Tag Archives: Straight No Chaser

Straight, No Chaser: Twenty-One Questions on Menopause

January 25, 2014Obstetrics and Gynecology844-SMA-TALK, Estrogen, Menopause, Progesterone, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Menopause (aka “the change of life”) seems to be one of those things that everyone knows about but many don’t understand well. Let’s approach the topic by reviewing a series of frequently asked questions.

1. Why does it occur?
Menopause is the completion of menstruation. It can occur naturally due to the exhaustion of a woman’s supply of eggs or for other reasons such as having a hysterectomy combined with removal of the ovaries that store these eggs.
2. When does it occur?
The average age of menopause is 51. Symptoms may start much earlier, but it’s usually after age 45.
3. How do I know that menopause has started?
The first thing you may notice at the beginning of menopause is irregular periods. Other changes may include alterations in the flow or duration of periods. To actually know that the process has begun, you should discuss your symptoms with your gynecologist.
4. What’s going on with my hormones during menopause?
Many of the symptoms of menopause are related to changing levels of estrogen and progesterone, two prominent female hormones made in the ovaries.
5. What is perimenopause?
Perimenopause is the timeframe between when menopausal symptoms begin and your last menstrual period. You can still have periods and get pregnant during this time.
6. What are the common symptoms of menopause?

A change in periods (shorter or longer, lighter or heavier, with more or less time between)
A change in your sleep patterns, with trouble sleeping
Hot flashes and/or night sweats
Mood swings
Less hair on the head and more on the face
Trouble focusing
Vaginal dryness

7. What is a hot flash?
A hot flash is a sudden warming sensation in your body, usually in the upper portions. This can result in flushing of your upper skin with redness and sweating, followed by shivering. Hot flashes tend to last between 30 seconds and 10 minutes.
8. How do I best deal with hot flashes associated with menopause?
Here are some tips to help you address those hot flashes and night sweats.

Drink cold fluids when symptoms begin.
Don’t smoke.
Dress in layers so that if symptoms begin, you may comfortably take off some clothing.
Dress and sleep in fabrics that allow your skin to “breathe.”
Lower the room temperature, especially when you sleep

9. I’ve heard that hot flashes aren’t as bad if I’ve had a hysterectomy. Is that true?
In some cases, yes. Overall, that correlates with age. If you have a hysterectomy without affecting the ovaries, then the ovaries are still able to make estrogen and progesterone (two important female hormones), and hot flashes may not occur or be as prominent early on. Once the ovaries stop making these hormones, symptoms may occur.
10. Why do I have problems with my bladder?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequent can lead to imperfect control, resulting in leaking and urinary tract infections.
11. Does sex change after menopause?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequently can lead to pain and other types of discomfort during intercourse. It is not uncommon to see a decreased level of interest after menopause. However, in some the feelings of freedom from possible pregnancy and other considerations lead many to feel sexually freer.
12. What causes early menopause?
Early (premature) menopause may be due to several factors, such as chemotherapy or pelvic radiation treatments for cancer, surgeries of the ovaries or uterus, genetics, chromosomal defects and certain autoimmune diseases (e.g., thyroid disease and rheumatoid arthritis–two conditions in which the body’s immune system may attack the ovaries).
13. Can I get pregnant after menopause?
By definition, no. Menopause represents the end of your menstrual periods, and as such you aren’t releasing any eggs that could be fertilized once this has happened. However, you can get pregnant during the perimenopausal period.
14. How is menopause medically managed?
Menopause is an occurrence, not a disease. However, some symptoms of menopause require treatment. More importantly (usually) considerations of and risks for breast cancer, heart disease and osteoporosis must be addressed. Your physician can be expected to have these conversations with you.
15. Can I still have periods after menopause?
By definition, no. “After menopause” is after you’ve had your last menstrual period. During the transition (i.e., the perimenopausal period), you may have a long gap between periods (i.e., irregular periods), but once menopause has occurred, you’re finished with menstruation.
16. Why do I seem to be more moody?
It is not clear that mood changes are directly related to menopause. Many other circumstances occurring simultaneously may be contributing to these feelings. Such considerations include stress, anxiety related to family changes (e.g., becoming an “empty nester” or having ill parents), depression or diminished physical fitness, all of which may independently cause emotional distress and mood changes.
17. Why do I develop problems with my bones?
Estrogen controls bone loss. The loss of estrogen occurring around the time of menopause contributes to women losing more bone than is being replaced. As this process progresses, bones become weaker or more likely to break.
18. Why do I develop problems with my heart?
This is likely multifactorial. Heart disease simply increases with age. So does obesity and high blood pressure, both of which are risk factors for heart attacks. Estrogen loss may also contribute.
19. How can I best stay healthy after menopause?
Read the next Straight, No Chaser post, which specifically answers this question.
20. When is it safe to say I’ve reached menopause?
It’s safe to say a woman has reached menopause when she has not had a period for one year.
21. Why don’t men go through this?
Men actually do have a version of menopause called andropause. It is discussed in this Straight, No Chaser.
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Work Nights?

January 24, 2014General Health and Wellness844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Do you work nights or stay on the road? Is it hard for you to find time to connect with your healthcare provider?
While we do not advocate skipping important doctor visits, we do suggest empowering yourself with the health and medical information that will keep you on track for reaching your health goals. Register at SterlingMedicalAdvice.com and contact your Personal Healthcare Consultant anytime, 24/7. Give us a quick call at 844-SMA-TALK (844-762-8255). We’re happy to help.
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Your Questions on Marijuana Myths and Facts Answered the Straight, No Chaser Way, Part 2

January 24, 2014Toxicology/Drugs844-SMA-TALK, cannibis, marijuana, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The issues surrounding marijuana use are serious and need full examination, particularly with decriminalization legislature passing and being considered in various parts of the country. It is very important that you are fully aware of the current level of medical understanding regarding marijuana use. Feel free to ask additional questions.

