Tag Archives: Straight No Chaser (composition)

Straight, No Chaser: High Blood Pressure (Hypertension)

hypertension-34

High blood pressure is called the silent killer. It’s common for me to see someone who thought they were ‘fine’ drop dead from its effects, never knowing it was about to happen and not having been aware of the warning signs and risk factors.
In lay terms, your heart is just a muscular pump pushing blood (containing oxygen and nutrients) around the body keeping stuff alive. The more you poison that pump (by ingesting unhealthy foods and inhaling other toxins) and strain the muscle by adding weight and clogging its vessels so it has to pump against more force (by being obese, not exercising and engaging in other unhealthy behaviors), the more likely that muscle is to strain until it gives out. Once it does, blood isn’t delivering what’s needed to your vital organs, and that’s when bad stuff happens.
bloodpressureThe vital organs in question and those bad effects include the following:
• The heart itself (no blood flow and no oxygen = heart attack; when the heart’s not strong enough to pump blood around the body = congestive heart failure)
• The blood vessels, especially the heart’s main offshoot, the aorta (too much strain = aneurysm, an outpouching from the main tubular system, stealing valuable blood from the rest of the body)
• The brain (no blood flow and no oxygen = stroke; aneursyms also occur in the brain)
• The kidneys (not enough blood flow or adequate enough function to clear the toxins from the kidney = renal failure)
• The eyes (poor blood flow and/or diseased eye blood vessels leads to vision loss)

blood_pressure_5_treat-img_1280x720-jpg

Bottom line: The heart is a muscle best thought of as a machine. Here’s three easy things you can do to reduce your risks.
• Get off your butt. Any exercise helps to get your heart pumping and blood flowing; strive for 20” three times a week at the very least.
• Close your mouth. Everything in moderation is cool, but introduce some fruits and vegetables into your life.
• Lose the salt shaker. At least taste your food first. It’s likely the food was already prepared with salt.
Did I mention stop smoking? Any questions?
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Here’s How You Complete End-of-Life Planning

durable-power-of-attorney

Now that you’ve had a chance to wrap your mind around the concept of needing to make end of life decisions, let’s discuss some specific mechanisms by which you can ensure your wishes are honored.
Living Will: This document, also known as medical directives, addresses those scenarios where you are unable to communicate your near death choices. The key consideration is that a living will keeps the power and decision-making in your hands, even when you’re incapacitated or otherwise unable to state your preference. You’ll want to have a copy of this form with you or with your family.
Do Not Resuscitate (DNR): A DNR form takes the living will consideration straight to the end of life question and explicitly states your preference not to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if needed.  Your physician will retain a copy of this document in your medical record as a way of alerting other medical providers (such as in the emergency room–if and when you show up there) of your desire.
Healthcare Power of Attorney (POA): The healthcare POA is your designee to carry out your medical wishes beyond what you have explicitly stated. A healthcare POA may serve more than one function.

  • If you haven’t made DNR or living will type decisions, a POA will make those decisions for you.
  • If you’ve made some decision and not others, the POA will fill in the gaps.
  • Making a POA designation is literally putting your life in someone else’s hands. Be very careful who you choose for this role. Some people will simply designate next-of-kin or a family member.  Others will want someone objective with no other motives (e.g., financial) than fulfilling their wishes. Either choice is much better than no choice, which too often leaves family members with competing interests and potentially having to carry the burden of making decisions for you that you could have made in advance.
  • Your POA will not be able to overturn decisions you’ve designated on the DNR form or your living will.
  • Your POA will not be able to make any decisions for you while you’re still able to do so unless you ask him/her to do so.

It’s important to know that you can simultaneously have a living will, DNR declaration and a Healthcare POA.  If you’re able, it may be wise to engage an attorney to sort through the various documents.
I hope for your sake and the comfort of any family you may leave behind that you take the time to engage in end-of-life planning for yourself and others in your family.  I’ve seen all too often how messy it gets when issues aren’t addressed in advance.  You really don’t want that happening to you at the end of your life.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Rashes on Your Palms and Soles; It's Not Always Hand, Foot and Mouth Disease

 
In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles.  However, there are a few of note, so here’s some Quick Tips to point you in the right direction. This doesn’t take long for you to learn, so commit this to memory, and you could save yourself a lot of drama down the road. Don’t forget to wear gloves and wash your hands!
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus.  It’s rather benign.
Hand-Foot-and-Mouth-Disease-3hand-foot-mouth-disease1hand-foot-mouth
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii).  If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.

RMSFRMSFfeet

If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease.  This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.

kawasaki

Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.

Kawasaki2

And yes, secondary syphilis presents with rashes on the palms and soles.  The real take home message is this.  Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed.  Trust me, you want to get treated before tertiary syphilis develops.  Here’s what that rash looks like.

