6 Emergency Complications of Type 2 Diabetes

6 Emergency Complications of Type 2 Diabetes
Uncontrolled diabetes can control your health. Help prevent these serious diabetes complications by learning the warning signs.
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.

Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
• Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
• Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
• Shortness of breath
• Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.

Stroke
Stroke warning signs may include:
• Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
• Feeling confused
• Difficulty walking and talking and lacking coordination
• Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.

Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
• Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
• Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
• Inflammation and tenderness anywhere on your body
• Red, itchy rash surrounded by small blisters or scales
• Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
• Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
• Sharp pain that gets worse at night
• Muscle weakness that makes walking difficult
• Bladder infections and problems with bladder control
• Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
• Erectile dysfunction in men and vaginal dryness in women

Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
• Swelling in your ankles and legs
• Leg cramps
• A need to go to the bathroom more often at night
• A reduction in your need for insulin
• Nausea and vomiting
• Weakness and paleness
• Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.

Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
• Blurry vision that lasts for more than two days
• Sudden loss of vision in one or both eyes
• Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
• A sensation of seeing "flashing lights"
• Pain or pressure in one or both eyes

Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
• Frequent urination
• Extreme thirst
• Feeling tired and weak
• Blurry vision
• Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor immediately. Together you can work to prevent these diabetes-related health complications.

By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH

Healthy Drink Suggestions Not Just for Diabetics

Coffee and tea are healthy gifts brimming with antioxidants and flavonoids. Research has shown that coffee may lower the risk of type 2 diabetes, Parkinson’s disease, liver disease, and cirrhosis, while green tea is believed to possibly reduce the risk of heart disease. The Republic of Tea and Celestial Seasonings sell several different varieties of green tea, including flavored, full-leaf, and decaffeinated. A gift of wine is a great way to toast the season and can be healthy, too. It’s believed moderate alcohol use (one drink per day for women, one to two drinks per day for men) may slightly increase HDL, the so-called good cholesterol

$500 socks and other insanely overpriced leg wear

Rodarte hand-crocheted socks, $500
These mohair and alpaca socks are spot clean only. Ewwwwwww.

Fancy socks and tights are more popular than ever this season, thanks to big-name designers like Prada, Givenchy and Chloé who all sent several incarnations down the runway. In fact, the New York Post recently reported that a $500 pair of socks from trendy fashion house Rodarte is currently being sold at Manhattan's Opening Ceremony boutique. Yes, $500. For socks. Surely the hand-crocheted, mohair yarn and alpaca wool cost more to make than a pair of cotton tube socks, but the designer label (one that's adored by First Lady Michelle Obama, Natalie Portman and Kirsten Dunst) is what really ups the value.

Truth be told, we think these knit socks are ugly. Also, they're incredibly impractical since they're full of holes and can't be washed. What's even funnier is that Rodarte co-designer Laura Mulleavy told Opening Ceremony that she "probably wouldn't wear any of the stuff I make." Sheesh. While we fully endorse staying cozy in wool socks and knit tights this season, we were astounded by the abundance of $50, $100, $500, and $1,000 pairs. The New York Post said that Bergdorf Goodman sold out of their $125 Marcoliani socks in 16 days. Seriously? Our tights budget is around $20 max and our socks usually come with a 3 for $15 price tag. Check out our slideshow of ridiculous and overpriced legwear, above. Also? Some suckers are willing to pay for this stuff. [New York Post]

7 Easy Lunches for Type 2 Diabetes

Sticking to your diabetes diet at lunchtime is easier than you think. Here's a week's worth of ideas to keep your midday meal interesting and healthy.

If breakfast is the most neglected meal of the day, lunch can often be the most hurried. Fast-food restaurants and food courts often prevail over more healthy options because we lead such hectic lives. But they don't have to be your only option — and, in fact, they shouldn't be your first choice if you have type 2 diabetes.

In general, try to pack your own lunch whenever possible — the health benefits can be enormous. Short on prep time? Put these quick and nutritious lunch ideas on your diabetes menu to fill you up and keep your blood sugar in check.

1. Salads

Salad should be a part of your lunch menu if you have diabetes. You can create a different salad every day of the week by varying your toppings. Try grilled chicken, shrimp, or fish, but avoid heaping on a lot of fattening ingredients, such as bacon bits and heavy cheeses.

Salads with lots of raw vegetables are best, including carrots, cucumbers, radishes, celery, and spinach. Sprinkle nuts or seeds on top, add a few dried cranberries, and garnish with some avocado chunks to give it zip. Always choose low-fat or fat-free salad dressings or, for a change, flavored vinegars.

2. Sandwiches

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As with salads, there are many ways to spice up a sandwich. Start with whole-grain bread or a whole-wheat tortilla. Add lean meat, such as turkey, ham, or grilled chicken; layer on your choice of veggies; add mustard, low-fat mayo, or hummus to the mix — and you have a filling and tasty lunch. Stay away from greasy chips, French fries, and other fattening sides. Instead choose fruit, a few pretzels, or carrot and celery sticks to complement your meal.

3. Hearty Soups

Soup can be a good option for lunch, with many healthy choices to consider. Chicken noodle, chicken and rice, and tomato (made without cream) are all good soup choices. Others include butternut squash, gazpacho and other chunky vegetable varieties, miso, and pasta and bean soups. Avoid cream-based soups and chowders. Remember, soup freezes well. You can make a large batch and freeze it in individual containers; with a microwave you have a nearly instant lunch.

4. Pasta

As long as you choose whole-grain pasta, you can eat all types of noodles, such as penne, angel hair, or spaghetti. Top it with a healthy tomato sauce, then add chicken, shrimp, or turkey meatballs and a variety of vegetables. Add a crisp salad and you have a healthy and filling lunch.

5. Pizza

Pizza can be a good choice &mash; in moderation. Choose a thin-crust variety, ask for light cheese, and include vegetables as the topping instead of fatty meats like pepperoni.

6. Tuna, Chicken, and Shrimp Salads

When you make these protein-based mixes, you can control the mayonnaise and the good-health factor. Choose low-fat mayonnaise, and not too much of it. Add fiber and bulk with chopped celery, diced bell pepper, and chopped onions to taste. Serve on whole-grain bread or scoop onto a bed of lettuce.

