Bee stings. Medication reactions. Food allergies. Latex. Animals. Dust. Cosmetics. What do these things have in common? You get allergic to them, and in differing degrees, they make you come to me huffing and puffing and puffy and thinking about not breathing anymore.
The basis of allergies is that your body is trying to defend you from infections. Sometimes our defense mechanisms are ‘inaccurate’, and the body overreacts to what normally might be harmless substances by producing a system wide reaction (antibodies) to certain triggers (allergens). This overreaction leads to our bodies fighting a war that isn’t meant to be fought. That manifests itself clinically by some subset of itchy rashes (wheals, urticaria or angioedema), shortness of breath, nausea, vomiting and other systemic systems. Again, it’s important to note that this can be both a systemic overreaction or just a local reaction.
One question I commonly get asked is “Why I am allergic to this now?” In other words, sometimes allergies occur after the initial exposure to seafood or peanuts, or maybe you had been stung by a bee in the past. That occurs because the first allergic exposure doesn’t always cause a visible reaction. However, it will sensitize the body such that you’re mobilized for subsequent exposures and will be prepared to ‘unload both barrels’ if it’s needed. Unfortunately, this reaction can be itself life-threatening. This life-threatening response is called anaphylaxis, and you’ll know it because more than one organ system of your body (heart palpations, breathing difficulties, gastric upset, itchy skin rashes, dizziness as your body goes into shock, etc.).
Although allergic reactions are more likely to occur in those with conditions like asthma, eczema, allergic rhinitis, seasonal allergies, and sleep apnea, to be clear, the acute allergic reaction is a different animal than seasonal allergies. If you have any sensation that you’re short of breath, your throat feels like it’s closing, you have any dizziness or altered mental status, palpitations, or if the rash is diffuse and spreading, please get to your closest emergency room. I wouldn’t be upset if you took the recommended dose of Benadryl along the way.
Final tip: Those of you who’ve suffered any type of allergic reaction to medication, food, animals, etc. should ask your physician about the utility of carrying an epipen, benadryl or steroids in the event of an emergency. If your risk profile warrants it, any or all of these could prove life saving. However, these medicines aren’t without risk, so you shouldn’t take any of them unless recommended by your physician.
Tag Archives: Conditions and Diseases
Straight, No Chaser: When Allergies Strike
Straight, No Chaser: Emergency Room Adventures – The Risk of Rabies
You can’t make this stuff up. It’s another busy night in the ER, and back-to-back patients come in, not related but dealing with the same issue. One’s a child bitten over the eye by a family dog with no shots. The next is a teenager attacked by a possum, which he decided to kick in the mouth, and of course he ends up being bitten. Both of these situations hold a certain risk of rabies exposure.
Rabies is a viral disease transmitted to humans through the bite (or scratch) of an infected animal. It infects the central nervous system, initially producing a multitude of symptoms that resemble the flu (fatigue, headaches, fever, malaise) and then progressing to exotic symptoms (including fear of water, increase in saliva, hallucinations, confusion and partial paralysis) culminating in death within days.
There is no cure for rabies once symptoms appear, so prevention is critical.
Animals that are especially likely to transmit rabies include bats (the most common culprit in the U.S.), foxes, raccoons, skunks and most other carnivores.
- Bites from these animals are regarded as rabid unless proven otherwise by lab tests. These animals must be killed and tested as soon as possible.
Animals that have been reported to transmit rabies include dogs, cats and ferrets.
- If bitten from these animals, and it appears rabid, treatment must begin immediately.
- If the biting animal appears healthy and can be observed for 10 days, then do so, but the animal must be euthanized at the first sign of rabies.
Others bites to consider include bites from rodents (woodchucks, beavers and smaller rodents), rabbits and hares, which almost never require post-exposure prophylaxis unless the area is a high rabies exposure area. In these instances decisions will be made in consultation with local public health officials.
So what should you do if bitten?
- Remember, there will be no immediate symptoms, so you can’t trust that you’re ok just because you’re feeling ok.
- Make every effort to secure the animal.
- Even if the animal isn’t available, go to the nearest emergency room as soon as possible after contact with a suspect animal.
What can you expect?
- Vigorous wound cleaning
- Assessment for and possible administration of two different types of vaccinations. These regimens can prevent the onset of rabies in virtually 100% of cases, one of which needs to be administered in five separate doses over a month’s time.
- Additional vaccination for tetanus, if appropriate
- Antibiotics if appropriate.
Remember, rabies is a fatal disease. It is meant to be avoided, but if you can’t avoid it, you need to get assessed as rapidly as possible. I hope this information helps you make correct decisions if you’re ever confronted with a rabies prone animal, and for goodness’ sake, please get any house pets all appropriate vaccines.
You can’t make this stuff up. It’s another busy night in the ER, and back-to-back patients come in, not related but dealing with the same issue. One’s a child bitten over the eye by a family dog with no shots. The next is a teenager attacked by a possum, which he decided to kick in the mouth, and of course he ends up being bitten. Both of these situations hold a certain risk of rabies exposure.
Rabies is a viral disease transmitted to humans through the bite (or scratch) of an infected animal. It infects the central nervous system, initially producing a multitude of symptoms that resemble the flu (fatigue, headaches, fever, malaise) and then progressing to exotic symptoms (including fear of water, increase in saliva, hallucinations, confusion and partial paralysis) culminating in death within days.
There is no cure for rabies once symptoms appear, so prevention is critical.
Animals that are especially likely to transmit rabies include bats (the most common culprit in the U.S.), foxes, raccoons, skunks and most other carnivores.
- Bites from these animals are regarded as rabid unless proven otherwise by lab tests. These animals must be killed and tested as soon as possible.
Animals that have been reported to transmit rabies include dogs, cats and ferrets.
- If bitten from these animals, and it appears rabid, treatment must begin immediately.
- If the biting animal appears healthy and can be observed for 10 days, then do so, but the animal must be euthanized at the first sign of rabies.
Others bites to consider include bites from rodents (woodchucks, beavers and smaller rodents), rabbits and hares, which almost never require post-exposure prophylaxis unless the area is a high rabies exposure area. In these instances decisions will be made in consultation with local public health officials.
So what should you do if bitten?
- Remember, there will be no immediate symptoms, so you can’t trust that you’re ok just because you’re feeling ok.
- Make every effort to secure the animal.
- Even if the animal isn’t available, go to the nearest emergency room as soon as possible after contact with a suspect animal.
