Tag Archives: SterlingMedicalAdvice.com

What's the difference between phenylephrine and pseudoephedrine?

sudafed

Unlike many things, this is a distinction with a difference, and one you should know. Both pseudoephedrine and phenylephrine are decongestants used to treat nasal congestion due to colds and allergies and other upper respiratory tract nuisances. The issue is pseudoephedrine can be made into methamphetamine. As a result, the U.S. Senate passed a bill restricting its sale. Pseudoephedrine products can still be purchased in limited quantities, but certain restrictions and other requirements are in place. In some states this includes requiring a prescription.
Regarding the difference between the two drugs, no studies have been done to confirm whether these two decongestants are equally effective, so we’re left to look at the chemical effects to judge.
There are some differences in the way the drugs are absorbed by the body:

  • The intestines will absorb only about 1/3 of the amount of phenylephrine in one tablet, while pseudoephedrine is 100% absorbed.
  • Phenylephrine’s effects do not last as long as those of pseudoephedrine. As a result, phenylephrine needs to be taken every four hours, while pseudoephedrine can be taken every four to six hours.

If you are considering trying either medication, discuss it with your physician or SMA consultant first. People with certain medical conditions such as diabetes, heart disease, high blood pressure, and overactive thyroid should not take products containing either of these ingredients. Also, people taking propranolol or certain antidepressants should avoid using these products.
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Straight, No Chaser: Do medications work differently in older people?

geriatrics_clip_image

The elderly are living longer and more productively. Part of being able to do so is by maintaining an understanding of how your actions  affect you. One common action of many of the elderly is taking medications. You should be aware that medications have changing effects with aging, and there are many different reasons for that fact.
First of all, changes in our physiology due to aging make the effects of drugs less predictable and consistent than in younger people. A slower metabolism, increases in body fat and alterations in the function of the kidney and liver (major mechanisms for drug elimination) have important ramifications for what ingested substances will do. Thus, the elderly require more stringent monitoring of drug levels and effects, and you may find that your physician needs to adjust medication doses. This same consideration explains why side effects are more common among the elderly.
Be reminded the presence of other diseases brings additional effects and challenges. Just as with one’s own relatively diminished function, disease imposes the same type of changes onto the body. This can speed the presence of side effects and toxicity as well as adjust the effective dose of a medication.
Have you ever seen the individual with a small ‘army’ of medications? Think about it. The more medications one takes, the more likely drug interactions will ensue and changes in effectiveness in any single medication may occur. This effect incrementally increases with each additional drug one takes. Similarly, the more medications one is taking, the most likely one is to make a mistake in taking the correct medication at the right time. Now consider your independently living parents or grandparents. The elderly often are more prone to make these types of errors.
What can you do about this? Get organized, and get help! Those daily medication containers are good solutions to incorrectly dosing medications. If you’re especially organized, a log is great—not necessarily for you, but for the physician that will be trying to figure out why you’re dizzy or have an altered mental status if and when that occurs.
Talk with each doctor you see or a pharmacist about what to expect from the combination of medications you take; it can make your lives a lot less complicated.
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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Straight, No Chaser: The Effects of PTSD on Children

PTSD-And-Children

This is part of a series on post-traumatic stress disorder (PTSD).

  • For a review of PTSD signs, symptoms and those at risk, click here.
  • For a review of PTSD diagnosis and treatment, click here.

Children are exposed to the same stimuli that creates post-traumatic stress disorder (PTSD), including physical abuse, sexual assault and the effects of war, but they may have different responses and  symptoms than adults. Symptoms unique to children typically involve developmental regression and may include the following:

  • Clinginess
  • Bedwetting
  • Cessation of speech
  • Acting out the scary event

Teens may become disruptive, disrespectful, or destructive, and they may express guilt or engage in revenge.
It is very important to get counseling for children that have experienced a traumatic event. The effects may be subtle but could be devastating and long-lasting.
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Straight, No Chaser: The Do's and Don't of Treating Frostbite

Alpha-Phi-Alpha-Ice-Cold-shirthypotherm1

There’s a cold front coming. You can’t avoid the exposure. Some of you will end up cold as ice (and twice as nice?). Would you really know what to do if you caught frostbite? I thought not, and the bad news is some of your instinctive tendencies are exactly what you ought not to do in this situation. Here are some do’s and don’ts if you ever find yourself or a loved one in this particularly precarious position.
The Do’s
A lot of this depends on the circumstances.

