Tag Archives: SterlingMedicalAdvice.com

Straight, No Chaser: The Treatment of Arthritis

December 28, 2013Geriatrics/Elderly Care, Medical Treatment, Orthopedics/Bones, Musculoskeletal SystemArthritis, Conditions and Diseases, Disease-modifying antirheumatic drug, health, Non-steroidal anti-inflammatory drug, Omega-3 fatty acid, Pain, Pharmaceutical drug, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The thing about treating arthritis is you’d better do it. If you’re not lucky enough to have a form that readily responds to treatment or if you didn’t get early treatment, your arthritis will progress and create an incrementally worse situation for you. Given that we’re discussing arthritis, we’re talking loss of mobility somewhere, maybe in your legs or hands, and pain.
The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause often cannot be cured.
Treatment considerations for arthritis fall into three general categories: lifestyle changes, medication and surgery. Let’s review each.
Lifestyle
The best time to enact lifestyle changes is before you’re struggling to return to normalcy. Exercise is a lifelong habit that will improve the quality and extend the quantity of your life. For starters, exercise maintains and improves muscle tone. It also strengths your bones and cartilage. This will reduce pain, fatigue and stiffness over the long term.
Exercise should include a tolerable level of aerobic activity, flexibility exercises to sustain your range of motion and strength training to maintain and improve your muscle tone. Physical therapy is another component; massage, heat and ice application, splints and other treatments are important in maintaining blood flow, mobility and positioning as stiffness and deformity increase over time.
Medication
Using medication for arthritis is a very delicate act. Many if not most arthritics are aging and may have other medical issues. Medications in these settings have risks for side effects and drug interactions, including kidney, liver and heart damage, stroke, ulcers and bleeding. Any medications should be coordinated with your physician. Typical over-the-counter (OTC) medical regimens begin with acetaminophen, then move to NSAIDs (non-steroidal anti-inflammatory agents such as ibuprofen, aspirin or naproxen).
When OTCs don’t work, your doctor may prescribe medicines, including steroids and other medications called biologics, immunosuppressants and DMARDs (disease-modifying anti-rheumatic drugs). These drugs all are effective in certain patients but can have serious side effects.
Surgery
Surgery is an option if and when other therapies haven’t worked and if the patient is healthy enough to have it. There are two primary options. Arthroplasty rebuilds the joint, and joint replacement starts from scratch.
Let’s start back where I’ll always hope you start: prevention. Here are some lifestyle change tips for holding off the onset of arthritis or slowing down its advance.

If you are overweight, do what you can to slim down. Weight loss significantly reduces joint pain in the legs and feet.
Eat a healthy diet full of fruits and vegetables. Among other things, a rich supply of vitamin E yields benefits you’ll need. Also eat foods rich in omega-3 fatty acids (e.g., salmon, mackerel, herring, flaxseed, canola oil, soybeans and soybean oil, pumpkin seeds, and walnuts).
Sleeping eight to 10 hours a night and taking naps during the day can help you both prevent and recover from flare-ups more quickly.
Avoid staying in one position for too long.
Try stress-reducing activities, such as meditation, yoga or tai chi.
Avoid positions or movements that place extra stress on your sore joints.
Change your home to make activities easier (e.g., grab bars in the shower, the tub, and near the toilet).
Consider capsaicin cream over your painful joints. Typically expect improvement after three to seven days if it’s going to help.

If and when you develop arthritis, it’s going to be a tough time. Get ahead of the challenge and take care of yourself in advance. Feel free to ask questions or leave comments.
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Straight, No Chaser: The Inevitable Disease (Assuming You Live Long Enough)

December 28, 2013Geriatrics/Elderly Care, Orthopedics/Bones, Musculoskeletal SystemArthritis, Conditions and Diseases, Facebook, health, Inflammation, Joint, Musculoskeletal Disorders, Osteoarthritis, Psoriatic arthritis, Rheumatoid arthritis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Actually, humans have a few different “inevitable” diseases, but today we’re discussing arthritis, specifically degenerative joint disease (osteoarthritis). For this conversation, the inevitability of arthritis is based in the gradual wear and tear on your joints. It seems our design includes an expiration date on our joints. By now, you’re likely wondering why. The answer is in the definition.
Arthritis is inflammation of one or more of your joints.

Inflammation is a process of some form of attack to an area, producing symptoms that usually include redness, swelling, warmth and pain.
A joint is the area where two bones meet.

It stands to reason that when regular use becomes wear and tear, ongoing inflammation ensues, the structure of your bones and joints changes and function decreases. This is why you see decreased movement and deformities in the involved joints of arthritics.
What I just described was a reasonable description of osteoarthritis, the most common form of arthritis, but in fact there are over 100 different types of arthritis. Given its importance in helping you understand and treat yourself and/or your loved one with arthritis, let’s review the common and distinguishing mechanisms.

Arthritis involves the breakdown of cartilage, which is the tissue coating the ends of two bones at a joint. Its purpose is to keep the bones in place and moving smoothly. When cartilage is damaged, the bones rub together. This damage results in pain, swelling, stiffness, warmth and redness—inflammation.
The causes of this inflammation are broad but typically center on four mechanisms:

The aging process itself causes sufficient wear and tear on the body, including bones and cartilage, such that the joints will suffer. This represents the most common form of arthritis: degenerative joint disease, aka osteoarthritis.
When you break bones, especially near a joint, the resulting damage and/or insufficient healing will expedite the development of arthritis.
When you develop certain infections, they can occur in the bones/joints or target those areas. This also can lead to arthritis.
The body’s immune system sometimes mistakenly views certain parts of the body as foreign. When this occurs, it will attack healthy tissue, including bones and cartilage. These conditions are known as autoimmune disorders, and they cause inflammation and can lead to acute and chronic arthritis.

You’ve heard of many different forms of arthritis. If you know anyone with any of the following diseases, they likely have arthritis as part of (if not the predominant feature of) the disease.

Ankylosing spondylitis
Gonococcal (i.e., due to gonorrhea) arthritis and other arthritis due to other bacterial infections
Gout
Juvenile rheumatoid arthritis (in children) and rheumatoid arthritis (in adults)
Psoriatic arthritis
Reactive arthritis (Reiter syndrome)
Scleroderma
Systemic lupus erythematosus (SLE)

The inflammation and other symptoms usually go away if you can find and treat the cause. If it doesn’t go away, or if it goes untreated, chronic arthritis will develop.
Here are the various conversations you should have with your physicians regarding arthritis:

“I have a family history of arthritis. Should I be concerned?”
“I have a newly swollen joint but didn’t strain or sprain anything.”
“All of a sudden my joint (or joints) have really started hurting.”
“My skin in my (knee, elbow or other joint) is very hot and very red.”
“I have arthritis, and now I’m having problems moving my joint.”
“I have arthritis, and the swelling is much worse.”
“I have arthritis, and my pain has lasted more than three days.”
“I have arthritis, and I have developed a fever plus my joints are really aching.”
“I have arthritis, and I seem to be losing weight.”