What can you expect?
- Vigorous wound cleaning
- Assessment for and possible administration of two different types of vaccinations. These regimens can prevent the onset of rabies in virtually 100% of cases, one of which needs to be administered in five separate doses over a month’s time.
- Additional vaccination for tetanus, if appropriate
- Antibiotics if appropriate.
Remember, rabies is a fatal disease. It is meant to be avoided, but if you can’t avoid it, you need to get assessed as rapidly as possible. I hope this information helps you make correct decisions if you’re ever confronted with a rabies prone animal, and for goodness’ sake, please get any house pets all appropriate vaccines.
Straight, No Chaser: The Week In Review and Your Take Home Messages
Well, it was a busy week. Let’s look at what you may have missed.
On Sunday, we started with reviewing the important of National Minority Organ Donor Awareness Month. Over 56% of people on the national organ transplant waiting list are minorities. Consider checking in at http://organdonor.gov/becomingdonor/stateregistries.html.
On Monday, we reviewed human bites, which involve any lesion caused by your teeth that breaks the skin. These range from over aggressive hickeys to the Mike Tyson variety to lesions caused by punching someone in the teeth. We posted your FAQs separately here. My bottom line is you need to get evaluated every bite (that breaks the skin) every time.
On Tuesday, we reviewed alcohol intoxication, abuse and dependency and gave you the tools to assess that all important question: Do You Drink Too Much? We included a special Alcohol Facts and Fiction post for your consideration. In case you were wondering, that beer belly isn’t from your beer and is the least of your worries, either from the alcohol or the belly sides of the equation.
On Wednesday, we went Back to the Future in discussing low back pain and identified life-threatening conditions associated with low back pain. Remember to lift with your knees instead of your back, and beware of night-time back pain or loss of motion, sensation, bowel and/or bladder control. You probably heard the word Cauda Equina for the first time.
On Thursday, we discussed spider bites, focusing on the Black Widow and Brown Recluse spiders. Do you remember what a volcano lesion is? We also discussed shingles and answered a lot of questions about the chickenpox and shingles vaccines. The Straight, No Chaser recommendation is to get them (the vaccines, not the diseases)!
On Friday, we busted a few myths about migraine headaches and discussed life-threatening conditions associated with headaches. I want you to remember the association between migraines, heart attacks and strokes. Review the list of ‘headache plus’ symptoms to prompt you to get immediately evaluated.
On Saturday, we taught you how to fall. Do you remember what FOOSH stands for? We also reviewed the causes and treatment of ingrown toenails. Sometimes the simplest advice is the best. Stop biting your toenails!
Thanks to all of you who have filled out the Straight, No Chaser survey. I hope you’re seeing improvements to your satisfaction. The Week in Review post is a direct result of your feedback. We have 500 followers now in a month, which isn’t bad for a blog on a topic that can be a boring as health and medicine. Thanks for your support and continued feedback.
Jeffrey E. Sterling, MD
Well, it was a busy week. Let’s look at what you may have missed.
On Sunday, we started with reviewing the important of National Minority Organ Donor Awareness Month. Over 56% of people on the national organ transplant waiting list are minorities. Consider checking in at http://organdonor.gov/becomingdonor/stateregistries.html.
On Monday, we reviewed human bites, which involve any lesion caused by your teeth that breaks the skin. These range from over aggressive hickeys to the Mike Tyson variety to lesions caused by punching someone in the teeth. We posted your FAQs separately here. My bottom line is you need to get evaluated every bite (that breaks the skin) every time.
On Tuesday, we reviewed alcohol intoxication, abuse and dependency and gave you the tools to assess that all important question: Do You Drink Too Much? We included a special Alcohol Facts and Fiction post for your consideration. In case you were wondering, that beer belly isn’t from your beer and is the least of your worries, either from the alcohol or the belly sides of the equation.
On Wednesday, we went Back to the Future in discussing low back pain and identified life-threatening conditions associated with low back pain. Remember to lift with your knees instead of your back, and beware of night-time back pain or loss of motion, sensation, bowel and/or bladder control. You probably heard the word Cauda Equina for the first time.
On Thursday, we discussed spider bites, focusing on the Black Widow and Brown Recluse spiders. Do you remember what a volcano lesion is? We also discussed shingles and answered a lot of questions about the chickenpox and shingles vaccines. The Straight, No Chaser recommendation is to get them (the vaccines, not the diseases)!
On Friday, we busted a few myths about migraine headaches and discussed life-threatening conditions associated with headaches. I want you to remember the association between migraines, heart attacks and strokes. Review the list of ‘headache plus’ symptoms to prompt you to get immediately evaluated.
On Saturday, we taught you how to fall. Do you remember what FOOSH stands for? We also reviewed the causes and treatment of ingrown toenails. Sometimes the simplest advice is the best. Stop biting your toenails!
Thanks to all of you who have filled out the Straight, No Chaser survey. I hope you’re seeing improvements to your satisfaction. The Week in Review post is a direct result of your feedback. We have 500 followers now in a month, which isn’t bad for a blog on a topic that can be a boring as health and medicine. Thanks for your support and continued feedback.
Jeffrey E. Sterling, MD
Straight, No Chaser: Find Something Better to Chew On! Ingrown Toenails
The overwhelming majority of cases of ingrown toenails I see come from people chewing on their toenails. So the really, really Quick Tip is keep your feet out of your mouth. If only it was that simple.
Ingrown toenails themselves aren’t the problem. The resulting skin infection and pain are what bring you in to see me. Remember that the ingrown toenail is caused by the nail burrowing into the skin of the toe instead of growing out and over it. I’ve always found it interesting that people wait so long for such things, but in this instance, if you are going to wait, there actually are things you can do to potentially make it better. You’ll know you need to do this if you have a red, swollen, painful toe and especially short toenails.
- Soak your feet two-three times a day for 15 minutes at a time.
- Attempt to lift the nail by placing cotton or dental floss under the toenail after you soak. The goal is to get that nail corner above the skin.
- Wear open-toed shoes. This is not the time when you’d want to have any pressure on your toes.
- Place a topical antibiotic on the area.
Have you ever seen a bad ingrown toenail get removed? If you have, you’ll likely agree that it’s a deterrent to having another one. Treatment usually involves lots of local anesthesia (i.e. needles) and partial manual removal of the toenail. It’s not a good day when this has to happen.
So, you can avoid this fate. Just follow a few simple steps to avoid it in the first place.