2ndsyphilis2ndarysyphilis

The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: The Curse of the Weekend Warrior – Achilles Tendon Rupture

Kobe

In high school I led the league in stolen bases, and in college my cohorts and I loved inventing ever more creative ways to dunk a basketball. Apparently, my calf muscles worked well. Somehow at a certain age, I quit those competitive sports cold turkey, partially because I knew an Achilles rupture was lurking out there somewhere.

achilles-tendon-rupture

The Achilles tendon connects the muscles at the back of the calf to the heel. The formula for damage is pretty simple and consistent. As you age your tendons tend to stiffen and shrink. As you age you change from the fine-tuned wannabe athlete most of us were to a recreational player, and we overextend ourselves. Others of us, in making a comeback (or just rushing to train for something like a 5K run), try to go from zero (0) to 60 way too soon. In either scenario, that overextension causes the tendon to tear or snap. You’ll recognize it immediately by the sound (pop) and the inability to walk/stand on your toes, which results from the lack of connection from the calf to the heel. (You need to point your foot downward to walk, which is where the Achilles comes in.) Other common occurrences of Achilles tendon rupture include falling from a height and landing on your feet or stepping into a sizeable hole.

achilles-Figure2

Besides being an older guy (or gal, but it’s about five times more common in men) trying to reclaim past glory, steroids and certain antibiotics (flouroquinolones, examples of which are Levafloxacin, aka Levaquin, and Ciprofloxacin, aka Cipro) weaken the tendons enough to predispose you to this injury.
Depending on your age and preexisting health status, you will have surgical and/or nonsurgical options available to you to repair the tendon. Nonsurgical treatment involves a specific type of walking boot or cast, and surgery is more likely when the tear is complete. You’ll need extensive rehabilitation and strengthening of the muscle around the repaired tendon to avoid reinjury. Don’t expect to return to your previous level of strength and activity for four to six months.
So what’s your take home message? Once again, know where opportunities for prevention are. Given how important it is to maintain physical activity as you age, it’s important to remind you to learn how to stretch and maintain musculature so you don’t injure yourself while trying to exercise. Don’t engage in more strenuous activities until and unless you’ve built up to the level where you’re prepared to do so. Achilles injuries occur most often when you’re trying to do too much too soon. Also, be mindful of slippery surfaces; that slide acts the same as an attempt to accelerate too rapidly.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: So… You Skipped Your Period? Let’s Discuss Secondary Amenorrhea

missed-periods-300x205

It happens all the time, but one thing that makes both men and women anxious is a missed menstrual period. Everyone’s always worried about being pregnant (and you should be).

amenorrhea

While a missed menstrual period is the defining feature of early pregnancy, it can be due to a number of other factors and conditions.
Skipped periods are a fact of life. Doctors use the term amenorrhea—primary and secondary amenorrhea—to describe the absence of menstruation.
Primary amenorrhea, which is very rare, is when a female has not yet started her monthly periods, though she is older than age 15 and has otherwise completed puberty. We discuss primary amenorrhea over at www.sterlingmedicaladvice.com.
Secondary amenorrhea, which is much more common, is the absence of periods in a previously menstruating woman. Periods may be irregular, with the woman skipping periods for the first few years after she begins menstruating and during perimenopause (the time preceding menopause). However, when the lapse in regular periods last for over six months, it is called secondary amenorrhea. (This designation does not pertain to post-menopausal, pregnant or breast-feeding women.)
Let’s jump right into the risk factors and causes. There are many, and these conditions tend interfere with the balance and levels of the body’s sex hormones.
Risk factors
You are more likely to have amenorrhea when the following factors are present:

  • Excessive exercise
  • Significant, sudden weight loss (e.g., gastric bypass, extreme diets)
  • Obesity
  • Severe anxiety or emotional distress
  • Very low body fat (less than 15% – 17%)

Other possible causes include the following:

  • Brain tumors (e.g., pituitary tumors)
  • Cancer/chemotherapy treatment
  • Dilatation and curettage (D&C)
  • Drugs used to treat schizophrenia or psychosis
  • Overactive thyroid gland
  • Polycystic ovarian syndrome
  • Reduced function of the ovaries
  • Severe pelvic infections
  • Use of hormone shots (e.g., Depo-provera) and the six-month period after cessation of these shots

Of course, you’re going to get evaluated, and the first question will be whether or not you are pregnant. The good news is for secondary amenorrhea (and even more so for skipped periods), simply addressing the underlying cause resolves the situation in most cases. However, don’t take it lightly. Get evaluated if you have concerns. Of course, you can feel free to contact your SMA expert consultant with any questions you have.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: STDs – Pubic Lice (Crabs)

Unfortunately, there’s no pleasant way around this topic. I hope the topic doesn’t make you crabby.

public lice_01

There is a story of legend in the medical community regarding the trends to start waxing or shaving pubic hair. It involves crabs (pubic lice). Back in the 1920s, when the clear preference for appearance involved a full “bush,” this was often accompanied with the frequent presence of pubic lice, particularly in the brothels of Las Vegas. Women took to shaving in an effort to relieve themselves from the presence of the lice. However, the newly shaved appearance apparently wasn’t good for business; as a result, these women began wearing pubic toupees.
So why am I telling this story? The toupees were made of beaver hair. That’s the origin of that terminology, in case you didn’t know… On to common questions about pubic lice.