This afternoon, I’ll discuss general treatment of arthritis and tips you can use to help yourself or your loved one with arthritis. I welcome any questions or comments you may have on this topic.
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Straight, No Chaser: When the Patient Knows Better

December 27, 2013General Health and Wellness, Public HealthAsthma, Conditions and Diseases, Cough, health, Influenza vaccine, medicine, Physician, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

So … your friendly neighborhood ER physician chats with a patient.

Client: “Doc, I’m sick. I need my asthma medicine. I need steroids, an inhaler and some antibiotics.”
Expert: “Oh really. How do you know that?”
Client: “Oh, I get the same thing this time every year.”
Expert: “Hmm. Same time every year, huh? Would you mind telling me your symptoms first?”
Client: “Cough, chest tightness, wheezing. I’m telling you. Same thing every year.”
Expert: “Have you gotten your flu shot this year?”
Client: “I haven’t had the flu shot since 2005, but I’m going to get it in January. But this is my asthma! C’mon, Doc. I just need my antibiotics and my asthma medicine.”
Expert: “There’s an adage in medicine that has been proven true a million times over. A physician that treats himself has a fool for a patient. Now, if physicians won’t treat themselves …”
If I’ve heard it once, I’ve heard it a million times.

“I know my body.”
“I’ve had the exact thing before.”
“I read it on the Internet.”
“I had a friend with the same thing.”
“I just want to make sure.”
“Well you have to do something, don’t you?”

Medicine is a science. By that, I mean a real science made of facts—not opinions, educated guesses or perspectives. There are seemingly a million paraprofessionals and incredibly intelligent people on the periphery of healthcare who have what we describe as an “experience base.” That means they “know” it because they’ve seen it or just read it. That is completely different than a knowledge base. Physicians have completed between seven and 10 years after undergrad learning, understanding and mastering the human body. What does that mean to you? Basically, the methodology for practicing medicine is not the linear A+B=C (i.e., “I have this symptom, therefore it must be this disease”).
Yes, this applies to you. Even you, dear “I know my body better than you do” reader. When you tell your physician that you’ve seen or experienced something before, you’re basically suggesting your sample size of one defines the entire universe of medicine. Even as it applies to you, the body is a wondrously complex creation with many, many variables affecting a single breath or heartbeat.
So, when your physician is telling you something different than what you believe or expect to hear about your condition, it’s not that s/he isn’t listening to you. It’s that s/he has listened to you and has come to a different determination. That’s why physicians have the power to write prescriptions, and you (and even pharmacists) don’t.
Of course, none of this is to say that your input isn’t valuable. It is valuable, and that’s why the physician asks you the questions. This is not even to say that physicians don’t make mistakes. This is to challenge you to allow the conversation to occur. Ask your own questions. Demand an explanation from your caregiver. Insist on being part of the care team and a partner in your treatment plan. Learn what to look for, what you can do at home and what should prompt additional measures. If you are stuck on a course of treatment before the conversation occurs, it is just as pointless as if a physician refuses to listen to your concerns.
Cut your physicians some slack. Many of you get so frustrated and outright angry when you don’t get your way. Physician’s offices and emergency rooms are not grocery stores. It’s not as if docs own the pharmaceutical company or the hospital. They’re just trying to care for you as best they can. As much as physicians love to provide satisfaction to patients, caring for you appropriately is of a higher order. Many of you understand this, and as such physicians continue to have among the highest rating of “trust” among professionals. It’s a privilege to take care of patients. The overwhelming majority of us still understand that fact.
Postscript: It was the flu.
PPS: A little advice from a friendly online SMA expert might have saved her the trip to the ER.
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Straight, No Chaser: The Challenges and Frustration of Acute Bronchitis

December 26, 2013Respiratory/LungsAcute bronchitis, Bronchitis, Bronchus, Chronic bronchitis, Cough, Fever, health, Inflammation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Tobacco smoking, WordPressJeffrey Sterling, MD

Imagine what it looks like when someone gets hit in the jaw. There’s the redness, swelling from excess fluid in the area, warmth and pain. Those are the components of inflammation. Now imagine those symptoms in your lungs as you’re trying to breath and deliver oxygen to the rest of your body. Off the top of my head, I can’t think of a more frustrating diagnosis than bronchitis for both patients and physicians alike. I’ll get into the reasons for that soon enough, but a bit of explanation is definitely in order.
Bronchitis is inflammation of a portion of the airways (the bronchi). Far and away, bronchitis is seen in smokers and after a viral, upper airway infection (e.g., a cold, the flu). In that last statement I slipped in two words that create the frustration regarding this condition: viral and smokers. There’s still more to come on what that means for you.
Everyone reading this has suffered from bronchitis at some point, and, based on what’s already been said, it’s easy to figure out what the symptoms would be. The inflammation of your airways leads to a cough, shortness of breath, chest discomfort, a mild fever and fatigue. If you have asthma, you’re likely to start wheezing. Another major source of frustration is even after the bronchitis has gone away or been treated, the cough stays around for up to an additional four weeks. This gives many the impression that they’re still sick, and leads them to demand that the doctor do something to “fix it.”
There are a few more problems dealing with or treating acute bronchitis.

Bronchitis is actually the most common cause of coughing up blood. Coughing up blood or producing blood-tinged mucus tends to make people anxious, and they often start thinking of things like cancer. That train of thought makes some people want to take every test possible to rule out cancer, “just to be sure.” Now your physician knows better and isn’t going to do that unless you have additional symptoms or tell a story more consistent with cancer. That often leads to a lot of frustration and sometimes anger.
Bronchitis is most often caused by smokers who don’t stop smoking even while they’re suffering. It is a very tense conversation (from both sides) when you return to the ER five days after being seen and diagnosed with bronchitis, and you’re complaining because you’re not better. Folks, even if your physician puts out the fire, if you continue to relight the match, it’ll continue to blaze.
Bronchitis is not pneumonia, which is an infection of the lungs. In most cases where bronchitis has an infectious cause, that cause is a virus. Viruses do not respond to antibiotics. You physician understands that you’re sick. Just because you’re sick and coughing, that doesn’t mean you need antibiotics or that antibiotics will cure you. Inappropriate antibiotic use is not without long-term complications that you should want to avoid. (Click here for a discussion on inappropriate antibiotic use.) In most cases, assuming you remove the source of inflammation (e.g., cigarette or cigar smoke, dust, allergens), your symptoms will improve on their own within a week, and all you need is supportive therapy such as cough, fever and pain medicines along with fluids and rest. You must also practice good hygiene to avoid spreading any viruses that may be causing the bronchitis.
What complicates this is when your weakened state and continued exposure to whatever is causing the inflammation allows a bacterial infection to land on top of your bronchitis. Ask your physician if it’s possible that this is what is going on. S/he will know how to proceed, including potentially using antibiotics.
In a majority of cases, a diagnosis of bronchitis will be a big source of frustration for patients because, from the physician’s standpoint, bronchitis is an easily diagnosed condition due to an obvious cause (such as a cold or cigarette smoking). As such, your physician is likely not to order a lot—or any—tests. Now from the patient’s standpoint, don’t you just hate going to the physician’s office or ER when you’re sick and “nothing” gets done? Well, especially in an ER setting, tests are not used to make diagnoses. They’re meant to be ordered if the results will change the management of the condition or might lead to a change in what is done with you (e.g., admit you to the hospital). Most often, that’s just not going to be the case with bronchitis. Now if after 3–5 days symptoms haven’t improved, you’ve stopped smoking and the mucus you’re coughing up looks a certain way, there’s plenty that will be done differently in most cases.

