the head (the fontanelles) may be sunken.
  • You’re having diarrhea and/or vomiting, particularly when you seemingly can’t keep any food down.

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5.  How can I treat my dehydration?
Here are some key points for you to understand.

  • IV fluids may be necessary for moderate to severe dehydration. However, IV fluids are not necessary to treat most cases of dehydration. In fact, IVs are rarely used to treat dehydration in the rest of the world outside of the U.S.
  • You will do much better treating dehydration if you sip instead of guzzle. If you’re vomiting, and your stomach is “upset,” you likely will precipitate more vomiting if you take in large amounts of fluids at a time. Think in terms of teaspoons or syringes of fluid.
  • You may have heard that electrolyte solutions aren’t the best for rehydrating yourself, but in fact water replacement without electrolytes isn’t what you want to attempt ideally. All things considered, electrolyte solutions and “freezer pops” are very effective for basic considerations of addressing hydration.
  • The next time you’re at your local pharmacy, ask the pharmacist to show you some rehydration solutions. These are especially effective.

6.  When do I need to see a physician for dehydration?
You or your loved one may be in the midst of a life-threatening condition if you’re light-headed, confused, dizzy, lethargic or have blacked out. This should prompt a 911 call or an immediate visit to the emergency room.
There are multiple other symptoms that should prompt you to contact your physician. Here are some of them, in addition to those listed in the previous questions.

  • You are sick and can’t keep down fluids, even when you’re sipping.
  • Vomiting has continued for more than 24 hours in an adult or more than 12 hours in a child.
  • Diarrhea has continued for more than five days.
  • You have bloody stools or vomit.
  • You notice an abnormally fast heartbeat.
  • Your infant has dry skin that sags back into position slowly when pinched up into a fold.
  • You or your child has little or no urine output for eight hours.
  • You notice irritability or less activity in your infant or child.

7.  What’s the worst that can happen?

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Dehydration can lead to death and other severe disturbances, including coma, brain damage, seizures, and shock. Just understand that if you think you could be dehydrated, you should be drinking fluids.
Remember: dehydration is something seemingly simple that can go horrible wrong if unattended. The better news is when you do enact preventive and early treatment measures, outcomes are generally very good. Feel free to refer to this information when the need arises. You can always contact your SMA expert consultant at www.sterlingmedicaladvice.com or 844-SMA-TALK for any questions you have on this or any other topic.
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 in the News: SCOTUS Acts and the Top Seven Facts You Should Know About the Affordable Care Act (Obamacare)



obamacare_150625.nbcnews-fp-360-200The US Supreme Court has reaffirmed the legality of the government’s ability to provide subsidies to the governmental healthcare exchanges established to deliver care in states not establishing their own exchanges. That makes this a pretty good time to review how the Patient Protection and Affordable Care Act (ACA) fits into the American healthcare landscape.
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Let’s start with the data: as of March 2015, the US Department of Health and Human Services reported a total of 16.4 million people covered due to the ACA between the Marketplace, Medicaid expansion, young adults staying on their parents plan, and other coverage provisions. According to Gallup that translates to an uninsured rate of 11.9%, down from a high of 18% in 2013.

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

The ACA was truly a Republican initiative at birth, for those keeping score. It was born out of the Heritage Foundation (a conservative think-tank) and is more or less a combination of plans proposed by Bob Dole and executed by Mitt Romney in Massachusetts. It does not provide universal coverage or even “Medicare for all” (those would have been current Democratic ideas, although Richard Nixon proposed the same) or allow a governmental takeover of hospitals, insurance companies or physician practices (those would be socialized medicine). At it’s simplest, it’s a capitalist give to insurance companies of 30 million new patients with enhanced governmental oversight.
Here’s those 7 positive facts:
1)    The 80/20 rule: The law requires insurers to spend at least 80% of premiums on direct medical care. This nearly doubles historical trends. This is meant to expand care greatly in certain areas such as prevention and mental health. If and when this doesn’t happen, you’ll get a rebate check.
2)    Preventative care is being emphasized: you likely won’t have to pay a co-payment, co-insurance or deductible to receive services such as screenings, vaccinations and counseling.
3)    Preexisting conditions: Health plans can’t limit or deny benefits or coverage to anyone under age 19 because of the existence of pre-existing conditions. These protections will be extended to all ages beginning in 2014.
4)    Choice and ER access: You choose your own doctor. You don’t need a referral from your primary care doctor to see an Ob-Gyn doctor. You don’t need pre-approval to seek ER services outside of your plan’s network (e.g. when you’re out of town). This means those ridiculous out of network charges should go away.
5)    Young Adult Coverage: If your plan covers children, you can add or keep your kids on your policy until they turn 26, even if they’re married, don’t live with you or are otherwise eligible to have their own plan.
6)    Consumer Assistance Program: This strengthens your ability to appeal and fight decisions made by your insurance provider and guarantees your right to appeal denials of payment.
7)     End on Annual and Lifetime Limits on Coverage for all new health insurance plans by 2014.