 pubic-lice-hair

What are pubic lice? Pubic lice (aka crabs) a parasitic insects found in the genital and pubic areas of humans.

 pubiclicevsheadlice

Where are pubic lice found? By definition, pubic lice are predominantly found in the genital and pubic areas in one’s hair. However, pubic lice have also been found in other areas of the body with coarse hair, such as the armpits, beard, eyebrows, eyelashes, legs and mustache. In fact, pubic lice on the eyebrows or eyelashes of children are regarded as a prompt to search for sexual abuse. It also is of note that lice on the scalp are head lice, which is a different consideration than pubic lice.
Whom do pubic lice infect? Anyone and everyone seem to be affected. Pubic lice are seen all over the world across all races, classes and ethnicities. Public lice are not seen in animals. Pubic lice are most commonly seen in adults, are considered to be a sexually transmitted disease (infection, aka STD or STI) and should prompt a search for other STDs. There have been occasional cases of spread through contact with articles such as bed linens, clothing or towels, but this is extremely rare. Lice can’t live away from the warmth of a human body very long, and their feet don’t allow for walking on or attaching to smooth surfaces, so they generally are limited to staying on their hosts.
Can I get public lice by sitting on a toilet? This commonly expressed concern is quite overstated. As noted, lice can’t live away from the warmth of a human body very long, and their feet don’t allow for walking on or attaching to smooth surfaces, so they generally are limited to staying on their hosts.

 pubicLice

What do pubic lice look like? Pubic lice have three forms: the egg (also called a nit), the nymph, and the adult.

  • Nit: Nits are lice eggs. When seen, they are usually found firmly attached to the hair shaft. They are oval and usually yellow to white. Pubic nits hatch in about 6–10 days.
  • Nymph: The nymph is a young, immature louse that just hatched from the nit. Pubic lice nymphs take about 2–3 weeks after hatching to mature into adults capable of reproducing. To live, a nymph must feed on blood.
  • Adult: The adult pubic louse resembles a miniature crab. Pubic lice have six legs; their two front legs are very large and look like the pincher claws of a crab. Pubic lice are tan to grayish-white in color. Females are usually larger than males. In can’t you’re thinking that doesn’t matter to those infected, it should because females lay eggs, continuing the cycle that causes human discomfort. To live, lice must feed on blood. If the louse falls off a person, it dies within 1–2 days. 

What are the signs and symptoms of pubic lice? The symptoms of pubic lice infestation include genital itching, visible lice eggs (nits) or visible crawling lice.

Pubic-lice

How is a pubic lice infestation diagnosed? The diagnosis of pubic lice is simply made by visualizing a louse or nit (egg) in the pubic hair or elsewhere. It is more common to need a magnifying glass to identify lice or eggs.
How are pubic lice treated? We will go into the treatment of pubic lice in some detail in an additional Straight, No Chaser. It’s too important to simply give a quick answer on this.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Prevention and Treatment of Carpal Tunnel Syndrome

carpel-tunnel-relief-

If you have carpel tunnel syndrome (CTS) or are at significant risk for developing it, you really should learn strategies to either prevent, limit progression or treat the condition. Of course, once you develop it, you’ll be more focused on treatment. Fortunately, very good options exist for all of these, and that’s what we’ll be reviewing in today’s Straight, No Chaser. Feel free to review this previous post on carpal tunnel syndrome, discussing its causes and risk factors.

carpal-tunnel-at-work prevention

How can carpal tunnel syndrome be prevented in the workplace?
Here are activities you should employ if you’re at risk for CTS. Your employer (through employee health services or even without such an entity) can develop an ergonomics program. This involves adapting the workplace (e.g. conditions and job demands) to the capability and needs of workers to complete assigned tasks. Components of ergonomics may include the following.

  • Redesign of workstations, tools and tool handles, and tasks to enable the wrist to maintain a natural position during work
  • Frequent rest breaks
  • Job rotation among workers
  • On-the-job conditioning
  • Stretching exercises
  • Use of splints to keep your wrists straight
  • Use of correct posture and wrist position
  • Wearing fingerless gloves to keep your hands warm and flexible

carpal tunnel syndrome keyboard

Of course if you have high-risk conditions such as obesity, arthritis or diabetes, you will do well to manage these conditions. Doing so will lessen the risk of subsequent development or worsening of CTS.
How is carpal tunnel syndrome treated?
In this post, we will address general, drug and surgical treatments. More detailed treatment considerations are covered at www.sterlingmedicaladvice.com.

Carpal-Tunnel-Syndrome-ice

General

  • Treatments for CTS should begin as early as possible and under a doctor’s direction.
  • Underlying causes such as diabetes or arthritis should be treated first.
  • Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending.
  • If there is inflammation, applying cool packs can help reduce swelling.