Please don’t take any of this to mean that you shouldn’t be seen for bronchitis. My effort today is to temper your expectations and help you appreciate what your physician is looking for and thinking. Here are some specific signs and symptoms to look for when you’re suffering from acute bronchitis that indicates a level of seriousness warranting prompt attention:

You have a documented high fever or have had a documented fever for more than three days.
You have greenish or bloody mucus, or you are coughing up only blood.
You have shaking chills.
You have chest pain or shortness of breath.
You have heart or lung disease (such as asthma or COPD/emphysema).

Over time, bronchitis can become chronic if the source of the inflammation isn’t removed. If you find yourself with ongoing symptoms for over three months, you will fall into a different category known as chronic bronchitis. Your physician will need to address additional considerations for you.
So often patients with bronchitis are looking for a “quick fix.” As is often the case, that fix is to be found in prevention. In this case, good hygiene and avoidance of smoke and other lung irritants can save you a lot of the shortness of breath and chest pain associated with bronchitis (pun intended).
Feel free to contact your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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

December 25, 2013Mental HealthChristmas, Facebook, Hanukkah, Happiness, Harvard School of Public Health, health, mental-health, Merry Christmas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Today is Christmas, and we want to celebrate the best parts of you! Even better, do that for yourself and allow that to translate into better health. We have previously discussed your bad habits and how they negatively impact your health. Click here for that discussion. The literature on negative energy and health is well documented and robust. In short, avoid negativity and those that bring it to you! That said, we’re following our own advice and going positive today. That’s the other half of the “health and emotions” equation:

STATE OF MIND = STATE OF BODY.

So here we go.

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

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

Speaking of Christmas, the Straight, No Chaser team greatly appreciates your readership, support and feedback. In a matter of a few months, over 3,000 of you both follow us and like us on Facebook. We’ve had readers in over 105 countries around the world. Most of all you’ve helped us successfully launch www.SterlingMedicalAdvice.com (SMA). We’ll continue to give you information to make a difference in your lives. Please continue to share your stories. It is very fulfilling and fascinating to hear how these efforts have made a difference in your lives. Feel free to continue to send us topic requests. We generally find a way to work them into the schedule.

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

Feel free to ask your SMA expert consultant if you have any questions on this post.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Flu Myths and Questions

December 24, 2013Infectious DiseaseCDC, Center For Disease Control and Prevention, Centers for Disease Control and Prevention, Disease, health, Influenza, Influenza vaccine, Influenza-like illness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Vaccination, Vaccine, WordPressJeffrey Sterling, MD

Every year 36,000 people die and over 200,000 are hospitalized each year due to the flu—in the U.S. alone. If you’re not getting a vaccine every year, you are subjecting yourself to a significantly higher risk and allowing fears and myths to get the better of you. Knowledge is power. Learn the facts.
Does the flu shot give you the flu?
No, no, no. The influenza vaccine cannot cause flu illness. There are vaccines that involve the delivery of live virus, including mumps, measles, rubella, chicken pox and polio. Influenza is not in that category. Flu shots are made either with ‘inactivated’ vaccine viruses that are not infectious or they contain no flu vaccine viruses at all (and instead have recombinant particles that serve to stimulate your immune system).
The most common side effects from the influenza shot are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. These symptoms are among the same symptoms you see with influenza, so it’s easy to confuse them as flu symptoms. They are not.
Controlled medical studies have been performed on humans in which some people received flu shots and others received shots containing salt water. There were no differences in symptoms other than increased redness and soreness at the injection site for those receiving influenza vaccine. The flu shot does not give you the flu.
I swear I’ve gotten the flu right after getting the flu shot! How is that possible if I can’t get the flu from the flu shot?
I always remind people that the flu vaccine does an even better job of preventing you from dying from the flu than it does in preventing you from catching the flu (and it does that at a 70–90% rate). It primes your immune system to better fight off the influenza virus when you’re exposed to it.
There are several reasons why someone still might get a flu-like illness after being vaccinated against the flu:

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

Please don’t get the wrong message from this section. These explanations are the exceptions, not the rule. In the overwhelming number of cases, the influenza vaccine does an excellent job of protecting against and prevent disease from the influenza virus.
Is it better to get the flu than the flu vaccine?
No. Influenza causes tens of thousands of deaths every year. If you have asthma, diabetes, heart disease or are especially young or old, you are placing yourself at significant risk by not getting vaccinated. Even if you aren’t in one of the above categories and are otherwise healthy, a flu infection can cause serious complications, including hospitalization or death.
Why do I need a flu vaccine every year?
The Center for Disease Control and Prevention (CDC) recommends a yearly flu vaccine for just about everyone six months and older. Once vaccinated, your immune protection decreases over time. These boosters are scheduled and dosed to help you maintain the best level of protection against influenza. Additionally, the virus mutates (changes) every year, so what you were covered for this year may not apply next year.
You can make a decision not to get vaccinated, and Straight, No Chaser has posted tips for you to protect yourself in the event you choose not to. (Click here to review.) However, you’re doing so in the face of the solid consensus of medical evidence and research. You should seriously question the motives or knowledge of someone who suggests that you should not get vaccinate for influenza, particularly if they profess to be involved in healthcare. Get vaccinated.
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Straight, No Chaser: The Medical Complications and Medication Treatment of Alcoholism

December 23, 2013Toxicology/DrugsAcamprosate, Alcoholic beverage, Alcoholism, Delirium tremens, health, Naltrexone, Neurological disorder, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There are interesting commonalities of certain drugs like alcohol and cigarettes. One is users that really enjoy them are able to do so for a long time while being oblivious to the growing danger those activities pose. Another commonality is even more so than mentally, when things go wrong physiologically, they really go very wrong.
Possible Complications
Alcoholism and alcohol abuse pose threats to many aspects of your health, including the following.

