Tag Archives: Conditions and Diseases

Fibromyalgia – Facts and Controversies

September 26, 2018General Health and Wellness, Mental Health, Neurology844-SMA-TALK, Behind the Curtain, chronic fatigue syndrome, chronic pain, Conditions and Diseases, fibromyalgia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Previously, Straight, No Chaser has discussed the frustration of uncertainty some patients have with having symptoms and not being given a diagnosis (much less a cure). Imagine if that uncertainty arose in the context of excruciating pain lasting for what seems like all day. There was a time when this was the case to a much greater extent, and then several medical conditions gained recognition and/or prominence. Some of these include chronic pain syndrome, chronic fatigue syndrome, temporomandibular joint syndrome (TMJ syndrome), endometriosis, inflammatory bowel disorder, vaginismus, vulvodynia and still other conditions. Today we will address one such condition, fibromyalgia.

The symptoms of fibromyalgia include muscle pain and fatigue. This pain may take one of several typical forms, including headaches, painful menstrual periods and – most interestingly – “tender points.” Tender points are specific places on the body that hurt when you apply pressure. These can occur most anywhere but usually involve the extremities, neck, back, hips and shoulders. Other symptoms include numbness and tingling in your hands and feet, difficulty sleeping and morning stiffness. In some cases a condition called “fibro fog” occurs, in which clouding of thinking and memory occurs. It shouldn’t be a surprise that these other symptoms often result in clinical depression.

Unfortunately, fibromyalgia is a condition, not a disease that we can attach to a specific cause. However, there are several diseases to which fibromyalgia has been linked. In short, many stressful life conditions and events can serve as triggers for this disorder. Some of the more notable conditions and triggers include ankylosing spondylitis (aka spinal arthritis), motor vehicle crashes, rheumatoid arthritis and systemic lupus erythematosus (aka lupus). So many such triggers exists that now over 5 million Americans have been labeled with the diagnosis. Interesting, 80-90% of those so diagnosed are women, most during middle age.

Given the absence of an identified cause, treatment is mostly symptomatic, attempting to address the pain and other things that disrupt one’s activities of daily living. More importantly, once affected, you need to implement the lifestyle changes that have been shown to help, including improving diet, exercise, getting enough sleep, changing one’s work and home environments, and taking medications as prescribed.

I would be remiss if I didn’t address the controversies surrounding fibromyalgia. Given the absence of a defined cause, many patients suffering from fibromyalgia and similar disorders are often perceived to be drug seeking, particularly in emergency departments. It is very frustrating for physicians to care for patients they can’t “fix.” Although drug seeking patients do exist, multiple medical studies have shown that inadequate treatment of pain remains one of the great faux pas of medicine. It is an equal disservice to give in to a patient’s request for pain medication as a routine matter without the benefit of a full evaluation. There are many defined medical conditions that present with pain. More deliberate and vigorous evaluations can not only put a more definitive name to the pain but can lead to better outcomes for those patients.

Order your copy of Dr. Sterling’s new 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.72hourslife.com. Receive introductory pricing with orders!

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The Other Side of 40 – Cerebrovascular System Health (Your Brain)

September 20, 2018General Health and Wellness, Mental Health, Health Prevention844-SMA-TALK, Behind the Curtain, Blood vessel, Brain, Cerebrovascular disease, Conditions and Diseases, health, Neurological Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Stroke, There are 72 Hours in a Day, Transient ischemic attackJeffrey Sterling, MD

Introduction

This Straight, No Chaser post is about cerebrovascular system health after age 40.

Last but not least, in the last part of this series, let’s talk about your brain. However, first we make a summary comment. Life after 40 poses both opportunity and obstacles. Age 35 to 40 is the age when your lifestyle begins to catch up with you. Alternatively, it is the age when the work you’ve put in begins to pay off. For those who’ve lived life smartly and healthily, 40 really is the new 30. For those who’ve lived life less diligently, 40 may as well be 60, and your health probably reflects that. It’s really not that difficult. Diet, exercise, don’t smoke and alcohol in moderation keeps a body strong. Now to your brain…

Changes

As you age, cholesterol based blockages (plaque formation) inside the arteries and hardening of the arteries in the blood vessels that supply the brain is called cerebrovascular disease, and it causes strokes. These changes begin in earnest at about age 35. Prior to the complete blockage of the blood vessels, the brain is deprived of adequate blood flow (and oxygen) resulting in less than optimal brain functioning, such as confusion, disorientation, memory loss and ‘mini-strokes’ (TIAs). Strokes may result in paralysis, speech disorder, and sensory deprivation in varying degrees.