Carpal-tunnel-wrist-bracing

Drugs

  • In special circumstances, various drugs can ease the pain and swelling associated with CTS. Nonsteroidal anti-inflammatory drugs (e.g. aspirin, ibuprofen, and other nonprescription pain relievers) may ease symptoms that have been present for a short time or have been caused by strenuous activity.
  • Other drugs occasionally used include diuretics (“water pills”), meant to decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

carpel-tunnel-syndrome-eagle-arms-cow-face-arms-open-the-shoulder-stretch-your-hands-the-idea-girl-says-youtube

Exercise and Alternative Therapies

  • Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.
  • Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproven. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

carpal-tunnel-surgery

Surgery

  • Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves cutting the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay.
  • Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Complications may include infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.
  • Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

If you focus on the prevention strategies, the need for surgery will be lessened, and treatments will be guided by your physician. Your first job should be to discuss the safety of your work environment and ensure you’re doing what’s needed to minimize your risk.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Carpal Tunnel Syndrome

carpal tunnel

Do you spend much time typing at work? Are you a construction worker who operates a jack hammer? Do you have arthritis that affects your wrist? Do you have occasional or constant numbness or tingling in your hand or wrist or pain that shoots up your wrist into your arm? If so I’d hope that you’ve had at least a passing conversation about carpal tunnel syndrome (CTS), a fairly common condition associated with work activities. CTS is part of a class of disorders called entrapment neuropathies.
Let’s review CTS by addressing common questions about the syndrome.

Carpal-tunnel-syndrome-picture

What is carpal tunnel syndrome?
CTS is basically a squeezing of the nerve (median nerve) that extends from the forearm to the palm; the pressure on the nerve occurs at the level of the wrist. The carpal tunnel is an area at the base of the hand (on the side of the thumb) that houses tendons and the median nerve. Because it is such a small space, irritation such as that which occurs from inflammation or injury can compress and/or pinch the median nerve.

carpel-tunnel-relief-

What are the causes of CTS?
Your anatomy sets the table for CTS in some cases. Some individuals simply are predisposed to CTS because of a smaller carpel tunnel. Beyond this, conditions that cause injury to the wrist and result in swelling are likely culprits; that said, in some cases no cause is identified. Known causes and/or contributors include the following.

  • Development of a cyst or tumor in the canal
  • Fluid retention during pregnancy or menopause
  • Fracture or sprain
  • Hypothyroidism
  • Overactivity of the pituitary gland
  • Repeated use of vibrating hand tools
  • Rheumatoid arthritis
  • Work stress

Interestingly and contrary to the popular narrative, there is little clinical data to prove that repetitive and forceful movements of the hand and wrist during work or leisure activities can cause CTS. However, it does stand to reason that if you have CTS, these activities can exacerbate the situation.

carpal tunnel syndrome sx

What are the symptoms of carpal tunnel syndrome?
Symptoms are easy to figure out if you view your nerve as electrical conductors of various signals caused by stimulation. Frequent burning, tingling, or itching starts gradually, as does numbness in the palm of the hand and the fingers, especially the thumb, index and middle fingers. Symptoms may begin at work or during the night (if you sleep with your wrists cupped). Other symptoms may include a sensation of hand swelling without visual evidence, hand tingling that progressively worsens throughout the day and decreased grip strength. Over time, some untreated patients may lose the ability to distinguish between hot and cold sensations by touch. Symptoms are usually first seen in the dominant hand.
Who is at risk of developing carpal tunnel syndrome?

  • Women are three times more likely than men to develop CTS.
  • Diabetics or those with other disorders directly affect the body’s nerves are more susceptible to nerve compression.
  • CTS usually occurs only in adults.
  • CTS is especially common in those performing assembly line work , such as manufacturing, sewing, finishing, cleaning and packing (e.g. meat, poultry, or fish). In fact, CTS is three times more common among assemblers than among data-entry personnel.

The next Straight, No Chaser will address prevention and treatment of carpal tunnel syndrome.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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Straight, No Chaser: Questions and Answers About Problem Gambling

problem gambling ribbon

Whether or not you’re willing to admit to a gambling addiction, the presence of a gambling problem should concern you. This Straight, No Chaser takes information  adapted from the Nevada Council on Problem Gambling to address your  questions and concerns.
How is problem gambling defined?
There are a variety of ways to define a gambling problem, but what they all have in common is the presence of a behavior pattern involving gambling that disrupts or damages one’s personal lifestyle, inclusive of family, vocational or other personal pursuits.
How widespread is problem gambling in the U.S.?
2 million (1%) of U.S. adults are estimated to meet criteria for pathological gambling in a given year. Although that’s a lot of people, it’s a small proportion of the approximately 85% of U.S. adults who have gambled at least once in their lives.
Isn’t problem gambling just about losing money? Actually, no. The reason the topic is being addressed in this space is problem gambling is an emotional problem that has financial consequences, not just the presence of being a bad gambler who has lost a lot of money. In fact, the American Psychiatric Association even has criteria for gambling addiction (see www.psych.org for more). The bottom line is the problem gambler has an obsession with gambling.

gambling-addiction

What are the symptoms of problem gambling? 