Birth defects (fetal alcohol syndrome)
Bleeding throughout your digestive tract, including the esophagus (up to and including rupture), gastritis (inflammation of the stomach) and ulcer disease.
Brain cell damage
Brain disorder called Wernicke-Korsakoff syndrome (includes dementia, mental status changes)
Cancer of the esophagus, liver, colon, and other areas
Changes in the menstrual cycle (period)
Delirium tremens (DT’s)
Dementia and memory loss
Depression and suicide
Erectile dysfunction
Heart damage
High blood pressure
Increased risks for behavioral disorders including depression and suicide
Increased risks for sexually transmitted infections (STIs)
Increased risks for trauma, including motor vehicle collisions, violence and head injuries with intracranial bleeding
Inflammation of the pancreas (pancreatitis)
Insomnia
Liver disease, including alcoholic hepatitis, cirrhosis and cancer
Nerve damage
Nutritional deficiencies

Treatment
Medical goals and patient goals are often different and seem to depend on the extent of perceptible injury that has occurred at the time of the decision to quit drinking. Often, patients will want to reduce drinking instead of stopping completely. Continued drinking in moderation is only as viable an option as the patient’s level of alcohol-related level of disease and the patient’s ability to stay limited in consumption and focused toward that goal.
Ideally, abstinence (the complete stopping of alcohol intake) is the goal, and it needs to be the goal if and when the desire to stop drinking is coupled with the presence of significant alcohol-related disease.
As everyone knows, the management of alcoholism requires multiple simultaneous approaches, including family and social networks. It is often the family network that helps the alcoholic come to the understanding that alcohol intake has disrupted his or her ability to function normally. It is a most unfortunate occurrence when this has not occurred prior to the development of significant medical disease. Individuals with alcohol problems are more likely to take the steps necessary to successfully withdraw from alcohol use.
Regarding the medical aspects of alcohol cessation, withdrawal is a very important consideration and is best done in a controlled manner. Components of effective withdrawal address the various medical and mental health considerations reviewed earlier and medical avoidance treatment.
Medical avoidance treatment includes medicine that prevent relapse via various methods, and they include the following:

Antabuse (generic name: disulfiram) is a well known and commonly used medicine that works by producing very unpleasant side effects with virtually any alcohol intake within two weeks of taking the medicine.

Naltrexone (brand name: Vivitrol) is an injectable medicine that works to decrease alcohol cravings.
Acamprosate is a drug that has been shown to lower relapse rates in those who are dependent on alcohol.

This is part of an ongoing series on alcohol use and abuse.

Click here to review the symptoms suggestive of alcoholism.
Additional posts will review a severe form of alcohol withdrawal, delirium tremens (the DTs) and non-medical aspects of treatment.

Feel free to contact your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: How to Prevent Getting the Flu Without Receiving the Flu Vaccine

December 22, 2013General Health and Wellness, Infectious Disease, Health PreventionCenters for Disease Control and Prevention, Flu Symptoms, Hand sanitizer, health, Influenza, Oseltamivir, Pharmaceutical drug, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, ZanamivirJeffrey Sterling, MD

Many people choose not to get the influenza vaccine (the “flu shot”) for various reasons. One of those reasons is due to an allergy to eggs. If you have an egg allergy, your options to combat influenza are different and don’t contain vaccination.
The best way to avoid the flu is prevention. Consider adopting these healthy habits before you ever get exposed:

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

Vitamin C, echinacea and zinc have long been touted to prevent colds and influenza. There are no studies confirming or refuting this claim. Despite assurances that these and other herbal medicines are safe alternatives because they’re “natural”, the active ingredients in them are the same as found in certain prescription medicines. Thus they too may interact with other medications and worsen certain medical conditions. Given this, you should discuss your use of supplements with your physician or pharmacist prior to use.
Another level of defense for you involves use of certain antiviral prescription medications. If you are exposed to someone (e.g. a family member) with influenza, and especially if you begin having flu-like symptoms, immediately contact your physician to discuss taking medicines to prevent catching the flu. Such medications include Tamiflu® (generic name: oseltamivir), Relenza® (generic name: zanamivir), Flumadine® (generic name: rimantadine) and Symmetrel® (generic name: amantadine). If you make the request more than 24-48 hours after the onset of symptoms, you likely won’t be given the medication, since it isn’t likely to be effective outside of this timeframe.
Feel free to contact your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Alcohol Abuse and Alcoholism

December 21, 2013Toxicology/DrugsAlcohol, Alcohol abuse, Alcoholism, Drink, Facebook, National Institutes of Health, Physical dependence, Self-esteem, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Substance abuse, United States, Withdrawal, WordPressJeffrey Sterling, MD

With all the focus of late on other forms of drug use and abuse (e.g., methamphetamine, marijuana), alcohol abuse seems to be lacking the attention it deserves. Fully one in six people in the United States has a drinking problem. In this segment of the Straight, No Chaser series on alcohol, we will explore problem drinking.
For an additional personal look at if you drink too much, click here.
“Problem drinking” is a way of describing alcohol intake that causes problems with your functioning. Alcohol abuse is an episode or continued excessive alcohol consumption that causes problems with your daily living activities, such as family or job responsibilities. Of course, a single episode of alcohol abuse can cost you your life if you’re an impaired driver who runs into a tree or some other calamity befalls you.
Alcoholism is alcohol dependence, which is comprised of two separate considerations:

Physical addiction to a drug is defined by tolerance and withdrawal symptoms. Tolerance is when you become acclimated to the same dose of drug, meaning, in this case, the same amount of liquor no longer gives you the same buzz. Withdrawal symptoms occur when you experience effects from no longer having the drug in your system.
Mental addiction to alcohol is illustrated by its increasingly prominent role in your life. Your life becomes centered around the pursuit and consumption of alcohol. It creates problems with your physical, mental and social health, controlling your life and relationships.

Many of you ask if alcoholism is hereditary. Hereditary means a specific thing medically, so the answer is no. However, we believe genes play a role and increase the risk of alcoholism. It is most likely that genetics “load the gun,” but environment “pulls the trigger.”
Regarding environment, there’s no fixed equation to if and when you’ll become dependent, but there is a correlation with certain activity and an increased risk. Consider the following activities as suggestive of a significant risk for development alcoholism:

Men who have 15 or more drinks a week (One drink is either a 12-ounce bottle of beer, a 5-ounce glass of wine or a 1.5 ounce shot of liquor.)
Women who have 12 or more drinks a week
Anyone who has five or more drinks at a time at least once a week
Anyone who has a parent with alcoholism

Here are some less hard signs, but these situations also have been shown to increase risk, according to the National Institutes of Health:

You are a young adult under peer pressure
You have a behavioral health disorder such as depression, bipolar disorder, anxiety disorders, or schizophrenia
You have easy access to alcohol
You have low self-esteem
You have problems with relationships
You live a stressful lifestyle
You live in a culture in which alcohol use is more common and accepted

Straight, No Chaser: Fifteen Tips to Care for Diabetic Skin

December 20, 2013Endocrine/Metabolic, Health PreventionAntibacterial, Blood sugar, Diabetes mellitus, health, Infection, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, WordPress, WoundJeffrey Sterling, MD

In this previous post, we discussed the frailty of the diabetic skin and discussed how that sets one up for skin infections, abscesses, ulcers, amputations and even death. Your best defense from these set of illnesses and tragedies is knowledge, prevention and prompt action. Here are some concern steps you can take to better care for the diabetic in your life. In the event you know a diabetic who appears healthy, I want you to pay special attention to him/her. Diabetes is a chronic and insidious disease. These changes occur over years, and your challenge is to slow the process down as long as possible.
If you have diabetes, these tips may help prevent skin damage and infections:

Do the best to can to control your blood glucose levels. The more out of control it is, the most damage it causes.
You must check your feet every single day for the rest of your life. Diabetes develop decreased sensitivity to their feet. It is extremely common to step on a sharp object and not realize that you’ve done so. A splinter or nail is an excellent medium for an infection.
Eat fruits and vegetables. Your skin needs all the nourishment it can get.
Develop better hygiene. Wash and dry your skin often and thoroughly; this will keep you less exposed to infections.
Make a point of keeping your groin, armpits and other areas prone to heavy sweat dry. Those moist areas in particular are most prone to becoming infected. Talcum powder is a good choice to use.
Stay hydrated. It’s an uphill battle with the frequent urination and high blood sugar (glucose) levels. Dehydration causes your skin to be more brittle and prone to infections.
Stay moisturized! Apply lotion early and often, especially after baths. Note those dry, cracked feet and get ahead of that happening if possible.
Remember: if you’re diabetic, at some point your hands will retain sensation longer than your finger. It’s common to see scald injuries from stepping in water hot enough to burn you without you feeling it initially. Check the water with your hands before stepping into a tub.
Use a milder, less irritating soaps that include moisturizer. Speaking of tubs, avoid bubble baths. Sorry.
Consider investing in a humidifier to prevent skin drying, especially in dry or cold climates.
Always take any skin wounds seriously, especially those on your feet. Avoid placing alcohol on any of your wounds.
Invest in some sterile gauze. If you develop a scratch or other wound, control the wound with it after cleaning.
Limit your self-help to cleaning and gauze wrapping. Only place topical antibiotics or take antibiotics for a skin infection under your physician’s supervision.
Always ask your physician to check your skin during an examination and ask him/her to teach you what to look for.
Immediately consult your physician or access the local emergency room if you have a burn, scratch, abscess (boil) or laceration that seems serious.

Straight, No Chaser: The Skin Problems of Diabetics, Part 1

December 19, 2013Endocrine/Metabolic, Health PreventionBlood flow, Blood sugar, Conditions and Diseases, Diabetes mellitus, diabetic foot ulcers, Endocrine Disorders, health, Infection, Pancreas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you are diabetic or caring for a diabetic, one of the things you’ve likely noticed is that the skin doesn’t always seem to look, feel or perform normally. Perhaps the first thing I’d want you to know as a means of understanding what’s going on is this combination of facts: the skin is the body’s largest organ and diabetics have issues with blood flow. Given all the area needing blood flow, it stands to reason that diabetics invariably would have skin problems.
On a practical level, appreciate that infections are the most common cause of death in diabetics. Even a small cut or scratch in this population can lead to loss of a limb if unrecognized and left untreated. Unfortunately, amputations among diabetics happens all too often. Is it preventable? With 100% confidence, yes. You can sufficiently reduce your risk of this ever happening. That said, there’s a reality that approximately 1/3 of all diabetes will have some type of skin problem, ranging from eczema and other localized itching problems to infections, abscesses, and gangrene.
By now you are likely wondering two things: How does this happen, and how can I prevent/help this?
First, diabetics suffer from frequent and excessive urination from those high blood glucose levels. This can lead to dehydration. Dehydrated skin is dry, red and has a waxy appearance. It becomes cracked, itchy, easily injured, harder to heal and easier to infect. Remember how diabetics have problems with poor blood circulation? That reduces the bodies’ ability to fight infections. So the first course of action for diabetics (beyond understanding the risks) is to be diligent in preventing infection.
I will dedicate a separate post to give you all the knowledge you need to prevent diabetic cuts, scratches and skin infections or to have them treated. In the meantime, the same rules apply to diabetics as they do to everyone else: an ounce of prevention is worth a pound of care. Diet and exercise can stave off the day when you’re fighting for your life because of a diabetic foot ulcer.
Click here for an explanation of basic facts about diabetes.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: "…Stop Wasting Money on Vitamins and Mineral Supplements."

December 18, 2013Diet and Nutrition, General Health and Wellness, Toxicology/Drugs, Health PreventionAnnals of Internal Medicine, Big Bang Theory, CBS, Edgar Miller, Johns Hopkins School of Medicine, Multivitamin, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United States, VitaminJeffrey Sterling, MD

placebo
If any of you are familiar with the hit comedy The Big Bang Theory on CBS, you may recall this scene from one of the first episodes featuring the genius, physicist and would-be Noble Prize winner and the ditzy, would-be actress:
http://www.youtube.com/watch?v=m0Eo7ju54aY

Sheldon (as Penny selects vitamin supplements): Oh boy.
Penny: What now?
Sheldon: Well, there’s some value to taking a multivitamin, but the human body can only absorb so much, what you’re buying here are the ingredients for very expensive urine.
Penny: Well, maybe that’s what I was going for.
Sheldon: Well then you’ll want some manganese.
Vitamins have been all over the news the last few days, based on an editorial published in this week’s edition of the prominent medical journal Annals of Internal Medicine. In short, the findings of the editorial, based on a review of relevant recent literature and covering approximately half a million individuals are that taking supplements and multivitamins to prevent chronic diseases is a complete waste of money. In fact, the title of the editorial is “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.”
And with that folks, let us declare today a Straight, No Chaser kind of day. I’m going to make this real simple.
Point #1: I’m a physician and a scientist. Physicians have every reason to embrace improvements in medicines and technology when they exist and no reason to shoot down them down when they’re effective. If it worked, we’d tell you.
Point #2: Opinions, anecdotes and personal experience do not constitute medical fact. Just because you felt better or believe your memory improved after taking a certain pill doesn’t mean the cause of your improvement was the pill.
Point #3: There is a phenomenon called the placebo effect that explains more than you’re willing to admit.
The placebo effect is a measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered. Even though placebos are not active medicines, they seem to have an effect in about 1 out of 3 patients. This is thought to represent the body mobilizing to address the concern for which you decided to take the pill. In this example, vitamins aren’t placebos because they actually have an effect on the body; however, the improvements you’re experiences aren’t directly attributable to those pills.
More than half of all adults in the United States take a multivitamin and/or additional supplements, including those touted to prevent cancer, heart disease and boost memory.
“The (vitamin and supplement) industry is based on anecdote, people saying ‘I take this, and it makes me feel better,’ said Dr. Edgar Miller, professor of medicine and epidemiology at Johns Hopkins University School of Medicine and co-author of the editorial. ”It’s perpetuated. But when you put it to the test, there’s no evidence of benefit in the long term. It can’t prevent mortality, stroke or heart attack.”
The vitamin and supplement industry rakes in nearly $12 billion annually, according to the researchers, with multivitamins its most popular product.
With that, allow me to again extol the virtues of a good diet.
Point #4: Most everything you’re looking for in a bottle can be obtained by a healthy diet, especially generous in servings of fruits and vegetables.
It is a fair point to make that a large number of us do not engage in a healthy diet, so much so that a multivitamin would be beneficial. Of course, that begs the question “If someone is not compliant with the direction to eat health foods, why would you presume they’d be compliant taking a multivitamin daily?” These pills are not inexpensive. Your better course of action is in spending that money on healthier food choices.
Point #5: It is an appropriate point to make that if you are suffering from a nutritional deficiency, you will benefit from a vitamin supplement.
Of course, the deficiency would have diagnosed by your physician, and the supplement would have been recommended by your physician. Short of that, in most cases, you’re allowing your fears to be played upon.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Sleep Apnea