6. Marijuana leads to more serious illicit drug use.
The premise that marijuana is a “gateway drug” is a horrible one, regardless of your political bent. Here are some facts:

Currently, people use legal drugs–specifically alcohol and tobacco–more widely than marijuana, and use of these legal drugs leads to illicit drug use more often than marijuana use.
Pointing the term “gateway drugs” at marijuana misses the point of how much more dangerous these legal drugs are than marijuana.
The majority of marijuana users never use other illicit drugs, according to the U.S. Department of Health and Human Services. A report by the Institute of Medicine found “no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs.” It is likely more accurate to say that the same factors that drive marijuana use lead to the use of other illicit drugs.
On the other hand, it’s irrelevant that the majority of marijuana users never use other illicit drugs. A statistically significant number do. If their basis for complacency about marijuana use is insignificant ill effect, those individuals will suffer the consequences of their subsequent decision to use. From a public health standpoint, it’s not an either/or proposition.

7. So marijuana doesn’t cause lung cancer?
Regarding medical considerations, heavy use can be harmful. Although marijuana use isn’t conclusively associated with lung cancer, heavy pot smokers are still at risk for some of the same health effects as cigarette smokers, like bronchitis. It would be unfair not to point out that these risks are associated with smoking marijuana, and these effects appear to be due to the smoke and not necessarily the cannabis itself.
8. You can overdose on marijuana.
Simply put, there isn’t a documented case of death directly attributable to marijuana overdose.
9. You can’t become dependent on marijuana.
I’ll resist the urge to make a joke about certain of your favorite celebrities. According to the National Institutes of Health, not only is it possible to become dependent on marijuana, but approximately nine percent of marijuana users became clinically dependent. To put this in perspective, 15% of cocaine users and approximately 25% of heroin users become addicted. By the way, there’s a 30% addiction rate for tobacco users.
10. Does marijuana cause withdrawal symptoms?
Yes, it does. Withdrawal symptoms include anxiety, nausea and insomnia. That said, these are minor compared with tobacco, alcohol, heroin and cocaine. The marijuana withdrawal syndrome is not considered life-threatening.
11. Marijuana has not currently been shown to contribute to traffic accidents and fatalities.
It is next to impossible to conduct a research study that would prove this point. What we do know is that studies have shown that smoking marijuana tends to affect spatial perceptions. If under the influence, drivers can lose concentration and experience slower reaction times, leading to swerving or following other cars too closely. Researchers have concluded that driving while high greatly increases the chances of having an accident, and smoking pot and drinking before driving is a particularly dangerous mix. Because of the varying effects of marijuana on individuals, it is hard to set a blood level that indicates intoxication in the same way as with alcohol.
12. Does marijuana causes criminal behavior?
The problem with that question is the word “cause.” It is true that the rate of pot use is higher among criminals, but that doesn’t mean that pot causes the criminal activity, and there is no compelling evidence to suggest that it does. It’s just as conceivable that criminals tend to engage in illicit drug use. Intuitively, the connection between marijuana and subsequent criminal activity isn’t obvious, given the relaxation that marijuana produces (which sharply distinguishes it from alcohol).
13. What’s the difference between smoking marijuana and consuming it in other ways?
When someone smokes marijuana, its active ingredient moves almost immediately into the bloodstream and to the brain. The effects typically last between one and three hours. When eaten, it can take between 30 and 60 minutes to have an effect, but that effect can last up to four hours.
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Nagging Questions about your Health?

January 23, 2014General Health and Wellness844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Do you have questions that you keep meaning to ask of your doctor the next time you see him or her? Contact your Personal Healthcare Consultant at 844-SMA-TALK or at SterlingMedicalAdvice.com. Get your questions answered immediately, and relieve yourself of that nagging concern so you can return to peace of mind.
We are prepared, 24/7, to give you the immediate and personal advice and information you need. Try us at 844-SMA-TALK (844-762-8255) or www.sterlingmedicaladvice.com.
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Your Questions on Marijuana, Myths and Facts Answered the Straight, No Chaser Way, Part 1