Challenges

Unlike many of the other systems I’ve discussed, the effects of these changes on our brain health status can be drastic, ranging from slight discomfort to death, and they involve major physical as well as social components. The social implications of these effects can be just as severe as the physical, as those suffering become less functional both mentally and physically. Unfortunately, in varying degrees stroke survivors become or perceive themselves to be a burden to others. Social interactions are doubly inhibited: internally, the patient is less able to interact; and externally, family, friends, and others may be less interested in interacting with them. This is sad, but true (think about the lives of the stroke survivors you may know…).

Solutions

The alternatives are twofold: after the fact, education is essential by a loved one’s support group and community, otherwise a stroke becomes a different type of life sentence. Physical and occupational therapy save lives and the quality of lives. Continuing to value and show value to your loved ones can make all the difference in the world. Before the fact, again, it’s preventive measures such as diet and exercise that have been shown to decrease or even prevent strokes. I cannot overemphasize how vital diet, exercise and the avoidance of toxins are to your long-term health.

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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.

Asthma Basics – Control and Treatment

September 2, 2018Medical Treatment, Respiratory/Lungs844-SMA-TALK, Asthma, Behind the Curtain, Chronic obstructive pulmonary disease, Conditions and Diseases, Emergency department, health, Inflammation, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post discussions asthma basics – control and treatment. The previous post discussed asthma triggers and symptoms.

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. At that point, the situation becomes completely different. These changes predisposes asthmatics to other conditions such as chronic bronchitis, COPD (chronic obstructive pulmonary disease) and lung cancer. These points simply reiterate the importance of identifying and removing those triggers.

Asthma Control is the Best Treatment

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:

Eliminate your exposure to cigarette smoke (including second hand smoke)!
Avoid long haired animals, especially cats.
Avoid shaggy carpets, window treatments or other household fixtures that retain dust.
Wear a mask to avoid triggers! 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. The conditions for which you should consider these include the following:
- If you’re spraying any kind of aerosol
- During allergy season
- If you’re handling trash
- If you react to cold weather
Be careful to avoid colds and the flu. Get a flu shot yearly.

Asthma Treatment Options

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.

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Asthma Basics – Triggers and Symptoms

September 1, 2018Respiratory/Lungs, Health Prevention844-SMA-TALK, Asthma, Behind the Curtain, Conditions and Diseases, health, Lung, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This post is on asthma basics, including triggers and symptoms.

Asthma concerns me. I’ve had many close friends and family suffer with the disease. In fact, a very good friend died of an attack while in medical school, because he didn’t have his inhaler with him. In other words, this is somewhat personal. I’ve probably given more lectures on asthma than any other topic over the years, and I can say without hesitation that relative to how much we know about its prevention and treatment, I can’t think of another disease where we under perform as much as with asthma management. According to data from the National Institutes of Health, over the last few decades the death rate has increased by over 55%. The prevalence rate has increased by 75%, and among African-Americans the hospitalization rate has increased over 35%. The good news is asthma can be controlled and effectively treated. In this primer, we’ll discuss quick tips to improve the health of the asthmatic in your life.

Asthma Made Simpler

The encouraging thing about asthma is that if you understand what causes it, you understand how to treat it. Here’s what you need to know about what causes asthma. For the purposes of discussion I am simplifying matters for general consumption.

Asthma is a result of certain triggers, causing inflammation to your airways over a long period of time with the occurrence of attacks (intermittent exacerbations). These triggers can be thought of as allergens. Examples of these triggers include cigarette smoke, dust, aerosols, cold air, long-haired animals (especially cats), seasonal pollens, and exercise (in some).
These triggers create a state of inflammation and hyperresponsiveness in the lungs, leading to the excessive production of mucus within the lungs’ various airway branches. If bad enough this will lead to complete obstruction of the airways. In other words you’ll stop breathing, and you will die without assistance and/or reversal.
Exacerbation of asthma include breathlessness, chest tightness, coughing, and wheezing. Basically, because you have the functional equivalent of snot in your lungs, your airways are narrowed, and you’re having difficulty breathing. After all, it’s harder to breathe snot than air. Now imagine how your lungs feel when you’re adding cigarette smoke to that mix.

Asthma Management Considerations

Let’s get logical. Asthma management is theoretically straightforward if you can pull it off. Prevention is treatment. I used to describe this as “Kill the Cat.” (This blog neither supports, advocates, nor is responsible for the harming of any animals resulting from this information.) In short, if you identify the triggers that precipitate your asthma attacks and then remove yourself from that environment, you will dramatically reduce, if not eliminate, your attacks. This is often described (incorrectly) in kids as “growing out of their asthma.” No one grows out of it, and you don’t cure asthma; asthmatics just stop having attacks because they’re not around the triggers.

In Part II, we discuss asthma management. In case you’re wondering, that’s where the toothpicks come in.