- Don’t bite your nails. As discussed in the human bites blog post, you’ve just added really bad bacterial to the mix for when the infection occurs.
- Don’t cut your toenail so short that you can’t see some of the white tips. Be sure to let the corners extend past the skin.
- Don’t wear excessively tight shoes that literally smash your toes onto themselves.
Here’s a final note: if you’re diabetic or otherwise immunocompromised, these infections can spread rapidly and extend into the bone – these infections are very serious. In some cases this has led to amputated toes. If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.
The overwhelming majority of cases of ingrown toenails I see come from people chewing on their toenails. So the really, really Quick Tip is keep your feet out of your mouth. If only it was that simple.
Ingrown toenails themselves aren’t the problem. The resulting skin infection and pain are what bring you in to see me. Remember that the ingrown toenail is caused by the nail burrowing into the skin of the toe instead of growing out and over it. I’ve always found it interesting that people wait so long for such things, but in this instance, if you are going to wait, there actually are things you can do to potentially make it better. You’ll know you need to do this if you have a red, swollen, painful toe and especially short toenails.
- Soak your feet two-three times a day for 15 minutes at a time.
- Attempt to lift the nail by placing cotton or dental floss under the toenail after you soak. The goal is to get that nail corner above the skin.
- Wear open-toed shoes. This is not the time when you’d want to have any pressure on your toes.
- Place a topical antibiotic on the area.
Have you ever seen a bad ingrown toenail get removed? If you have, you’ll likely agree that it’s a deterrent to having another one. Treatment usually involves lots of local anesthesia (i.e. needles) and partial manual removal of the toenail. It’s not a good day when this has to happen.
So, you can avoid this fate. Just follow a few simple steps to avoid it in the first place.
- Don’t bite your nails. As discussed in the human bites blog post, you’ve just added really bad bacterial to the mix for when the infection occurs.
- Don’t cut your toenail so short that you can’t see some of the white tips. Be sure to let the corners extend past the skin.
- Don’t wear excessively tight shoes that literally smash your toes onto themselves.
Here’s a final note: if you’re diabetic or otherwise immunocompromised, these infections can spread rapidly and extend into the bone – these infections are very serious. In some cases this has led to amputated toes. If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.
Straight, No Chaser: When That Headache is More Serious Than a Migraine
All headaches are not created equal. Earlier we discussed migraines, but there’s a lot more to headaches than those. In fact, when you come to an emergency room with a history of migraines and tell us you’re having a migraine, we still aren’t thinking about migraines as the first consideration. It’s all about the life-threats. The lead picture suggests items to avoid if you’d like to improve your prognosis for headaches in general and especially certain ones like brain aneurysms.
Secondary headaches are those related to some other illness or condition that produces headaches as a symptom. These are much more common causes of headaches than migraines. They’re even more important because they could represent life-threatening conditions. So we’ll put aside the headaches caused by things like panic attacks and hyperventilation, influenza, dental pain, sinusitis, ear infections, eye strain, dehydration, hangovers, hunger and ‘brain-freeze’ (Yes, ‘ice-cream headaches’ really are a thing!), and point you to some conditions about which you should be concerned (I’m intentionally leaving out many especially uncommon and otherwise esoteric conditions. I wouldn’t want to encourage any hypochondriacs out there.).
- AVM (arteriovenous malformation): an abnormal formation of blood vessels inside your brain
- Concussions and post-concussive syndrome
- Brain aneurysm: a ballooning of one of your brain’s arteries
- Brain tumor
- Carbon monoxide poisoning
- Encephalitis/Meningitis: inflammation and/or infection of different components of your brain
- Subarachnoid hemorrhage: and other intracranial hemorrhages
- Stroke
- Temporal arteritis: inflammation of an important forehead artery with potentially devastating consequences to your sight.
Given that I’ve blogged on several of these already (you can always enter the term in the search box on the right for more details), I’m going to focus on the symptoms you may have that may suggest your headache is different enough to get evaluated for a possible life-threat.
Consider this a ‘headache plus this symptom = go to the emergency room’ list
- Altered mental status
- Confusion
- Difficulty standing or walking (different from baseline)
- Fainting after a headache
- High fever, greater than 102 F to 104 F (39 C to 40 C)
- Nausea or vomiting that’s not hangover related
- Numbness, weakness or paralysis on one side of your body
- Slurred speech
- Stiff neck
- Vision disturbances (blurred or inability to see)
All headaches are not created equal. Earlier we discussed migraines, but there’s a lot more to headaches than those. In fact, when you come to an emergency room with a history of migraines and tell us you’re having a migraine, we still aren’t thinking about migraines as the first consideration. It’s all about the life-threats. The lead picture suggests items to avoid if you’d like to improve your prognosis for headaches in general and especially certain ones like brain aneurysms.
Secondary headaches are those related to some other illness or condition that produces headaches as a symptom. These are much more common causes of headaches than migraines. They’re even more important because they could represent life-threatening conditions. So we’ll put aside the headaches caused by things like panic attacks and hyperventilation, influenza, dental pain, sinusitis, ear infections, eye strain, dehydration, hangovers, hunger and ‘brain-freeze’ (Yes, ‘ice-cream headaches’ really are a thing!), and point you to some conditions about which you should be concerned (I’m intentionally leaving out many especially uncommon and otherwise esoteric conditions. I wouldn’t want to encourage any hypochondriacs out there.).
- AVM (arteriovenous malformation): an abnormal formation of blood vessels inside your brain
- Concussions and post-concussive syndrome
- Brain aneurysm: a ballooning of one of your brain’s arteries
- Brain tumor
- Carbon monoxide poisoning
- Encephalitis/Meningitis: inflammation and/or infection of different components of your brain
- Subarachnoid hemorrhage: and other intracranial hemorrhages
- Stroke
- Temporal arteritis: inflammation of an important forehead artery with potentially devastating consequences to your sight.
Given that I’ve blogged on several of these already (you can always enter the term in the search box on the right for more details), I’m going to focus on the symptoms you may have that may suggest your headache is different enough to get evaluated for a possible life-threat.