January 23, 2014Toxicology/Drugscannabis, marijuana, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The truth of it all is that politicians are a terrible source of scientific and medical information. There are actually legitimate concerns about the use and legalization of marijuana. There is also real value to be obtained from the use and legalization of marijuana. This and the next post will provide you information without the bias you’ve become used to. You can click here for basic information on marijuana use and intoxication.
1. Does the research on marijuana prove that it’s safe?
Of course it’s not “safe.” The air we breathe and the water we drink aren’t “safe.” The better question is “How harmful is it and is that level of harm/risk acceptable?”
Research on marijuana has actually been limited and is largely under the control of the governmental entity charged with identifying risks and harm – instead of benefits. The relative unavailability of marijuana for research has been a source of complaints from the medical community for years, as it has largely limited medically reasonable use and limits.
The research that has been conducted suggests that marijuana is relatively safer than alcohol, tobacco and other illicit drugs. This is not the same as saying it is safe. Marijuana smoke contains carcinogens, just as tobacco smoke does. However, available research concludes that even heavy marijuana use doesn’t lead to lung cancer. Specifically, even the heaviest marijuana smokers don’t seem to consume enough to lead to a positive association with cancer. Any association that does exist with cancer seems to be due to the additives and the smoke itself, not the marijuana.
2. Smoking marijuana really doesn’t place you at risk for harm, does it?
The really big problem with marijuana is you’re doing other things while intoxicated. Car accidents occur in those who drive while high. The fact that it occurs at a lower rate than accidents from drunk drivers should NOT be reassuring. Being intoxicated from marijuana increases risks for many other injuries, which is why users really need to be kept in a safe environment.
Similarly, in the instances when individuals are using marijuana while drinking or using other drugs, the risks for injury and illness become compounded by this simultaneous use. Given that the injuries don’t care where they came from, data gets skewed because of the association with marijuana use.
3. Is it true that more teens smoke pot than cigarettes?
In 2011, for the first time, use of marijuana by teenagers exceeded cigarette use. Overall, one out of every 15 high school students reported they smoke most days.
4. Marijuana doesn’t affect kids any differently than adults, does it?
Teen exposure on a regular basis does appear to lead to a permanent decrease in IQ. The developing brain should not be exposed to it. Given that more teens are now using pot than smoking cigarettes, this is an immediate area of concern.
5. Does marijuana cause mental illness or long-term brain deficits?
This doesn’t appear to be the case, with the caveat that regular exposure to marijuana in the developing brain leads to a permanent decrease in IQ.
6. Marijuana leads to more serious illicit drug use.
The premise that marijuana is a “gateway drug” is a horrible one, regardless as to which side of the political spectrum you reside. Here are some facts:

Currently, legal drugs, specifically alcohol and tobacco, are more widely used and more often lead to use of additional illicit drugs than marijuana. As an additional consideration, talking about “gateway drugs” misses the point when currently legal drugs are much more dangerous than marijuana.
The majority of marijuana users never use other illicit drugs, according to the U.S. Department of Health and Human Services. A report by the Institute of Medicine found “no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs.” It is likely more accurate to say that the same factors that drive marijuana use lead to the use of other illicit drugs.
On the other hand, it’s irrelevant that the majority of marijuana users never use other illicit drugs. A statistically significant number do, and if that’s based on having developed a sense of complacency due to marijuana use without significant ill effect, those individuals will suffer the consequences of that decision. From a public health standpoint, it’s not an either/or consideration.

Check back for questions on addiction, medical complications and other questions regarding marijuana use. Feel free to ask your SMA expert consultant any questions you have on this topic.
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Ask the Question – at 844-SMA-TALK!

January 22, 2014General Health and Wellness844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

When you get to the doctor’s office or the emergency room, you’re going to tell the doctor what you’ve been experiencing and then ask a question. What’s wrong with me? What should I do? Am I going to be ok? Our healthcare system offers us the blessings of the luxury of some of the most knowledgeable doctors in the world – when available.
Now you can ask these same experts your important question online or on the phone, from your home or office or grocery store line. We are prepared, 24/7, to give you the immediate and personal advice and information you need. Try us at 844-SMA-TALK (844-762-8255) or www.sterlingmedicaladvice.com.
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Straight, No Chaser: Weeding Through the Basics of Marijuana Use and Intoxication

January 22, 2014Toxicology/Drugscannabis, marijuana, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Let’s start by getting the obvious out of the way. For those of you who keep asking me: Yes, I’m finally discussing the use and effects of marijuana. In this series, we will review the facts (and only the facts) on its clinical effects, the health risks and benefits, intoxication, public health considerations and myths, facts and fiction. Let’s get started.

Marijuana (cannabis) is the most commonly used illegal drug in the U.S. It is estimated that over 100 million Americans have used marijuana. Consumption usually occurs by smoking, which produces a rapid onset of symptoms, but some people eat it.

The “high” of marijuana (intoxication) is typically a euphoric, relaxed state. Other typical side effects include sleepiness and an increased appetite.
Less frequent, more serious and less desirable side effects include the following:

decreased memory
motor skills and perception
dryness of the mouth
dryness and redness of the eyes
panic
paranoia or acute psychosis

Much of the conversation about marijuana involves not just the drug itself but other drugs taken or other activities performed while using marijuana. Along those lines, additional side effects seen in marijuana users not directly attributable to the marijuana itself include abnormal heartbeats and rhythms, chest pain, headache, heart attacks with and without cardiac arrest, high blood pressure, hyperactivity, physical violence, seizures and strokes.
Treatment is largely supportive. It’s necessary to make sure that secondary injuries from irresponsible actions don’t occur. Therefore, it’s important to keep intoxicated individuals in a safe environment. In some instances when medical attention is needed, it is necessary to treat with medicines to combat anxiety and address injuries or side effects that have occurred.

Twenty states and the District of Columbia have enacted medical marijuana laws. Marijuana has been known for thousands of years to have certain medicinal effects, most notably as a treatment for pain and as an appetite stimulant, which has applicability in certain scenarios. Although physicians may not yet prescribe medical marijuana without violating federal law, they may legally recommend it.
Marijuana as treatment for pain has proven useful for patients suffering from the following conditions.