  • Give warm fluids if possible.
  • If the person is wet, remove wet clothing.
  • If s/he is wearing tight clothing, remove whatever’s constricting.
  • Move to as warm of a climate as feasible; if not possible, then shelter the person from the cold. Avoid movement of the frostbitten parts to the extent possible.
  • Gently separate affected fingers and toes, and if you can, wrap them loosely in sterile dressing.
  • If you have transportation, get to an emergency room as soon as possible.
  • If immediate care or transportation is not available, soak the affected areas in warm (preferably circulating and never hot) water. Alternatively, place warm coverings to affected areas for up to 30 minutes at a time. If skin is soft and feeling returns, you’ve done a good job.
    • Be mindful that burning pain and swelling will occur during rewarming.
  • Apply dry, loose and preferably sterile dressings to the frostbitten areas. Keep frostbitten fingers or toes separated with dressings.
  • Delay rewarming if you are not in an area safe from the risk of refreezing. Refreezing of thawed extremities is even more dangerous than the initial freeze.  

DO NOT

  • Rub or massage the frostbitten area.
  • Peel or pop any blisters that may be present.
  • Use dry heat, such as from a hair dryer, a radiation, heating pad, electric blanket or campfire. These heat source may be ok to keep the rest of you warm (particularly your core), but this type of direct heat can further damage frostbitten tissue.
  • Rewarm until you can be sure it can stay thawed.
  • Smoke or drink alcohol during recovery. These activities can interfere with blood circulation and cause additional problems.

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Straight, No Chaser: Your HIV and STD Risks from Sexual Activities Other Than Intercourse

sexual-risk-factors-2

Today, your sexual IQ goes up, and hopefully your risk for sexually transmitted infections (STIs), including HIV, goes down.
This is the fifth and last post in a series on HIV and AIDS.

  • For an explanation of what AIDS is, click here.
  • For an explanation of how HIV is contracted, click here.
  • For an explanation of the signs and symptoms of HIV/AIDS, click here.
  • For an explanation of the risk of contracting HIV from specific acts of sexual intercourse, click here.

Here are some terms you should understand.
Rimming: oral-anal contact
Fingering: digital sexual stimulation

Now let’s review.

Performing Oral Sex On A Man

  • You can get HIV by performing oral sex on your male partner. The risk is not as pronounced as it is with unprotected vaginal or anal sex, but oral sex clearly is a mode of transmitting HIV.
  • You are also at risk for getting other sexually transmitted infections (STIs), including herpes, syphilis, chlamydia and gonorrhea.
  • Using condoms during oral sex reduces the risk of contracting HIV and other STIs.
  • Your risk of contracting HIV from oral sex is reduced if your male partner does not ejaculate in your mouth.
  • Your risk of contracting HIV from oral sex is reduced if you do not have open sores or cuts in your mouth.

Receiving Oral Sex If You Are A Man

  • The risk of contracting HIV is less with receiving oral sex than many other sexual activities, but it is still present.
  • Your risk of contracting HIV from receiving oral sex is reduced if you do not have open sores or cuts on your penis.
  • Oral sex also presents a risk of contracting other STIs, most notably herpes.

Performing Oral Sex On A Woman

  • Significant levels of HIV have been found in vaginal secretions, so there is a risk of contracting HIV from this activity, although the risk is not a great with other sexual activities.
  • It is also possible to contract other STIs from performing oral sex on a woman.
  • There are effective barriers you can use to protect yourself from contact with your partner’s vaginal fluids. You can  use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (According to the Centers for Disease Control and Prevention, plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)

Receiving Oral Sex If You Are A Woman

  • The risk for contracting HIV while receiving oral sex is significantly lower than for unprotected vaginal sex, but it is still present.
  • It is also possible to contract other STIs while receiving oral sex.
  • There are effective barriers you can use (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.

Oral-Anal Contact (Rimming)

  • The risk of contracting HIV by rimming is very low but comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
  • You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.

Digital Stimulation (Fingering)

  • There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.
  • The use medical-grade gloves and water-based lubricants can during fingering eliminates this risk.

If you have any additional questions, please feel free to ask questions or provide comments. I cannot more highly endorse the websites at cdc.gov and the US Department of Health and Human Services.
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Straight, No Chaser: Your HIV and STD Risks From Specific Acts of Sexual Intercourse

stirisks

Let’s be clear that we’re explicitly discussing the types of sexual behaviors that will lead to transmitting HIV and other sexually transmitted infections (STIs). Over the next two days, we will run the gamut of sexual behavior and its implications.
This is the fourth in an ongoing series on HIV and AIDS.

  • For an explanation of what AIDS is, click here.
  • For an explanation of how HIV is contracted, click here.
  • For an explanation of the signs and symptoms of HIV/AIDS, click here.

What I hope to accomplish here is to identify those activities that place you at significant risk for contracting HIV and other sexually transmitted infections  (STIs). The take-home message is you really should identify your partner’s health status before you begin sexual activity.
Today we will focus on four types of sexual activity and discuss the risks of each. Let’s start with some terminology.