December 17, 2013Sleephealth, Hypertension, Non-rapid eye movement sleep, Obstructive sleep apnea, Sleep, Sleep apnea, Sleep disorder, Slow-wave sleep, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We’ve discussed many components of sleep and sleep disorders. A very common condition that many of you are walking around with undiagnosed is sleep apnea. Sleep apnea is a common, recurring sleeping disorder in which your breathing temporarily pauses during your sleep. Have you ever awakened and felt as if you were choking or coughing? We may be talking to you.
The pauses of sleep apnea range in frequency and severity. They can last seconds or minutes. They may occur about 30 times in an hour.
Let’s pause there. I just told you that many of you are suffering from a disorder in which you stop breathing while asleep. Think about what that means.
Physiologically, if you’re not breathing while you’re asleep, your body will adjust. If you are in a stage of deep sleep, you’ll be kicked into light sleep, which is a lesser quality of sleep, and your body won’t be as replenished as it would otherwise. Your body will be less rested as a result, and you will suffer throughout the day.
Sleep apnea is most commonly due to some level of obstruction—obstructive sleep apnea. Do you have a large tongue or big tonsils? Are you overweight? Are you a big snorer? We may be talking to you. That snoring may be the sound of air moving past some obstruction. By the way, obstructive sleep apnea occurs more often in overweight people, but it can occur in anyone.

Now to the “So What?” of the conversation. This is about the quality of your life. Sleep apnea is about insufficient quantity and quality of sleep. It’s about excessive daytime sleepiness. It’s about recurring episodes of inadequate levels of air resulting from the breathing difficulty. These facts have consequences. Refer to the lead picture above for an illustration of the various types of symptoms and problems that are associated with sleep apnea. Sleep apnea also brings risks for the following conditions and diseases if left untreated.

Diabetes
Heart attacks
Heart failure
High blood pressure
Irregular heartbeats (arrhythmias)
Obesity
Strokes

Sleep apnea is easy and hard to diagnose at the same time. Many of you are suffering with it unsuspectingly as we speak. The person you sleep with may have expressed concern about your snoring or choking while you sleep. If so, get checked.
Sleep apnea once diagnosed is treatable with some combination of lifestyle changes, breathing devices and mouthpieces. Surgery is used in some cases.
We’ve reviewed many components of sleep and sleep disorders. Be mindful that sleep is your body’s time to rest and recover from the day’s activity. Any disruption in its ability to do that does not bode well for you over the long term. If your sleeping habits are problematic for you, you really should get evaluated. Getting this situation addressed can dramatically improve the quality of your life.
Finally, review the attached video for an illustration of what’s happening during sleep apnea. Excuse the scary music!
http://www.youtube.com/watch?v=Wm-TZ-dO_rQ
This discussion has focused on obstructive sleep apnea and not the less common form, central sleep apnea. The symptoms are similar, so if you have the other condition, it would be determined by your physician.
This post is part of a Straight, No Chaser series on sleep and sleep disorders.

Click here for a discussion of normal sleep and how much you need a day.
Click here and click here for discussions about insomnia.
Click here for a discussion of night terrors.
Click here for a discussion of hypersomnia (excessive sleepiness).
Click here for a discussion of narcolepsy (sleep attacks).

Straight, No Chaser: The Risks and Benefits of Coffee

December 16, 2013Diet and Nutrition, General Health and WellnessCaffeine, Coffee, Diabetes mellitus type 2, Drink, Harvard School of Public Health, health, Parkinson, Parkinson's disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Today, I come to praise coffee, not to bury it—and I don’t even drink it. Here’s the point: Coffee is a reasonably healthy beverage choice. The problem with coffee appears to be what you do to it! More about that in a moment. I’d like to review recent findings from a massive study on coffee and health from the Harvard School of Public Health. (Go Crimson!)
Those of you who’ve made a big deal of reducing your coffee intake as a means of improving your health would be much better off focusing on better eating and exercise habits, and on smoking and alcohol cessation. Regarding coffee specifically, it’s important to state that any discussion of the risks and benefits of coffee are in reference to black coffee. If you’re guzzling high calorie coffee products with lots of sugar, whipped cream, caramel and other additives that increase calories and fat, you’ve migrated to an entirely different conversation, and that one isn’t so pleasant.
Coffee has beneficial health effects, including the following:

It may protect against Type 2 diabetes.
It may protect against Parkinson’s disease.
It may protect against liver cirrhosis and liver cancer.
People who regularly drink coffee actually have a somewhat lower risk of death from heart disease than those who rarely drink coffee.

The “problem with coffee” is more about what you do while you’re drinking coffee.

Drinking coffee often occurs while smoking cigarettes, and if you’re a smoker you’re not getting any health benefits from pretty much anything associated with that activity.
People who drink coffee are less likely to exercise and use dietary supplements, and they tend to have a less healthy diet.
The weight of evidence on whether coffee increases the risk of heart disease or certain cancers is clearly leaning toward suggesting the negative ramifications are associated with the other habits of coffee drinkers and not the coffee consumption itself.
As mentioned earlier and to further the last point, adding syrups, sugars and milks can increase the caloric intake high enough that regular consumption may lead to weight gain and increase your risk for Type 2 diabetes.

What about tea? Chinese data is different than US data. US research has not shown the type of benefits of tea that Chinese research has. It is thought that this is likely due to US tea drinkers consuming weaker varieties of tea, and they tend to drink less of it. (The Chinese studies feature approximately a liter a day of Oolong tea.)
Here are some bottom line considerations:

Drinking as much as up to six cups a day of black coffee is not associated with increased risk of death from any cause, including death from cancer or cardiovascular disease.
If you are a pregnant female, have difficulty controlling diabetes or high blood pressure, or if coffee gives you tremors or palpitations, you may wish to avoid it.
You should brew coffee with a paper filter, to remove a substance that causes increases in LDL cholesterol.
Coffee likely has health benefits, but more research needs to be done to definitively state the extent of those benefits.
The health benefits of coffee are likely neutralized or overrun by unhealthy substances added to coffee and associated unhealthy habits of coffee drinkers.

Maybe coffee is another of those instances in which Straight, No Chaser is best!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Understanding Normal Sleep and How Much Sleep You Need