Glaucoma
Nausea
Neuropathic pain (nerve damage)
Movement disorders and spasticity

Marijuana is an appetite stimulant that has been proven useful for patients suffering from the following conditions:

HIV
AIDS wasting syndrome
Dementia

If this part of the conversation seemed simple to you, it’s because marijuana is a rather simple drug on many levels. That said, I know what your questions are! Next up, we’ll address many myths and controversies involving marijuana. Feel free to ask any questions you have on this topic.
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Personal Healthcare Consulting

January 21, 2014General Health and Wellness844-SMA-TALK, personal healthcare consulting, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Some people have personal trainers, personal chefs, nannies… SterlingMedicalAdvice.com introduces Personal Healthcare Consulting. Immediate, 24/7 personal medical and healthcare information and advice is at your fingertips—online or on the phone. Our services provide you the information and advice you need when your physician is not available. Contact your Personal Healthcare Consultant at SterlingMedicalAdvice.com or 844-SMA-TALK, especially if you have health challenges and goals. We’re here for you.
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Straight, No Chaser: Self Assessment of Alcohol Dependency

January 21, 2014Toxicology/Drugs844-SMA-TALK, Alcohol abuse, Alcohol dependency, Alcohol intoxication, Alcoholism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight, Straight No ChaserJeffrey Sterling, MD

The number one response to the post on acute alcohol poisoning was pretty simple: “How can I tell if I’m drinking too much over the long haul?” And so it’s back to back the Straight, No Chaser (literally) days. The problems with most intoxicating substances involve the same consideration. You had the most incredible time and got the most incredible high the first time, and you spend the rest of your life chasing the joy of that first buzz, which for most drugs you’ll never get again. The difference with alcohol abuse is that alcohol is legal and comparatively inexpensive, so you get to keep trying without much fuss (at least initially).
Let’s set the stage by standardizing some terms:

Alcohol intoxication: You’re drunk and under the influence of alcohol.
Alcohol abuse: Your drinking habits are unhealthy, resulting in bad consequences (e.g., at work, in your relationships, with the law).
Alcohol dependency: You’re physically and/or mentally addicted to alcohol. You crave liquor and seemingly can’t do without it. Dependency involves withdrawal symptoms when alcohol is not in your system. These symptoms may include anxiety, nausea, sweating, jitteriness, shakes and even withdrawal seizures.

Alcoholism is a chronic disease. Unfortunately, some of us start with a predisposition based on genes and strong influences based on family and cultural considerations. It is so much more than either a lack of willpower or an inability to quit. This disease has a predictable course and defined effects on various parts of the body, leading to specific means of death if unaddressed. Because I’m Straight, No Chaser, I’m not going to deal with the subjective “I can handle my liquor” or “I can stop anytime I want.” I’m going to give you some medical data that defines when you’re doing damage to your body. It’s actually pretty simple.
Are you this guy or gal? (Keep in mind a standard drink is defined as one 12 ounce can of beer, one glass of wine or one mixed drink.)

Women having more than three drinks at one time or more than seven drinks a week
Men having more than four drinks at one time or more than 14 drinks a week

If so, you’re causing damage. We’ve discussed the damage in these additional Straight, No Chaser posts.

Now let’s discuss dependency. Consider the possibility that you may be dependent on alcohol if you have any of these problems over the course of a year:

While you’re drinking, you can’t quit or control how much you drink.
You have tried to quit drinking or to cut back the amount you drink, but can’t.
You need to drink more to get a previous effect. (This is called “tolerance.”)
You have withdrawal symptoms (discussed earlier) when you stop.
You spend a lot of your time either drinking, recovering from drinking or giving up other activities so you can drink.
You continue to drink even though it harms your relationships and causes physical problems.

So What?
Unfortuantely, I’m pretty sure no one is giving up alcohol by reading this. Alcohol is part of the American social fabric. We live, celebrate and commemorate milestones with it. It’s glamorized throughout society. It’s constitutionally approved. I appreciate that. In moderation, it’s a good time. Just understand that it’s not a free ride. The danger is in the insidious nature of this disease, meaning issues may creep up on you before you ever know what’s hit you. Then we’re having a completely different conversation.
I look forward to any questions or thoughts on the topic.
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No Gurnee Needed

January 20, 2014General Health and Wellness, Health Prevention844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If the paramedics didn’t bring you in on the stretcher, there’s a good chance—greater than a 70% chance, in fact—that you can stay home and contact us for medical advice. Don’t worry; our expert consultants have the same credentials, experience and expertise as the docs you’ll be seeing at the doctor’s office or emergency room. And there’s a 100% chance our services won’t cost you the $1300 average cost of an ER visit.
Avoid unnecessary doctor/ER visits. Register at SterlingMedicalAdvice.com or call 844-SMA-TALK. Then SHARE us with your friends and family, please. Thank you.
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Straight, No Chaser: When Alcohol Becomes Toxic – Or Deadly

January 20, 2014Toxicology/DrugsAlcohol intoxication, ethanol, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Ok. We now know the teams playing in the Super Bowl. Maybe you’ve already begun planning the party or have identified where you’ll be watching. Well, forewarned is forearmed. It’s not my intention to spoil the “buzz” of Super Bowl Sunday, but allow me to provide some liquor for thought. Most everyone knows the effects of getting drunk. What most seem to forget is that alcohol has a continuum of effects that isn’t restricted to becoming “buzzed,” intoxicated or just drunk. Alcohol poisoning also includes effects such as coma and death.
Some of you may be reflecting on the times when you felt most intoxicated. Perhaps it was a college event, a New Year’s Eve party or a sports event (or all of the above). Your first take home message of the day is alcohol poisoning isn’t about how you feel. It’s simply about the concentration of alcohol in your blood and the effects that amount of alcohol will have on your system. This is commonly described as BAC – blood alcohol content.
As BAC increases, so do the effects of alcohol. Let’s quantify the amount of alcohol that is associated with danger, how symptoms progress with alcohol poisoning and the different BAC levels that are associated with danger.
Amount
We’re talking about acute alcohol toxicity and poisoning. This is typically brought on via a large intake of alcohol (e.g., binge drinking). Bingeing is generally regarded as at least four to five drinks (for women and men, respectively) within two hours. This level of drinking will raise your BAC into the “legally drunk” level and increase the risk of adverse consequences. Such amounts can overwhelm the body’s metabolism and elimination of alcohol from the blood. When this occurs, further alcohol intake will rapidly increase BAC and impair bodily functions, most notably those of the brain.
Note the following chart, which gives a rough estimate of the general effects of different amounts of alcohol based on your weight. It is very important to realize that weight, age, sex and other considerations play into the individual effects of alcohol on you.

