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Straight, No Chaser: Healthy, Sustainable Weight Loss – Let's Get Started

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How to Lose Weight, and What is Healthy Weight Loss (AKA, How Much, How Soon and How)?
Let’s start with the How. Commercial voice: “You should contact your physician before starting any weight loss routine”. We ended things on the last post talking about the caloric balance equation, which (simplified) means you need to get off your derriere, and close your mouth. Without getting too technical, to lose weight, 1 pound equals 3,500 calories, so your net caloric intake must be cut by at least 500 calories per day to lose a pound a week. Here are some Quick Tips to cut calories (and I will not be discussing any of the popular diets or medical remedies (with one exception in the next post); you can see your physician or nutritionist about those. Besides, guess what? Most of you don’t need a fad diet. Keep it simple. And…more importantly, you should be more concerned with healthy regimens that help you keep the weight off, not drastic efforts that have proven to have quick short-term but unsustainable long-term outcomes).
1) Work out: If you can sprint, do so. If you can’t, jog. If you can’t jog, walk. I like working out while watching sports, because my heart’s pumping anyway. Weight training at the same time is even better. Once you hit a good exercise regimen, your metabolism will improve, making weight loss that much easier.  By the way, the next post is on metabolism; stay tuned.
2) Hungry?  Start counting calories.  Use this standard to determine what your daily calorie intake should be.  Meal plan so you don’t exceed that level.  Remember the caloric equation to lose weight: Amount expended minus the amount eaten should be 500 calories a day.  In the next post, I’ll give you a Quick Tip for an extra 400 calories a day you can lose.
3) Still hungry? Try brushing your teeth. Don’t laugh. It actually works. And it gives you nice teeth. Otherwise try drinking water or chewing calorie-free gum. All these are nice, simple inexpensive appetite suppressants.
How Soon? It’s natural for anyone trying to lose weight to want to lose it very quickly. But evidence shows that people who lose weight gradually and steadily (about 1-2 pounds per week) are more successful at keeping weight off. Healthy weight loss isn’t just about a “diet” or “program”. It’s about an ongoing lifestyle that includes long-term changes in daily eating and exercise habits. Think health instead of weight, and the weight will improve.
How Much? If you were my patient (but you’re not!), I’d tell you to forget about ideal body weight and BMI – for now. Focus on a modest weight loss, like 5-10% of your current weight. Even this success will improve your blood pressure, cholesterol and blood sugar levels. Once you accomplish that goal, do it again. So even if the overall goal seems large, see it as a journey rather than just a final destination. Seek to learn new eating and physical activity habits that will help you live a healthier lifestyle. These habits may help you maintain your weight loss over time. To that end, I love healthy challenges. Try a 30-day water instead of pop (soda)/coffee, etc. challenge, or even better, give yourself a 30-day ‘fruit for dessert challenge’ or ‘salad of your choice for lunch’ challenge. When that’s done, immediately do it again.  Learn to integrate healthy habits into your quest to lose weight, and you’ll increase the odds of having sustainable weight lost. At the end of the day, it’s been well established that those who maintained a significant weight loss report improvements in not only their physical health, but also their energy levels, physical mobility, general mood, and self-confidence. Good luck, and check back for the next post on how to fine-tune your metabolism!
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Straight, No Chaser: The Adverse Health Effects of Obesity and Why You Gain Weight