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From the SterlingMedicalAdvice.com Health Library: “My Doctor Said I Was a High-Risk Asthmatic. What Does That Mean?”

August 31, 2018General Health and Wellness, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Bispebjerg, Conditions and Diseases, health, Pregnancy, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you have an asthmatic in your life, it’s important to know that asthmatics die. The risk of death is higher in certain asthmatics. If you or your loved one is in this subset of asthmatics, you really must be diligent in avoiding those triggers that cause asthma attacks. You must also be attentive and consistent in taking your ‘controller’ medicines.
These circumstances define a high risk asthmatic:

A history of sudden severe asthma attacks
Prior need to be intubated (placed on a respiratory aka breathing machine)
Prior admission to a hospital ICU (intensive care unit)
Greater than one admission or two ER visits in the past year
An ER visit within the last month
Needing to use two or more inhalers per month
Current or recent oral steroid use
Illicit drug use
Concomitant cardiopulmonary or psychosocial disease

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Straight, No Chaser: Five Frequently Asked Questions on Lupus

August 30, 2018Cardiology/Heart, Endocrine/Metabolic, Genital/Urinary, Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs, Skin/Dermatology844-SMA-TALK, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, LupusJeffrey Sterling, MD

What is lupus? What causes it?

In general terms, lupus is a disease in which your immune system malfunctions and attacks your healthy tissue. This is known as an autoimmune disease. The consequences of lupus are pretty profound because the body’s immune response can be pretty indiscriminate. Lupus can damage your heart, brain, skin, kidneys, lungs, blood vessels, joints and other tissues, meaning it can present in a multitude of ways. This occurs most often in the type known as systemic lupus erythematosus (SLE). The cause is unknown.

Can anyone get lupus? Who is most at risk?

Anyone can get lupus, but certain groups are more at risk, including the following.

Women are most at risk.
African American women are affected by lupus two to three times more often than Caucasian women.
Lupus is also more common in Hispanic, Asian, and Native American women.
Black and Hispanic women are more likely to have severe forms of lupus.

What are the symptoms of lupus?

Because of the variety of locations that can be affected, lupus can have a wide variety of symptoms in different people. The most common symptoms include joint pain or swelling, muscle pain, fatigue, fever, a red facial rash (aka “butterfly rash”), chest pain with breathing, sun sensitivity, hair loss, eye, leg and gland swelling, and mouth ulcers. The fingers and toes also may tend to become pale or purplish.

Symptoms tend to flare (come and go) and can change in severity and type between attacks, with new symptoms occurring at any time.

How is lupus diagnosed?

The diagnosis of lupus really is often a source of frustration. There’s not a defining diagnostic test, and because it mimics so many other conditions, it can take years for a correct diagnosis to be made. Tests can range to routine blood tests to samples of tissue that looks at suggestive changes under a microscope.

What are the treatments for lupus?

Lupus has no definitive cure. Management focuses on control of the various parts of your body separately affected by the disease. The approach to care involves prevention, prompt treatment and reduction/elimination of long-term damage to the parts of your body (organs) being affected.

Along those lines, treatments also involve two components. The first is to attempt to normalize the immune system, prevent and reduce flare-ups and minimize the pain and other symptoms when flares occur. The second component involves treating the consequences of the organs affected by lupus (e.g. high blood pressure, high cholesterol, infections). In case you were wondering, alternative medicines have not been shown to be effective in treating lupus beyond stress reduction. Given the impact of medications on your immune system, it’s not advisable to add additional medicines to your treatment regimen without coordination with your primary care physician.

As much as anything, those with lupus need to become empowered and active in their management. Routine health activities (diet and exercise) that produce global health benefits, along with stress reduction have often proven to be as important as other components of the care plan. It the best cases, management of lupus is a group activity. Make sure your team is assembled and working in the same direction.

Straight, No Chaser: Early and Delayed Puberty

July 30, 2018Diet and Nutrition, Endocrine/Metabolic, General Health and Wellness, Obstetrics and Gynecology844-SMA-TALK, Behind the Curtain, Conditions and Diseases, early puberty, precocious puberty, puberty, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

The onset of puberty is an anxious enough time without it being complicated by being early or late. You may be familiar with the changes related to puberty, but you also should know what can cause these changes to be premature or delayed. First we should review some normal benchmarks.
Puberty usually happens between ages 10-14 for girls and ages 12-16 for boys. In girls, breast development is usually the first sign of puberty, followed by growth of pubic and armpit hair, with the onset of menstruation occurring last. In males, enlargement of the penis and testicles is usually the first sign, followed by hair growth, then voice deepening and the development of muscles and facial hair. Both sexes may experience acne and see a two-three year growth spurt during puberty.