  • Receptive sex risks speak to risks to the receiver.
  • Insertive sex risks speak to risks to the giver.
  • Bottoming is a way of describing receptive anal sex.
  • Topping is a way of describing insertive anal sex.

Now, let’s review.

Receptive Vaginal Sex

  • Vaginal sex without a condom is a high-risk behavior for HIV infection.
  • HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
  • If you currently have an STI or vaginal infection, your risk for contracting/transmitting HIV is increased because your tissue will be inflamed. This has nothing to do with the presence or absence of symptoms.
  • Female condoms protect HIV infection if used correctly. However, the risk still exists for any area exposed and infected (in the presence of an open sore or bleeding, for example).
  • Barrier birth control methods (such as diaphragms, IUDs and cervical caps) DO NOT protect against STIs or HIV infection. If infected semen or sperm contracts inflamed or otherwise injured vaginal tissue, the risk of transmission/contraction is present.
  • Birth control pills do not protect against HIV or other STIs.

Insertive Vaginal Sex

  • HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
  • Condom use is a critical means of protection against STIs that are present without obvious symptoms. Use condoms with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Receptive Anal Sex (Bottoming)

  • Bottoming without a condom provides the highest risk for contracting HIV, more so than any other sexual behavior.
  • HIV has been identified in pre-ejaculatory semen. “Pulling out” prior to ejaculation may not decrease your risk.
  • Rectal douching before anal sex can increase your HIV risk. Douching irritates the rectal tissue and can make you more receptive to contracting HIV. Soap and water in a non-abrasive manner are adequate means of cleanliness.
  • If bottoming, you will best minimize the risk of transmitting HIV and other STIs by always using a water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize irritation to the rectum during sex and subsequent transmission.

Insertive Anal Sex (Topping)

  • Topping without a condom is a high-risk behavior for transmission of HIV and other STIs. An infection may be present. If small sores, scratches or tears are also present, they would provide a ready path of entry and transmission of HIV.
  • Similarly, those same lesions in your partners rectum could harbor infected cells in blood, feces or other fluid, which, when contacted, could infect you through your penis.

Check back for the next post in this series on HIV/AIDS. It will focus on HIV and STD risks from sexual activities other than intercourse.
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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Straight, No Chaser: What are the Symptoms of HIV and AIDS?

This is the third in an ongoing series on HIV and AIDS.

  • For an explanation of what AIDS is, click here.
  • For an explanation of how HIV is contracted, click here.

The National Institutes of Health has a nice method of categorizing HIV signs and symptoms, which I’ll replicate here. There are several take home messages, and I’ll use the pictures to communicate them.

HIV signs-symptoms-2
HIV Positive Without Symptoms
Many people who are HIV-positive do not have symptoms of HIV infection, and symptoms only evolve as their condition deteriorates toward AIDS (Acquired Immunodeficiency Syndrome). Sometimes people living with HIV go through periods of being sick and then feel fine.
HIV signs-symptoms2
Signs and Symptoms of Early HIV
As early as two–four weeks after exposure to HIV (but sometimes as far out as three months later), people can experience an acute illness, often described as “the worst flu ever.” This is called acute retrovirus syndrome (ARS) or primary HIV infection. This represents the body’s natural response to HIV infection. During primary HIV infection, there are higher levels of virus circulating in the blood, which means that people can more easily transmit the virus to others.
Symptoms resemble a flu-like syndrome, including fever, chills, nights sweats, muscle aches and fatigue. Other symptoms may include a rash, sore throat, swollen lymph nodes and ulcers in mouth. It is important to state that not everyone gets ARS when they become infected with HIV.
hiv-and-aids ss3
Signs and Symptoms of Chronic or Latent Phase HIV
After the initial infection and seroconversion, the virus becomes less active in the body, although it is still present. During this period, many people do not have any symptoms of HIV infection. This period is called the ‘chronic’ or ‘latency’ phase. This period can last up to 10 years—sometimes longer.

HIV opportunistic-infections-4

Signs and Symptoms of AIDS
While the virus itself can sometimes cause people to feel sick, most of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that attack the infected individual’s compromised immune system.
When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome at late stages.
Unless symptoms are discovered late, HIV/AIDS is much better being diagnosed early based on risk factors and exposures. That said, use the knowledge provided to prompt evaluation and testing.
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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We're in the Giving Mood: Free Subscriptions to SterlingMedicalAdvice.com

New Logo

Ok, we’ve lost it, and we’re giving it away for FREE! We’re so excited about SterlingMedicalAdvice.com that we’re giving it away for the month of December! If you like us on Facebook or follow us on Twitter at @asksterlingmd or follow the Straight, No Chaser blog at www.jeffreysterlingmd.com you can then go to www.SterlingMedicalAdvice.com and receive a free December subscription to our service (you will receive a SterlingAdviceSM plan).
Try it for free, and experience the difference personalized healthcare consulting can make in your family’s life. Thank for your support, and Happy Holidays.
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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Straight, No Chaser: How Do You Contract HIV/AIDS?