Symptoms of Alcohol Poisoning
Alcohol poisoning occurs when there is so much alcohol in the bloodstream that it is able to affect and shut down areas of the brain controlling basic life-support functions (i.e., breathing, heart rate, and regulation of your core temperature). Symptoms of alcohol poisoning include confusion, difficulty breathing and remaining conscious, vomiting, seizures, slowed heart rate, clammy skin, dulled responses, such as no gag reflex (which prevents choking) and an extremely low body temperature.
BAC can continue to rise even when a person is unconscious. Alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body. This makes “sleeping it off” a very dangerous proposition, and you should not assume one will be better by doing so. Alcohol is a depressant to the brain. Among its activities is dulling the gag reflex. Coupling that with alcohol’s irritant effects on the stomach, a person who drinks to the point of passing out is in danger of choking on vomit, which in turn could lead to death by asphyxiation (inadequate oxygenation). Even survival can leave a victim of an alcohol overdose with brain damage.
Effects
The following charts approximate the BACs that occur with varying numbers of drinks. Let’s continue to think about binge drinking, focusing on the following male/female charts after one hour of drinking. Although there is individual variation in the clinical effects of the number of drinking one may have, the clinical effects of alcohol are rather consistent at various BACs. These levels eventually reach a point of toxicity known as alcohol poisoning. This designation is particularly meaningful in that it reflects the level at which the level of alcohol in the blood begins to shut down areas of the brain controlling basic life-support functions (i.e., breathing, heart rate, and regulation of core temperature).

Clinical Effects at Various BACs
This next section is at a level of specificity that you won’t remember, but I want to go through the detail to demonstrate the increasing dangers seen with increasing levels of intoxication. Don’t be lulled into comfort by the lower levels. Even small levels of alcohol in the system affect judgment and coordination. Increased amounts affect the body and mind more dramatically, leading to the ability to kill.
The following effects of different levels of BAC are approximations. Individual reactions vary, sometimes widely.

BAC .02 percent to .04 percent
This level tends to produce mild relaxation, loosened inhibitions and some lightheadedness. Prevailing moods may intensify.
BAC .05 percent to .07 percent
This level tends to intensification and exaggeration of emotions and behavior. Euphoria may begin, and a feeling of relation and warmth may overcome you.
BAC .08 percent to .09 percent
At this level you’re losing an ability to accurate assess your level of functioning. You may have slurred speech, impaired motor skills and a degree of imbalance. Your sense of seeing and hearing clearly are diminished, and your reduced judgment often leads to continued drinking when this would actually be a good time to stop. This level corresponds to a diminished ability to evaluate sexual situations.
BAC .10 percent to .12 percent
At this level you’re clearly suffering. You have diminished motor skills, coordination, balance, judgment and memory. Emotions become even more exaggerated at both extremes. Some people become loud, aggressive or belligerent, and others may seem depressed. This BAC level also corresponds to when men may have trouble getting an erection.
BAC .14 percent to .17 percent
At this level euphoria may give way to unpleasant feelings. You have difficulty talking, walking or even standing up. Your judgment and perception are severely impaired. You may become more aggressive and are at increased risk of accidentally injuring yourself or others. A blackout may occur at this level.
BAC .20 percent
At this point, neurologic effects are present. You may feel confused, dazed or otherwise disoriented and may need help to stand up or walk. If you are injured, you probably won’t realize it because you won’t feel pain, and if you do realize it, you may be inclined not to do anything about it. At this point you may experience nausea and start vomiting. Your gag reflex is impaired, so you could choke if you throw up. Since blackouts are likely at this level, you may not remember any of this.
BAC .25 percent
At this point, all mental, physical and sensory functions are severely impaired. You’re emotionally numb. There’s an increased risk of death due to asphyxiation (inadequate oxygen) caused by choking on vomit and of seriously injuring yourself by falling or other accidents.
BAC .30 percent
You’re probably in a stupor. You have little comprehension of where you are or what’s really going on around you. You may suddenly pass out and be difficult to awaken.
BAC .35 percent
This blood alcohol concentration is similar to the physical effects of surgical anesthesia. You may stop breathing.
BAC .40 percent to .50 percent
You are probably in a coma. The nerve centers controlling your heartbeat and respiration are slowing down, and it’s a miracle if you survive.

Let’s bring things full circle. Someone weighing 100 pounds who has consumed 9-10 drinks in less than an hour is at risk of death. Here’s how. The term “lethal dose” (LD) is used to describe the blood concentration that produces death from drugs (in this case, alcohol) in half the population. Most authorities agree that BACs in the 0.40 percent to 0.50 percent range meet the requirement. That percent is an average, not an absolute standard. Fatal overdoses from alcohol at BACs lower than 0.40 percent have been documented, as have cases of survivors at BACs higher than 0.50 percent. If you refer to the above chart correlating number of drinks, weight and BAC levels, you can now figure out how dangerous different numbers of drinks can be.
Here’s a final take home message for you. Alcohol poisoning is a life-threatening condition and requires immediate medical attention. You don’t have time for cold showers, hot coffee or walking. Not only will these not reverse the effects of alcohol overdose, but they could actually make things worse.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
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The ER ISN'T as Sexy as You Think!