7. Veggie Stir-Fry

For a more exotic lunch, go for a bowl of vegetable stir-fry and brown rice. Avoid the fast-food version, which can be high in fat and sodium, and make it yourself by sautéing the vegetables with a healthy cooking spray and soy sauce. Prepare it the night before for dinner, making enough to bring leftovers for lunch.

More Healthy Lunch Tips for Type 2 Diabetes

To better control type 2 diabetes, keep these tips in mind:

Choose low-fat or fat-free salad dressings and watch how much you use.
Pick whole-grain bread over white bread.
Practice portion control.Follow the diabetes food pyramid: Eat more grains, beans, and starchy vegetables and less fats, sweets, and alcohol. In between and equally divided are protein choices, non-starchy vegetables, fruit, and milk and dairy products.
Choose lean protein sources, such as turkey, ham, chicken, lean roast beef, and fish.
Avoid fried foods.
Stay away from fatty chips and mayonnaise-based salads, like potato salad. Complement your meal with sliced carrots and celery or fruit salad.
If you are craving a sweet after lunch and fresh fruit just won't do, reach for sugar-free, fat-free frozen yogurt. Be careful of sorbets and sherbets that are loaded with sugar.
Avoid sugary beverages; drink water and tea instead.
Consult with a certified diabetes educator or registered dietitian to get more lunch ideas. How much and what types of food you should eat varies, depending on your specific needs — a dietitian can help create a meal plan that is right for you.

When to Test Children for Diabetes

Q: My husband is a type 1 diabetic, and we didn't know that until he went for a physical and the doctor said his body was in "ketosis" (shutting itself down). We didn't expect that since he looked healthy, and we didn't recognize any symptoms except frequent urination. At what age should we have our three children (ages 13, 15, and 16) checked? Are there more obvious signs in children? Do you recommend any particular diet as a starting point for better eating? Sorry for the many questions, I am just trying to keep my info straight. Thank you very much in advance for your time in answering this. Have a great day.
— Christina, Kansas
A:
These are all great questions. Discovering that you or a loved one has type 1 diabetes can be overwhelming — and troubling to parents who worry that their children are at risk of developing the disease. How wonderful that you are thinking about trying to prevent that from happening!

There isn't a definitive answer to your question regarding early screening. First of all, even though your husband has type 1 diabetes, it does not mean that your children will invariably develop the disease. In fact, very few children of diabetic parents do. The bad news is that we do not have a way to determine who will and who won't. Second, even when we know the specific inherited tendencies for diabetes, there are many factors in the environment that are yet undiscovered triggers. If we knew these factors, we might then be able to work on reducing their influence. Third, we do not know the rate at which a person who carries the genetic risk actually develops diabetes. They may develop the disease early or it may take many years for diabetes to establish a foothold. Fourth, we do not have an effective treatment or preventive measure to stave off type 1 diabetes among those who are at greatest risk of developing it.

In light of all these factors, the best way to move forward is to do the following:

Make sure your children get regular checkups and talk to your pediatrician about new developments in early diagnosis and prevention efforts. There are ongoing studies, the results of which will teach us more about how to proceed. There might also be research projects that your children might participate in that may give them access to genetic and immunology tests not available to the general public. These tests can give you a better idea of your children's specific odds of developing diabetes.Have your children undergo blood glucose tests starting now, biannually or annually, to prevent severe symptoms such as ketosis from being the stimulus for a diagnosis.
Watch out for the following signs and symptoms: excessive thirst, frequent urination, weight loss, fatigue, or blurred vision; and much less common signs of ketosis, including nausea and vomiting, abdominal pain, lethargy, and decreased alertness and rapid breathing. These are the same signs and symptoms as in adults.While there are no specific dietary supplements or diet recommendations, a healthy lifestyle and maintaining a healthy weight will help in general. Specific recommendations depend on your children's caloric needs, activity level, and preferences. I frequently tell my patients that their first loyalty is to nutrition — making sure they have adequate nutrients (i.e., vitamins, minerals, and protein intake) necessary for survival. In the children's case, it is important to take their growth and developmental needs into account. You might consult a dietitian for specific suggestions.

Finally, coping with a diabetic parent can be a frightening experience for children. I would advise that you and your husband normalize the daily routines of his care, which include home blood glucose testing, doctor's visits, diet and exercise regimens, insulin injections, and discussing the symptoms of high and low sugar levels. This way, you can avoid crises and show your children that diabetes is a condition that can be managed as long as you take care of yourself. This knowledge will help them a great deal in the event that they are someday diagnosed with diabetes, however small the odds may be. Best wishes to you and your husband and children. I hope all goes well.

1 in 3 Americans will have diabetes by 2050

In the United States, 1 in 3 people will have Type 2 diabetes by 2050 if current trends continue, according to a new report from the Centers for Disease Control and Prevention.

The projections, released today, are alarming to U.S. health officials, who say the numbers highlight the need for interventions to keep the number of new cases from climbing.

Currently, 1 in 10 Americans has Type 2 diabetes. But if new cases develop as projected, its prevalence could double or triple over the next 40 years, said Ann Albright, director of the Division of Diabetes Translation at the CDC.

"We can't have that, it's unsustainable," Albright told MyHealthNewsDaily.

Type 2 diabetes is the most common form of diabetes, and is triggered by a
combination of unchangeable factors, such as family history and race, and controllable factors, such as obesity and inactivity, according to the Mayo Clinic.

It's also the seventh leading cause of death in the United States, according to 2007 data, and is the leading cause of leg and foot amputations, kidney failure and new cases of blindness in adults under age 75, according to the CDC.

The costs of diabetes add up to about $174 billion a year, the CDC said.
Explaining the increase

An aging population and the growth of minority populations are expected to add to the disease's prevalence, Albright said. African-Americans, Latinos, Native Americans and certain Asians and Pacific Islanders are at high risk of developing diabetes.