HIV-AIDS-21

Today is World AIDS day. This isn’t 1983. The mystery of how HIV infection is contracted has come and gone. You need to be knowledgable to be empowered.
This is the first blog in an ongoing series on HIV and AIDS.

  • For an explanation of what AIDS is, click here.
  • For an explanation of the signs and symptoms of HIV/AIDS is, click here.

First, let’s address a simple principle. The HIV virus can live and reproduce in high levels in blood other body fluids, including breast milk, rectal mucus, semen (and pre-semen) and vaginal fluids. If any of those fluids are infected and are transmitted to another’s body, that individual can become infected with HIV. In special circumstances (such as healthcare workers), individuals may become exposed to other areas that may contain high levels of HIV, including amniotic fluid (in pregnancy women), cerebrospinal fluid (from the brain and spinal cord) and synovial fluid (from various joints).
Now please take a moment and look at the lead picture. In addition to those circumstances listed, you should know that fluids such as feces, nasal fluid, saliva, sweat, tears, urine or vomit don’t by themselves contain high enough levels to transmit HIV. However, if those fluids are mixed with blood and you have contact with both fluids, you may become infected via these routes.
HIV is transmitted through body fluids in very specific ways:

  • During anal, oral or vaginal sex: When you have anal, oral, or vaginal sex with a partner, you will have contact with your partner’s body fluids in areas very likely to be high in HIV viral load if your partner is infected. HIV gets transmitted in these instances through small breaks in the surfaces of the mouth, penis, rectum, vagina or vulva. One of the reasons HIV infection rates are higher in individuals with herpes and syphilis is because those diseases cause open sores, creating additional opportunities for HIV-infected body fluids to enter the body.
  • During pregnancy, childbirth or breastfeeding: Babies have constant contact with their mother’s potentially infected body fluids. Means of transmitting HIV from mother to child include through amniotic fluid, blood and infected breast milk.
  • As a result of injection drug use: Injecting drugs puts you in contact with blood. If those needles and their contents are contaminated, you can be directly delivering HIV into your bloodstream.
  • As a result of occupational exposure: Healthcare workers must be constantly diligent against this method of transmission. Risks of HIV transmission to healthcare workers occur through blood transferred from needlesticks and cuts, and less commonly through contact of infected body fluids splashed into the eyes, mouth or into an open sore or cut.
  • As a result of a blood transfusion or organ transplant: Fortunately, these days, this is very rare given the stringency of screening requirements in the United States, but it is possible to transmit HIV through blood transfusions or organ transplants from infected donors.

How does one get AIDS?
AIDS is a progression of HIV into its later stages and occurs after one’s immune system is severely damaged. You don’t “get AIDS” as much as HIV progresses to AIDS in certain circumstances. Many of us recall that HIV could progress in this way to AIDS in a matter of a few years a few decades ago. Fortunately, with the development of specialized medications in the 1990s, people with HIV are living much longer with HIV before they develop AIDS.
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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Straight, No Chaser: Post-Traumatic Stress Disorder – Signs, Symptoms and Those at Risk

ptsd-1

I deal with disease and death everyday as an Emergency Physician, and it’s dehumanizing on many levels. Imaging having to pronounce someone dead despite giving your version of a superhuman effort to resuscitate them and then having to deliver the news to a family deep in prayer and holding on to strings of hope. Oh yeah, and then you immediately get to return to a room filled with patients and families oblivious to anything you’re dealing with as an individual, who are completely immersed in their personal situations and often complaining because “you took too long.” Imagine the lives of morticians or cemetery workers, having to stare at and feel the remains of the dead all day everyday. Imagine the lives of those habitually raped or viciously beaten by a loved one as a child. And, of course, there are the soldiers. Over 7.5 million Americans are thought to be suffering from post-traumatic stress disorder (PTSD), approximately one in every 40 individuals.
Traumatic and post-traumatic stress are not only able to affect your reality, but to adjust your reality. The body’s normal “fight-or-flight” response to danger or extremely stressful situations can evolve into abnormalities in your behavior if you are continually immersed in these environments. One such as the emergency physician may become desensitized and/or empowered to address situations that would make otherwise normal individuals recoil, or one may become overly sensitive, hyper-stressed and prone to a fight response to lesser stimuli—or no stimuli at all.
There are three categories of symptoms of PTSD, which are easily remembered by thinking of a hyperactive “fight-or-flight” response: reliving traumatic experiences, avoiding circumstances or situations that remind one of the experience, and reacting out of hyperarousal to stimuli suggestive of the experience.