Consider this a ‘headache plus this symptom = go to the emergency room’ list
- Altered mental status
- Confusion
- Difficulty standing or walking (different from baseline)
- Fainting after a headache
- High fever, greater than 102 F to 104 F (39 C to 40 C)
- Nausea or vomiting that’s not hangover related
- Numbness, weakness or paralysis on one side of your body
- Slurred speech
- Stiff neck
- Vision disturbances (blurred or inability to see)
Straight No Chaser: Myth Busters Edition – Migraine Headaches Fact vs. Fiction
There are 30 million migraine sufferers in the U.S. alone. Women are thrice as likely to have them, but both sexes have to address the issues raised by them. Here are some important facts regarding migraines and myths surrounding them, based on questions I’ve actually been asked. And yes, regarding the lead picture, I refuse to say she’s lion.
Myth #1: I can’t help if I get migraines. They’re hereditary, right?
There are a few things about being predisposed to having migraines I want you to know.
- If you have one parent with migraines, there’s a 50% chance you’ll have them.
- If both your parents have migraines, there’s a 75% chance you also will.
- 4 of 5 migraine sufferers have a relative with migraines.
These facts represent a predisposition. In order to have migraines, you must have triggers that will set off the migraine. That’s a vital consideration in your effort to prevent, reduce and effectively treat your migraines.
Myth #2: This is a woman’s disease. They stress out more and are more emotional. That’s why they get headaches.
It is true that there is a strong hormonal component to migraines, particularly regarding estrogen and progesterone. In fact, the incidence of migraines between the sexes is pretty equal until puberty. Migraines are increased during pre-menstruation, when hormone levels are high. Menopause may ease migraines. All of this said, men still get migraines as well because of the presence of other triggers. It certainly does not appear to be true that women suffer stress at a disproportionate rate sufficient to claim it as more of a trigger in women than in men. Both sexes’ stress responses include release of substances that expands blood vessels, causing migraines.
Myth #3: My migraines won’t get any easier as I get older.
Along the same lines as Myth #2, diminished hormone production that accompanies aging may help explain how most migraine sufferers have less frequent and less intense migraines after age 40. Because of hormonal fluctuations during perimenopause, this reduction may not be seen.
- Most people who get migraines have fewer headaches and their headaches aren’t as strong once they hit 40. However, this may not be the case for women going through perimenopause. If hormones are a trigger for a woman’s migraines, then she could have more headaches during the period around menopause.
Myth #4: Once I’m diagnosed with migraines, only narcotics will help.
First of all, trigger identification and prevention is vital. Migraine trigger management and treatment is a topic unto itself, but I’d like to point out a few important considerations.
- Think triggers first and last. The list of triggers includes foods (think chocolate, alcohol, aged cheese and caffeine; results vary with the individual), cold, stress, smoking and certain medications. Alterations in mealtimes, exercise and sleep patterns must be monitored as well, these tend to exacerbate migraines. Migraine sufferers are advised to maintain a headache log to identify triggers as things occur.
- A special comment about caffeine: It helps some people, but for others it’s a migraine trigger, particularly if you’re a heavy user. If you don’t drink many caffeinated beverages, one may help if you’re having a less than severe migraine. If you’re taking enough in to create a caffeine dependency, overnight withdrawal may be enough to trigger a morning migraine.
Patients must become their own experts on how and when you use different medications.
- I hope you and your primary care physician have discussed and have you focusing on your abortive medications. These medicines can stop further progression of migraines if used early enough at the first sign of a migraine.
- Painkillers have consequences. As tolerance to and dependence on narcotics develop, withdrawal symptoms become more prominent. Rebound headaches are a major component of these symptoms. That’s a vicious cycle that doesn’t have a happy ending. It’s important to note that your health care professionals do appreciate there is a difference between being drug seeking and drug dependent.
Myth #5: Migraines really don’t cause problems beyond the headaches, right?
Wrong. If you have migraines, take special care to ensure you have a healthy heart and a low risk for strokes. Refer to the Straight, No Chaser archives (or just type in the search engine to the right) for information on stroke recognition and heart attack recognition. If you’re a female and have migraines with aura (certain warning symptoms that precede you migraine like nausea, dizziness, light sensitivity, and seeing zig-zag lines), your heart attack risk climbs by over 90% and your stroke risk more than doubles (increases by up to 108%). The presence of migraines without aura also raises the risk of heart attack and stroke but by lesser amounts.
As per routine at Straight, No Chaser, the message is simple, but execution is key. Prevention is protection, and knowledge is power. Check back this afternoon for life threatening causes of headaches, and feel free to send questions and comments. Take good care.
There are 30 million migraine sufferers in the U.S. alone. Women are thrice as likely to have them, but both sexes have to address the issues raised by them. Here are some important facts regarding migraines and myths surrounding them, based on questions I’ve actually been asked. And yes, regarding the lead picture, I refuse to say she’s lion.
Myth #1: I can’t help if I get migraines. They’re hereditary, right?
There are a few things about being predisposed to having migraines I want you to know.
- If you have one parent with migraines, there’s a 50% chance you’ll have them.
- If both your parents have migraines, there’s a 75% chance you also will.
- 4 of 5 migraine sufferers have a relative with migraines.
These facts represent a predisposition. In order to have migraines, you must have triggers that will set off the migraine. That’s a vital consideration in your effort to prevent, reduce and effectively treat your migraines.
Myth #2: This is a woman’s disease. They stress out more and are more emotional. That’s why they get headaches.
It is true that there is a strong hormonal component to migraines, particularly regarding estrogen and progesterone. In fact, the incidence of migraines between the sexes is pretty equal until puberty. Migraines are increased during pre-menstruation, when hormone levels are high. Menopause may ease migraines. All of this said, men still get migraines as well because of the presence of other triggers. It certainly does not appear to be true that women suffer stress at a disproportionate rate sufficient to claim it as more of a trigger in women than in men. Both sexes’ stress responses include release of substances that expands blood vessels, causing migraines.
Myth #3: My migraines won’t get any easier as I get older.
Along the same lines as Myth #2, diminished hormone production that accompanies aging may help explain how most migraine sufferers have less frequent and less intense migraines after age 40. Because of hormonal fluctuations during perimenopause, this reduction may not be seen.
- Most people who get migraines have fewer headaches and their headaches aren’t as strong once they hit 40. However, this may not be the case for women going through perimenopause. If hormones are a trigger for a woman’s migraines, then she could have more headaches during the period around menopause.
Myth #4: Once I’m diagnosed with migraines, only narcotics will help.
First of all, trigger identification and prevention is vital. Migraine trigger management and treatment is a topic unto itself, but I’d like to point out a few important considerations.