January 19, 2014General Health and Wellness, Health Prevention844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Yes, ER docs are the best. However, here’s my free advice for the day. Skip the ER trip if you can.

You won’t find Clooney in the ER. What you will find is a longer wait and higher cost than you want or often need. Did you know the average cost of an ER visit nationally is over $1300? Did you know hospital bills are the number one cause of personal bankruptcies? That’s not sexy.

Avoid unnecessary doctor/ER visits when you register at SterlingMedicalAdvice.com or call 844-SMA-TALK. SHARE us with your friends and family, please. Thank you.
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Straight, No Chaser: So What Do I Need to Know About the Prostate?

January 19, 2014Genital/Urinarybenign prostatic hypertrophy, BPH, Prostate cancer, prostatitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Continuing in our review of topics of Men’s Health, today we explore the prostate. There are generally five questions people ask me about the prostate, so let’s take the time to address them. These topics are individually discussed in detail at www.sterlingmedicaladvice.com.

1. What is the prostate?

The prostate is a male-only organ located in front of the rectum and under the bladder. It surrounds the urethra, which is the tube through which urine flows on its way out of the penis. Understanding this anatomy helps one understand the nature of problems that arise related to the prostate. The prostate is part of the male reproductive system. It’s a gland that contributes to the fluid (seminal fluid) that carries sperm out of the body (i.e., semen).
2. Doesn’t it get infected?

Prostatitis is the presence inflammation or infection of the prostate gland. It has many different causes. When an infection with bacteria causes prostatitis, it is called bacterial prostatitis. Bacterial prostatitis can be a particularly long-lasting infection, requiring antibiotics to treat.

Acute bacterial prostatitis is an infection that produces signs and symptoms rapidly.
Chronic bacterial prostatitis is an infection that lasts for at least three months.

3. Why does the prostate get large?

A condition known as benign prostatic hypertrophy (BPH) occurs in men as they age. As a general rule, 50% of men have it by age 50, and 80% have it by age 80. The prostate normally is only the size of a walnut. When BPH occurs, the prostate has enlarged to a point where it may press upon the urethra, disrupting the normal flow of urine, preventing normal emptying. It is important to understand that the growth seen in BPH is not cancer.
4. What’s the relationship between the prostate and sex?
When people ask me this question, they have one of two concerns.

Some medical studies have drawn a relationship between a higher frequency of ejaculations and a lower risk of prostate cancer. This trend is not currently considered definitive; to be clear there is no conclusive evidence that the risk of prostate cancer is reduced by frequent ejaculation.
The male equivalent of a “G-spot” is described as being near the prostate.

5. Is prostate cancer deadly?

Prostate cancer is usually slow growing, but may occasionally be aggressive. Cancerous prostate cells may break off and spread to other parts of the body, particularly the bones and lymph nodes. Prostate cancer usually is seen in men after 50 and even when discovered often doesn’t require especially aggressive management.
Your bottom line? You especially need a prostate exam and other considerations yearly after age 50.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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Baby's Sick? Contact SterlingMedicalAdvice.com

January 18, 2014General Health and Wellness, Pediatrics/Kids Health, Health Prevention844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

When you contact SterlingMedicalAdvice.com or 844-SMA-TALK, you’ll receive advice immediately from expert consultants who have spent decades caring for children and who are still dedicating their careers to doing so. Statistically speaking, more often than not you can avoid taking the baby out of the house at all.
Avoid unnecessary doctor/ER visits. Register at SterlingMedicalAdvice.com or call 844-SMA-TALK. Then SHARE us with your friends and family, please. Thank you.
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Straight, No Chaser: Maintain Healthy Testosterone Levels Without Replacement Therapy

January 18, 2014Endocrine/Metabolic, Genital/Urinaryhypogonadism, Low testosterone, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, TestosteroJeffrey Sterling, MD

Male virility is a fascinating topic medically. It is truly an example of how confidence and mental fortitude (or the absence thereof) can directly translate into physical performance. Thus, it doesn’t come as a surprise when TV ads seek to sew seeds of doubt into you. (“Don’t perform like you used to? Maybe it’s Low-T! Here’s a miracle pill!”)
As mentioned in the previous post, many factors control testosterone, most notably a natural drop associated with aging. In fact, your levels are considered normal until about age 30, then you lose approximately 1% per year until you reach a state by age 70 where you’re expected to be clinically below normal – and that’s just due to the age-related considerations. Factors you can control affect not only your sexual health but your physical and mental health, too. These include appropriately managing your diet, exercise, sleep and stress. Let’s look at the effect each has on maintenance of healthy testosterone levels.
Diet:

It will forever be true that what you place in your mouth either strengthens you or slowly poisons you. Here’s a quick list of foods that are specifically good for boosting your testosterone levels.

Bananas – Banana are rich in B vitamins, which are needed to manufacture testosterone.
Brazil nuts – It’s the magnesium contained within that increases testosterone.
Chicken liver – It’s the zinc! Zinc increases testosterone levels.
Cruciferous vegetables – Broccoli, cabbage and cauliflower help eliminate the hormone estrogen from the body, which increases testosterone. Choosing these healthy foods also helps weight loss, which in turn increases testosterone production.
Eggs – It’s really about the vitamin D contained within eggs; vitamin D deficiency has been shown to correlate with higher estrogen levels and lower testosterone levels.
Garlic (as part of a high protein diet) – This combination increases testosterone production.
Oysters – It’s the zinc! Zinc increases testosterone.
Pineapples – It’s the magnesium contained within that increases testosterone.
Pumpkin seeds – It’s the zinc! Zinc increases testosterone.