  • increasing preoccupation with gambling
  • a need to bet more money more frequently
  • restlessness or irritability when attempting to stop
  • “chasing” losses
  • loss of control manifested by continuation of the gambling behavior in spite of mounting, serious, negative consequences.
  • In extreme cases, problem gambling can result in financial ruin, legal problems, loss of career and family, or even suicide.

What kind of people become problem gamblers? Actually, it’s been shown that anyone who gambles can develop problems. Remember, a gambling problem is defined by the outcome of a meaningful disruption to at least part of one’s life. Many problem gamblers are views as previously responsible and mentally strong until propelled into the crises brought on by gambling. This is not an affliction of just the irresponsible, weak-minded or weak-willed. It is of note that children and teens can also develop gambling problems.
Is problem gambling “caused” by predatory activity of casinos, lotteries, etc.? Just as a liquor store doesn’t “create” an alcoholic, neither does a casino or lottery cause gambling addiction; it does however provide the opportunity for a predetermined genetic tendency to develop addiction to become manifest.
How is the problem gambler addicted without ingesting something? It’s a misconception that substances are required to produce an addiction. Gambling produces alterations in mood and a need to reproduce behavior to achieve the positive benefits associated with the changes in mood. Just as with substance-induced addictions, tolerance develops, meaning in time it takes increasingly higher amounts of the behavior (gambling) to reach the desired effect. This leads to the same type of cravings and withdrawals seen in other addictions.

ncpg logo

How do I get help for problem gambling? There is a national helpline that is offered by the National Council on Problem Gambling. Call 800-522-4700 for concerns.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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From the Health Library of SterlingMedicalAdvice.com: “Why would my doctor tell me not to take a decongestant?”

decon

As you struggle from allergies season, the lede is a reasonable question, here is its answer.
Based on how ubiquitous cold and flu remedies are, you would think they were the safest medications known to man. That’s actually not the case and in some instances can be quite far from the truth. The reason for this is simple. Decongestants work by manipulating blood vessels. Specifically, they narrow nasal blood vessels, creating more room for air flow and mucous drainage while reducing swelling and other effects of inflammation. This is a major part of how you treat upper respiratory viral infections like colds and the flu; antibiotics don’t work against viruses.
Unfortunately, if you have certain medical issues, you should not take decongestants. Here’s a list of situations that can make it dangerous to take decongestants:

  • Allergies to pseudo-ephedrine
  • Children under age 4
  • Diabetes
  • Glaucoma
  • High blood pressure
  • Heart disease
  • Kidney disease
  • Prostate disease
  • Pregnant
  • Breast feeding women
  • Thyroid disease

So … even if it’s an over the counter preparation, if you’re not sure, head over to the pharmacist before you make that purchase at the store. Of course, you can always connect with your SterlingMedicalAdvice.com consultant as well.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Foot Corns and Calluses

Corns and callous 3
It’s really not my intention to be corny or callous here, but it’s almost in the name. This Straight, No Chaser looks at two very common problems of the feet.
First things first: even though “you know it when you see it,” let’s be clear what we’re describing, because although both corns and calluses can result from pressure and/or friction such as that occurring from tight-fitting shoes, loosely fitting high-heeled shoes or not wearing socks. However, there are differences between the two.
Corn

  • Corns are painful, smaller lesions that typically have a hard center with inflamed skin surrounding it. The presence of this inflamed skin suggests corns will hurt when pressure is applied. Corns usually aren’t seen on weight-bearing parts of the foot (although they can be), so if this is happening on the sides or toe of your toes, it is likely a corn.

Callus3-300x284

  • Calluses are typically larger and usually painless lesions, although they can have a range of sizes. They usually develop on the soles of your feet, especially under the heels or balls, on your palms, or on your knees. Calluses vary in size and shape and are often larger than corns.

In short, if your feet have any type of raised, hard lesion, any thickened, dry or scaly skin, or area of tenderness or pain with or without these symptoms should be a cause for concern.
Perhaps the most important considerations for you are to know what you can do to address these conditions yourself and when to see your physician.
Here are some self-help efforts you may attempt at home to prevent and address those corns and calluses. If you’re diabetic, you shouldn’t be attempting to treat these conditions on your own because of the increased incidence of infection and risks of amputation.

  • Moisturize. Keeping your skin soft prevents much of the friction that can be at the root of corn and callus formation. Moisturizing also facilitates removal of thickened skin. This can involve soaking as well as using lotions.
  • Avoid tight shoes and wear comfortable socks. This will help you prevent and address corn or callus issues. Here’s a simple tip: your shoes are too tight if you can’t wiggle your toes.
  • Use pads. Simple over-the-counter pads can cushion the impact between shoes and your skin.
  • Thin affected areas. After bathing or other moisturizing efforts, tough skin can be removed with objects such as an emery board, nail file or pumice stone.