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Earlier, we identified the differences between a ‘normal’ weight and being overweight and/or obese. Today’s goal is to help you understand specific risks of carrying extra weight.  We’ll also set the table for losing weight by discussing why weight gain occurs.  It bears repeating that none of this has anything to do with the perception of one’s physical attractiveness.
Let’s focus on three considerations.
1. What are the health risks?
As body weight increases, so does the risk for several different medical conditions and illnesses, including the following:
• Arthritis
• Cancers (breast, endometrial, and colon)
• Diabetes
• Gynecological problems (abnormal periods, infertility)
• Heart disease (heart attacks, heart failure, hardening of the arteries)
• High cholesterol
• Liver and gallbladder disease (gallstones)
• Sleep apnea and other respiratory problems
• Stroke
In the event that these risks are just words on a page, learning a little bit about some of them might provide the motivation needed to avoid them.
2. What is a realistic goal for weight loss?  What’s the balance between family predisposition and the foods I eat?
No matter what I tell you today, it’s unlikely to turn you into a supermodel. The goal (independent of your consultation with your own health care provider) is to get you to optimize your situation based on the things you can control. Yes, genetic factors do play a role in obesity, but beyond that you are more than able to close your mouth and get off your…couch. You are able to limit your fat and caloric intake and put down the salt shaker. Yes, genetics count, but behavior and environmental (culture, socioeconomic status) consideration play at least as much of a role. These latter considerations can even jumpstart your metabolism beyond your genetic predisposition.
3. Why do I gain weight if I’m still active?
The most simple way to answer this is that weight gain occurs from an energy imbalance.  You’re taking in too many calories, and/or you’re not engaging in enough physical activity. It’s an equation, and the weight gain occurs when you’re on the wrong side of the equation. It’s not much more complicated than this. Either do less of the eating, more of the activity, or both.  I mentioned in a previous post on caloric counts that you must have an excess of 500 more calories expended than you ingest daily every day for a week just to lose one pound.  It takes work.  This is the simple answer as to why fad diets don’t work long-term.  You can’t cheat the equation.  The moment you stop being diligent, you’re headed in the wrong direction.  Your weight loss plan must include lifestyle changes for the long-term.
In the next post, we’ll identify some very simple methods to combat obesity based on the information provided to this point. Feel free to ask any questions or submit any comments you have.
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Straight, No Chaser: The United States of Obesity – The Crossroads Between Health and Happiness

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Obesity in the United States places many at a crossroad between self-esteem and health.  Often, larger frames are celebrated as more desirable.  Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise.  Of course, our culture embraces and contributes to obesity.  Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport.  I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health.  If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed.  As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:
Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.
Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.
‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight No Chaser: The United States of Obesity – The Crossroads Between The Pursuit of Health and Happiness

obesity_trends_20092obesity4

Obesity in the United States places many at a crossroad between self-esteem and health.  Often, larger frames are celebrated as more desirable.  Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise.  Of course, our culture embraces and contributes to obesity.  Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport.  I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health.  If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed.  As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:

Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.

Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.

‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Smoking Cessation

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You’ve all been asked what things you’d take with you on a desert island.  I’ll pose and answer the opposite question, but not on an island but regarding your life.  Getting you to stop smoking is certainly one of the three gifts I’d offer you if it was within my power.  This post won’t be about the dangers of smoking – I’ll continue to hit you over the head with those at every opportunity.  Given that I’m into producing positive outcomes, I’m going to discuss with you effective means of smoking cessation and the benefits of stopping.
The question on your mind is obviously how to stop.  Personally, I’m of the Yoda mindset.  You know, when he was teaching Luke Skywalker, he famously said “Do or Do not. There is no try.”  I can hear you now, “But Doc, I’m addicted…”  Sure you are.  There are many things in medicine about which I’m absolutely sure.  One of these is the most effective way to stop smoking is to quit.  Cold turkey.  The moment you’re motivated.  Not only is this premise supported by the data, which I’ll discuss momentarily, but here’s the benefit of over 20 years in clinical emergency medicine practice and having seen hundreds of people stop, stay stopped, and letting me know months and years later that they stayed stopped.  Despite being addicted, people are amazingly able to quit cold turkey, and they will do it in one of five circumstances.

When they develop the will

After the birth of their first child

After their first heart attack

After their first stroke

When they die

For those of you convinced that you can’t, here’s a fact: today there are more former smokers than current smokers.

I want to point out that I appreciate the difference between cigarette smoking and nicotine dependence.  My particular concern for your health lies in the delivery of smoke (containing over 7000 other toxins, approximately 70 of which can cause various cancers) into the airway system that is supposed to deliver oxygen throughout your body for the maintenance and health of your organ systems.  Still I want you to know I understand and appreciate the difficulty of smoking cessation.