  • Reliving can involve flashbacks, scary thoughts and nightmares. Victims have been known to actually re-experience the physical and mental episodes, complete with palpitations, sweating, jitteriness and severe anxiety. Such experiences can become incapacitating.
  • Avoidance is in many ways the opposite end of the “fight or flight” syndrome. In this example, avoidance isn’t just being proactive and staying away from reminders of the experience, but it can escalate to loss of emotions or even recollection of the event. This isn’t a strategic decision; it’s a defense mechanism gone haywire. As an example, imagine the near-drowning victim who refuses to even sit on the beach.
  • Hyperarousal leads one to be on edge, sensitive and prone to overreact. In contrast to the other two symptoms listed, hyperarousal tends to be a constant state of being. PTSD victims with hyperarousal describe themselves as easily angered and always stressed.

Many if not most of us will experience traumatic events in our lives sufficient enough to cause tremendous stress. There are circumstances that enhance the risk of developing PTSD.

  • Childhood trauma is especially dangerous in that the developing brain can respond “appropriately” in coding for abnormal circumstances and exposures. Subsequent trauma can trigger PTSD-quality responses.
  • Women are more likely to develop PTSD than men.
  • Mental illness may abnormally shape responses to traumatic events.
  • There is some evidence that susceptibility to the disorder may run in families. Individual differences in the brain or genes may predispose an individual.
  • The relative absence of social support and a functional network is a severe risk.

Conversely, if you have strong coping mechanisms, you may be able to lower your risk for developing PTSD after trauma. Consider the following protective factors:

  • A predisposition toward optimism
  • The ability and inclination to seek out support from others, ranging from friends, family and/or an active support group
  • A mental orientation that you “performed well” in the face of the danger
  • A mental orientation of learning from the experience instead of allowing the experience to define you
  • Sufficient mental fortitude to be able to carry on in the face of the symptoms (fear, anxiety) that follow the event

The presence of these “resilience factors” does not suggest that those suffering from PTSD are lacking in any way; it suggests the best opportunities for you to avoid succumbing to the enormous pressures that exist.

  • Check here for a discussion of the diagnosis and treatment of PTSD.
  • Check here for a discussion of the effects of PTSD on children.
  • Check here for a discussion of the effects of PTSD on communities after mass trauma.

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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Straight, No Chaser: "Abnormally" Foul-Smelling Stools

FoulSmellingStool

Obligatory disclaimer: this blog is in response to a reader request (Thank you?), not a commentary on the quality of your Thanksgiving cuisine… and we’re off…
There’s an obvious joke here about the native smell of stools, but that’s not what we’ll be discussing today. Most people are aware of how their stools normally smell. How should you react when your stools are abnormally foul-smelling?
Let’s address this conversation by understanding what normally produces the smell and consistency, what causes changes in the smell and what should prompt you to get evaluated.
Normally your stools smell the way they do because of a combination of them being waste products of certain food (which once digested and impacted by resident bacteria in your lower intestines release foul-smelling by-products) and releasing flatulence (gas).
It should stand to reason that conditions that change either the composition of your stools (e.g. a change in your diet), the presence of bacteria in your lower intestines (e.g. taking antibiotics) or conditions changing the production of gas or absorption of your food would lead to foul-smelling stools, and indeed these are common causes.
There are significant medical conditions associated with the above, including the following:

  • Celiac disease – Gluten foods damage the part of the small intestine that absorbs nutrients; this malabsorption leads to abnormal stools.
  • Cystic fibrosis
  • Food allergies/Lactose and other carbohydrate intolerance (or allergies) – These conditions also leads to malabsorption.
  • Inflammatory bowel disease (e.g. Crohn’s disease, ulcerative colitis) – Among other things, these conditions inflame the intestines, limiting absorption and leading to diarrhea and foul-smelling stools.
  • Medication/multivitamin overdose
  • Pancreatitis

Foul-smelling stools should always warrant concern and reflection on whether any dietary changes might have caused the change. Here are some signs that, if present should prompt a visit to the ER or a conversation with your SterlingMedicalAdvice.com expert.

  • Abdominal pain
  • Black, bloody or pale stools
  • Fever and/or chills
  • Unintended weight loss

Finally, as long as I have your attention, remember to wash your hands and fully cook your meats. These simple preventable steps can ward off many conditions that affect your digestive tract.
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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Straight, No Chaser: The Holiday Blues – Tips to Deal with Depression and Stress This Time of Year

HolidayDepression Holiday_Depression-300x199

I don’t mean to bring anyone down during what is supposed to be the ‘most wonderful time of the year’, but in reality there are many people hurting. For some, life’s tragedies happen this time of year the same as they might any other time. For others, this may have already happened, and this time of year is a permanent reminder of an unfortunate experience. For others still who struggle with depression, anxiety and mental illness all year, the holiday season can exacerbate these feelings and may make holidays especially long, depressing and potentially dangerous times.
My goal today is not to drag you into the dumps but to empower you with tips to assist you in the event this is a difficult time for you. By the way, I’m extremely thankful that you’ve chosen to give me moments of your day and life. I take that gift seriously and hope you continue to find it a worthwhile use of your time.
Here’s five tips for your holiday mental health:

  1. Remove yourself from stressful environments and avoid situations you know will create conflict, mental duress and/or danger. I can not emphasize this enough. If you put yourself in a bad situation, you can not be surprised when bad things happen.’
  2. Find support. Specifically, have ‘go-to’ friends and family that provide you comforting support. There’s a time and place for tough love, but in the midst of depression or suicidal ideation, ‘buck up’ is not good advice. Know where your support lies and be sure (in advance) that it will be accessible if you need it.
  3. Find success and happiness where it is. During the holidays, people tend to lament what isn’t. That’s not a formula for success. Yes, all of your family may not be around, but celebrating happy memories with the ones you can often fills the room with the joyous presence of loved ones not around. Enjoy the pleasures and successes you do have access to, whether big or small. Focusing on the positive keep you positive.
  4. If you’re struggling, admit it.  You already know you’re hurting. Often the first step to getting past it is acknowledging it. Once done, then you can put coping mechanisms in place to address your feelings.
  5. Avoid holiday activities that will create post-holiday angst. This applies to eating, drinking, shopping and personal interactions. Some use the holiday as an excuse to overindulge as if the consequences won’t be there afterwards. Reread #1 above.

Know when you need professional help. If your support system doesn’t sufficiently address your needs, and you’re feeling severely depressed, can’t function or are suicidal or homicidal, find a physician or mental health professional ASAP. Of course, you can always contact your SterlingMedicalAdvice.com expert. If you type mental health, depression or other keywords into the search bar above, you can access many other Straight, No Chaser blogs on behavioral health concerns that may provide you the support you need. I wish you all the best today and throughout the year, and hopefully the picture below will reflect the only type of blues you’ll have to deal with this year.
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Straight, No Chaser: When Eating Goes Wrong, Part II – Bulimia

Bulimia…-nerviosa-1bulimia

If you read Part I of this conversation on eating disorders (anorexia nervosa), you will recall that eating disorders are a mix of an abnormal body image combined with abnormal behaviors that lead to medical consequences.
The ‘Bizz-Buzz’ of bulimia nervosa is ‘binge-purge.’ What that means is bulimics engage in frequent episodes of eating excessive amounts of food (bingeing) followed by one of several methods of eliminating what was just ingested (purging). This methods include forced vomiting (most common), use of diuretics or laxatives, fasting or excessive exercise. It is important to note that the bulimic feels a lack of control over these episodes.
Bulimia is an especially dangerous disease because it usually occurs in secret, and victims are able to hide it. This means symptoms will typically be further along when discovered. Bulimics usually manage to maintain a normal or healthy weight despite their behavior and may appear to be the person who ‘never gains weight’ despite ‘eating like a horse.’ This is a key differentiator between bulimia and anorexia. Otherwise, the two diseases do share some of the same psychological pathology, including the fear of weight gain and the unhappiness with physical appearance.
Treatment considerations for bulimia are similar to those for other eating disorders. A combination of psychotherapy, reestablishment of normal nutritional intake and medications usually leads to marked improvement. Again, the particular challenge with bulimics is discovering the condition in the first place. As with anorexia nervosa, treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. Medications may include antidepressants, such as fluoxetine (Prozac), if the patient also has depression or anxiety.
Let’s recap by revisiting where we started with our conversation on anorexia. Our society doesn’t do the job it should in promoting a normal image of health. The typically promoted American ideal of beauty sets standards that lead many to pursue unrealistic means of meeting that ideal. In the setting of an actual American population that is obese by medical standards, this becomes even more of a problem. The levels of stress, anxiety and depression resulting from this reality sometimes leads to eating disorders. Remember, eating disorders aren’t just habits. They are life-threatening conditions. If you or a loved one is suffering, please seek help immediately.
Post-script: If you’re wondering about the lead picture of the teeth, you’re viewing the effects of all that regurgitated acid on the enamel layer of your teeth.  I know. It’s not your best look.
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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Straight, No Chaser: When Eating Goes Wrong, Part I – Anorexia