Corns_and_Calluses
Here are some cues that your corn or callus needs to be addressed.

  • If you have diabetes, vascular disease or have been otherwise told that you have poor blood flow
  • If your pain is beyond your ability to control it on your own

Medical treatment for corns and calluses will involve optimizing the preventive mentioned previously, use of shoe inserts and consideration of medicinal and surgical options. The medical and surgical options aren’t necessarily first-line thoughts, but they are more likely to be considered if additional foot issues exist. As is often the case, your best option is prevention.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: When Back Pain Could Be Life Threatening

Emergency
Back pain hurts, but there are various causes of that pain that will kill or cripple you.  Here’s some information on some diseases that present with back pain representing life-threats.  Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards.  Forewarned is forearmed.
Let’s start where we left off on post discussion general low back pain and identify what I was talking about….
Here are a few clues to help you hone in on whether your back pain requires emergency attention.  Remember pain and pathology (serious disease) are two different considerations.  I’m describing medical emergencies here and admittedly being overly simplistic.

  • Direct blow to your back:  Think Fracture
    • The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back.  It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy.  That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
  • Fever and new onset back pain: Think Spinal Epidural Abscess
    • A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones.  It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood.  Antibiotics for about a month and/or surgery may be required.
  • Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
    • There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies.  CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects.  This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs.  Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
  • New onset back pain after age 65: Think Cancer
    • There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer.  The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement.  Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present.  It could represent a significant advancement of disease.
  • Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
  • Night-time back pain: Think Metastatic Cancer.
    • Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
  • Sudden sexual dysfunction: See Cauda Equina Syndrome above
  • Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
  • Unexplained new weight loss and new onset back pain: Think Cancer
    • There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
  • Work-related back injuries
    • This isn’t as much a life-threatening consideration as it is a limb and career-threatening one.  Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed.  Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs.  I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future.  The take home consideration here is to use these cues to know when to get rapidly evaluated.  Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Sciatica

Sciatica

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.
What is sciatica?

sciatica nerve

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.
What are the symptoms of sciatica?
sciatica screams
Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

  • Pain (e.g. pins and needles, burning or aching)
  • Weakness (can progress to an outright inability to move)
  • Numbness
  • Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

  • After sneezing, coughing or laughing
  • After walking or bending backwards
  • At night
  • When standing or sitting

What causes sciatica?

sciatica spinal stenosis

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

  • Bruise or fracture to one of your pelvic bones
  • Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
  • Infection (a rare but important cause in those with new fever and back pain)
  • Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
  • Pregnancy
  • Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
  • Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
  • Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
  • Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news). 

How is sciatica treated?
If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.
SCIATICA PAIN RELIEF

  • In some cases, no treatment is required and recovery occurs on its own.
  • Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
  • Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
  • Reduced and limited activity is best for the first few days. Bed rest is not recommended.

Sciatica treatment

  • For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
  • Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
  • Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
  • Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Why Are Athletes At Such Risk For Pulmonary Embolus?

pe awareness

Let’s begin today’s Straight, No Chaser by being sure not to overstate the case. All things being equal, young healthy individuals and superbly conditioned athletes have diminished risks for diseases across the board. However, all things aren’t equal. The nature of being a professional athlete and many of the tasks associated with being a professional athlete have resulted in some very high-profile cases of pulmonary emboli (PE).

  • Former NBA star Jerome Kersey of the Portland Trailblazers died last year from a PE.dvt kersey_600x600
  • NBA stars Chris Bosh of the Miami Heat and Mirza Teletovic of the Brooklyn Nets were diagnosed with pulmonary emboli and missed most of last season.Miami Heat Media DayNBA: Brooklyn Nets at Toronto Raptors
  • Former NFL star of the Kansas City Chiefs Derrick Thomas died from a PE in 1989.

dvt derrick_20thomas_20-_20vert_2091

  • Tennis superstar Serena Williams lost a year of her prime (and nearly her life) from a PE in 2010.dvt serena-williams
  • Cleveland Cavaliers center Anderson Varejao suffered a similar health scare during the 2012-13 season.dvt AndersonVarejaoCavs120312

Straight, No Chaser has previously discussed deep vein thrombosis (DVT) and pulmonary embolism. It’s the risks that bear paying attention to; athletes and their activities increase the susceptibility to DVTs and PEs.

  • Driving or flying long distances. Athletes scan the globe competing. Any activity requiring you to be inactive for greater than four hourly increases the risk of developing a DVT. That risk increases the longer one remains inactive.
  • Dehydration. The advent of sports and rehydration drinks has reduced this risk, but one should appreciate that with the amount of perspiration occurring during athletic events, the risk of dehydration is present. Dehydration can directly lead to increasing the thickness of blood, which makes the development of clots more likely.
  • Hormones. Those taking birth control pills that contain estrogen have an increased risk of DVTs and PEs.
  • Immobilization: Any injury, cast or brace that results in immobility will allow your blood to pool and increase your risk of a DVT or PE.
  • Injuries. Any injury to a vein or a severe muscle injury can increase the risk for developing DVT.
  • Surgeries: Surgeries combine a few independent risks for DVTs, such as immobilization, the risks of dehydration and injuries to vein.