  • Nicotine dependence in the most common chemical dependence in the U.S.
  • Quitting smoking often requires multiple attempts.
  • Nicotine withdrawal produces bothersome symptoms (e.g. irritability, reduced concentration, increased appetite with possible weight gain, and anxiety)

The good news is more than two-thirds of smokers profess a desire to stop smoking, and yearly over half of smokers attempt to stop.  That’s likely a result of knowing that no matter when you stop, you will improve your health outcomes.  Each incremental inhalation of cigarette and cigar smoke produces damage better left unproduced.  Let’s just hope you don’t wait until permanent damage has set in.  Consider a sampling of the following benefits that are sitting there waiting for you.

  • Reduction of the risk for cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix, as well as certain leukemias.
  • Reduction of the risk for heart disease, stroke and peripheral vascular disease.
  • Reduction of the risk for COPD (chronic obstructive pulmonary disease)
  • Reduction of the risk for infertility

In my next post, I’ll review specific methods and tips to help you and/or your loved one stop.  Today’s as good of a day as any.
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Straight, No Chaser: High Blood Pressure

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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.
The 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)
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?
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Straight, No Chaser: The Week In Review

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Based on the response to this week’s posts, I’d say it was an informative week for you.  Remember to click the underlined topics to go to the mentioned post.  Let’s recap the week.
On Sunday, we reviewed night terrors and differentiated them from nightmares.  Remember, if your child develops these, it’s very important to protect them from harm during the episode, and try to identify the source of any increased stress.
On Monday, we reviewed the late Dr. Martin Luther King, Jr.’s comments on healthcare and its relevance today.  Injustice in healthcare is still shocking and inhuman, as health care disparities abound.  Monday also brought a review of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare.  As the time of implementation gets closer, I will revisit implementation of the ACA, particularly health care exchanges, what your options are, and what’s to be done with the 20 million Americans who will still be uninsured.  I will also be discussing how this blog and my national efforts will dovetail into these considerations.  Stay tuned.
On Tuesday, we began our series on toxins and detoxification.  The first post discussed the power our body naturally and normally has to detoxify and to defend us from harm.  The second post offered specific, natural Quick Tips to enhance your body’s capabilities.  Taken together, I strongly recommend you internalize this information (no put intended).  All the other exotic methods typically promoted are, at best, enhancements to what we already do unless disease limits us.  At worst, they can cause damage themselves.
On Wednesday, we looked at some of the environmentally toxic dangers to our bodies, focusing on various toxins affecting our lungs, skin, kidneys, liver and intestines.  If knowledge is power, your brain should be stuffed after reading that post.  Stop smoking (Yes, you.).  Wednesday also brought a review of detox diets.  My advice is simple.  Proceed with caution, and don’t expect any miracle cures.  In fact, the better course of action is to use any such efforts as a launch into a more modest long-term regimen of healthy diet and exercise.
On Thursday, we reviewed colon cleansing, looking at oral solutions and rectal colonics.  These were turbulent topics, to say the least.  Please consult your physician before starting any of these diets or cleansing programs.  They are not without risk and consequence in certain patients.  Thursday also brought a review and wrap-up of the toxin/detoxification series.  I enjoyed your questions, comments and thoughts.
On Friday, we reviewed insomnia.  Do you remember the difference between primary and secondary insomnia?  There are important treatment considerations attached to each, so consider reviewing.  I also gave you 10 Quick Tips to help your difficulty sleeping and answered your questions. 
On Saturday, we peeled back the brains of physicians and taught you how we decide if and when ankle x-rays are needed.  I really do want your feedback when you mention the Ottawa Ankle Rules to your physicians.  I’m sure you’ll have stories about hearing them muttering “Damn internet!” under their breath!  Saturday also brought a review of a normal calorie intake.  I think this is a pretty important topic for several reasons.  I hope you learned the different between sedentary, moderately active and active lifestyles.  Also, many of us have no idea how much we should be eating and how many calories we should have daily.  Also, this will serve as a nice launching pad for my review of obesity next week.
Speaking of the next two weeks, I will be focusing on revisiting some fundamental bread and butter topics (no pun intended).  I continue to hope you enjoy Straight, No Chaser and appreciate your supporting this blog, which has now reached readers in 60 countries around the world in every continent.  I’ll keep bringing the information, and you keep taking advantage of it.