- Think triggers first and last. The list of triggers includes foods (think chocolate, alcohol, aged cheese and caffeine; results vary with the individual), cold, stress, smoking and certain medications. Alterations in mealtimes, exercise and sleep patterns must be monitored as well, these tend to exacerbate migraines. Migraine sufferers are advised to maintain a headache log to identify triggers as things occur.
- A special comment about caffeine: It helps some people, but for others it’s a migraine trigger, particularly if you’re a heavy user. If you don’t drink many caffeinated beverages, one may help if you’re having a less than severe migraine. If you’re taking enough in to create a caffeine dependency, overnight withdrawal may be enough to trigger a morning migraine.
Patients must become their own experts on how and when you use different medications.
- I hope you and your primary care physician have discussed and have you focusing on your abortive medications. These medicines can stop further progression of migraines if used early enough at the first sign of a migraine.
- Painkillers have consequences. As tolerance to and dependence on narcotics develop, withdrawal symptoms become more prominent. Rebound headaches are a major component of these symptoms. That’s a vicious cycle that doesn’t have a happy ending. It’s important to note that your health care professionals do appreciate there is a difference between being drug seeking and drug dependent.
Myth #5: Migraines really don’t cause problems beyond the headaches, right?
Wrong. If you have migraines, take special care to ensure you have a healthy heart and a low risk for strokes. Refer to the Straight, No Chaser archives (or just type in the search engine to the right) for information on stroke recognition and heart attack recognition. If you’re a female and have migraines with aura (certain warning symptoms that precede you migraine like nausea, dizziness, light sensitivity, and seeing zig-zag lines), your heart attack risk climbs by over 90% and your stroke risk more than doubles (increases by up to 108%). The presence of migraines without aura also raises the risk of heart attack and stroke but by lesser amounts.
As per routine at Straight, No Chaser, the message is simple, but execution is key. Prevention is protection, and knowledge is power. Check back this afternoon for life threatening causes of headaches, and feel free to send questions and comments. Take good care.
Straight, No Chaser: When That Back Pain is the Least of Your Problems
Back pain hurts, but there are various causes of that pain that will kill or cripple you. Here’s some information on some diseases that present with back pain representing life-threats. Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards. Forewarned is forearmed.
Let’s start where we left off on the last post and identify what I was talking about….
Here are a few clues to help you hone in on whether your back pain requires emergency attention. Remember pain and pathology (serious disease) are two different considerations. I’m describing medical emergencies here and admittedly being overly simplistic.
- Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
- Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
- Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
- New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
- Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
- Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer.
- Sudden sexual dysfunction: See Cauda Equina Syndrome above
- Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
- Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
- Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.
Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs. I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future. The take home consideration here is to use these cues to know when to get rapidly evaluated. Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
Back pain hurts, but there are various causes of that pain that will kill or cripple you. Here’s some information on some diseases that present with back pain representing life-threats. Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards. Forewarned is forearmed.
Let’s start where we left off on the last post and identify what I was talking about….
Here are a few clues to help you hone in on whether your back pain requires emergency attention. Remember pain and pathology (serious disease) are two different considerations. I’m describing medical emergencies here and admittedly being overly simplistic.
- Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
- Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
- Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
- New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
- Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
- Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer.
- Sudden sexual dysfunction: See Cauda Equina Syndrome above
- Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
- Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
- Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.
Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs. I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future. The take home consideration here is to use these cues to know when to get rapidly evaluated. Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
Straight, No Chaser: Your Questions about Human Bites
It seems that you found today’s post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?
- Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…
2) What’s a Boxer’s Fracture?
- A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.
3) Is a human’s mouth really dirtier than a goat’s mouth?
- It’s correct to say the bacteria in a human’s mouth cause more disease.
4) Is a bite the same as a puncture wound?
- The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).
5) I received a bite and didn’t get stitched up. Why?
- This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
- Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
- It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.
6) Why didn’t Dracula ever get Hepatitis or HIV?
- Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.
It seems that you found today’s post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?
- Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…
2) What’s a Boxer’s Fracture?
- A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.
3) Is a human’s mouth really dirtier than a goat’s mouth?
- It’s correct to say the bacteria in a human’s mouth cause more disease.
4) Is a bite the same as a puncture wound?
- The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).
5) I received a bite and didn’t get stitched up. Why?
- This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
- Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
- It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.
6) Why didn’t Dracula ever get Hepatitis or HIV?
- Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.
Straight No Chaser: Human Bites
I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious, but as an emergency physician knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first Quick Tip is to do the same.
Maybe it’s where I’m located, but I tend to see way more ‘fight bites’ than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who ‘won’ the fight being the one who has to come in for medical treatment. He will have cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize how concentrated all of the structures (tendons, blood vessels, muscles and bones) are in the hand. He also doesn’t know that they’re confined to a very limited space, and seeding an infection in that space makes things really bad really quick. These guys are very dangerous because they tend to deny ever getting into the fight, ascribing the injury to something else (like punching a tree) – at least until I ask him why a tooth is inside his hand.
Then there’s the “Yes, I was bitten” variety, including activity where the teeth engaged the victim instead of the fist engaging a tooth. Think of the above Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears and other unmentionables)! Children sometimes need to learn to stop biting as a behavior. Biting is sometimes seen in sexual assault, physical abuse and in self-mutilating behavior or with mentally handicapped individuals.
A third type is the ‘We love too much!’ variety. These may include hickeys (that actually break the skin), folks biting off their hangnails, and individuals who create skin infections by biting their toenails and fingernails. Yes, it happens more than you’d think.
The commonality to all of these scenarios is saliva found its way through the skin. Because of the virulence of those bacteria contained within, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness and possibly pus from the wound and fever develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, you need to be evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop, and in fact these bites require immunization for tetanus. Bottom line: there’s no reason not to get evaluated if you develop those signs of infection I mentioned, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.
So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies, peroxide, alcohol and anything else that burns. You’re making things worse for yourself (those agents cause skin damage more than they’re ‘cleaning’ the area).
2) Apply ice – never directly to the wound, but in a towel. Use for 15 minutes off then 15 minutes on.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious, but as an emergency physician knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first Quick Tip is to do the same.
Maybe it’s where I’m located, but I tend to see way more ‘fight bites’ than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who ‘won’ the fight being the one who has to come in for medical treatment. He will have cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize how concentrated all of the structures (tendons, blood vessels, muscles and bones) are in the hand. He also doesn’t know that they’re confined to a very limited space, and seeding an infection in that space makes things really bad really quick. These guys are very dangerous because they tend to deny ever getting into the fight, ascribing the injury to something else (like punching a tree) – at least until I ask him why a tooth is inside his hand.