Regarding the onset of puberty, there’s a normal range, and some variations may run in families. Here are some signs that you may need to get early onset of puberty evaluated.

Onset of breasts and pubic hair in a girl before age seven-eight
Increase in testicle or penis size in a boy before age nine

Delayed puberty can also be an issue. Use this range to determine if you should take your child to get evaluated.

In girls: no development of breast tissue by age 14 or no menstrual periods for five years after the first appearance of breast tissue
In boys: no testicle development by age 14 or development of the males organs isn’t complete within five years of the beginning of their development

“What does all of this mean?” In more instances early or delayed puberty is just that – a variation of normal, with no cause identified. However, there are two groups of potential issues where premature and delayed puberty may not be a normal variant:

Nutrition can play a role. Eating certain foods can facilitate early puberty. Alternatively, malnutrition can cause delayed puberty. Abnormalities in hormone levels, bone structure, growth or disturbances within the brain could all have a role. Follow the guidelines above to make sure early or late onset of puberty isn’t a sign of a more serious medical matter.
Social consequences can be devastating. Pre-teen and teen years are when self-esteem and personality are being developed. The ability of loved ones to provide love regardless of physical appearance is important. If early or late puberty is something that runs in your family, share that information with the child. If a medical evaluation or psychological counseling would provide comfort, please don’t delay.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: When Fainting is Deadly

July 26, 2018General Health and Wellness844-SMA-TALK, anemia, arrhythmia, Behind the Curtain, Conditions and Diseases, fainting, Hypoglycemia, panic attacks, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vasovagal syncopeJeffrey Sterling, MD

1. So can faints be deadly?

Potentially. There are three separate sets of considerations. The brain can’t survive very long without adequate oxygen. Whatever caused that faint, if it continues to deny oxygen to the brain, can lead to seizures, strokes and death. The process that caused the faint could be deadly in and of itself. Such things would include heart attacks, strokes, seizures due to bleeding inside the brain. Significant injuries may occur after the faint. Someone who falls may subsequently suffer a head or neck injury, which could be deadly, independent of the cause of the faint. It’s worth mentioning that it’s an especially odd behavior that people seem to travel to the bathroom when they feel dizzy. All things considered, it’s better to faint in your soft bed or surrounding carpeted floor than on the hard tile of a typical bathroom with even harder sinks, toilets and tubs in close proximity.
2. My doctor always warns me about high blood sugars. You mentioned low blood sugars as a cause of faints. Am I putting myself in danger if I’m taking sugar and my sugar level is already high?
If you know all of that, yes. More often, you know none of that. Here’s the deal. Both a high and low glucose (blood sugar) count can cause altered mental status, fainting and coma. If your glucose level is especially high, say 900, and you drink some orange juice, it won’t make much of a difference. If your glucose level is 0, and you are given some orange juice, your life just got saved. In other words, it’s medically worth the risk if you don’t know what the glucose level is.
3. Can a loved one really take my breath away?
Yes. Overstimulation can lead to syncope in a variety of ways as mentioned previously.
4. What’s with the goats?
If you’re referring to Tennessee fainting goats, they exist. The goats don’t actually faint. When startled, they become stiff to the point of being unable to move their legs. Subsequently, the terrified goats can’t run and just topple over. Here you go.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: You’re Way Too Comfortable With Fainting

July 25, 2018Cardiology/Heart, Neurology844-SMA-TALK, anemia, arrhythmia, Behind the Curtain, Conditions and Diseases, fainting, Hypoglycemia, panic attacks, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vasovagal syncopeJeffrey Sterling, MD

Don’t faints seem mysterious? It’s as if your computer crashed and had to reboot. Although we never seemingly figure out why computers are so crazy, fainting (syncope) is reducible to a common denominator: something causes a decrease in blood flow to your brain. Recall that oxygen and other needed nutrients are carried in blood, so even a temporary stoppage or shortage of blood flow shuts things down. Now extrapolate that to strokes and comas, which are often due to serious and prolonged causes of blockage to the blood vessels supplying the brain. This is a prime example of why good blood flow and good health are so important. The brain is a highly efficient, oxygen and energy-guzzling organ. Shut it down for even a few seconds, and bad things start to happen. Consider fainting a warning sign.

I’m going to start by offering some Quick Tips to help if you find yourself around someone who has fainted. Then, I will get into the weeds of why these things happen for those interested. I’m doing this so you can check these and determine where your risks may be.

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

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

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

Avoiding Mosquito-Bourne Diseases

July 19, 2018Infectious Disease, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, dengue, japanese b encephalitis, malaria, mosquito, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, west nile virus, yellow feverJeffrey Sterling, MD

Introduction

This Straight, No Chaser post is about avoiding mosquito-bourne diseases.