Straight No Chaser: Top Seven Facts You Should Know About the Affordable Care Act (Obamacare)



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In general, the Patient Protection and Affordable Care Act (ACA) attempts a nifty set of tricks: it aims to add over 30 million currently uncovered Americans to insurance rolls while slowing the rate of growth of health care costs, then ultimately reduce the costs of care. This simultaneously makes insurance providers huge winners and slight losers (30 million new customers but less profit per customer), as well as hospitals, physicians and pharmaceutical companies, who are meant to make a little more money while working a lot harder for it. The basic premise is there’s already plenty of money in the system (America spends over 17% of the gross domestic product – over $2 trillion annually on health care; no other country spends more than about 11% of GDP on health care) to provide what we need. 

The ACA was truly a Republican initiative at birth, for those keeping score. It was born out of the Heritage Foundation (a conservative think-tank) and is more or less a combination of plans proposed by Bob Dole and executed by Mitt Romney in Massachusetts. It does not provide universal coverage or even “Medicare for all” (those would have been current Democratic ideas, although Richard Nixon proposed the same) or allow a governmental takeover of hospitals, insurance companies or physician practices (those would be socialized medicine). At it’s simplest, it’s a capitalist give to insurance companies of 30 million new patients with enhanced governmental oversight.
Here’s those 7 positive facts:
1)    The 80/20 rule: The law requires insurers to spend at least 80% of premiums on direct medical care. This nearly doubles historical trends. This is meant to expand care greatly in certain areas such as prevention and mental health. If and when this doesn’t happen, you’ll get a rebate check.
2)    Preventative care is being emphasized: you likely won’t have to pay a co-payment, co-insurance or deductible to receive services such as screenings, vaccinations and counseling.
3)    Preexisting conditions: Health plans can’t limit or deny benefits or coverage to anyone under age 19 because of the existence of pre-existing conditions. These protections will be extended to all ages beginning in 2014.
4)    Choice and ER access: You choose your own doctor. You don’t need a referral from your primary care doctor to see an Ob-Gyn doctor. You don’t need pre-approval to seek ER services outside of your plan’s network (e.g. when you’re out of town). This means those ridiculous out of network charges should go away.
5)    Young Adult Coverage: If your plan covers children, you can add or keep your kids on your policy until they turn 26, even if they’re married, don’t live with you or are otherwise eligible to have their own plan.
6)    Consumer Assistance Program: This strengthens your ability to appeal and fight decisions made by your insurance provider and guarantees your right to appeal denials of payment.
7)     End on Annual and Lifetime Limits on Coverage for all new health insurance plans by 2014.
The bottom line is 30 million American are being formally brought under the umbrella of the health care instead of relying on emergency departments or going without care.  Despite not being a perfect solution, if we were to list societal priorities, closing this gap to this extent is high enough on the list that the downstream consequences are less important as considerations.  As a public health initiative, this act will accomplish many things, including putting in motion changes in health care disparities due to the lack of access to care.  I would challenge all the critics of the ACA to answer one question whenever they have an argument about why they continue to oppose implementation of the ACA: “Is your concern worth leaving 30 million Americans without structured healthcare?”
I welcome your comments and questions.
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Straight, No Chaser – The Week In Review