Advances in medicine, which may help people with the disease live longer, and better detection of diabetes are other reasons why its prevalence could dramatically increase by 2050, she said. Right now, 24 million Americans have Type 2 diabetes, but a quarter of them don't know it, according to the CDC.

And because people are living longer, more cases are likely to come from older people. The percentage of people ages 65 and older with diabetes is expected to increase; it was 12.4 percent in 2000, but will be 19.6 percent in 2030, Albright said.

"We're living longer, but Type 2 diabetes does get more prevalent as you age," she said. "The body's ability to use insulin does gradually decline, but that can be slowed by maintenance, diet and regular physical activity."

Need for interventions
Right now, about 60 million people in the United States have pre-diabetes — a stage of insulin resistance before full-blown diabetes. If these people don't change their exercise and eating habits now, they will develop diabetes in the next three to six years, Albright said.

"They don’t have a big window," she said.

It will take a combination of personal decisions and policy changes to turn the diabetes rate around. Making healthy food more accessible and implementing prevention programs will help, she said.

One such program is the CDC's new National Diabetes Prevention Program, which aims to provide people with information about diabetes, promote lifestyle changes and reduce disparities between different groups.

A clinical trial showed that high-risk people who went through this prevention program reduced their risk of developing diabetes by 58 percent, according to the report.

"It's not enough for research to be done, you need to get the [information] in people's hands," Albright said. The intervention program makes use of the research, but "environmental and lifestyle changes need to complement it to be successful."
MyHealthNewsDaily Copyright © 2010. All rights reserved.

Flaxseed and Diabetes

Q: Is flaxseed beneficial for people with type 2 diabetes? Does it help my prostate gland as well?
– Desiree, Kansas
A:
Yes, flaxseed may help lower your sugar levels, and it plays a role in the prevention of prostate cancer as well. However, the strength of the evidence is too weak to permit definitive recommendations. Nonetheless, flaxseed is rich in alpha-linolenic acid (ALA), an essential fatty acid that appears to be beneficial in preventing heart disease and related illnesses. Flaxseed contains the right ratio of omega-3 to omega-6 fatty acids, is high in fiber, and provides a phytoestrogen called lignan, which may have antioxidant properties that protect against certain cancers.

There is some evidence that eating flaxseed reduces blood sugar levels after a meal and increases insulin levels because of its high content of soluble fiber. (It is 28 percent fiber, of which two-thirds is soluble.) Indeed, flaxseed carbohydrate (what remains after the oil is removed) was used in a study that showed a beneficial effect. Although this result was not duplicated in other studies, flaxseed has been shown to improve insulin sensitivity. An interesting, yet unproven, potential benefit may be the prevention of type 1 and type 2 diabetes; in animal models, flaxseed has been shown to delay the onset of the disease.

Flaxseed might help your prostatic health as well. In fact, the American National Cancer Institute has singled out flaxseed as one of six foods that deserve extensive research. Why? Because flaxseed contains a large amount of phytonutrients that serve as antioxidants, as well as those omega-3 fatty acids, which seem to play a role in preventing the formation of abnormal cells in the body. In terms of your specific question, flaxseed may reduce the prostate-specific antigen (PSA), a protein produced by the cells of the prostate gland that is often used as a marker for cancer. Also, men whose prostatic fluids contain high levels of lignan (the phytoestrogen found in flaxseed) seem to have a low risk of prostate cancer, though study results of this were not conclusive.

One word of warning: Flaxseed is high in calories. Here's an idea of how much you might need to consume to obtain its beneficial effects — 1 tablespoon of flaxseed has 5 grams of fat and weighs 12 grams. You need to take 40 to 50 grams of flaxseed, which is equal to about 4 tablespoons and has a total of 20 grams of fat. Milled flax has 36 calories per tablespoon; flax oil has 124 calories per tablespoon. (Flaxseeds are more nutritious than their oil.) These caloric considerations are important in the control of your glucose level.

Stay tuned, as I am sure there will be more studies that will guide us better in using flaxseed to stay healthy.

What Is Peripheral Artery Disease?

Peripheral artery disease (PAD) can sometimes go undetected, so it's important to know the symptoms. Plus, learn about the possible complications of PAD and how the condition is treated.

Restricted blood flow anywhere in your body can be a serious health problem that can ultimately affect your heart. When blood flow to the legs is reduced, the condition is called peripheral artery disease, or PAD, explains Joshua A. Beckman, MD, director of the Cardiovascular Fellowship Program at Brigham and Women's Hospital and assistant professor at Harvard Medical School in Boston. PAD occurs when arteries in the legs become hardened due to the build-up of plaque (cholesterol and other fatty substances) — a condition called atherosclerosis.

Who Develops PAD
"PAD often develops in people who smoke or have diabetes," says Dr. Beckman. In addition, it is commonly found in people who are between the ages of 50 and 69. In people above the age of 65, approximately 20 percent of men and 16 percent of women have PAD.

Other risk factors for PAD include:
Having high blood pressure
Having high cholesterol
Having a history of heart disease
Undergoing hemodialysis to treat kidney disease
Having had a stroke

"About half of the people who have PAD do not have specific symptoms and have no way to know they have the disease," says Beckman. "Of the half that do have symptoms, the majority describe feeling discomfort in an area like the calf, hip or thigh while walking."

If you have any of the risk factors for PAD, you should ask your doctor about PAD even if you aren’t experiencing symptoms. Your doctor can still diagnose PAD through one or more tests.

Signs of PAD
The pain people with PAD experience while walking is called intermittent claudication. You may feel a burning, aching, heaviness, or leaden feeling because the exercising muscle is demanding more blood than can be delivered due to poor blood flow in the legs. "The discomfort occurs only with walking and is typically relieved with a few minutes of rest," says Beckman.

It can be easy to discount this pain as arthritis, a result of aging, or an injury from exercise. But if you continue to notice these symptoms when you walk, and they stop when you rest, PAD could be the reason.

When PAD worsens and blood flow is severely restricted, the feet and legs may be painful even without exercise.