Sometimes things occur so frequently that you become sensitized to the real danger they present. This thought occurred to me when I saw Bill Gates talking about efforts to eliminate the various threats posed by mosquitoes. Yes, mosquitoes.

Mosquitos are Much More Dangerous and Deadly Than You Think

Including the damage humans inflict on each other during times of war, mosquitoes are responsible for more human suffering than any other organism on earth. Well over one million humans die every year from diseases transmitted by mosquitoes, and with worldwide travel having increased as it has, the risk is greater than ever. Even if you don’t know the diseases caused by mosquitos, you may have heard of them.

Malaria

West Nile virus

Dengue fever

Yellow fever

Japanese B encephalitis

Getting into the specifics of these various diseases is beyond the scope of this particular post. What I’d like for you to appreciate is this list comprises various diseases with deadly consequences.

The D’s of Mosquito Prevention

Furthermore, you’re not defenseless. There are steps you can take to lessen your risks. In the interest in making this manageable, I’m going to focus on the “Ds of mosquito prevention”, because as is the case with most things, prevention is more effective than attempting to cure a disease once it is obtained.

Dusk and Dawn: Try to steer your activity away from the times when mosquitoes are most active.
Drain: Get rid of standing water around your home. This is where mosquitoes will lay eggs.
Dress: During those times when mosquitoes are most active, wear clothing that covers as much of your skin as practical.
DEET: Use mosquito repellent. Repellents containing up to 30% DEET are effective. Additionally, picaridin, oil of lemon eucalyptus and IR3535 are effective, according to the Center for Disease Control and Prevention (CDC).

Other Tips

Here are a few other simple tips.

Cover doors and windows with screens to keep mosquitoes from entering your home.
Keep infants indoors or use mosquito netting over carriers.
If you have a water garden, stock it with mosquito-eating fish, such as gambusia, goldfish, guppies or minnows.
If you’re traveling, be aware of peak exposure times and places, and schedule around these times if possible. Avoid outbreaks.

Being just a bit more sensitive to the risks mosquitoes pose could be an important component of your overall health strategy. Be smart, and be healthy.

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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.

Do’s and Don’t of Snake Bites

July 17, 2018Environmental, Infectious Disease, Toxicology/Drugs844-SMA-TALK, Antivenom, Behind the Curtain, Conditions and Diseases, health, health care provider, postaday, Rattlesnake, Snake, Snake bite, snake bites, Snakebite, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, triangular heads, Venomous snake, Wound, wound cleaningJeffrey Sterling, MD

Introduction

This Straight, No Chaser post is about 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 after Snake Bites

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 after Snake Bites

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.

When to See a Physician

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.

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Your Questions about Human Bites

July 15, 2018Infectious Disease, Medical Treatment, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bite marks, Bites and Stings, Boxer's fracture, cat bite, Conditions and Diseases, Dracula, health, human bite, Infection, laceration repair, metacarpal bone, pinky finger, puncture wound, snake bit, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Wound, Wounds and InjuriesJeffrey Sterling, MD

Introduction

The votes are in, and it appears that Jaws (from James Bond fame) found the previous post, well… biting.

Here’s your questions and answers about human bites

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…

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 (5^th 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.

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.

Are human bites the same as puncture wounds?

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).

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.

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 a while 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.

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Types and Treatment of Human Bites

July 14, 2018Infectious Disease, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bites and Stings, Biting, Cellulitis, Conditions and Diseases, Hangnails, health, human bite, Infection, Mike Tyson, Open wound, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Tetanus shot, Wound, Wounds and InjuriesJeffrey Sterling, MD

Introduction

This Straight, No Chaser post is about different types and treatment of 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. However, 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.

Fight Bites are Human Bites

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 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, the structures in the hand (tendons, blood vessels, muscles, and bones) are highly concentrated. He also doesn’t know that they are confined to a very limited space and seeding an infection in that tight space makes things really bad really quick. This guy is very dangerous because he tends 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.

Actual Human Bites

Then there’s the “Yes, he bit me” variety, where the teeth were the aggressor that engaged the victim instead of the fist engaging the tooth. Think of the Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears, and other unmentionables)! Children, as another example, sometimes bite and need to learn to stop that behavior. Biting is sometimes seen in sexual assault, physical abuse, self-mutilation, or with mentally handicapped individuals.

Nibbles are Also Human Bites

A third type is the ‘We love too much!’ variety of bites. These may include hickeys that actually break the skin. Other examples of “friendly” bites are folks biting off their hangnails, fingernails, and toenails and create skin infections. Yes, it happens more than you’d think, and no, you don’t have to be a vampire.

The commonality to all of these scenarios is saliva that found its way through the skin. Because of the virulence of the bacteria contained within the saliva, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness, fever, and possible pus from the wound develop.