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I hope this was another week of good health for you.  Let’s review how Straight, No Chaser tried to contribute to your health and wellness.  Don’t forget to click on any of the underlined topics for links to the original posts.
On Sunday, we reviewed eye emergencies.  Don’t forget that even transient vision loss could be a stroke in progress, and certain causes of vision loss have a limited window of time in which treatment must occur.  Act quickly!  By the way, I didn’t mention this information that occurs more commonly than you’d think: If you ever have eye discharge so copious that it seems like you’re tearing pus, this is probably gonorrhea.  Get it treated, lest you could lose an eye.  Now that I have your attention…
On Monday, we reviewed syncope (aka fainting) in two parts, talking about the entity (click here) and the life-threatening conditions associated with faints.  You’re way too cavalier with faints; please get them evaluated.  Faints can either be the result of significant disease or can secondarily produce significant head and neck injuries from the falls.  Stop going to the bathroom (with all the hard stuff in there) when you’re feeling dizzy.  That’s not a good place to black out!
On Tuesday, we discussed suicide and depression in-depth, reviewing demographic information, information for your self-assessment, and tips on how to recognize when help is needed (and how you can avoid depression).  I’m pleased that you’ve made these topics the most read topics yet, and I sincerely hope this information helps some of you.
On Wednesday, we reviewed the overuse of the emergency room, which will become a major theme of this blog.  Those creature comfort visits are 8 times more expensive than the same visits done at a primary care physician’s office.  In Texas, the average ER cost is $1020.  Just because you’re not necessarily paying up front doesn’t mean the hospital won’t ensure you’ll pay eventually.  Remember, hospital bills are the #1 cause of personal bankruptcy in the U.S.  Straight, No Chaser was created to point you toward better options.  Stick around, and we’ll get you there.  Wednesday also brought a review of vomiting and diarrhea (viral gastroenteritis).  Learn about oral rehydration therapy.  Viral gastroenteritis is a good example of something that feels really… bad but is usually self-limited and will go away on its own, as long as you stay hydrated.
On Thursday, we reviewed end of life decision-making.  I know this struck home for a lot of you, bringing back not so fond memories.  That said, you must begin to think about how you want to be treated in your last days.  There are many tragedies during this time that tear families apart.  Use the tools discussed on the post on living wills, power of attorney designations and DNR considerations to make sure your interests are the only consideration being addressed when the time comes.
On Friday, we seemed to prick a nerve or two (no pun intended) discussing circumcision.  If nothing else, be an educated consumer.  Even now, considerations are perhaps best summed up by the posture of the American Academy of Pediatrics, which declines to recommend routine circumcisions for all newborns but notes that if you are inclined to get the procedure (which should be a big if), the benefits outweigh the risks.  Friday afternoon, we reviewed hearing loss and the damage the activities of daily living produce.  This is a pretty good example of how we take our health for granted.  Just a little bit of protection and prevention over the first 40 years of your life will make a big difference later on.
Saturday, we discussed two different types of sounds that come out of you.  First, we discussed snoring (which is always annoying but never boring) and gave you some Quick Tips to overcome it.  We also discussed hiccups, which everyone gets at some point, but no one ever wants.  We also gave you Quick Tips on hiccup cures here.  Remember those ABCDEs!
We continue to listen to your comments and feedback, and over the next few months, some major changes will be occurring.  Please continue to forward your topic requests.  I promise I’ll get to them all eventually.  Maybe I’ll start doing reader submission posts.  As we continue to grow, your support, referrals and follows are much appreciated.  Have a happy and healthy week.
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Straight, No Chaser: The Week In Review and Your Take Home Messages