Risks of Untreated PAD
Untreated PAD can lead to heart attack or stroke. People with untreated PAD are six to seven times more likely to experience heart attack or stroke than those without the disease. Beckman estimates that the risk of death in those with untreated PAD is 15 to 30 percent over five years.

Amputation is also a risk of untreated PAD, though it isn't common in either people who do not experience PAD symptoms or in those who experience intermittent pain. But between 1 and 2 percent of people with PAD may either experience severe pain in their legs while resting, a wound on their foot that won't heal, or even gangrene, says Beckman. Then amputation is a more serious threat unless action is taken.

Treating PAD
Treatment for PAD usually entails a combination of prescribed medication and a healthier lifestyle to manage atherosclerosis, lower cholesterol and blood pressure levels, and improve blood flow in your legs.

Here are steps your doctor may recommend to treat and manage PAD:

Quit smoking
Take medications to manage contributing health problems, like high cholesterol and high blood pressure
Take anti-clotting medications to prevent blood clots
Walk and get other exercise frequently
Achieve and maintain a healthy body weight
Eat a healthy diet of low-cholesterol, low-fat, and low-calorie foods

In some cases, blockages in the legs may need to be opened up with a catheter in a procedure called angioplasty and propped open with a small tube called a stent. In cases of severe PAD, bypass surgery may be needed to reroute blood flow in the legs.


By Diana Rodriguez
Medically reviewed by Pat F. Bass III, MD, MPH

Does Medicare Cover Therapeutic Shoes?

Yes, Medicare will cover the cost of one pair of therapeutic shoes (diabetic shoes) and inserts for people with diabetes if you have a medical need for them. The Medicare payment for therapeutic shoes is subject to the requirement that they are necessary and reasonable for protection of insensitive feet or neuropathy (nerve damage in the feet). To ensure that Medicare pays for your shoes, you must follow the steps below:

Your treating doctor must complete a certificate of medical necessity for the therapeutic shoes and document the need in your medical records. So, do not order anything until you have visited your doctor - no matter what the sales person tells you.

The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.

The supplier must receive the order before Medicare is billed and must keep it on file.

If you receive your Medicare through a Medicare Advantage Plan (like a HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of diabetic shoes.

Medicare will cover one of the following per calendar year:
One pair of depth-inlay shoes and three pairs of inserts or;
One pair of custom molded shoes (including inserts) and two additional pairs of inserts. This option is only available if you cannot wear depth-inlay shoes due to a foot deformity.

In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.

Medicare will not cover deluxe features: A deluxe feature is one that does not contribute to the shoe's therapeutic function - for example, a custom style, color or custom material.

Warts require persistent treatment

Warts can be the nemesis of many kids and moms. Everyone asks the same question “how do I get rid of them”?

Just like some people get colds or have allergies, some people get warts while others don’t. All of our immune systems and how we react to the environment are different.

Warts are caused by a subtype of the human papilloma virus, form as a result of a rapid growth of cells on the outer layer of the skin as the body tries to wall off the virus. Once you have the virus, you can’t get rid of it, so you are more likely to get warts again.

The majority of patients who come in for wart treatment are children, some of whom might have more than 30 to 40 warts on a foot. Statistics say up to a third of school-age children will get warts, which can be embarrassing and painful, especially if they are plantar warts found on the bottom of the foot. Within two years, many of the warts will go away on their own, but often people don’t want to wait that long.

Warts won’t threaten your health and normally you can get rid of them if you follow the protocol the doctor has in place.

So how does a parent know when to take their child to a doctor vs. buying a salicylic acid product over the counter and tackling it at home?

If you have just one wart on the hand or even the foot, take your child to a doctor. If your child has multiple of warts or they have spread, you need to see a podiatrist. The longer you wait, the more you will have and the deeper they will become.

Warts, especially plantar warts, are sometimes mistaken as calluses, so seeing a podiatrist for a definite diagnosis is important. The virus is shoved deeper into the bottom of the foot, and because it’s a pressure point on the foot, the body will build up a callus to protect it, which can make it hard to differentiate.

Often a telltale sign of a wart is little black dots that appear within it, which are actually small clotted blood vessels that bring nutrients to the warts, which can bleed when disturbed

There are several treatments for warts, which vary according to the frequency and severity of the warts.

The first line of treatment is usually debridement — or cutting down of the wart — and application of a salicylic acid or a chemical called cantharadin that causes the wart to blister. Patients usually need to return for about six weeks for more treatments and apply salicylic acid daily at home in between visits. Noncompliance at home is the No. 1 reason that this treatment doesn’t work.

Warts may also be “frozen” off with liquid nitrogen, surgically cut out under a local anesthetic in the doctor’s office or treated with laser therapy. Often plantar warts require more aggressive treatment because they are deeper and thicker.

In very rare cases, warts can become cancerous — a condition called verrucous carcinoma — but this wart would be noticeably different in that it would be very large, may bleed and may have a discharge with a foul odor, Clarke said.

Tips to avoid warts:

• Since a moist environment causes the wart-producing virus to be more aggressive, wear flip-flops when walking around wet, public areas, such as swimming pools, locker rooms and in public showers.

• If someone in your household has warts, clean the shower with bleach before other family members use it.

• Family members with warts on their feet should try to keep shoes or slippers on in the house and not walk around barefooted.

• Keep feet dry and avoid irritating the soles of the feet because a cut or scrape can be an entry point for the virus.

• Don’t bite your fingernails or cuticles because this can spread warts from finger to finger.

Type 2 Diabetes Affects Famous Folks, Too

Diabetes can affect everyone, and celebrities are no exception. Here are some notable people living with type 2 diabetes and successfully managing this condition.

Larry King of CNN and Sherri Shepherd of “The View” are two notable celebrities who live with type 2 diabetes. And they are far from the only well-known names with this type of diabetes — not surprising when you consider that more than 800,000 new cases of type 2 diabetes are diagnosed each year. Despite the challenges of this condition, these celebrities have learned to survive and even thrive with type 2 diabetes. Here’s how they've adapted and a few lessons you can take away from their stories

Larry King
He’s one of the most well-known television interviewers alive, but Larry King has faced many challenges in life other than confrontational guests. In a 2006 interview with Diabetes & You magazine, he revealed that a heart attack in 1987 made him give up smoking and change his lifestyle — and that a diagnosis of type 2 diabetes in 1998 threw him another health curveball. King fights back against complications with a healthy diet, medications, and frequent checks of his A1C blood levels.