Then there’s the “Yes, I was bitten” variety, including activity where the teeth engaged the victim instead of the fist engaging a tooth. Think of the above Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears and other unmentionables)! Children sometimes need to learn to stop biting as a behavior. Biting is sometimes seen in sexual assault, physical abuse and in self-mutilating behavior or with mentally handicapped individuals.
A third type is the ‘We love too much!’ variety. These may include hickeys (that actually break the skin), folks biting off their hangnails, and individuals who create skin infections by biting their toenails and fingernails. Yes, it happens more than you’d think.
The commonality to all of these scenarios is saliva found its way through the skin. Because of the virulence of those bacteria contained within, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness and possibly pus from the wound and fever develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, you need to be evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop, and in fact these bites require immunization for tetanus. Bottom line: there’s no reason not to get evaluated if you develop those signs of infection I mentioned, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.
So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies, peroxide, alcohol and anything else that burns. You’re making things worse for yourself (those agents cause skin damage more than they’re ‘cleaning’ the area).
2) Apply ice – never directly to the wound, but in a towel. Use for 15 minutes off then 15 minutes on.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
Straight, No Chaser: Trauma Quick Tips and The Week In Review
This week in Straight, No Chaser, we reviewed multiple topics related to Trauma, the #1 cause of death between ages 1-44. Here’s the Week In Review and featured Quick Tips.
1) Over the weekend, we started with discussions of Amputations of Permanent Teeth and Fingers.
- Remember, you lose 1% viability per minute for a dislodged tooth. Get help quick! https://jeffreysterlingmd.com/2013/07/27/straight-no-chaser-saturday-quick-tips-the-tooth-of-the-matter-is/
- The transport of displaced fingers and teeth is vital to successful reimplantation. Never place them directly on ice! https://jeffreysterlingmd.com/2013/07/28/sunday-quick-tips-give-me-the-finger/
2) On Monday, we talked about Motor Vehicle Crashes.
https://jeffreysterlingmd.com/2013/07/29/straight-no-chaser-human-shark-week-part-1-motor-vehicle-trauma/
https://jeffreysterlingmd.com/2013/07/29/trauma-quick-tips-how-to-survive-that-motor-vehicle-crash-mvc/
- Avoiding distracted driving is the most important factor in preventing crashes.
- Wearing your seat beat is the most important factor in surviving crashes.
- The middle back seat (while wearing a seat belt) is the safest place in the car.
3) On Tuesday, we reviewed Traumatic Brain Injuries/Concussions.
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussions-part-i/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussion-part-ii/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-concussions-post-script-a-neurologists-thoughts/
- Dr. Flippen, a neurologist from UCLA, reminded us that most patients will recover but never as fast as they wish.
- After a head injury, expect not to be released back to sporting activity for at least two weeks.
4) On Wednesday, we reviewed Mass Disasters and talked about the importance of an Emergency Kit.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-when-disaster-strikes/
- Remember to have access to 1 gallon per day per person, half for drinking and half for cooking/hygiene.
5) On Wednesday, we also discussed Dog, Cat and Shark Bites.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-who-let-the-dogs-out-animal-bites/
- Cat scratches are also a major infection risk and should be evaluated.
- Who’d have thought sharks were nibbling you out of curiosity instead of biting you out of hunger?
6) On Thursday, we reviewed Penetrating Trauma (Gunshot and Stab Wounds). https://jeffreysterlingmd.com/2013/08/01/straight-no-chaser-gunshot-and-stab-wounds/
- Remember the ‘Golden Hour’ of Trauma and get seen as soon as possible after being stabbed or shot, just as soon as you ensure your safety.
- It is very important to avoid worsening possible spinal injuries by excessive movement.
7) On Friday, we reviewed Residential Fires and its associated trauma.
- In Part I, we emphasized the importance of installing smoke and carbon monoxide detectors, having an escape plan and not sticking around to fight the fire. https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-the-roof-is-on-fire-the-trauma-of-residential-fires/
- In Part II, we discussed treatment of possible injuries that may occur. https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-your-questions-on-treatment-of-fire-related-injuries/
- Remember if any head or neck injuries exist, try your best not to move.
- Remember that if you’re feeling like you have the flu after being exposed to a fire, it could be carbon monoxide poisoning!
8) On Saturday, we reviewed Snakebites.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-stop-the-life-you-save-may-be-your-own-snake-bites/
- We debunked the myth about sucking venom out of snakebite wounds. Don’t do it!
9) Saturday, we also reviewed Elderly Falls.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-ive-fallen-and-cant-get-up-quick-tips-on-elderly-falls/
- We identified head injuries/bleeds, lacerations and hip fractures as injuries to guard against.
- We discussed the importance of home improvements, diet, exercise and checking for osteoporosis and vision checking for maintainance of health.
This week in Straight, No Chaser, we reviewed multiple topics related to Trauma, the #1 cause of death between ages 1-44. Here’s the Week In Review and featured Quick Tips.
1) Over the weekend, we started with discussions of Amputations of Permanent Teeth and Fingers.
- Remember, you lose 1% viability per minute for a dislodged tooth. Get help quick! https://jeffreysterlingmd.com/2013/07/27/straight-no-chaser-saturday-quick-tips-the-tooth-of-the-matter-is/
- The transport of displaced fingers and teeth is vital to successful reimplantation. Never place them directly on ice! https://jeffreysterlingmd.com/2013/07/28/sunday-quick-tips-give-me-the-finger/
2) On Monday, we talked about Motor Vehicle Crashes.
https://jeffreysterlingmd.com/2013/07/29/straight-no-chaser-human-shark-week-part-1-motor-vehicle-trauma/
https://jeffreysterlingmd.com/2013/07/29/trauma-quick-tips-how-to-survive-that-motor-vehicle-crash-mvc/
- Avoiding distracted driving is the most important factor in preventing crashes.
- Wearing your seat beat is the most important factor in surviving crashes.
- The middle back seat (while wearing a seat belt) is the safest place in the car.
3) On Tuesday, we reviewed Traumatic Brain Injuries/Concussions.
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussions-part-i/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussion-part-ii/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-concussions-post-script-a-neurologists-thoughts/
- Dr. Flippen, a neurologist from UCLA, reminded us that most patients will recover but never as fast as they wish.
- After a head injury, expect not to be released back to sporting activity for at least two weeks.