anorexia-nervosa

Our society doesn’t do the job it should in promoting a normal image of health. The typically promoted American ideal of beauty sets standards that lead many to pursue unrealistic means of meeting that ideal. In the setting of an actual American population that is obese by medical standards, this becomes even more of a problem, as individuals give up on realistic goals and settle into unhealthy eating habits that lead to disease due to obesity.
Most people are aware of two eating disorders–on the low side (obesity is another conversation): anorexia and bulimia. It is important to note that eating disorders are real medical and mental diseases. It is equally important to understand that they can be treated. It is vitally important to understand that when left untreated these disorders lead to a much higher incidence of death than in those without these conditions. These diseases cause severe disturbances in one’s diet, so much so that individuals spiral out of control toward severe disease and death in many instances. Sufferers of eating disorders often have a distorted self-image and ongoing concerns about weight and appearance. (This is as true for those pathologically overweight and in denial as it is for those pathologically underweight.)
Today, I’ll discuss anorexia. Anorexia nervosa is an eating disorder with nearly a 20 times greater likelihood of death that those in the general population of a similar age. Why, you ask? Simply put, they’re suffering the consequences of starving themselves. Anorexics have a maniacal and relentless pursuit of thinness, even in the face of being extremely thin. They couple an unwillingness to maintain a healthy weight with an intense fear of gaining weight. They possess a distorted view of their bodies and severely restrict their eating in response. They are obsessed.
Other symptoms and habits of anorexics include a lack of menstruation (among females, though men suffer from anorexia, too), binge-eating followed by extreme dieting and excessive exercise, misuse of diuretics, laxatives, enema and diet medications. The medical manifestations of anorexia are serious and can include osteoporosis or osteopenia (bone thinning), anemia, brittle hair and nails, dry skin, infertility, chronically low blood pressure, lethargy and fatigue, and heart and brain damage. It’s worth noting again that people die from anorexia. It is to be taken seriously.
The key components of treating eating disorders in general are stopping the behavior, reducing excessive exercise and maintaining or establishing adequate nutrition. The pursuit of adequate nutrition is vital enough that when patients develop dehydration and chemical imbalances (i.e., electrolyte abnormalities), they need hospitalization to correct deficiencies.
Specific management of anorexia involves addressing the psychological issues related to the eating disorder, obtaining a healthy weight, and consuming sufficient nutrition. This may involve various forms of behavioral therapy and medication. Regarding medication use, although some (such as antipsychotics or antidepressants) have been effective in addressing issues related to anorexia such as depression and anxiety, no medication has been proven effective in reversing weight loss and promoting weight gain back to a healthy/normal level. Similarly, behavioral therapy has been shown to assist in addressing the roots causes of anorexia but insufficient in addressing the medical issues that the disease contributed to or caused. Ultimately, it appears that a combination of medications, other medical interventions and behavioral therapy is the most effective course. As is the case with most illnesses, the earlier treatment is initiated, the better the outcome tends to be.
Please maintain a sufficient sensitivity toward those with anorexia. It’s a life-threatening condition, not the punch line of a joke about someone’s appearance.
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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I just got prescribed an antidepressant. About what should I be concerned?

antidepressant_medications_sign AntidepressantsCartoon4

For the answer to this concern, let’s go straight to the Food and Drug Administration’s (FDA) site, which roughly states the following:
Antidepressants are safe and popular, but research and case history demonstrate that they may have unintentional effects on some people, especially adolescents and young adults. During the first one to two months of initial treatment, patients of all ages taking antidepressants should be watched closely.
Possible side effects to look for are the following:

  • suicidal thoughts or behavior
  • worsening depression that gets worse
  • unusual changes in behavior such as insomnia, agitation, or withdrawal from normal social situations.

If you or a loved one witness or exhibit any of these types of changes shortly after taking antidepressants, please seek medical help immediately. A life could be in the balance.
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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Straight, No Chaser: What is AIDS?

HIV

This is the first blog in an ongoing series on HIV and AIDS.

  • For an explanation of how HIV is contracted, click here.
  • For an explanation of the signs and symptoms of HIV/AIDS is, click here.

After all these years, it’s still an interesting and important enough question to ask and to know how to answer. Most know that AIDS is a devastating disease caused by the HIV virus. However, courtesy of the National Institutes of Health, consider the following:
A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.
I – Immuno – Your body’s immune system includes all the organs and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is “deficient,” or isn’t working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.
Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections.
You will be diagnosed with AIDS if you have one or more specific opportunistic infections, certain cancers (such as Kaposi’s sarcoma) or a very low number of CD4 cells (a measure of the strength of your immune systems function).  If you have AIDS, you will need medical intervention and treatment to prevent death.
Check back to Straight, No Chaser for additional posts on HIV/AIDS, including risk factors and symptoms, progression/complications and treatment.
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Straight No Chaser: Warning Signs of Cancer – Take CAUTION

fight-cancer

Cancer. The Big C. The medical ‘death sentence’. No diagnosis scares as much as cancer, which is why it is so important that you be as empowered as possible. Be reminded that if you fall into certain risk categories, please get screened. Because many cancers are asymptotic during early stages, screening and early detection gives one the best possible chance for a good outcome.
In the event that symptoms are present, it’s helpful for you to know what typical symptoms are. Courtesy of the American Cancer Society, here is a mnemonic that teaches signs and symptoms to alert you to the possibility of cancer. Think ‘CAUTION’.