When to Get Evaluated after Human Bites

The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, get 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. 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, 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.

What You Can Do after a Human Bite

So here’s your duty if you haven’t successfully avoided the bite:

At home, only clean the open wound by running water over the area. Avoid the home remedies like peroxide, alcohol, and anything else that burns. Those agents make things worse by damaging the skin more than they “clean” the area.
Apply ice—never directly to the wound—but in a towel. Use for 15 minutes on and then 15 minutes off.
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.
Get in to be evaluated. Be forthcoming about whether or not it was a bite.

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Straight, No Chaser: Your Questions About Gunshots and Stab Wounds

June 30, 2018Trauma844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Gunshots, Stab wounds, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

There has been a lot going on in the news this entire year related to trauma, particularly gunshot wounds. This Straight, No Chaser answers your questions related to penetrating injuries from bullets and stabs.

Your Top Five Questions

1. Why don’t we remove the bullets every time?

Removing bullets may cause more damage than leaving them in the body. Sometimes it’s not worth the effort.
2. What’s with the tubes that go in the chest?

Chest tubes are used to treat a pneumothorax (a collapsed lung). The problem is there’s air in the space between the lung and the chest wall. This can interfere with normal breathing and may be life threatening. The tubes go through the chest wall to release the air from that space, thus allowing re-expansion of the lungs.
3. Why would doctors ever need to slit someone’s throat to save his or her life?

That describes either a cricothyrotomy or a tracheostomy, and it’s not “slitting” the throat as much as it is creating an opening in the airway to permit airflow. This is usually necessary because of some airway obstruction at the upper throat (foreign body in the throat, etc.) with an inability to clear it. This procedure is only done to save a life.
4. Why would you die from a wound to the thigh?
Fractures of certain bones and laceration of certain blood vessels might cause so much blood loss that you could bleed to death. Infection and blood clots are additional considerations that could be life-threatening. We’ll spare you the pictures.
5. What about gunshot or stab wounds to someone pregnant?
Penetrating trauma to the abdomen is typically less fatal to the mother than to a fetus because the fetus is literally acting as a shield. In the event any wound has placed the mother’s life at risk or the mother has died from the wound, under certain extreme circumstances, an emergency C-section may be performed to save the baby.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
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Straight, No Chaser: Erectile Dysfunction, Part Two – Causes

June 23, 2018General Health and Wellness, Genital/Urinary844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Erectile dysfunction, Erection, health, Hypercholesterolemia, Impotence, Men's Health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Substance abuse, There are 72 Hours in a DayJeffrey Sterling, MD

In my last post on erectile dysfunction (ED), I gave a simplistic way to understand and address it. However, the truth of the matter is the overwhelming majority of cases of ED are not related to stress or other psychological issues. First, some sense of ‘reasonable’, expected performance should be established, especially as one ages (as discussed here). Beyond that, you should know that approximately 90% of ED cases involve an underlying medical concern, including, but not limited to, the following:

Diabetes

High blood pressure

Changes/disease to your blood vessels

Low testosterone

Kidney disease

Smoking

Alcohol and Drug abuse

Obesity and High cholesterol

Effects of your medications

Therefore, today’s message is simple and brief, but I’d suggest it’s probably more important than you have previously thought. You should consult your physician if and when you or your partner’s sexual performance becomes an issue. You may actually discover something that will not only save his performance, but his life.
Finally, in the next post we will review the wide variety of treatment options for ED.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: Erectile Dysfunction, Part One

June 22, 2018General Health and Wellness, Genital/UrinaryConditions and Diseases, Erectile dysfunction, Erection, health, Heart disease, Impotence, Men's Health Week, Western pattern dietJeffrey Sterling, MD

It seems appropriate to follow-up a post on age-related changes in your genitourinary system with a discussion on erectile dysfunction (ED). The nature of the topic is such that I’m going to approach this in two different ways. Today, I’ll give you a functional, overly simplistic view of ED and tomorrow, I’ll look at it from more of a clinical orientation, because there really are nuances involved. So keep in mind the lead picture. There are many medical and psychological issues that can lead to problems having erections. I’ll get into that more tomorrow.
In many ways, your health is related to the quality of your blood flow, both in quantity (successful circulation to tissues) and quality (relative absence of toxins we ingest and deliver throughout). This is true for the brain (mental health, absence of strokes), the heart (stamina, absence of heart disease/attacks), and your penis (sexual function, lack of impotence), as well as every other organ.