Randy Jackson
According to an interview with Everyday Health, when “American Idol” judge Randy Jackson got his type 2 diabetes wake-up call, he weighed about 350 pounds with a blood sugar level of more than 500. Rather than let the disease get the best of him, though, Jackson fought back by modifying his diet and getting plenty of healthy exercise, including walking. He also had a gastric bypass operation to help get his weight down.

Patti LaBelle
In an interview with Everyday Health, Patti LaBelle revealed that her mother died of type 2 diabetes complications at age 58. Yet LaBelle remained in denial about her own risk until she passed out onstage during a concert. After four long years of ignoring her symptoms, LaBelle finally took charge of her health, starting a regular exercise routine and a healthy diet. Today, LaBelle is 20 pounds lighter, is a diabetes spokesperson, and even has her own cookbook called Patti LaBelle’s Lite Cuisine.

Sherri Shepherd
Though Sherri Shepherd has garnered a lot of fans for her comedic chops on “The View,” she has also faced a rather public divorce and a diagnosis of diabetes. In an interview with Good Housekeeping magazine, the celebrity revealed how her mother died at age 41 from complications of type 2 diabetes. Vowing to not follow in her mother’s footsteps, Shepherd has forsaken sweets for a healthy diet and exercise and dropped from a size 16 to a size 8

Ben Vereen
Over the years, he’s been nominated for and won Tony, Golden Globe, and Emmy awards for his dancing, singing, and acting. These days, the multi-talented Ben Vereen spends most of his time as an advocate spreading awareness about type 2 diabetes. In an interview with WLS-TV ABC 7 News in Chicago, Vereen stressed the importance of people with diabetes checking their blood sugar in public. Vereen admits that this was the hardest hurdle for him to overcome, but now this celebrity is as comfortable reading his blood sugar as he is checking his cell phone.

David Wells
Type 2 diabetes can affect athletes, too, even successful ones like major league baseball pitcher David Wells. Though always large for a pitcher, Wells had a fruitful major league career, even achieving the hallmark pitching achievement, a perfect game. In 2007, he went public about his type 2 diabetes when he revealed his diagnosis to ESPN. Today, Wells is retired from pitching, but still works in baseball as a color commentator on television.

Joe Gibbs
As the head coach of the National Football League’s Washington Redskins, Gibbs won three Super Bowl titles in the 1980s and '90s. Since then, he has gone on to become one of the most successful owners on the car racing circuit with his team, Joe Gibbs Racing. According to the Web site dLife.com, Gibbs has compared dealing with a race car to diabetes management: If you don’t take care of the appropriate maintenance, you can’t expect either one to keep running

By Wyatt Myers
Medically reviewed by Pat F. Bass III, MD, MPH

Preventing Gout

Q: What dietary restrictions should I follow to prevent another attack of gout?

Earl, Kansas
A:
Gout is the result of an excess of monosodium urate crystals in the body. When the crystals accumulate in the spaces between joints, they can cause excruciating pain, most commonly felt in the big toe. Indulging in meat, seafood, and alcohol can play a role. Studies have shown that individuals who are prone to developing gout should reduce their intake of meats and seafood because these foods promote uric acid formation. Low-fat diet products, on the other hand, appear to decrease the risk of gout. Protein consumption has no effect, while alcohol raises uric acid levels, which may provoke an episode of gout. It is recommended that people at risk for gout drink 10 to 12 eight-ounce glasses of nonalcoholic liquids every day to reduce the risk of developing kidney stones. Drinking plenty of fluid helps to flush the body of uric acid crystals, which characteristically accumulate in people with this disease. It is also suggested that gout sufferers maintain a stable weight, work to avoid obesity, and avoid using diuretics or water pills.

10 Tips for Staying Healthy With Type 2 Diabetes

If you've been diagnosed with type 2 diabetes, these simple strategies can help you avoid complications and enjoy life. Finding out you have type 2 diabetes may cause a swirl of emotions and questions. How did this happen? What should you do? How will you be treated?

Jenny De Jesus, RN, CDE, a diabetes educator at the Friedman Diabetes Institute at Beth Israel Medical Center in New York City, explains it in rather simple terms: “Staying healthy with diabetes is all about making choices. The four most important things people with diabetes can do are making healthy food choices, getting some exercise, testing their blood glucose, and taking their medications. And it’s important to stay informed and ask questions during your doctor visits. The more you know, the more you can do for yourself to control your diabetes.”

Type 2 Diabetes: 10 Lifestyle Choices for Staying Healthy

If you’re one of the millions of people who developed type 2 diabetes as a result of lifestyle factors, consider making these important changes:

1.Healthy food choices. Start by choosing foods that are low-fat and low-sugar and emphasizing vegetables, fruit, and fiber. The next part of this strategy is portion control — eat the right amount for a healthy diet and weight control.
2.Eat regularly. Resist eating huge meals once or twice in a day. Space your food intake throughout your waking hours by having smaller, more frequent meals and planned snacks at regular intervals.
3.Exercise regularly. Doctors usually recommend that people do aerobic exercises — those that make the heart work, such as cycling or jogging. But not everyone can, for various reasons. You should discuss this with your doctor to see what type of exercise works best for you.
4.Check your blood glucose. How often you check your blood glucose depends on you and your doctor. Whatever your personalized plan involves, that is the routine you should maintain. By checking your blood glucose, you become aware of what affects your levels and you may be able to catch problems before they get out of hand.
5.Take your medication. It may sound like an obvious rule, but many people don’t take their medications as prescribed. And be sure to take only those medications that have been prescribed for you and you alone, and in the doses and frequency prescribed for you.
6.Stay informed. While much of the scientific information and the latest research may be hard to understand, try to be aware of any health reports of new or changing treatments for type 2 diabetes. Stay informed, and don’t hesitate to ask your health care team if progress you hear about in the news applies to you.
7.Talk about it. Some people with chronic diseases like type 2 diabetes get tired of taking care of themselves all the time. If you feel overwhelmed, talk about your feelings to a friend, family member, doctor, or a worker at a diabetes clinic. Airing your problems may be just the help you need.
8.Prevent sores. One of the problems that affects many people with type 2 diabetes is sores on the feet that can develop into such severe wounds that sometimes amputation of the foot is needed. Because of this, it’s very important that you inspect your feet regularly for blisters, cuts, and sores. If you are having problems with your feet or you find a sore that isn’t healing, speak with your doctor immediately.
9.Educate family and friends. Don’t keep your type 2 diabetes a secret. It’s always a good idea to educate your family and close friends about your disease so they can learn what to watch for and help you manage. If your loved ones know how to recognize the signs of dangerously high or low blood glucose levels, a potential tragedy may be avoided.
10.Identify yourself. Wear a medical alert bracelet or, at the very least, carry an identification card that tells people you have type 2 diabetes. These will speak for you if you’re in a crisis and can’t speak for yourself.
Living with type 2 diabetes doesn’t have to be complicated, but it does involve taking steps to ensure that you live well by managing your diabetes.

By Marijke Vroomen-Durning, RN
Medically reviewed by Pat F. Bass III, MD, MPH

Top 10 Tips for Treating Children's Feet

You worry about your kids' eyesight, eating habits, and overall health — but don't forget about their feet. Learn 10 tips for treating and preventing foot problems in kids. You make sure that your children’s teeth, ears, skin, and other body parts are healthy and clean. But what about their feet?

“The feet are often neglected when it comes to taking care of kids’ bodies,” says Elizabeth Kurtz, DPM, a podiatrist in Chicago and spokesperson for the American Podiatric Medical Association (APMA). “It’s important to pay attention to children’s feet from the [time they’re born] to head off problems down the line.”

Kids’ Feet: Keeping Them Healthy

These 10 tips can help ensure successful development and optimal foot health for kids:

1.Look carefully at your newborn’s feet. Be on the lookout for anything unusual. Problems you notice at birth may not disappear by themselves. Early treatment can often correct abnormalities, such as club foot, a congenital condition that occurs in about one in 1,000 births. “Casting a club foot within a few days after birth can often prevent the need for surgery,” says Paul W. Esposito, MD, professor of orthopedic surgery and pediatrics at the University of Nebraska College of Medicine in Omaha.
2.Lightly cover your baby’s feet. Tight covers can keep your baby from moving freely and could even retard normal development, according to the APMA. “Kicking and moving the legs and feet around helps strengthen the muscles in preparation to walk,” says Dr. Esposito. Activity gyms for babies can also help strengthen little feet.
3.Let your toddler go shoeless. When kids first start to walk, going without shoes indoors is good for normal development. “Walking barefoot or wearing just socks strengthens the muscles in the feet and helps develop the grasping action of the toes,” says Esposito. Plus, your little walker will enjoy the sensation of various surfaces — like lush carpet or cool tile — beneath his feet.
4.Watch for lingering toe-walking. Walking on the toes is usually normal when kids first start to walk, but if a child walks exclusively on the toes after age 2, tell your pediatrician. Persistent toe walking could be linked to cerebral palsy, muscular dystrophy, or other nervous system problems, says Esposito.
5.Cut toenails straight across. This will help prevent painful ingrown toenails. Signs of an ingrown toenail include pain, redness, and swelling. If an ingrown toenail does occur, ease the pain by putting a little bit of cotton between the skin and the ingrown toenail, suggests Dr. Kurtz. Then head for your pediatrician or a podiatrist. A simple in-office procedure can safely fix the problem.
6.Keep feet clean and dry. Preventing bacterial and fungal infections starts with good hygiene. Thoroughly wash your kids’ feet at bath time. Afterward, dry them well between the toes to prevent athlete’s foot, a fungal infection that thrives in moisture.
7.Buy well-fitting shoes. Always take your child with you when purchasing shoes. Kids’ feet need to be measured every single time, since they grow so rapidly. Too-tight shoes can cause blisters, corns, calluses, or ingrown toenails that can become infected. “If your child is constantly taking her shoes off, that’s a red flag that they may be uncomfortable,” says Kurtz.
8.Prevent foot injuries. Walking barefoot outdoors on dirty pavement exposes kids’ feet to splinters, cuts, and severe injuries. “The main reason I see children in the summer is for splinters and foreign objects in the foot,” says Kurtz. Another potential problem is plantar warts, a condition caused by a virus which invades the sole of the foot through cuts or breaks in the skin. Wearing shoes when playing on pavement or hazardous environments can prevent this problem.
9.Cover cuts. Wash minor cuts, scrapes, and scratches on the feet with soap and water and keep them covered with a bandage until they’ve healed. It’s a myth that exposing injuries to fresh air will help them heal better. “Exposure to fresh air means exposure to germs,” says Kurtz.
10.Show and tell. Kids learn by imitating. Clean and properly dry your feet and have your child copy. Also demonstrate how to cut toenails to prevent painful problems. “Many adult foot problems start in childhood,” says Kurtz.
Explaining why good foot hygiene is important and showing your kids how to care for their feet is good medicine for a lifetime of foot health


By Jan Sheehan
Medically reviewed by Pat F. Bass III, MD, MPH

Yao Ming's career could be over

Houston Rockets center Yao Ming(notes) has a stress fracture in his left ankle -- the injury is related to the ankle sprain that he suffered earlier this year -- and you have to wonder if this streak of injuries is ever going to end.

An MRI performed today on Rockets center Yao Ming revealed a stress fracture of the Medial Malleolus in his left ankle. The fracture, which is related to his previous injury of the Tarsal Navicular bone, presented itself during the course of his current rehabilitation program. There is no timetable for his return at this time.
It should be noted that this stress fracture isn't related to the stress fractures Yao has had to deal with in his actual feet, and that it's only related to the ankle sprain he suffered in November, but if the guy can't come back from a sprained ankle without one of his bones developing a crack (stress fractures aren't clean breaks, but they're serious stuff nevertheless), how is this ever going to work?