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Well, it was a busy week. Let’s look at what you may have missed.
On Sunday, we started with reviewing the important of National Minority Organ Donor Awareness Month. Over 56% of people on the national organ transplant waiting list are minorities. Consider checking in at http://organdonor.gov/becomingdonor/stateregistries.html.
On Monday, we reviewed human bites, which involve any lesion caused by your teeth that breaks the skin. These range from over aggressive hickeys to the Mike Tyson variety to lesions caused by punching someone in the teeth. We posted your FAQs separately here. My bottom line is you need to get evaluated every bite (that breaks the skin) every time.
On Tuesday, we reviewed alcohol intoxication, abuse and dependency and gave you the tools to assess that all important question: Do You Drink Too Much? We included a special Alcohol Facts and Fiction post for your consideration. In case you were wondering, that beer belly isn’t from your beer and is the least of your worries, either from the alcohol or the belly sides of the equation.
On Wednesday, we went Back to the Future in discussing low back pain and identified life-threatening conditions associated with low back pain. Remember to lift with your knees instead of your back, and beware of night-time back pain or loss of motion, sensation, bowel and/or bladder control. You probably heard the word Cauda Equina for the first time.
On Thursday, we discussed spider bites, focusing on the Black Widow and Brown Recluse spiders. Do you remember what a volcano lesion is? We also discussed shingles and answered a lot of questions about the chickenpox and shingles vaccines. The Straight, No Chaser recommendation is to get them (the vaccines, not the diseases)!
On Friday, we busted a few myths about migraine headaches and discussed life-threatening conditions associated with headaches. I want you to remember the association between migraines, heart attacks and strokes. Review the list of ‘headache plus’ symptoms to prompt you to get immediately evaluated.
On Saturday, we taught you how to fall. Do you remember what FOOSH stands for? We also reviewed the causes and treatment of ingrown toenails. Sometimes the simplest advice is the best. Stop biting your toenails!
Thanks to all of you who have filled out the Straight, No Chaser survey. I hope you’re seeing improvements to your satisfaction. The Week in Review post is a direct result of your feedback. We have 500 followers now in a month, which isn’t bad for a blog on a topic that can be a boring as health and medicine. Thanks for your support and continued feedback.
Jeffrey E. Sterling, MD

Straight, No Chaser Poll: Help Improve the Experience!

Thank you for taking the time to answer a few very simple questions.  Doing so will help me provide an even better blog for you.  Of course, I expect your answers to be Straight, No Chaser.









Thank you sincerely for your support and feedback.  Feel free to offer suggestions and topics you’d like to see covered.

Jeffrey Sterling, MD

Straight, No Chaser: Trauma Quick Tips and The Week In Review

cch trauma
This week in Straight, No Chaser, we reviewed multiple topics related to Trauma, the #1 cause of death between ages 1-44.  Here’s the Week In Review and featured Quick Tips.
1)   Over the weekend, we started with discussions of Amputations of Permanent Teeth and Fingers.

  1. Remember, you lose 1% viability per minute for a dislodged tooth.  Get help quick!  https://jeffreysterlingmd.com/2013/07/27/straight-no-chaser-saturday-quick-tips-the-tooth-of-the-matter-is/
  2. The transport of displaced fingers and teeth is vital to successful reimplantation.  Never place them directly on ice!  https://jeffreysterlingmd.com/2013/07/28/sunday-quick-tips-give-me-the-finger/

2)   On Monday, we talked about Motor Vehicle Crashes.
https://jeffreysterlingmd.com/2013/07/29/straight-no-chaser-human-shark-week-part-1-motor-vehicle-trauma/
https://jeffreysterlingmd.com/2013/07/29/trauma-quick-tips-how-to-survive-that-motor-vehicle-crash-mvc/

  1. Avoiding distracted driving is the most important factor in preventing crashes.
  2. Wearing your seat beat is the most important factor in surviving crashes.
  3. The middle back seat (while wearing a seat belt) is the safest place in the car.

3)   On Tuesday, we reviewed Traumatic Brain Injuries/Concussions.
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussions-part-i/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussion-part-ii/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-concussions-post-script-a-neurologists-thoughts/

  1. Dr. Flippen, a neurologist from UCLA, reminded us that most patients will recover but never as fast as they wish.
  2. After a head injury, expect not to be released back to sporting activity for at least two weeks.

4)   On Wednesday, we reviewed Mass Disasters and talked about the importance of an Emergency Kit.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-when-disaster-strikes/

  1. Remember to have access to 1 gallon per day per person, half for drinking and half for cooking/hygiene.

5)   On Wednesday, we also discussed Dog, Cat and Shark Bites.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-who-let-the-dogs-out-animal-bites/

  1. Cat scratches are also a major infection risk and should be evaluated.
  2. Who’d have thought sharks were nibbling you out of curiosity instead of biting you out of hunger?