Excluding truly medical considerations, the two surest ways I know to be a sexual stud (without implants or being of a certain age) are to have a legitimately healthy ego (psychologic health) and more importantly, to be in good physical shape and otherwise healthy. However, for now, given that an erection simply results from strong blood flow to the penis, your overall health better enables that process (the first time as well as if you want multiple contiguous encounters). Everything being equal, the best way for a guy to be able to have sex for whatever you define as a ‘sufficient’ period of time (besides being of a certain young age) is to maintain good cardiovascular health by spending that physician-recommended 20-30 minutes or more at a time on a treadmill, bike, running, etc.

Drugs like Viagra, Cialis, etc. are really nothing more than drugs that lower blood pressure (and resulting demands by other bodily organs on your blood), such that your penis’ call for an erection is otherwise unimpeded. Sounds good? The risk is varying forms of a ‘steal syndrome’, where that blood isn’t being distributed to your heart and brain, which could result in a heart attack or stroke. That’s why you must “ask your doctor if you’re healthy enough for sex” before using…
Bottom line: practice for good sex and stamina during sex by working out. It’s just another benefit to being healthy.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
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.
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Straight, No Chaser: Straight Talk About Vasectomies

June 21, 2018Genital/Urinary844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Vas deferens, VasectomyJeffrey Sterling, MD

A couple’s conversation about having a vasectomy can either be a tense one or it can be a display of trust and cohesion. The decision by a man to have a vasectomy can be a soul-searching “moment of truth.” In this Straight, No Chaser, let’s look at seven of the issues surrounding vasectomies. At the end there’s an illustration of the procedure. Yes, it involves a clip.
A vasectomy is a surgical procedure that involves cutting the tube (the vas deferens) that carries sperm from the scrotum to the testes. The vasectomy prevents sperm from leaving the testes so that the man can’t impregnate a woman.

Issue 1: Why would you want it?
The answer to this is relatively straightforward. You’d want a vasectomy if you don’t want any, or any more, children. This is a form of sterilization.
Issue 2: When would it be a good option?
If you’re in a relationship and both partners agree that you’ve either had all the children you want or don’t want the risk of having any children, a vasectomy would be a reasonable option. Other considerations may include if you can’t use other forms of birth control, if pregnancy would be medically unsafe, or if the risk of genetic disease or a birth defect in your offspring is greater than you’re willing to accept.
Issue 3: When wouldn’t it be a good option?
This gets a little dicey and relates to levels of instability, either in your relationship or other personal situations. A decision to have a vasectomy to please your partner or salvage a relationship may not be the best choice. If you’re young or unmarried, you are subject to many life changes that may prompt reevaluating whether you really want a child. For example, if you marry/remarry, children may become more important than they currently are. A vasectomy is a surgical procedure with risks. A decision to have it done as a convenience (e.g., because you are unreliable or don’t want to use other forms of birth control) is irresponsible.
Issue 4: How successful is the procedure?
Vasectomies are very successful and have a failure rate of approximately 1 in 2,000. Comparatively speaking, the analogous procedure in females (tubal ligation) has a failure rate of 1 in 200-300. Typical failure rates are due to having sex too soon after the procedure. It takes time for existing sperm to be cleared from both ends of the vas deferens; that existing sperm can still impregnate a woman. This is a major reason why men should wait a week after the surgery and until the sperm count has been documented to be zero in the seminal fluid. To a much lesser extent, rare spontaneous reconnection of the clipped portions of the vas deferens may produce failures.
Issue 5: What complications exist?
Vasectomies are generally very safe, and the complications associated with it are those seen with any surgery. These include pain, swelling and infection. Remember, as we just discussed, the circumstances under which post-vasectomy pregnancies can occur.
Issue 6: What happens should I choose to have it reversed?
It is important for men considering a vasectomy to read and fully understand the next sentence. If you have a vasectomy, you should not consider it reversible. That said, you can spend a lot of money for a microsurgical reversal procedure that is successful about 50% of the time if done within 10 years of the vasectomy and approximately 25% of the time if done after 10 years. Be advised that such reversals are associated with a higher level of birth defects.
Issue 7: About what other considerations should I be concerned?

Men seemingly are most often concerned about post-vasectomy ability to have an erection or orgasm. Vasectomies do not diminish a man’s ability to have either.
You should be concerned about the spread of sexually transmitted infections (STIs), which a vasectomy does not prevent. A false sense of confidence may exist after a vasectomy knowing that pregnancy is extremely unlikely, but that has nothing to do with STIs. In fact the greater inclination to have unprotected sex after a vasectomy may put men at greater risk for transmitting or receiving STIs.
Vasectomies do not increase the risk of testicular or prostate cancer.