4) On Wednesday, we reviewed Mass Disasters and talked about the importance of an Emergency Kit.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-when-disaster-strikes/
- Remember to have access to 1 gallon per day per person, half for drinking and half for cooking/hygiene.
5) On Wednesday, we also discussed Dog, Cat and Shark Bites.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-who-let-the-dogs-out-animal-bites/
- Cat scratches are also a major infection risk and should be evaluated.
- Who’d have thought sharks were nibbling you out of curiosity instead of biting you out of hunger?
6) On Thursday, we reviewed Penetrating Trauma (Gunshot and Stab Wounds). https://jeffreysterlingmd.com/2013/08/01/straight-no-chaser-gunshot-and-stab-wounds/
- Remember the ‘Golden Hour’ of Trauma and get seen as soon as possible after being stabbed or shot, just as soon as you ensure your safety.
- It is very important to avoid worsening possible spinal injuries by excessive movement.
7) On Friday, we reviewed Residential Fires and its associated trauma.
- In Part I, we emphasized the importance of installing smoke and carbon monoxide detectors, having an escape plan and not sticking around to fight the fire. https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-the-roof-is-on-fire-the-trauma-of-residential-fires/
- In Part II, we discussed treatment of possible injuries that may occur. https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-your-questions-on-treatment-of-fire-related-injuries/
- Remember if any head or neck injuries exist, try your best not to move.
- Remember that if you’re feeling like you have the flu after being exposed to a fire, it could be carbon monoxide poisoning!
8) On Saturday, we reviewed Snakebites.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-stop-the-life-you-save-may-be-your-own-snake-bites/
- We debunked the myth about sucking venom out of snakebite wounds. Don’t do it!
9) Saturday, we also reviewed Elderly Falls.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-ive-fallen-and-cant-get-up-quick-tips-on-elderly-falls/
- We identified head injuries/bleeds, lacerations and hip fractures as injuries to guard against.
- We discussed the importance of home improvements, diet, exercise and checking for osteoporosis and vision checking for maintainance of health.
Straight, No Chaser: Stop, The Life You Save May Be Your Own – Snake Bites
So you’ve been snake bitten. What will you do next?
First things first. Stay calm. Call 911. Realize that most snake bites are non-venomous (A really quick tip regarding the likelihood of a venomous snake: most have triangular heads.). Here’s 10 additional steps to take while waiting for your help to arrive.
5 Things To Do
- Protect yourself. Get out of the snake’s striking distance. It should be trying to get away from you as well.
- Lie down. Keep the wound below the level of the heart.
- Be still. Activity simply facilitates spreading of any venom present.
- Cover the wound with a loose, clean dressing. Immobilize the extremity if possible.
- Remove all restrictive clothing and jewelry from the area, because the area will swell.
5 Things Not to Do
- Try to suck out venom.
- Try to cut out the area bitten.
- Apply any constrictive dressings.
- Apply any cold or ice packs to the wound site.
- Run to help.
If you’re lucky enough to have a snake bite kit, you’ll simply follow those instructions, which are a modified version of the instructions I’ve just given.
You will need to be seen by a health care provider for consideration of the following:
- Anti-venom may be needed.
- Tetanus immunization may be needed.
- Appropriate wound cleaning will be needed.
- Antibiotics for skin infection may be needed.
Let me know if you have any questions.
So you’ve been snake bitten. What will you do next?
First things first. Stay calm. Call 911. Realize that most snake bites are non-venomous (A really quick tip regarding the likelihood of a venomous snake: most have triangular heads.). Here’s 10 additional steps to take while waiting for your help to arrive.
5 Things To Do
- Protect yourself. Get out of the snake’s striking distance. It should be trying to get away from you as well.
- Lie down. Keep the wound below the level of the heart.
- Be still. Activity simply facilitates spreading of any venom present.
- Cover the wound with a loose, clean dressing. Immobilize the extremity if possible.
- Remove all restrictive clothing and jewelry from the area, because the area will swell.
5 Things Not to Do
- Try to suck out venom.
- Try to cut out the area bitten.
- Apply any constrictive dressings.
- Apply any cold or ice packs to the wound site.
- Run to help.
If you’re lucky enough to have a snake bite kit, you’ll simply follow those instructions, which are a modified version of the instructions I’ve just given.
You will need to be seen by a health care provider for consideration of the following:
- Anti-venom may be needed.
- Tetanus immunization may be needed.
- Appropriate wound cleaning will be needed.
- Antibiotics for skin infection may be needed.
Let me know if you have any questions.
Straight, No Chaser: Concussions Post-Script – A Neurologist's Thoughts
I’d like to welcome and thank my good friend and noted UCLA Neurologist, Dr. Charles Flippen, II to Straight, No Chaser as a contributor to this topic.
His words:
“Everyone should understand the need for both physical and cognitive rest following concussion to allow full recovery (no symptoms, no meds). That may include postponing tests and/or reduced academic workload with graduated “return to play”. Regarding post-concussion syndrome, most patients will recover, never as fast as they would wish. It will usually be stepwise with headache as usually among the last symptoms to resolve.”
I’d like to welcome and thank my good friend and noted UCLA Neurologist, Dr. Charles Flippen, II to Straight, No Chaser as a contributor to this topic.
His words:
“Everyone should understand the need for both physical and cognitive rest following concussion to allow full recovery (no symptoms, no meds). That may include postponing tests and/or reduced academic workload with graduated “return to play”. Regarding post-concussion syndrome, most patients will recover, never as fast as they would wish. It will usually be stepwise with headache as usually among the last symptoms to resolve.”
Straight, No Chaser: Why is Life so Traumatic? (aka Human Shark Week!)
Introduction
If there were a human equivalent to shark week, it would be TRAUMA WEEK! That’s right. Trauma has all the drama, excitement and tragedy as shark bites and often makes about as much sense as exposing yourself to a shark.
Trauma is the #1 cause of death between ages 1 and 44. In fact, according to the Centers for Disease Control and Prevention, trauma accounts for more deaths during the majority of life than all other causes combined, checking in at just over 50%. Traumatic causes of injury are so common and avoidable that it’s worth looking at the top entities separately. This week we will do just, informing you of where the danger lies and offer simple tips to keep you alive.
So buckle up (literally). We’ll get into motor vehicle collisions, brain injuries, domestic abuse, suicides and homicides, drownings and other home/recreational injuries. Trauma. Unfortunately, it’s for everyone.
Follow us!
Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK. Likewise, please share our page with your friends on WordPress! Also like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.
