ooh so common foot pain. . . plantar fasciitis.

Posted on September 27, 2011 by drlesliegreenberg

flickr.com/photos/flea_ef/ 4462368202

Is the first step of the day your worst?    Plantar fasciitis may be your problem.

Risk factors for plantar fasciitis are

  • excessive running,
  • high arch,
  • when one leg is longer than the other,
  • obesity,
  • occupations with prolonged standing or walking,
  • sedentary lifestyle,  and
  • Achilles tendon tightness.

Your physician will perform a history and physical which may reveal plantar fasciitis as the diagnosis.  X-rays are rarely needed.

Treatment can be done in stages.  Initial treatment should be tried for a few weeks.

  1. rest
  2. modification of activities,
  3. ice massage,
  4. pain medication, and
  5. stretching

    night splint flickr.com/photos/ cellphonesusie/1294933595/

If heel pain persists, then physical therapy, foot orthotics, and night splinting (see picture) may be needed.

Foot orthotics  are inserts that fit into shoes.  Ones that may help include over-the-counter heel cups, over-the-counter heel or arch orthotics, and custom-made foot orthotic.

90% of patients will improve with the above techniques.  Pain lasting 6 months depspite therapy may require shock wave therapy or a surgery called plantar fasciotomy.

Here’s a video of stretching exercises http://www.youtube.com/watch?v=t2KkdMlqRZU

Hope this helps.

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New guidelines: Do not screen the healthy for Vitamin D level

Posted on September 25, 2011 by drlesliegreenberg

The Endocrine Society recently gave guidelines  that vitamin D lab work should only be obtained for those “at risk.”  Risk factors include

  • Obese,
  • African-Americans,
  • pregnant and breastfeeding women,
  • patients with malabsorption syndromes.

Not surprisingly, some causes of vitamin D deficiency include (the above), obesity, fat malabsorption syndromes, bariatric surgery, nephrotic syndrome.

This leads to the question of. . . How much Vitamin D should I take a day?  Well, it depends on your age. . .

Infants and children aged 0-1 require at least 400 IU a day to maximize bone health

Between ages 1 to 70, pregnant, or breastfeeding women require at least 600 IU/day

Adults 70 years and older require at least 800 IU/day

You’ll find VitaminD2 or D3 at the store and either can be taken for the treatment or prevention of Vitamin D deficiency.

Vitamin D is well documented to help with muscle strength and is therefore thought to help prevent falls in the elderly.  There is insufficient evidence to suggest vitamin D supplementation in excess of above recommended daily needs.  This is because there is insufficient evidence to show that Vitamin D prevents cardiovascular disease or death, or improves quality of life.

Look at the chart below for dietary Vitamin D or take a vitamin D supplement.  Hope this helps.

Table 3: Selected Food Sources of Vitamin D
Food IUs per serving* Percent DV**
Cod liver oil, 1 tablespoon 1,360 340
Salmon (sockeye), cooked, 3 ounces 447 112
Mackerel, cooked, 3 ounces 388 97
Tuna fish, canned in water, drained, 3 ounces 154 39
Orange juice fortified with vitamin D, 1 cup (check product labels, as amount of added vitamin D varies) 137 34
Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup 115–124 29–31
Yogurt, fortified with 20% of the DV for vitamin D, 6 ounces (more heavily fortified yogurts provide more of the DV) 88 22
Margarine, fortified, 1 tablespoon 60 15
Liver, beef, cooked, 3.5 ounces 49 12
Sardines, canned in oil, drained, 2 sardines 46 12
Egg, 1 large (vitamin D is found in yolk) 41 10
Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 0.75–1 cup (more heavily fortified cereals might provide more of the DV) 40 10
Cheese, Swiss, 1 ounce 6 2

* IUs = International Units.

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My husband was chosen as a Wichita “Health Care Hero”

Posted on September 23, 2011 by drlesliegreenberg

“Health care hero”. . . and my hero.  Congratulations to my husband.

Dr. Mark Stovak –  Wichita Business Journal.

http://www2.bizjournals.com/wichita/events/2011/health_care_heroes/2011/07/dr-mark-stovak.html

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Packaging Error Leads to Recall of Multiple Lots of Oral Contraceptives

Posted on September 22, 2011 by drlesliegreenberg

A recent packaging error may make your contraceptive choice unsafe.  Please read the article to assure that your oral contraceptives are not among the recalled.  Read on. . . .

Packaging Error Leads to Recall of Multiple Lots of Oral Contraceptives — AAFP News Now — American Academy of Family Physicians.

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Do you think you need your (or your kid’s) tonsils out?

Posted on September 20, 2011 by drlesliegreenberg

tonsilitis

More than 530,000 tonsillectomies are performed annually on US children.  The American Academy of Otolaryngology-Head and Neck Surgery has provided an evidence-based (meaning there is good research) guide to identify patients who may most benefit from tonsillectomy.

You may ask. . . why not just take out the tonsils?  Risks and benefits need to be weighed.  There is risk with every surgery, infection and bleeding are the most common.  So, a patient needs to show benefit before risk should be taken.