All things considered, professional athletes remain young and healthy. The occasional occurrence of these life-threatening conditions serves as a warning for us all to be aware of the risks. If world-class athletes are subject to the above risks, then the rest of us certainly are. Be informed and take appropriate precautions.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: The Curse of the Weekend Warrior – Achilles Tendon Rupture

Kobe

In high school I led the league in stolen bases, and in college my cohorts and I loved inventing ever more creative ways to dunk a basketball. Apparently, my calf muscles worked well. Somehow at a certain age, I quit those competitive sports cold turkey, partially because I knew an Achilles rupture was lurking out there somewhere.

achilles-tendon-rupture

The Achilles tendon connects the muscles at the back of the calf to the heel. The formula for damage is pretty simple and consistent. As you age your tendons tend to stiffen and shrink. As you age you change from the fine-tuned wannabe athlete most of us were to a recreational player, and we overextend ourselves. Others of us, in making a comeback (or just rushing to train for something like a 5K run), try to go from zero (0) to 60 way too soon. In either scenario, that overextension causes the tendon to tear or snap. You’ll recognize it immediately by the sound (pop) and the inability to walk/stand on your toes, which results from the lack of connection from the calf to the heel. (You need to point your foot downward to walk, which is where the Achilles comes in.) Other common occurrences of Achilles tendon rupture include falling from a height and landing on your feet or stepping into a sizeable hole.

achilles-Figure2

Besides being an older guy (or gal, but it’s about five times more common in men) trying to reclaim past glory, steroids and certain antibiotics (flouroquinolones, examples of which are Levafloxacin, aka Levaquin, and Ciprofloxacin, aka Cipro) weaken the tendons enough to predispose you to this injury.
Depending on your age and preexisting health status, you will have surgical and/or nonsurgical options available to you to repair the tendon. Nonsurgical treatment involves a specific type of walking boot or cast, and surgery is more likely when the tear is complete. You’ll need extensive rehabilitation and strengthening of the muscle around the repaired tendon to avoid reinjury. Don’t expect to return to your previous level of strength and activity for four to six months.
So what’s your take home message? Once again, know where opportunities for prevention are. Given how important it is to maintain physical activity as you age, it’s important to remind you to learn how to stretch and maintain musculature so you don’t injure yourself while trying to exercise. Don’t engage in more strenuous activities until and unless you’ve built up to the level where you’re prepared to do so. Achilles injuries occur most often when you’re trying to do too much too soon. Also, be mindful of slippery surfaces; that slide acts the same as an attempt to accelerate too rapidly.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Syphilis Prevention, Treatment and the Tuskegee Experience

tuskegeesyphilis4
Syphilis should be a word derived from something meaning horrible. In an earlier post, we reviewed the rather horrific progression of the symptoms of syphilis. An additionally horrible consideration is that treatment is so very easy once identified. Of course, that’s not the most horrific aspect of the disease. Read on.
Looking back retrospectively, advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. However, as discussed in the post discussing the symptoms of syphilis, remember that treating syphilis at any point can prevent the most severe complications that lead to death. Which brings us to Tuskegee – and keep in mind this is Straight, No Chaser.

tuskegee

In the early 1930s, the US Public Health Service working with the Tuskegee Institute in Alabama began a study to evaluate the effectiveness of current treatments for syphilis, which at the time, were thought to be at least as bad as the disease. The study was conducted on 600 Black men, who were convinced to participate in the study with the promise of free medical exams, meals and money for burial, ‘if’ it was necessary.
The study was initially meant to last 6 months, but at some point a governmental decision was made to continue the study and observe the natural progression of syphilis until all subjects died of the disease, with a commitment obtained from the subjects that they would be autopsied ‘if’ they died. There were several problems with this decision.

  • None of the patients participated under informed consent. They believed they were being treated as opposed to being observed and having medicine withheld while they were being allowed to die. In other words, the subjects were not aware of the purpose of the study.
  • Penicillin was established as a true, rapidly effective treatment for syphilis and the standard of care by 1947. The study continued 25 years beyond this treatment option being available.
  • Efforts by concerned individuals failed to end the study for 5 years prior to a whistleblower going to the press in 1972. The study was ended in a day.

The aftermath of the study includes the following:

  • Reparations averaging a mere $15,000 per individual were given ($9M total) as well as a formal apology, delivered by President Clinton. Yep, the victims received the equivalent of $15,000 per person on average for 40 years of carrying syphilis 25 years after there was a known cure, after infecting wives and unborn children in several documented cases.
  • Strict requirements for protocols for human study (i.e. Institutional Review Boards) were implemented for the first time.