  • Change in bowel or bladder habits
  • A sore that does not heal
  • Unusual bleeding or discharge
  • Thickening or lump in the breast, testicles, or elsewhere
  • Indigestion or difficulty swallowing
  • Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore
  • Nagging cough or hoarseness

Additional symptoms that may be suggestive include unexplained weight loss, persistent headaches, nausea, vomiting, fatigue or pain, repeated infections and fever. Given that these non-specific symptoms could be due to many other things, as a cancer consideration, typical recommendations are to get these types of symptoms evaluated if they’ve been present for more than two weeks.
Just remember, cancer is something you want to detect, not ignore. If you wait until it’s too late, then, well it’ll be too late.
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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Straight, No Chaser: Your Questions About Taking a Daily Aspirin

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Thanks for your enthusiastic response to yesterday’s post on taking an aspirin.  Today, I’ll follow up with some of your questions.
So you’ve been told to take a daily aspirin to reduce your risk of a heart attack because you likely fell into one a high-risk category. Here are some logistical considerations about what to do.
1) Is there a better time of day to take an aspirin?
Recent data suggests that most heart attacks occur early in the morning. The best time to take an aspirin is relatively soon before you have that heart attack. However, since your heart doesn’t give you a heart attack alarm clock (and many of us aren’t especially mindful of heart attack recognition), the best move would seem to be to take an aspirin before going to bed, and recent research supports that an aspirin taken before going to bed offers the most protection from a heart attack. There are limitations to doing this (e.g. taking aspirin on an empty stomach if you have a history of ulcers may not prove to be the most pleasant thing), and you should discuss such timing with your physician.
2) Is there a better dose of aspirin to take?
That’s a question your physician will answer and is dependent on your personal situation. That said, doses as low as 75-81 mg have been shown to be effective. You may be placed on any dose up to 325 mg/day. It really is important to take an aspirin dose recommended by your physician for this consideration.
3) Is it better to chew or swallow an aspirin?
Chewing an aspirin is the quickest way to achieve effective blood levels. In case you were thinking about taking an alka-seltzer (which contains aspirin), that’s also good – but it’s just not as good as chewing an aspirin.
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Should I Take a Daily Aspirin?

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So… I’m stuck on a desert island, and I’m allowed to take two medications. I’m pretty sure aspirin is going to be one of them. This begs the question “Who should take a daily aspirin?”
The answer is actually easy: anyone and only anyone whose physician recommends it. The better question is when will your physician recommend it?
The benefits of aspirin in reducing heart attack risk have been known and well described for quite a while now, and you should check this list to see if you’d benefit from taking a daily aspirin. Truth be told, it’s of such importance that if you’re of a certain age, you should have this conversation with your physician at your next physical exam. Here’s a partial list that will get you a daily aspirin or very strongly considered for one.

  • If you’ve previously had a heart attack
  • If you’ve had a coronary artery stent or surgery
  • If you’ve previously had a stroke (caused by a blood clot) or TIA (transient ischemia attack, aka ‘mini-stroke’).
  • You’re a male over 50.
  • You’re a female over 60.
  • You have a bad risk factor profile (i.e. You smoke, have diabetes, high blood pressure or high cholesterol levels, are overweight, don’t exercise or have a personal or family history of heart disease)

The above list actually isn’t exhaustive but is sufficient for most individuals’  ability to remember to start a conversation with their physician.  These considerations will be measured against others that would suggest you shouldn’t be taking a daily aspirin (e.g. allergy, bleeding ulcers, a bleeding disorder or if you’re taking certain other medications).
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"Why would my doctor tell me not to take cough medicine for my cold or flu?"

coughmed

The first thing to appreciate about cough and cold preparations is they only provide relief of symptoms.  The body itself is providing the actual healing of what is usually a viral infection. The cough associated with a cold, flu or bronchitis will go away on its own (sooner rather than later, assuming you’re not smoking while sick; smoking further inflames your airways, thus stimulating coughing).
The nuisance symptoms of a cough often are most disturbing at night while you’re trying to sleep. Cough suppressants (antitussives) are medications that reduce your cough reflex. Additionally, you will often see the word ‘expectorant’ associated with cough medications; this component helps to hydrate and thus thin the mucus, making it easier for the body to expel.
So… some physicians prefer to allow the body to work these issues out on its own.  It is common to be told to only take cough medications at night to help you sleep, unless you need to take them to also get through your day.
Also, be reminded that all medications have side effects; you may recall that drug allergies or adverse drug reactions (which were covered here) may be additional reasons that your physician may not want you to take cough and cold preparations. If you have any questions in real time, you may always contact your physician or your SterlingMedicalAdvice.com 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.

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