Tonsillectomies are performed for two main reasons: to prevent strep throat and to minimize sleep-disordered breathing.

The “Paradise Criteria”  justifies tonsillectomy–depending on a minimum number of  infections.

  • 7 sore throat episodes (described
    below) in the past year or
  • 5 episodes in each of the previous two years or
  • at least 3 episodes in each of the previous three years.

“Sore throat episodes” requires at least one of the following

  1. fever more than 100.9 degrees Fahrenheit,
  2. tender lymph nodes in the
    neck, measuring  more than 2 cm in size,
  3. visible pus on the tonsils,
  4. “positive” strep throat culture.

These “sore throat episodes” must be documented in the
medical record.

So, as a family physician, I conscientiously keep up with my
subspecialists guidelines and refer patients to surgeons as needed. Of course, antibiotics should be given for any (suspected or) proven case of streptococcal pharyngitis.

Hope this helps.

http://oto.sagepub.com/content/144/1_suppl/S1.long

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Multivitamins: Do young children need them? – MayoClinic.com

Posted on September 18, 2011 by drlesliegreenberg

flickr.com/photos/armitage77/ 5316562330

I was asked recently to comment on if multivitamins are needed for children. “The run-of-the-mill child who is thriving does not require a multivitamin,”  says Dr. Jatinder Bhatia, chair of the AAP’s committee on nutrition.   There are a few sets of patients who would benefit.  Read on. . .

Multivitamins: Do young children need them? – MayoClinic.com.

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Is caffeine harmful to a pregnancy? How much can you safely have?

Posted on September 15, 2011 by drlesliegreenberg

flickr.com/photos/waytru/ 1190139568

British Medical Journal published a study of 2,635 low-risk pregnant patients, their caffeine consumption amounts, and pregnancy outcomes.  The results were pretty
interesting.   The study was performed because past studies had shown that caffeine use of more than 300 mg a day seemed to be associated with fetal growth restriction (lower weight infants) and miscarriage.  But, researchers were
unsure if past studies were done taking into account all the important
factors.

The results of the BMJ study showed that with increasing caffeine consumption, babies at birth weighed less.  For example, when compared to women who drank on average 50 mg caffeine per day those who drank 200 mg caffeine a day had babies weighing 2.5 ounces less at birth and those who drank 300 mg caffeine a
day had babies weighing 5.75 ounces less at birth.

One take-away point is that there is a small, but notable,
decrease in infant birth weight dependent on amount of maternal caffeine intake.  Researchers state that although a safe threshold cannot be determined, maternal caffeine intake of less than 100 mg per day minimizes the risk of fetal growth restriction.

http://www.bmj.com/content/337/bmj.a2332.full

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Are you interested in the HCG diet?

Posted on September 13, 2011 by drlesliegreenberg

Have you heard the “buzz” about the HCG diet?  I have.   My patients asked me to research it.  I think this is a great article and I especially love the FDA’s use of the words “fraudulent” and “illegal.”  Read on. . .

HCG Diet Dangers: Is Fast Weight Loss Worth the Risk? – US News and World Report.

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Does acupuncture help headaches?

Posted on September 11, 2011 by drlesliegreenberg

flickr.com/photos/kightp/ 4527224826

Yes!  A Cochrane review of 4,419 patients showed that acupuncture is AS effective as traditional migraine headache treatment in the prevention of headaches.  Evidence has shown that acupuncture, when used in addition to, or in place of, routine medical management (medications) reduces the frequency of migraine headaches.

Europe is more progressive than the US with 21.4% of English physicians performing acupuncture (or referring patients for acupuncture).  In Germany, acupuncture is the most commonly used preventive treatment for migraine headaches.

Hmmmmmm. . . interesting—and effective–treatment option.

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Nasal saline irrigation. My patients know that I am a FAN of this!

Posted on September 7, 2011 by drlesliegreenberg

.flickr.com/photos/debrisdesign/ 502255811

What is it?  It is a way to bathe and flush out virus, bacteria, allergens and mucus from the nasal cavity.  It is thought to help by direct cleansing, removing inflammatory mediators, and helping the nasal hairs (mucociliary function) work better.

Why should I do it? Patients feel better:  less post-nasal drip, less bothersome cough at bedtime, less sniffling.  In addition, it has been shown to decrease use of antibiotics and medication-based (not saline) nasal sprays.

Who should NOT do nasal saline irrigation?  Those with incompletely healed facial trauma
or those with difficulty controlling their breathing (as they may inhale the saline solution when they should be exhaling).

Who does it help most?  Those with “rhinosinusitis”—a drippy, congested nose.   It may also help with symptoms from (allergic or irritant-caused) rhinitis or a cold.

Is it expensive? No.  There are nasal irrigation kits at the pharmacy.  In addition, you can buy the salt/baking soda packs, or make your own (see the Wisconsin School of Medicine
web link below).

Thanks to the University of Wisconsin School of Medicine and Public Health for a recipe for saline solution, instructions for irrigation, trouble-shooting tips and links to audio and video teaching media.

http://www.fammed.wisc.edu/research/past-projects/nasal-irrigation

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