"This is very sad," Rockets owner Leslie Alexander told KRIV-TV in Houston. "This is a very disappointing moment in the history of the Rockets organization, for our wonderful fans, for the city of Houston and for everybody in our organization. I feel terrible for Yao."

Yao's Rockets still have legitimate playoff aspirations. They've had a bad-luck streak in losing both Yao and point man Aaron Brooks(notes) so far, and their 10-15 record isn't quite representative because they've lost quite a few close games. But this is news that tends to enervate, to say the very least.

It could also be the best thing for all involved, as the Rockets start to properly rebuild, and Yao takes another near-full year off to work his feet back to health. But a silver lining like that is just too depressing to consider right now.

As it stands right now, this could be the injury that ends Yao Ming's career. Hopefully he has the wherewithal to ignore what many of us would have done by now (accept retirement) and work his way back to health.

High heels dangerous to women’s health

Nearly three million women suffer high-heels related injuries which need medical attention, a recent study suggests. The Sun reported that 3000 women in the age group of 18 to 65 were studied by Hot Shoes, makers of comfort footwear.

Most women twisted an ankle or tore a tendon but there were serious cases also of smashed teeth, broken bones and nasty falls. Yet, even this is not enough to dissuade 60 per cent of those interviewed for the study who said that they will continue wearing heels.

Almost 90 per cent of participants reported discomfit and ruined nights because of high heels. And 61 per cent reported sitting the night out due to the pain.

Only two per cent of those interviewed said that they did not wear high heels. Medical reports suggest that high heels could lead to foot deformities, posture problems, neck injuries and permanent damage in some cases. A 2001 Harvard study also found that high heels can set the stage for osteoarthritis of the knees.

Another study done by the shoe firm MBT claims high heel-induced injuries like twisted ankles, bunions and ingrown toenails cost the UK £29 million a year. The MBT study that included 1,000 women found that four in 10 women suffered an injury in their heels, such as falling over or twisting their ankles from wearing glamorous footwear.

A worrying trend is that women are getting cosmetic surgeries to fit into their Manolo Blahniks and Jimmy Choos. More than half of the 175 members of the American Orthopedic Foot & Ankle Society who responded to a recent survey by the group said that they had treated patients with problems resulting from cosmetic foot surgery.

The society will soon issue a statement condemning the procedures, said Rich Cantrall, its executive director.

Celebrities routinely undergo such surgeries as they more than anyone develop foot problems and ugly bunions and toes due to constant wearing of high Heels. Victoria Beckham was recently in the news for such a surgery.

High heels have been in fashion as far back as 1000 BC. They were a social status symbol. Women in the 16th and 17th century took it to great heights and teetered around in 5-8 inches high shoes. They had attendants to help them move and sometimes carried stylish canes to support them. It is only in the 20th century that demand for comfortable, fashionable shoes came from liberated women. Whatever the evidence to the contrary, it is still very difficult to separate women from their high-heels as history relates.

Obese Adolescents at Greatest Risk of Becoming Severely Obese Adults

Obese adolescents are 16 times more likely to become severely obese by age 30 than their healthy weight or even overweight peers, according to a new study....

Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.

It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.

The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.

"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."

Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.

Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.

"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."

To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).

Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.

On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.

"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."

The Lowdown on Glycemic Load

Carbohydrates are controversial when it comes to diet these days. But what separates the good from the bad is a food's glycemic load, which has a big impact on blood sugar levels.

Every food you eat affects your body differently, and not just in terms of your long-range health, but also in the way it is processed and the effect it has on your energy level and blood sugar.

Glycemic Load and Diet: The Basics

The glycemic load is a classification of different carbohydrates that measures their impact on the body and blood sugar. The glycemic load details the amount of carbohydrates a food contains and its glycemic index, a measurement of its impact on blood sugar. “The glycemic index ranks foods based on how quickly they're digested and get into the bloodstream," says Sandra Meyerowitz, MPH, RD, a nutritionist and owner of Nutrition Works in Louisville, Ky. “Its glycemic load takes into consideration every component of the food as a whole, so it's a different number. It changes everything."

Because the glycemic load of a food looks at both components, the same food can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared.

Glycemic Load and Diet: The Effect on Your Health

Foods with a low glycemic load keep blood sugar levels consistent, meaning that you avoid experiencing the highs and lows that can be caused by blood sugar that jumps too high and quickly drops — the candy bar effect.

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Watching the glycemic load of the foods you eat can have a big impact on your health in many ways. A diet focused on foods with a low glycemic load can:

Make it easier to lose weight and avoid the dreaded diet plateau
Keep blood sugar levels more consistent
Burn more calories
Help prevent insulin resistance and diabetesLower heart disease risk
"It makes more sense to use the glycemic load because when you eat a food you don’t just eat one food by itself — you eat a whole bunch of foods together," says Meyerowitz. Looking at the total picture of foods you eat, rather than just the individual pieces, gives you a clearer and more accurate picture of the foods that make up your diet.

Glycemic Load and Diet: Glycemic Loads in Favorite Foods

It's tough to figure out on your own if a food has a high or a low glycemic load, but as a general guideline, the more fiber a food has the better. Here is a glycemic load reference list with many common foods to let you know which are low, medium, and high.

Foods with a low glycemic load of 10 or less:

Kidney, garbanzo, pinto, soy, and black beans
Fiber-rich fruits and vegetables, like carrots, green peas, apples, grapefruit, and watermelon
Cereals made with 100 percent bran
Lentils
Cashews and peanuts
Whole-grain breads like barley, pumpernickel, and whole wheat
Whole-wheat tortillas
Tomato juice
Milk
Foods with a medium glycemic load of 11 to 19:

Whole-wheat pasta and some breads
Oatmeal
Rice cakes
Barley and bulgur
Fruit juices without extra sugar
Brown rice
Sweet potato
Graham crackers
Foods with a high glycemic load of 20 or more:

High-sugar beverages
Candy
Sweetened fruit juices
Couscous
White rice
White pasta
French fries and baked potatoes
Low-fiber cereals (high in added sugar)
Macaroni and cheese
Pizza
Raisins and dates
Focusing on the glycemic load of foods is particularly important for people with diabetes to help maintain a steady blood sugar, but everyone can benefit from understanding and monitoring the glycemic load in their diet.