Copyright ©2013- 2019 · Sterling Initiatives, LLC · Powered by WordPress
Introduction
If there were a human equivalent to shark week, it would be TRAUMA WEEK! That’s right. Trauma has all the drama, excitement and tragedy as shark bites and often makes about as much sense as exposing yourself to a shark.
Trauma is the #1 cause of death between ages 1 and 44. In fact, according to the Centers for Disease Control and Prevention, trauma accounts for more deaths during the majority of life than all other causes combined, checking in at just over 50%. Traumatic causes of injury are so common and avoidable that it’s worth looking at the top entities separately. This week we will do just, informing you of where the danger lies and offer simple tips to keep you alive.
So buckle up (literally). We’ll get into motor vehicle collisions, brain injuries, domestic abuse, suicides and homicides, drownings and other home/recreational injuries. Trauma. Unfortunately, it’s for everyone.
Follow us!
Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK. Likewise, please share our page with your friends on WordPress! Also like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.
Copyright ©2013- 2019 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Understanding Asthma – Toothpicks and Snot (Part 2 of 2)
As we move into discussing asthma treatment, remember that asthmatics die at an alarming rate. I mentioned yesterday (and it bears repeating) that death rates have increased over 50% in the last few decades. If you’re an asthmatic, avoid taking care of yourself at your own peril. Your next asthma attack could be your last.
The other thing to remember is that asthma is a reversible disease – until it’s not. At some point (beginning somewhere around age 35 or so), the ongoing inflammation and damage to the lungs will create some irreversible changes, and then the situation’s completely different, possibly predisposing asthmatics to other conditions such as chronic bronchitis, COPD (chronic obstructive pulmonary disease) and lung cancer. This simply reiterates the importance of identifying and removing those triggers.
Given that, let’s talk about asthma control as treatment. Consider the following quick tips you might use to help you reduce or virtually eliminate asthma attacks:
- Avoid cigarette smoke (including second hand smoke) like the plague!
- Avoid long haired animals, especially cats.
- Avoid shaggy carpets, window treatments or other household fixtures that retain dust.
- If you’re spraying any kind of aerosol, if it’s allergy season, if you’re handling trash, or if you react to cold weather, wear a mask while you’re doing it. It’s better to not look cool for a few moments than to have to look at an emergency room for a few hours or a hospital room for a few days.
- Be careful to avoid colds and the flu. Get that flu shot yearly.
If and when all of this fails, and you’re actually in the midst of an asthma attack, treatment options primarily center around two types of medications.
- Short (and quick) acting bronchodilators (e.g. albuterol, ventolin, proventil, xopenex, alupent, maxair) functionally serve as props (‘toothpicks’, no not real ones, and don’t try to use toothpicks at home) to keep the airways open against the onslaught of mucous buildup inside the lungs combined with other inflammatory changes trying to clog the airways. These medications do not treat the underlying condition. They only buy you time and attempt to keep the airways open for…
- Steroids (e.g. prednisone, prelone, orapred, solumedrol, decadron – none of which are the muscle building kind) are the mainstay of acute asthma treatment, as they combat the inflammatory reaction and other changes that cause the asthma attack. One can functionally think of steroids as a dump truck moving in to scoop the snot out of the airways. The only issue with the steroids is they take 2-4 hours to start working, so you have to both get them on board as early as possible while continuing to use the bronchodilators to stem the tide until the steroids kick in.
If you are not successful in avoiding those triggers over the long term, you may need to be placed on ‘controller’ medications at home, which include lower doses of long-acting bronchodilators and steroids.
So in summary, the best treatment of asthma is management of its causes. Avoid the triggers, thus reducing your acute attacks. Become educated about signs of an attack. When needed, get help sooner rather than later. And always keep an inhaler on you. It could be the difference between life and death.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
As we move into discussing asthma treatment, remember that asthmatics die at an alarming rate. I mentioned yesterday (and it bears repeating) that death rates have increased over 50% in the last few decades. If you’re an asthmatic, avoid taking care of yourself at your own peril. Your next asthma attack could be your last.
The other thing to remember is that asthma is a reversible disease – until it’s not. At some point (beginning somewhere around age 35 or so), the ongoing inflammation and damage to the lungs will create some irreversible changes, and then the situation’s completely different, possibly predisposing asthmatics to other conditions such as chronic bronchitis, COPD (chronic obstructive pulmonary disease) and lung cancer. This simply reiterates the importance of identifying and removing those triggers.
Given that, let’s talk about asthma control as treatment. Consider the following quick tips you might use to help you reduce or virtually eliminate asthma attacks:
- Avoid cigarette smoke (including second hand smoke) like the plague!
- Avoid long haired animals, especially cats.
- Avoid shaggy carpets, window treatments or other household fixtures that retain dust.
- If you’re spraying any kind of aerosol, if it’s allergy season, if you’re handling trash, or if you react to cold weather, wear a mask while you’re doing it. It’s better to not look cool for a few moments than to have to look at an emergency room for a few hours or a hospital room for a few days.
- Be careful to avoid colds and the flu. Get that flu shot yearly.
If and when all of this fails, and you’re actually in the midst of an asthma attack, treatment options primarily center around two types of medications.
- Short (and quick) acting bronchodilators (e.g. albuterol, ventolin, proventil, xopenex, alupent, maxair) functionally serve as props (‘toothpicks’, no not real ones, and don’t try to use toothpicks at home) to keep the airways open against the onslaught of mucous buildup inside the lungs combined with other inflammatory changes trying to clog the airways. These medications do not treat the underlying condition. They only buy you time and attempt to keep the airways open for…
- Steroids (e.g. prednisone, prelone, orapred, solumedrol, decadron – none of which are the muscle building kind) are the mainstay of acute asthma treatment, as they combat the inflammatory reaction and other changes that cause the asthma attack. One can functionally think of steroids as a dump truck moving in to scoop the snot out of the airways. The only issue with the steroids is they take 2-4 hours to start working, so you have to both get them on board as early as possible while continuing to use the bronchodilators to stem the tide until the steroids kick in.
If you are not successful in avoiding those triggers over the long term, you may need to be placed on ‘controller’ medications at home, which include lower doses of long-acting bronchodilators and steroids.
So in summary, the best treatment of asthma is management of its causes. Avoid the triggers, thus reducing your acute attacks. Become educated about signs of an attack. When needed, get help sooner rather than later. And always keep an inhaler on you. It could be the difference between life and death.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