Most men are satisfied with vasectomies, because most men who have vasectomies do so in the context of a stable and healthy relationship. Men who are most likely to seek reversals do so in the context of unexpected life events (e.g., new partner/marriage with a desire for kids). Sometimes their reconsideration is in response to a tragedy. If you are considering a vasectomy, please only do so after a solemn view of the rest of your life. If you believe it to be stable, you will likely be satisfied with the outcome.
The following clip (click the link) is courtesy of the National Institutes of Health and demonstrates the logistics of the various approaches to the procedure. Feel free to leave any comments or ask any questions you may have.
Vasectomy
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
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Straight, No Chaser: What Would You Do If Your Tongue Suddenly Swelled? Learn About Angioedema

June 11, 2018Endocrine/Metabolic, Head/Eyes/Ears/Nose/Throat, Skin/Dermatology844-SMA-TALK, anaphylaxis, angioedema, Behind the Curtain, Conditions and Diseases, epinephrine, epipen, hypersensitivity reaction, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Here at Straight, No Chaser, we want you to know how to prevent disease and injury because that’s a lot easier than the alternative. However, if and when the time comes, you should also have a few tools in your arsenal to stave off a life-threatening situation. One of the more scary examples of needing help is acute swelling of your tongue, sometimes so much so that your airway appears as if it will be blocked.
The most common cause of acute tongue, lip or throat swelling is called angioedema. This is an allergic reaction and occurs in two varieties.

A life-threatening allergic reaction (anaphylaxis) sometimes occurs shortly after an exposure to substance such as medicine, bee or other insect stings or food. It can throw your entire body into a state of shock, including involvement of multiple parts of the body. This can include massive tongue swelling, wheezing, low blood pressure resulting in blackouts and, of course, the rash typified by hives (urticaria).
Sometimes lip, tongue and/or throat swelling may be the only symptoms. This is more typical of a delayed reaction to certain medications, such as types of blood pressure medications (ACE inhibitors and calcium channel blockers), estrogen and the class of pain medication called NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen)

With any luck, you would already know you’re at risk for this condition, and your physician may have prompted you to wear a medical alert bracelet or necklace. In these cases, your physician may have also given you medicines and instruction on how to take them in the event you feel as if your tongue is swelling and/or your throat is closing. These medicines would include epinephrine for injection, steroids and antihistamines such as Benadryl. As you dial 911 (my recommendation) or make your way to the nearest hospital, taking any or all of these medications could be life-saving. By the way, those are among the same medicines you’ll be treated with upon arrival to the emergency room. In severe cases, you may need to be intubated (i.e. have a breathing tube placed) to maintain some opening of the airway.

If the swelling is (or assumed to be) due to any form of medication, symptoms will improve a few days after stopping it. If the swelling in this instance becomes severe enough, treatment may resemble that of the life-threatening variety.
There are few things better than cheating death. If you’re at risk, carry that injectable epinephrine (e.g. an Epi-pen). If you’re affected, take some Benadryl and/or steroids if you’ve been taught what dose to take, and most importantly, don’t wait to see if things improve. Get evaluated, get treated and get better!
I welcome your questions and comments.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
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.
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When Your Jaw Pain Could Be a Heart Attack

June 7, 2018General Health and Wellness844-SMA-TALK, Acute coronary syndrome, Behind the Curtain, Conditions and Diseases, heart attack, jaw pain, Myocardial infarction, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, temporomandibular joint syndrome, There are 72 Hours in a Day, TMJ syndromeJeffrey Sterling, MD

Introduction

This Straight, No Chaser looks at when your jaw pain could represent a heart attack.

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

Why Would Heart Attacks Show Up in the Jaw?

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.

How to Tell if that Jaw Pain Probably Isn’t from a Heart Attack

Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

How to Tell if that Jaw Pain Could Be from a Heart Attack

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

If exertion exacerbates the pain, this makes the heart more likely as a cause.
If rest does not relieve the discomfort, this makes the heart more likely as a cause.
Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain.

Other considerations

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. When rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.

On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.

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Straight, No Chaser: When Your Headache is Life-Threatening

June 3, 2018Neurology844-SMA-TALK, arteriovenous malformation, AV malformation, Behind the Curtain, Carbon Monoxide, Conditions and Diseases, encephalitis, meningitis, Migraine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Subarachnoid bleed, temporal arteritis, There are 72 Hours in a DayJeffrey Sterling, MD

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 aren’t thinking about migraines first. The ER is 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. In other words, alcohol, cocaine and cigarettes increase your risk for life-threatening causes of headaches.

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” are a real thing!) Today we’ll point you to some conditions about which you should be concerned. (I’m intentionally leaving out especially uncommon ones 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 that can steal blood away from needed areas

Brain tumor
Carbon monoxide poisoning: from breathing exhaust fumes
Encephalitis/Meningitis: inflammation and/or infection of different components of your brain
Subarachnoid and other intracranial hemorrhage: bleeding inside various parts of the brain

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 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)
Worse headache of your life

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