Here’s the other dietary consideration for you: In general, most anything you eat that adds to your level of obesity will result in lowered testosterone levels. Number one on that list is processed sugar—think fructose, meaning soda/pop, fruit juices. The relationship between diet and testosterone is way more intricate than this, but if you incorporate the steps just mentioned, you will see a difference in your overall health and sexual health.
Exercise:

I will limit this part of the discussion to two manageable considerations.

If you’re overweight, you are more likely to have low testosterone levels. Globally losing weight will work to your advantage. Check these Straight, No Chaser posts to address obesity and weight loss.
Intense strength training also boosts testosterone levels. When strength training to boost testosterone, you’ll want to increase the weight, lower your number of reps and slow down the motion on each rep. Also try to work a large number of muscles, as occurs with dead lifts or squats.

Stress Management:

When you’re under a significant stress, your body releases high levels of the stress hormone cortisol. Cortisol blocks the effects of testosterone. Over the longterm, stress chronically blocks the effects of testosterone, producing all of the undesired symptoms that accompany that state.
You know to how reduce your stress. Here are techniques shown to be effective in this setting.

Deep breathing
Laughter
Meditation
Positive visualization
Prayer
Yoga

Sleep:

Here’s something you likely didn’t know. Testosterone is only produced by your testes at night. Even more impressive production coincides at a specific point in the sleep cycle immediately before REM (rapid-eye movement) sleep. This production and replenishment is most complete in men getting at least eight hours of sleep/night. Conversely, testosterone levels are significantly lower in those receiving less than six hours of sleep/night. Note this is total sleep at night, not consecutive hours of sleep (assuming you are able to rapidly fall back asleep). Get your sleep!
These are very important considerations. As is the case with many conditions, your health is not going to be found in a medicine bottle. The fundamentals of taking care of yourself are your best course of action for longevity and health. This is especially important in the management of low testosterone, given that testosterone therapy has serious side effects and increases risks for certain conditions, including signaling the body to stop producing its own testosterone and the following:

Acne
Prostate enlargement
Prostate cancer
Reduction in sperm production
Sleep apnea

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

January 17, 2014General Health and Wellness844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Knowing there’s an ER nearby creates peace of mind. You can get immediate and effective care when something goes terribly wrong. So it makes sense that you’d run over just in case something has gone terribly wrong—early detection being key to battling certain illnesses.
HOWEVER, every headache isn’t cancer; every stomach ache isn’t a ruptured appendix. Some symptoms don’t require any treatment at all. Yes, sometimes it is better to be safe than sorry, but popping over to the ER to visit and chat with a physician is very expensive and time consuming.
That’s why we’ve developed SterlingMedicalAdvice.com. We’d like to provide you that same level of comfort, using the same experts you’d see in the ER or doctor’s office—for a fraction of the cost and with no waiting.
Avoid unnecessary doctor/ER visits. Register at SterlingMedicalAdvice.com or call 844-SMA-TALK. Then SHARE us with your friends and family, please. Thank you.
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Straight, No Chaser: The Specter of Low Testosterone

January 17, 2014Endocrine/Metabolic, Genital/Urinaryhypogonadism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, testosteroneJeffrey Sterling, MD

Are you someone who had never heard of Low-T until recent commercials starting telling you that you weren’t normal? Let’s review what all the fuss is about.
As most people know, testosterone is the most important male sex hormone that in many ways and for many defines “manhood,” contributing to the following:

Changes of puberty, including deepening of your voice
Production of pubic, facial and body hair
Production of sperm
Facilitation of sex drive
Maintenance of bone health, which assists growth

In case you were wondering, this is what “male menopause” looks like.
Certain parts of the brain (hypothalamus and pituitary gland) signal how much testosterone needs to be produced. Most production occurs in the testes.
The symptoms of low testosterone are predictable. Symptoms include a reduction in sex drive, erections and sperm count. Men may also see an enlargement of their breasts. Additional symptoms (over the long-term) may include smaller testes, less energy, mood changes, loss of muscle size and strength, and weakened bones.

The aging process normally reduces sex drive, sperm count and frequency of erections. Aging also reduces testosterone such that clinically low testosterone levels invariably occur by age 70. The presence of these two independent facts can make it confusing to know if these symptoms are simply part of the aging process or might be attributable to a disease in the areas that either produce or regulate testosterone. In other words, although a natural age-related reduction in testosterone level is normal, it may or may not be the cause of lower sex drive.

Low testosterone in the absence of aging really is thought to be more of a sign of disease than a disease unto itself. The primary goal is to ensure than none of the more serious causes of low testosterone are present. Some of the more serious causes and considerations leading to low testosterone include injury, infection or cancer to the testes, radiation therapy or chemotherapy, hormonal disorders such as pituitary gland tumors or diseases, liver and kidney disease, diabetes, HIV/AIDS, obesity, certain genetic disorders and use of opiates (pain-killers).
Based on the cause and your health status, you may be prescribed testosterone replacement therapy. Testosterone replacement may occur via periodic injections, skin patches/gels, skin pellets or tablets that stick to the gums.
Testosterone replacement is not like taking a pill for an erection. These are hormones and come with long-term risks, the most notable being prostate cancer. Therefore, those males with prostate or breast cancer aren’t candidates for testosterone replacement therapy. Other side effects of testosterone replacement therapy include acne, breast enlargement, fluid buildup in the legs, ankles and feet, increased red blood cell count, prostate enlargement and sleep apnea.
Here are groups with significant enough risks from testosterone replacement therapy that they require monitoring if treated this way:

African-American men
Men over 40 years of age who have close relatives with prostate cancer
All men over 50 years of age

So what should you do with this information?