It shouldn’t surprise anyone that many African-Americans remain distrustful of governmental public health efforts to this day; for many, this study continues to be the reason while vaccination isn’t optimally taken advantage of (e.g. HPV) and why organ donation rates are so relatively low in the African-American community. Even though this posture contributes to the adverse health outcomes that exist in the African-American community, it isn’t hard to see why the fear and distrust exists.
Let’s bring this full circle. When it comes to syphilis, prevention is best, and full treatment is available. At the very least, I certainly can say you’ve been warned. Folks have given their lives to make your warning possible. I welcome your questions and comments.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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From the Health Library of SterlingMedicalAdvice.com: “Why would my doctor tell me not to take a decongestant?”

decon

As you struggle from allergies season, the lede is a reasonable question, here is its answer.
Based on how ubiquitous cold and flu remedies are, you would think they were the safest medications known to man. That’s actually not the case and in some instances can be quite far from the truth. The reason for this is simple. Decongestants work by manipulating blood vessels. Specifically, they narrow nasal blood vessels, creating more room for air flow and mucous drainage while reducing swelling and other effects of inflammation. This is a major part of how you treat upper respiratory viral infections like colds and the flu; antibiotics don’t work against viruses.
Unfortunately, if you have certain medical issues, you should not take decongestants. Here’s a list situations that can make it dangerous to take decongestants:

  • Allergies to pseudo-ephedrine
  • Children under age 4
  • Diabetes
  • Glaucoma
  • High blood pressure
  • Heart disease
  • Kidney disease
  • Prostate disease
  • Pregnant
  • Breast feeding women
  • Thyroid disease

So … even if it’s an over the counter preparation, if you’re not sure, head over to the pharmacist before you make that purchase at the store. Of course, you can always connect with your SterlingMedicalAdvice.com consultant as well.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: End of Life Decision Making

end-of-life_tcm7-91616

Having this conversation when death is staring you or a loved one in the face is not the most ideal situation. Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.”
I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. It needs to sink in: at any age your life could be at risk, and at any age you could die. When your life is threatened, if you have specific desires, you’ll need someone comply with decisions. It could happen today. You need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.

AdvanceDirective

Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and subsequently with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

  • Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
  • Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
  • Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document, and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That scenario doesn’t have to happen.
  • Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
  • If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering, or will you want to be allowed to die?
  • Will you want the medical staff to feed you if you can’t feed yourself?
  • Will you want to donate your organs?

endoflifedeath

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: End of Life Decision Making

AdvanceDirective

Do you have a living will? Do you know what advance directives are? Have you assigned a healthcare power of attorney? For the overwhelming majority of you who do not, I hope to turn those answers to “Yes.” I’m not talking about anyone’s fictitious “death panels.” What I’m describing are the legal tools at your disposal that enable you to control the circumstances surrounding your death. Please understand that at any age your life could be at risk, you could die, and you could need someone comply with decisions; as such, you need to be protected now. You’re much more protected having declared your interests and desires than not. Read on.
Simply put, advance directives should result after a thoughtful conversation between you and your loved one(s) and, subsequently, with your healthcare provider. Advance directives document your preferences on what specific decisions should and shouldn’t be made in an effort to save your life or allow your life to end. Here are some of the decisions that can be covered by advanced directives. They don’t all have to be addressed. You may just include the ones of interest to you, leaving discretion to your physicians and/or family just as may have occurred, say, when you weren’t in a coma.

  • Do you care to be intubated? The use of breathing tubes to either protect your airway or breathe for you when you’re unable to is a big deal. The decision to accept or forego this might be an immediately life-prolonging or life-ending decision.
  • Do you care to have advanced cardiac life support in the event that your heart either stops or is unstable? As with intubation, there’s an immediacy to this decision that’s better addressed in a moment of quiet reflection than in the emotion of crisis.
  • Do you want transfusions of blood or other blood products? Some religions have strong declarations on the topic. If you haven’t made your decision not to receive blood known in a legal document and you are unable to express that decision in a life or death situation, physicians will try to save your life with an infusion. They will not adhere to your choice, because they won’t know what it is. That doesn’t have to happen.
  • Do you want “every possible thing done for you,” or might there be a limit in the face of perceived medical futility (i.e., minimal chance of any success)? Basically, this question gets at whether you’d like to go in peace or in a blaze of resuscitative glory and heroic effort.
  • If you’re in the midst of a terminal illness and/or are comatose with no perceptible chance of recovery, will you want medicines and treatments (such as dialysis to remove toxins from your body) to ease pain and suffering or will you want to be allowed to expire?
  • Will you want the medical staff to feed you if you can’t feed yourself?
  • Will you want to donate your organs?

As you can see, these are serious questions to consider, and I’d hope you’d agree they are worthy of conversation well in advance of a tragedy. In my next post, I’ll discuss some related logistical considerations around end-of–life care and decision-making. I hope this has gotten you to thinking and planning on having important conversations.
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

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.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
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