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The bottom line is up to 30 million American are being formally brought under the umbrella of the health care instead of relying on emergency departments or going without care.  Despite not being a perfect solution, if we were to list societal priorities, closing this gap to this extent is high enough on the list that the downstream consequences are less important as considerations.  As a public health initiative, this act will accomplish many things, including putting in motion changes in health care disparities due to the lack of access to care.  I would challenge all the ongoing critics of the ACA to answer one question whenever they have an argument about why they continue to oppose implementation of the ACA: “Is your concern worth leaving 30 million Americans without structured healthcare?”
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.

The Smart Condom as STI Protection

Introduction

This Straight, No Chaser looks at an innovative use of condoms protecting you from STIs: the smart condom.

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In the News

In the news is the concept of the smart condom, a prophylactic meant to identify the presence of STDs in real-time (meaning during sex). Let’s think this through. First, knowing this was developed by a group of teenage students is fascinating and raises a lot of questions, a few of which I’ll ask and answer. I would love to have been in the room during the first production meeting just to enjoy the dynamic between the kids and the adults…
So! We’ll make this “smart condom.” It’s going to detect various STDs!

Let’s Talk!

  • Cynical, Straight, No Chaser-type doctor: Well, what would really be smart is getting checked for STDs before the decision is made to have sex.

Nope. You’ve got to meet people where they are. No one has time for that!

  • So what you’re saying is folks will engage in foreplay during which the condom will be used as a dipstick to determine the presence of a STD.

Coloured condoms
No, Doc. Nobody’s stopping during foreplay! During sex, the condoms will glow various colors if a STD is detected. Let’s say green for chlamydia, yellow for herpes, purple for HPV (human papilloma virus, the cause of genital warts) and blue for syphilis.

  • Where do I start… so the condoms will glow during intercourse. Are we expecting the participants to take an immediate break during the initiation of sex to check on this?
  • Or how about this: if you have a green glow, how do you know chlamydia is present instead of a combination of syphilis and herpes (because a mixture of blue and yellow pigments produces green)? Keep in mind, the individual with one STD is much more likely to have multiple STDs.
  • Plus, I’m not sure of the utility for HPV. About 75% of us have it anyway and there’s no treatment. This is another argument for prevention even more than detection.

Sigh. Why are you being difficult? It’s better for people to know whenever they can, so the STD can be identified and people can be prompted to go in for evaluation!

  • You could be right, and it’s good to protect the innocent, but your premise flies in the face to the reality of many individuals prone to contract STDs.
    • They tend not to use condoms at all.
    • Their behavior isn’t curbed by the presence of an STD.
    • Knowledge of an STD isn’t necessary a prompt for treatment for an STD.
    • Anyone conscientious enough to use a smart condom is probably smart enough to have gotten him or herself and any partner tested prior to engaging in sex.

Well do you have any better ideas?

  • Actually, I support the idea as an option. Anything used to help identify STDs is a good public health initiative, and even periodic use by allegedly monogamous couples would be a good deal. But could we enhance it? How about a electric zapper connected to the condom prompted by the chemical reaction? If the condom was really smart, it would make you stop having sex!

Doc, don’t you have a patient or something to do? Meeting’s over!

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Straight, No Chaser Vlog: Heart Disease

As part of the launch of http://www.jeffreysterlingbooks.com and Behind the Curtain: A Peek at Life from within the ER, the Straight, No Chaser vlog (video blog) series presents “health care basics” to keep you safe, healthy and out of the emergency room. Heart disease has been the number one cause of death in the US. Protect your heart!
In the meantime, if you’d like to read Behind the Curtain ahead of its national launch, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com!
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: Quick Tips to Save a Drowning Victim

Drowning-Prevention-Circle Infographic

Can you swim? Have you ever witnessed someone drowning or almost drown? I’ve actually been rescued. It’s a truly horrifying experience. It only takes a few minutes of your time to learn how to perform in this life-threatening environment. This Straight, No Chaser discusses simple but critical you can take to save a life – even if you can’t swim. Remember, prevention and preparation give the best opportunity for survival in many circumstances.
1. If the victim is still conscious, attempt to hand him something that can be used to pull him from the water. If you’re out of handing distance, throw either a floatable object or something he can hold onto and with which he can be pulled to safety.
2. If the victim has fallen into solid ice, and you have enough individuals, consider forming a human rope, with each individual interconnected and at least two individuals safely connected back on firm land.
Drowning-Survival-Infographic3. The victim should be removed from the water at the earliest opportunity. Forego inclination to perform chest compressions or rescue breathing in the water.
4. If possible, remove the victim from the water as flat (horizontal) as possible. You want to make every effort to avoid damage to the neck throughout this entire process (this actually would be additional injury to the neck; there’s a fair chance such an injury has already occurred).
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5. Once victims are out of the water, NEVER assume death unless you’re a qualified medical professional. Begin CPR, as described in this Straight, No Chaser.
6. If the victim has an altered mental status, check the airway for foreign material and vomitus. Use your fingers to sweep away any material visible between the mouth and throat.
7. The Heimlich maneuver (abdominal thrusting) is not effective in removing swallowed water. Don’t waste valuable time with it.
8. If you’ve successfully saved a drowning victim, don’t bother taking off wet clothes. It’s not worth the possible agitation to the neck, and recent medical thought suggests that cooling after certain likely types of cardiac arrest is especially beneficial in reducing brain injury and death. This consideration is much more important than any benefit to be gained from warming the patient. Sounds weird, but it’s the truth.
Drowning_safety_children_CPSC

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

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.

Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress.

Straight, No Chaser: The Role of Gunshot Wounds in a Nation at War with Itself

gunviolence

Apparently there is going to be an ongoing need to address this… Somewhere in the midst of reconciling the parts of me that are physician, public health professional and African-American male, I realized that I don’t have the luxury to simply review the medical aspects of gunshot wounds. As an African-American, I have lived my entire life learning and having it reinforced that I and others of my kind are a misunderstanding or inappropriate interaction away from becoming a statistic. As a physician I get to treat, and as a public health professional I get to report and fashion broad solutions to various challenges, but as an African-American, I get to live a certain reality that for me began when my father died from a so-called “random gunshot” wound when I was a small child.

GunshotWoundsBrain_300x

The trauma inflicted by a gunshot wound is not theoretical. It is a medical lie that such a thing as a warning shot exists, if indeed a bullet enters your body. Penetrating injuries to virtually all areas of the body (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshot wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone). When you shoot someone, you have factored in a possibility that the wound you inflict could be fatal. Police officers shooting individuals are aiming at areas correlating with defined statistic probabilities of death, none of which is zero. No one should ever be allowed to claim otherwise.

gun violence chicago

We live in a country that is without debate the most violent country on earth, both outside of and within all parts of our borders. From the individual’s rights to bear militia levels of arms to the police’s increasing position as military units, from the contradictions of allowing both “Open Carry” and “Stand Your Ground,” we are spiraling toward an inevitable conclusion.
You want to participate in a challenge? Stop being so deficient of attention about what’s happening before our eyes, and think and ask what the inevitable conclusion of all of this is going to be. Regardless of your political persuasion, there are issues to be addressed.

gun-violence

Consider the following facts from the Children’s Defense fund,

  • approximately 2900 children and teens died from guns in the US in both 2008 and 2009. (Does anyone think the numbers have declined since then?) That’s one child or teen every 3 hours. That’s eight children or teens every day. That’s 55 children or teens every week for two years. What is our country’s response to this? What are you specifically doing to contribute to a solution to this?
  • Young Blacks are being exterminated by gunshot wounds in this country. Black children and teens accounted for 45% of all child and teen deaths in those years, while only accounting for 15% of the total child population. Are you just going to read this statement passively without wondering about and contributing to a solution?
  • Black males 15-19 were eight times as likely as White males of the same age and two-and-a-half times as likely as their Hispanic peers to be killed in a gun homicide in 2009. In fact, gun homicide is the leading cause of death among Black teens ages 15-19 in 2008-2009.
  • The most recent analysis of data from industrialized nations shows that 87% of the children under age 15 killed by guns in these nations lived in the U.S. The homicide rate in the U.S. for teens and young adults ages 15-24 was 42.7 times higher than the combined rate for all other nations.
  • In spite of all this, in absolute numbers more White than Black children and teens have died from gun violence since data started being collected.

Using more recently available data, the Centers for Disease Control and Prevention lists the number of firearm-induced deaths in 2013 as 11,068. This accounted for over 68% of all murders in the U.S. last year.

GunViolenceend

What is it going to take to get the American public and leaders to stand up to protect the lives and safety of children over the lobbies of gun owners and sellers? America can walk and chew gum at the same time. We can fashion reasonable safety measures and restrictions that will save lives while working within the framework of current interpretations of the Constitution by the Supreme Court. This will not occur without pressure from the populace.
Martin Luther King, Jr had two famous and related quotes that are relevant and applicable here.

  • “Our lives begin to end the day we become silent about things that matter.”
  • “In the end, we will remember not the words of our enemies, but the silence of our friends.”

If you are not willing to take specific actions to eradicate the challenges facing us, that makes your condolences somewhat hollow after tragedies have occurred. It is past time to get involved in whatever way you can or choose. The life you save may be your own.
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.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress.

Straight, No Chaser: Sickle Cell Disease/Anemia and World Sickle Cell Day

sca

I don’t type this post with any amount of joy. 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 today’s topic. Today is World Sickle Cell day, meaning it’s a day calling for awareness of Sickle Cell Disease. Here are some answers to basic questions meant to provide you information about the disease.

  1. 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).

  1. How do I get Sickle Cell Disease?

sickle-cell inheritance

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.

  1. Is this the same as Sickle Cell Anemia?

sickle_cell_disease_sm

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
  1. 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.

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

sickle-cell blockage

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.

  1. 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. These patients live a life of pain and go through life treated as drug-seekers in a way we never see others treated (e.g. those with cancer or Lupus, for example). 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.
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.

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