Charles Lerner, MD, Internal Medicine Office. Destin, Florida

10/07/2023

09/07/2023

Moving office to new location soon

08/03/2023

IRON DEFICIENCY ANEMIA

Iron deficiency anemia is a common type of anemia — a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body's tissues.

Iron deficiency anemia is due to insufficient iron. Without enough iron, your body can't produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, iron deficiency anemia may leave you tired and short of breath.

You can usually correct iron deficiency anemia with iron supplementation. Sometimes additional tests or treatments for iron deficiency anemia are necessary, especially if your doctor suspects that you're bleeding internally.

Iron deficiency anemia signs and symptoms may include:

Extreme fatigue
Weakness
Pale skin
Chest pain, fast heartbeat or shortness of breath
Headache, dizziness or lightheadedness
Cold hands and feet
Inflammation or soreness of your tongue
Brittle nails
Unusual cravings for non-nutritive substances, such as ice, dirt or starch
Poor appetite, especially in infants and children with iron deficiency anemia

Iron deficiency anemia isn't something to self-diagnose or treat. So see your doctor for a diagnosis rather than taking iron supplements on your own. Overloading the body with iron can be dangerous because excess iron accumulation can damage your liver and cause other complications.

07/21/2023

Signs of a heart attack

So, what does a heart attack really feel like? People most often report:

Chest pressure or tightness. Imagine the feeling of someone sitting on your chest. That’s close to the sensation brought by a heart attack. “It can feel very oppressive,” says Dr. Lerner

Heartburn-like discomfort. It’s quite common for heart attacks to feel like acid reflux. In fact, the symptoms can be nearly identical. (Learn how to tell the difference between a heart attack and heartburn.)

Shortness of breath. Some heart attacks don’t cause pain at all. These “silent heart attacks” are most common in people with diabetes and older adults.

Pain on the left side. Signs of a heart attack could include pain radiating up to the left side of your jaw or down your left arm. Some people complain of a backache, too.

Fatigue. This symptom is most common in older people and can be misdiagnosed as a flu-like illness.

Nausea and sweating. While these symptoms can come with heavy chest pain, they also can occur by themselves, especially in women

What a heart attack doesn’t feel like

Not all chest pain is a heart attack symptom, clarifies Dr. Lerner Pain is unlikely to be heart-related when it:

Is momentary, lasting only for a few seconds.

Feels like a pricking sensation.

Is in a small, well-localized area of your chest.

Gets better or worse with breathing or positional changes.

Can be reproduced when you press on your chest or move your arm.

Radiates below your abdomen and into your legs.

Any heart attack — even a minor one — can damage your heart muscle. Early treatment can minimize that damage.

“Every minute truly counts with a heart attack,” stresses Dr. Lerner “If you feel like something’s wrong, get seen. Don’t ignore chest pressure, shortness of breath or nausea that lasts for more than 10 minutes and seems to be getting worse. Listen to your body.”

In general, call 911 if:

Symptoms occur suddenly and persist for more than 10 minutes.

Shortness of breath and/or chest discomfort occurs while you’re at rest.

You develop symptoms and are a middle-aged or older adult with risk factors such as past or present smoking; diabetes; or a family history of heart disease.

Younger women who smoke or have diabetes, hypertension or ovarian dysfunction also are more vulnerable.

And it is important to call 911 for an ambulance. The reason? About 1 in 300 people having heart attack symptoms end up developing a life-threatening arrhythmia on the way to the hospital. If it happens in the ambulance, treatment can begin immediately.

07/06/2023

POTS? What is it

DEFINITION AND MANIFESTATIONS OF POTS

Postural Orthostatic Tachycardia Syndrome

POTS is a chronic syndrome defined by a sustained increase in heart rate of at least 30 beats per minute (bpm) within 10 minutes of standing in adults (or ≥ 40 bpm in patients ages 12 to 19) without accompanying orthostatic hypotension, which is defined as a fall in systolic blood pressure of 20 mm Hg or greater or a fall in diastolic blood pressure of 10 mm Hg or greater.

The onset is typically often follows a trigger such as infection, surgery, trauma, or childbirth. Heat, fever, dehydration, morning hours, strong emotion, and menstruation have been known to exacerbate symptoms. The typical age at onset is between 15 and 45, and at least 80% of patients are women.

A typical presentation of POTS is in a young active woman with a subacute onset of lightheadedness, dizziness, provoked by standing, often following a viral illness, surgical procedure, trauma, or prolonged period of inactivity. The patient may report that symptoms are worse in warm weather or morning hours, or when feeling particularly stressed or anxious.

The diagnostic evaluation of POTS starts with a focused history centering on symptom onset and progression,other medical conditions, precipitating and exacerbating factors. Other topics and investigations include the following:

Diet, including meal size and frequency and the volume of salt and water intake, is important in looking for symptom triggers and developing treatment strategies. Reducing the size of meals reduces the likelihood of postprandial hypotension, with less blood flow routed away from the brain to the gastrointestinal system.

Exercise tolerance (length and type of exercise) can be used to assess the severity of symptoms and evaluate treatment efficacy over time.