December 15, 2013SleepNon-rapid eye movement sleep, Rapid eye movement sleep, REM, Sleep, Sleep apnea, Sleep deprivation, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Do you ever think about why we sleep? Our bodies are highly efficient machines that utilize a lot of energy over the course of a day. In particular, our brain utilizes a lot of oxygen and energy. Sleep is meant to be a process organized by the brain and responsive to our body’s needs. Sometimes those needs are immediate, and sometimes those needs are scheduled. Contrary to what is often thought, we’re not designed to just black out when we’re tired. Sleep is actually a process orchestrated by the brain.
How and when we sleep is governed by a number of factors. These include factors under our control, such as whether or not we are sleep deprived, and factors beyond our conscious control. Chief among the latter consideration is the fact that we actually do have an internal “clock” that regulates our biologic rhythm (also called a circadian rhythm) over a 24-hour period. The circadian rhythm maintains our sleep-wake cycle and prompts us to want to sleep during similar times of the day and/or night. Sometimes that internal rhythm and the body’s routine call for sleep can be disrupted, making sleep a response to abnormal functioning within the brain (such as occurs in narcolepsy).
Sleep also has an internal organization—the sleep cycle—regulated by different areas of the brain. Sleep occurs in two stages, which recur through the night: rapid eye movement (REM) sleep and non-rapid eye movement (non-REM) sleep. Non-REM sleep is further divided into four stages (1 through 4), with stages 3 and 4 often referred to as “deep sleep.” In adults, non-REM sleep occupies around 80 percent of the night, and REM sleep 20 percent. REM sleep occurs every 90-110 minutes. These cycles recur until we awaken due to a schedule or decision to arise. You will feel most refreshed after sleeping and waking up at the completion of the final stage in a sleep cycle.
The body replenishes and restores itself during non-REM sleep, releasing hormones to repair damage done during the day. During REM sleep, you process memories and thoughts from the day and you dream. As best as we understand dreams, they also represent a form of processing mental information that you received during the day. During REM sleep, we normally lose the use of our limb muscles. Yes, it’s true that while we’re sleeping (at least in REM sleep), we have an active mind in an inactive body. This is actually a good thing. This normal loss of muscle activity during REM sleep helps prevent us from acting out our dreams. Thus, it stands to reason that sleepwalking and night terrors usually occur in non-REM sleep. When disorders of REM sleep occur and patients lose that protective phase of muscle inactivity, patients may act out violent dreams and harm themselves or others.
How much sleep you need is best defined by how well you function on different amounts of sleep, and as such, there is quite a bit of variation on what is considered normal and needed. For many adults, the average normal amount of sleep is around 7.5 hours per night. Many of you know people that can function on much less, and others that require as much as 9 hours per night. In general, your body feels most rested if you awaken at the end of a sleep cycle. Given that each cycle takes about 90 minutes, many people find that they’re more refreshed if they sleep some increment of 1.5 hours (e.g., 6, 7.5 or 9 hours).
If you are getting what you consider to be an adequate amount of sleep but are still unrefreshed and sleepy, then you might have an organic sleep disorder and should consider seeking professional consultation.
Additional Straight, No Chaser Blogs have addressed several of the sleep disorders.

Click here and click here for discussions about insomnia.
Click here for a discussion of night terrors.
Click here for a discussion of hypersomnia (excessive sleepiness).
Click here for a discussion of narcolepsy (sleep attacks).
Check back for a discussion of sleep apnea.

Straight, No Chaser: Narcolepsy – The Sleep Attack

December 14, 2013SleepCataplexy, Conditions and Diseases, Excessive daytime sleepiness, health, Narcolepsy, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a series on sleep disorders.

Click here and click here for discussions about insomnia.
Click here for a discussion of night terrors.
Click here for a discussion of hypersomnia (excessive sleepiness).
Check back for a discussion of sleep apnea.

When you hear about narcolepsy, it’s usually in the context of some joke, but it’s a horrifying condition. Looking at the lead picture, imagining blacking out while driving a car. A diagnosis of narcolepsy should prompt certain lifestyle changes.

To better understand this condition, let’s look at certain truths of narcolepsy.

Narcolepsy doesn’t happen just because you’re tired.

Narcolepsy is a brain disorder. The part of your brain that regulates your cycle of being awake vs. being asleep is disturbed. The drop attack is not fading into sleep. It is an irresistible shut down. Now, narcoleptics do suffer from severe sleepiness throughout the day, but the sleep attacks aren’t predictable based on how tired one is.

Narcoleptics have severe disruptions of the activities of daily living.

Just remembering that this is a drop attack will help you appreciate the danger of narcolepsy. It can occur at any time during any activity. The unpredictability of the condition renders it very dangerous to the sufferer, and it makes performing at work, at school, in social and in many other settings very difficult.

Narcoleptics are likely suffering from other sleep disorders.

Understand that narcolepsy is a disruption of the sleep/wake cycle. That disturbance can manifest in other ways, including poor sleep quality and frequent nighttime waking. However, narcoleptics do not tend to spend more total time asleep during the day than unaffected individuals.

In addition to the sleep attacks, the main symptoms are excessive daytime sleepiness and cataplexy.

Cataplexy is a sudden voluntary muscle loss while one is still awake—the horror before the horror, if you will. Individuals feel limp and/or unable to move. Other symptoms may include hallucinations and an extension of the cataplexy to outright paralysis before and after the episode. Now the drop attacks themselves typically last seconds to minutes and result in a temporary feeling of refreshment before the sleepiness phenomenon reoccurs.

There’s no special rhyme or reason to who suffers from narcolepsy.

Narcolepsy occurs the world around and in men and women at a roughly equal rate. It typically occurs in children through young adulthood, but it can occur at any age. Surprisingly, it often is underdiagnosed. Don’t let that happen to you. With any form of a blackout or sleep attack, please get evaluated and be sure to ask if the episode could have been narcolepsy.

Check back for a discussion of causes, diagnosis and treatment of narcolepsy.

Straight, No Chaser: Why Are You So Sleepy?

December 13, 2013SleepConditions and Diseases, health, Hypersomnia, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, WordPressJeffrey Sterling, MD

This is part of a series on sleep disorders.

Click here and click here for discussions about insomnia.
Click here for a discussion of night terrors.
Check back for discussions of narcolepsy and sleep apnea.

Are you one of those individuals who is always tired and sleepy? You take iron, you exercise and you’re getting sleep at night. However, you’re still tired? What’s that about?
Hypersomnia (i.e., excessive sleepiness) is characterized by prolonged nighttime sleep and/or recurrent bouts of excessive daytime sleepiness or prolonged nighttime sleep. This is not the variety of sleepiness due to physical or mental exhaustion or insufficient sleep at night. Hypersomnia makes you want to nap repeatedly during the day. Ironically, even if you do take a nap or even after you sleep overnight, you’re still fatigued.
The functional importance of this is somewhat obvious. Hypersomnia interrupts your life, your work, your ability to normally interact with others. Symptoms are what you might expect from someone not getting enough sleep. Here’s a typical list:

restlessness
anxiety and irritation
decreased energy
slow thinking
slow speech
loss of appetite
hallucinations
memory difficulty
loss the ability to function in family, social, occupational, or other settings

Hypersomnia is difficult. It takes time to realize you’re affected beyond just regular fatigue. It’s also difficult to pin down the cause. Consider the following potential groups of causes:

Physical causes may include damage to the brain (e.g., from head trauma) or spinal cord, or from a tumor.
Medical and mental/behavioral health causes may include obesity, seizure disorder (epilepsy), encephalitis, multiple sclerosis and other sleep disorders (e.g., sleep apnea, nacolepsy).
Mental/behavioral health causes may include depression, drug or alcohol use.
Medications or medication withdrawal may cause hypersomnia.

Unfortunately, treatment is symptomatic and often requires some degree of trial and error. For some individuals, stimulants, antidepressants and other psychoactive medications are effective. For others, behavioral changes appear to be more effective.
Any disruption in the quality or amount of sleep warrant investigation. Discuss your concerns with your physician if you have the opportunity. You always have the option of discussing with your SterlingMedicalAdvice.com expert consultant.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: What You Can Do To Manage Hypothermia and Serious Cold Exposure

December 12, 2013Environmental, Health PreventionEmergency department, Facebook, Frostbite, Hypothermia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, WordPressJeffrey Sterling, MD

Is this the most famous illustration of frostbite? Do you remember the movie reference?