6)   On Thursday, we reviewed Penetrating Trauma (Gunshot and Stab Wounds)https://jeffreysterlingmd.com/2013/08/01/straight-no-chaser-gunshot-and-stab-wounds/

  1. Remember the ‘Golden Hour’ of Trauma and get seen as soon as possible after being stabbed or shot, just as soon as you ensure your safety.
  2. It is very important to avoid worsening possible spinal injuries by excessive movement.

7)   On Friday, we reviewed Residential Fires and its associated trauma.

  1. In Part I, we emphasized the importance of installing smoke and carbon monoxide detectors, having an escape plan and not sticking around to fight the fire.   https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-the-roof-is-on-fire-the-trauma-of-residential-fires/
  2. In Part II, we discussed treatment of possible injuries that may occur.  https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-your-questions-on-treatment-of-fire-related-injuries/
  3. Remember if any head or neck injuries exist, try your best not to move.
  4. Remember that if you’re feeling like you have the flu after being exposed to a fire, it could be carbon monoxide poisoning!

8)   On Saturday, we reviewed Snakebites.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-stop-the-life-you-save-may-be-your-own-snake-bites/

  1. We debunked the myth about sucking venom out of snakebite wounds.  Don’t do it!

9)   Saturday, we also reviewed Elderly Falls.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-ive-fallen-and-cant-get-up-quick-tips-on-elderly-falls/

  1. We identified head injuries/bleeds, lacerations and hip fractures as injuries to guard against.
  2. We discussed the importance of home improvements, diet, exercise and checking for osteoporosis and vision checking for maintainance of health.

Straight, No Chaser: The Roof Is On Fire – The Trauma of Residential Fires

Image
As Trauma Week winds down on Straight, No Chaser, we work our way back home, which sadly is the site of most traumatic injuries.  In fact, about 85% of all U.S. fire deaths occur in homes.
The good news is the number of residential fire-related deaths and associated injuries is going down, but that won’t help you if you aren’t aware of how to prevent them and get to safety and cared for in the event a fire occurs in your home.  Let’s address this right off the bat.  You’re most likely to die or be injured from a fire if you’re in one of the following groups, according to the Center for Disease Control (but of course, the fire doesn’t check who’s being burnt):

  • Poor
  • Rural
  • African-American
  • Native American
  • Ages less than 4 or over 65

In the U.S. (2010 data), someone dies every 169 minutes and is injured every 30 minutes, amounting to over 2,500 deaths and over 13,000 injuries (and that’s not including firefighters).  Interestingly, victims aren’t burning to death as much as they are dying from inhalation injuries from smoke and gases (estimated to be the cause of death in between 50-80% of cases).  Speaking of smoke, although cooking is the #1 cause of fires, smoking is the leading cause of fire-related deaths.  Alcohol consumption is a contributing factor in 40% of residential fire deaths.  Most fires occur in the winter.
So What To Do?

  • Install a smoke alarm.  They work.  Over one-third of residential fire deaths occur in homes without alarms.
  • Plan your escape in advance.  Have an exit strategy based on where a fire might break out in your home.
  • Don’t fight the fire.  Nearly ½ of fire related injuries occur from efforts to fight the fire.  Get out of the house.  Of course if you have easy access to an extinguisher, use at your discretion.

Tips on How You’ll Be Treated
Fire-related injuries commonly involve burns and bony injuries (bruises, sprains, fractures), which will be addressed as needed.  However, the most important fire-related injuries involve the airway.  These injuries may be due to the heat’s effects on the airway (burns, swelling and inflammation) and/or the effects of carbon monoxide and/or cyanide (inability to oxygenate).  One important fact for families to realize is the presence of any soot/burns anywhere near or in the mouth or nose needs to be evaluated.  Such signs and symptoms are powerful predictors of potential airways damage and imminent failure.

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