Medications with side effects that mimic POTS symptoms include diuretics, vasodilators, antipsychotics, anticholinergics, nonstimulant medications for attention deficit hyperactivity disorder (eg, atomoxetine), and oral contraceptive pills with antimineralocorticoid action (eg, those that contain drospirenone)

The physical examination should include a complete cardiac and neurologic assessment. Look for clues pointing to diseases that can produce a POTS-like phenotype, such as:

Thyroid dysfunction (exophthalmos, goiter, hair-thinning, nail discoloration)

Anemia (pallor, jaundice, cool or discolored extremities)

Connective tissue disorders such as Ehlers-Danlos syndrome (joint hypermobility).

Treatments:

Once the diagnosis of POTS is established, initial treatment is aimed at reducing symptoms, improving quality of life, and educating the patient. Nonpharmacologic strategies should be the first intervention and include the following:

Volume expansion by increasing oral intake of water to 2 to 3 L/day and salt to 10 to 12 g/day (regular intravenous fluid infusions are not recommended and are potentially harmful

Compression garments including abdominal and thigh compression and full abdominal and leg compression

Sleeping with the head of the bed elevated 4 to 6 inches

Removing exacerbating factors such as large meals and medications

A graded exercise program featuring endurance reconditioning and lower-body resistance training can be highly beneficial

Behavioral and cognitive therapy should also be considered for patients with significant anxiety, somatic hypervigilance, or catastrophizing behaviors.

TAKE-HOME POINTS

Although the etiology and pathophysiologic mechanisms underlying POTS remain uncertain, a clinical diagnosis can be made with a focused history, examination, and basic diagnostic evaluation.

Initial treatment strategies are simple and include optimizing fluid intake, compression stockings, avoiding known triggers, exercise to improve stamina, and cognitive behavioral therapy to reduce hypervigilance.

06/30/2023

STYE

Do you sometimes get tender, red swollen bumps at the edge of your eyelids? They’re probably styes.

And although they can be painful (and almost always uncomfortable), you can take steps to avoid them. If you want to know how to make them go away, there’s good news. In most cases, you can treat them yourself at home with a little stye self-care.

How do you get a stye?

A stye is an infection in an eyelash follicle or tear gland.

If you scratch or get bacteria in the area, the follicle or gland sometimes gets blocked and infected​.

“Styes typically occur on the outside edge or just under the eyelid,” Dr. Lerner says. “They’re bumps that look like pimples, surrounded by redness. They usually last about three days, pop and then heal in about a week.”

And while styes are very common, you’re more likely to get one if you:

Had a stye before.
Have eyelids that are inflamed (a condition known as blepharitis).
Have skin conditions like dandruff.
Have diabetes.
Have high cholesterol.
Have hormonal changes.

Apply a warm compress
You can help the process along by placing a warm, clean, damp cloth on the affected eye for at least 10 to 15 minutes a few times a day.

Folding up a damp washcloth and microwaving it for 10 to 20 seconds can work well. Just be careful the cloth doesn’t get too hot to use on your eyes. It’s convenient as a warm compress because as any edge of the washcloth gets too cool, you can refold for a warmer side.

Use baby shampoo
Over-the-counter ointments and solutions are also available to treat styes, but Dr. Lerner recommends a tried-and-true, inexpensive option.

“Simply wash the eye gently with baby shampoo or a mild natural soap that doesn’t burn your eye,” he advises. “Dilute the shampoo or soap in warm water and apply to your eyelids gently with a clean cotton swab or washcloth.”

Forgo makeup or contacts
Also, to avoid further irritation and infection, he recommends not wearing makeup or contacts when you have a stye.

“You want to keep the area clean and uncovered — cosmetics and contact lenses can prevent this,”

AVOID:

Massaging the area to help drainage is not generally recommended for someone to do at home,” he says. “Although massage may provide temporary relief, it should be done under the guidance of a healthcare professional and with caution. Sometimes, massage in the area can make the condition worse or lead to complications by increasing the risk of spreading the infection or causing damage to the surrounding tissues.”

Additionally, you may have seen people touting the use of coconut oil to help with a stye.

Coconut oil is not a standard recommended approach for stye management,” he warns. “There is limited scientific evidence to support the use of coconut oil for treating styes. Although coconut oil has antimicrobial and anti-inflammatory properties that may have potential benefits, additional studies are needed to determine its true efficacy.”

Should you pop a stye?

If you’re wondering how to get rid of a stye fast, you may be tempted to pop it. As styes often look like pimples, it can be tempting to squeeze them — but don’t do it.

“When a stye comes to a head or when it pops, it will slowly drain and heal, but you should always let it do that on its own time,” Dr. Lerner stresses.

To help prevent styes, follow these tips:

Wash makeup off before bedtime so eye follicles don’t get plugged overnight.
Replace eye makeup about every six months to avoid bacterial growth.
Avoid sharing eye cosmetics or personal items like mascara, eyeliner or towels.
Wash your hands regularly, especially when using or handling contact lenses.
If you have allergies, don’t rub your eyes.

SEE DOCTOR IF:

The stye hasn’t started to improve in 1 to 2 weeks.
It gets worse quickly.
It becomes extremely painful.
It grows in size.
It bleeds.
It affects your vision.
It spreads to the white of the eye (a sign of infection).
You develop a fever.
You see redness in the cheeks or other parts of the face (the infection is likely spreading).