Understand that certain age-related changes occur naturally and don’t represent disease.
Understand that the premature presence of these symptoms could represent disease and need to be evaluated.
Understand that a desire to avoid the symptoms associated with low testosterone is best done with routine health measures (diet and exercise) that help the body function and maintain healthy levels of testosterone naturally.
Understand that a decision to seek treatment for these symptoms isn’t as simple as getting a pill or a patch. Hormonal treatment has real and serious associated side effects and risks and should only be done with the consultation and consent of your physician and endocrinologist (hormone specialist).

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

January 16, 2014General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Why waste it?

co-pays
deductibles
facilities fees
transportation and parking
time off work

Avoid unnecessary doctor/ER visits. Call your personalized expert consultants to work with you on the most cost effective means of addressing your healthcare concerns. Register at SterlingMedicalAdvice.com or call 844-SMA-TALK. Then SHARE us with your friends and family, please. Thank you.
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Straight, No Chaser: The Top 50 Things I've Learned in 50 Years on Earth Related to Health (Part II)

January 16, 2014General Health and WellnessSterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I could muse on my observations on human nature forever. I’ve been very fortunate to have had this front row seat to life’s quirks and nuances. You can go here for the first 25 items on my list. Thanks for being a part of this.
26. In an emergency room, the physicians spend at least as much time treating your fears as they do any medical issues that exist.
27. You can do anything you choose. Physicians aren’t the morality police, so don’t ask any doctor to justify your bad decisions. We provide information, then treat. Judging you really isn’t our thing.
28. For every person that brags about how the bullet was less an inch away from doing something really bad, I can point to a hundred people from whom the bullet was on target. Avoid a gunfight.
29. There is nowhere on your body where a burning sensation is meant to feel good. Contrary to popular belief, a “hunk of burning love” is not a good thing.
30. You have less control and margin for error than you think regarding your bad habits. Usually it’s not if something bad will happen; it’s when.
31. Proof that love is blind is offered every time you see a mother grab a newborn covered in all that childbirth.
32. Want to see your future health? Look at your immediate family. They’re the ones who will either be cooking and caring for your or stressing you out and sending you to an early grave. I bet you already know … and don’t forget to look in the mirror!
33. People overuse the ER because it’s convenient and for most people doesn’t cost anything. They’ll stop when something more convenient is made available or when the ER is made less available.
34. Not being able to breathe appears to be the most terrifying way to die. Smokers, you’ve been warned.
35. If you’re one of those still driving a car without a seat beat or a motorcycle without a helmet, you can’t be surprised when it happens.
36. Delivering a child into the world is still the most amazing thing I’ve done in an emergency room.
37. Nothing matches the look on a patient’s face when you explain that you’re going to stick a needle directly into his penis and extract blood in order to reduce his erection that won’t otherwise go down. Quick! Look in the mirror! That’s the look.
38. If you brag to me that “I haven’t seen a doctor in 40 years, and I’m just doing fine,” I fear for what is about to be discovered.
39. I’ve never had a patient who told me, “I’m going to die today” make it out of the emergency room. Don’t ever say those words to a doctor.
40. People ask me what the oddest thing I’ve ever done to a patient. Cracking their chest open to massage or manually repair a heart is pretty high on the list.
41. No one’s “happiest day of my life” was on a day when they were sick. Stay healthy, and enjoy more happy days.
42. Ladies, it’s true. Men are much less tolerant of pain than women.
43. Nothing combines physical, mental and spiritual trauma like being sexually assaulted. No one recovers from rape. At best, they develop sufficient coping mechanisms to deal with it.
44. Proof that we’re still only animals is found in people who punch walls.
45. I suspect drug addiction wouldn’t be nearly as devastating if people didn’t allow denial to prevent them from dealing with it for so long.
46. The hardest part of my job is keeping a straight face. If you were doing this, 90% of the time you’d either be laughing, crying or screaming.
47. Your infants are a lot more resilient than you believe they are.
48. When the time comes, most people are much more ready to die than their family members are for them to die.
49. What do I know that you don’t? I’ve seen the story of how your bad habits end. More importantly, I’ve also seen how happy older, healthy people are. If you could see how consistently true that is, you’d be motivated to straighten up and fly right.
50. Medical miracles really do happen. In your time of need, don’t ever stop believing. Or praying.
Feel free to contact your SMA expert consultant with any questions you have on any topic. Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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The Price of a Pill, The Price of Peace of Mind

January 15, 2014General Health and Wellness, Health Prevention844-SMA-TALK, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Do you know how much over-the-counter pain medicine costs as line items on your ER bill? Have you ever heard of the $12 Tylenol? Snoop around on the Internet and see how much you will save in pharmaceuticals alone by avoiding unnecessary ER visits.
Chat 24/7 with your personal healthcare consultant about your pharmaceuticals questions through your Sterling Advice Plus subscription and for advice on whether you really should have a physician examine you.
Register at SterlingMedicalAdvice.com or call 844-SMA-TALK. Then SHARE us with your friends and family, please. Thank you.
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.
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