I’ll admit that my orientation is different than yours. I’ll argue that your orientation should be closer to mine. What’s the difference, you may ask? I’ve actually seen the consequences of your unfortunate actions, and these consequences occur with a much greater frequency than you may imagine. “An ounce of prevention is worth a pound of cure” isn’t just a catchy quote from Ben Franklin. It’s an “Oops, I should’ve had a V-8 moment” when you’re in front of me, my nurses and big invasive medical treatment options in an emergency room.
Cold exposure is a good example of this. We’ve previously discussed frostbite, but there must be more to the story than frostbite. Frostbite is not a necessary pit stop on the way to very bad things happening due to cold exposure. More importantly, for as bad as frostbite is, there are worse things that can happen to you from cold exposure. This is a relatively important conversation. You need more tools at your disposal than “Just bundle up.” We’ll explore these tools in two parts: basic care and emergency care.
The Basics – Prevention

Layers of loose clothing are better. Wear more than one pair of socks, at least until you’re back indoors.
Use a hat that actually covers your scalp. (Major heat loss occurs through the scalp.)
Use a hat that covers your ears and a scarf that covers your nose. (These areas are prone to frostbite.)
Wear mittens. They are better for protecting your fingers than gloves.
People greatly underestimate the effect of the combinations of being cold and wet or being exposed to cold and windy conditions. If you have water-resistant, wind-proof options, use them.
If you know you’re going to be exposed to the cold for a significant period of time, eat up and rest up beforehand. Avoid alcohol and cigarettes prior to and during such journeys.

Treatment You Can Do If Exposed:

Know what symptoms could be a result of hypothermia. Check previous posts for a refresher.
Your first step is to call 911, especially if any mental status changes (e.g., confusion) are present. Time is of the essence.
Do you know CPR? Refer here for a very easy refresher (you’ll commit it to memory in 2 minutes) of when to use it and how to perform it.
Can you get inside? Cover yourself with warm blankets and drink warm (nonalcoholic) fluids if possible. Remove wet and tight clothing (and cover back up with dry ones if possible).
You’re stuck outside? You should be thinking about reducing exposure to the cold, the wind and any wetness as much as possible. Don’t forget to provide a layer between the backside and the ground. Prioritize covering the scalp.
Think about giving or receiving a hug as a means of warmth. If you have access to warm compresses or towels, preferentially apply to the armpits, groin, neck and chest.

Your take home message is death from hypothermia can be avoided with the knowledge and application of basic fundamental considerations. Even better, you can usually choose to avoid exposure to bitterly cold conditions. I hope you find this information useful and never need to use it.
This is part of a series on medical conditions resulting from cold exposure.

Click here for a discussion of frostbite.
Click here for a discussion of the symptoms of and risks for hypothermia

Straight, No Chaser: Hypothermia (Low Body Temperature)

December 11, 2013EnvironmentalDisease, Facebook, Human body temperature, Hypothermia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Temperature, Twitter, WordPressJeffrey Sterling, MD

This is part of a series on cold-related medical disorders.

To review the Do’s and Don’ts of Frostbite, click here.

Hypothermia is low body temperature. It’s not the “Oh, it’s cold outside” type of cold, but it is the “Oh, your life is in danger!” variety. Medically, hypothermia is a core body temperature below 95 °F (35 °C), and it can be produced by either an absolute cold exposure or sufficient heat loss beyond the body’s ability to generate a response.

What you want to know about hypothermia is the conditions and risks that set you up for it. Anyone can get hypothermia if you’re exposed to bad enough conditions, including the following:

Being outside without sufficient clothing in cold conditions
Being outside with wet clothing in cold and windy conditions
Excessive exertion or insufficient food or fluids while in cold and/or windy conditions
Excessive cold water exposure (e.g. immersion while ice fishing or boating)

Persons most likely to get hypothermic include the very old or young and those who are chronically ill or malnourished. Persons of normal health can get hypothermia if excessively fatigued or under the influence of alcohol or other drugs.
Typical symptoms of hypothermia include weakness, drowsiness, confusion and lack of coordination. Skin becomes cold, pale and frostbitten. Shivering becomes obvious and uncontrollable. Eventually, the heart and breathing rates will slow, and mental ability will progressively fade. Ultimately, the body can go into shock, and the heart and brain can cease functioning. Prolonged exposure will result in death if untreated.
For now I will leave you with the following considerations.

If you find someone in the cold who is not responding, don’t assume s/he’s dead.
Placing someone in direct heat, such as is given via a heating pad or lamp, or in hot water is not the approach and should not be done.
Do not give alcohol to someone exposed to extreme cold.

In the next post in this series we will discuss treatment and prevention strategies for extreme cold exposure.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Mass Trauma, Community Stress and Post-Traumatic Stress Disorder

December 9, 2013Mental Health, TraumaCognitive behavioral therapy, health, mental-health, Post-Traumatic Stress Disorder, Posttraumatic stress disorder, PTSD, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Symptom, TraumaJeffrey Sterling, MD

This is the fourth in a series on Post-Traumatic Stress Disorder (PTSD).

For an introduction to PTSD, including signs, symptoms and those at risk, click here.
For a discussion of the diagnosis and treatment of PTSD, click here.
For a discussion of the effects of PTSD in children, click here.

When entire communities are affected by a mass trauma such as a natural disaster, a terrorist attack or the effects of war, many can develop signs of post-traumatic stress disorder (PTSD). In these instances, symptoms tend to develop in the first few weeks after the episode. This is a normal, expected and shared community response to serious trauma. Fortunately, when communities suffer trauma, resources are more likely to become readily available, which allows many to experience a lessening of symptoms over time.
In the immediate timeframe of the event, vital measures should include the following.

Getting medically evaluated and to a safe place
Securing food and water
Contacting loved ones or friends
Learning what is being done to help and either provide or receive help as needed

Unfortunately, some just do not get better on their own. Although most people tend to improve with time after a community disaster, it is not uncommon for some to become more distressed and to exhibit more symptoms of PTSD, depression, and other mental health conditions. There are so many variables in play based on the type of disaster that occurred. Some people are effective at rebuilding their lives if the available resources are appropriate for the type of effect it had on them personally, but others may experience ongoing stress from loss of jobs and schools, trouble paying bills, finding housing, and getting healthcare. These types of stressors compound the effects of the disaster and may delay recovery in those affected by PTSD.
Many in the public health communities are embracing a comprehensive version of mass trauma “psychological first aid”. This complement to medical and financial resources is meant to fill existing voids in post-community disaster care delivery. Otherwise treatment approaches are generally similar to treatment of other forms of PTSD.
At the end of it all, disasters are just that. It would be a good thing for you and your family to be aware of the types of community disasters you may be exposed to and prepare before you ever need help. Having emergency numbers and other resources on your person at all times can be the difference between life and death when seconds count. Click here for a related Straight, No Chaser on Mass Trauma, and here’s hoping you either never need such assistance or you’re prepared enough during a disaster to make it through ok.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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