By Diana Rodriguez
Medically reviewed by Christine Wilmsen Craig, MD

Diabetes is the 6th leading cause of death in the United States

LANGLEY AIR FORCE BASE, Va. - Diabetes is the sixth leading cause of death in the United States, claiming more than 180,000 victims annually. Part of the debilitation of diabetes is the effect the disease has on feet, resulting in painful sores, immobility and potential amputation. However, with attention and preventative measures, some effects may possibly be avoided.

According to Maj. Hjalmar Contreras, 633d Medical Group podiatrist, diabetic foot infections are the most common reason for hospital admissions among diabetic patients, accounting for 25 percent of all diabetic admissions.

“Without proper care, diabetic patients may develop ulcers on their feet, which occur in 15 percent of diabetic patients,” said Contreras.

Diabetes affects the feet in two ways: contributing to vascular disease and damaging nerves. Vascular disease impairs circulation, creating an oxygen deficiency in tissues. This deficiency could result in poor healing, infections and even gangrene. Symptoms of vascular disease include changes in the skin of the feet, such as lack of hair or thinning of skin, absent peripheral pulses and arterial Doppler abnormalities.

“Diabetes and smoking pose the greatest risk of peripheral vascular disease,” said Contreras, noting that PVD is 30 times more prevalent in diabetic patients.

Diabetes also damages the three nerve systems -- autonomic, sensory and motor -- resulting in a loss of feeling in the feet. This condition is known as diabetic neuropathy. Symptoms of neuropathy include a loss of protective sensation, dry flaky skin and foot deformities.

Most of the aforementioned conditions can be avoided or limited by prevention, said Contreras. To help prevent complications from diabetes, follow these 10 guidelines:

1. Inspect your feet daily. Check for cuts, scrapes, bruises or blisters.
2. Never soak your feet. There’s little way of knowing what may be in the water, and contaminants may irritate or cause infections. Wash your feet in lukewarm water, and carefully dry between toes.
3. Moisturize your feet. Use lotions and creams. Do not use petroleum jelly, and do not apply any topical solution between toes.
4. Cut toenails straight across, leaving the front edge. Don’t pull or rip off nail edges.
5. Never use chemical corn removers on your feet. These may cause blisters, burning holes in the skin. Never cut calluses with razors -- use a pumice stone instead.
6. Change your socks daily. Keep socks clean and dry, and avoid tight socks and stockings.
7. Never walk barefoot. Check the insides of your shoes daily.
8. Avoid smoking.
9. Wear shoes that fit. Tip: leather shoes easily adapt to feet and may provide more comfort.
10. Get annual check-ups.

“Controlling your glucose levels decreases chances of foot problems by 50 percent,” added Contreras.”While developing complications from diabetes may not be completely avoidable, practicing sound prevention measures will greatly diminish the chances of problems occurring.”

How Can Diabetes Hurt the Skin?

Diabetes can hurt your skin in two ways:
If your blood glucose is high, your body loses fluid. With less fluid in your body, your skin can get dry. Dry skin can be itchy, causing you to scratch and make it sore. Also, dry skin can crack. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds germs and makes infections worse. You may get dry skin on your legs, feet, elbows, and other places on your body.

Drinking fluids helps keep your skin moist and healthy.
Nerve damage can decrease the amount you sweat. Sweating helps keep your skin soft and moist. Decreased sweating in your feet and legs can cause dry skin.

Is Gout Prevention Possible?

Is Gout Prevention Possible?
You can't always control whether you get gout, but you can make diet and lifestyle changes to lessen your risk. Start taking gout prevention steps today. What can you do for gout prevention? "There are a number of risk factors for gout, some of them modifiable, some of them less modifiable," says Daniel Solomon, MD, MPH, associate professor of medicine at Harvard Medical School and physician in the rheumatology, immunology, and allergy department at Brigham and Women's Hospital in Boston.

Gout develops in people who have high levels of uric acid, produced when the body breaks down substances called purines, which are found in many foods, particularly meat and seafood. Excess uric acid can form sharp, needle-like crystals in the joints, leading to pain and swelling.

While some people will develop gout no matter what they do, there are some lifestyle and diet factors that can cause high uric acid levels. Researchers have identified a number of gout prevention strategies to help reduce your risk of developing gout or, if you already have gout, lower your chances of having a severe gout attack in the future.

Gout Prevention: Know Your Risk Factors

When it comes to gout prevention, scientists still don't know how much control people have over their risk of developing gout. "Gout is related to genes, environmental [influences], and gender," says Dr. Solomon. There seems to be a genetic component since gout sometimes runs in families. Also, men are at higher risk of developing gout than women. And the risk of gout increases with age.

But researchers have identified a number of gout risk factors that you can work to control:

Purine-rich diet
Excess weight
Excessive alcohol consumption
High cholesterol
Diabetes
High blood pressure
Certain medications, including some diuretics, niacin (a B vitamin), low-dose aspirin, cyclosporine, and several cancer drugs
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Gout Prevention Strategies

If you are looking for ways to reduce your risk of developing gout, try the following:

Limit purines in your diet. Hyon Choi, MD, DrPH, clinical associate professor of medicine in the rheumatology section at Boston University School of Medicine, says reducing the amount of purine-rich foods in your diet can lower your chances of developing gout. Eat less salmon, herring, sardines, organ meats, mushrooms, and asparagus.Reduce the red meat and seafood in your diet. In his research on gout risk factors, Dr. Choi and his colleagues found that people who had more red meat and seafood in their diet were at higher risk of developing gout.Eat more dairy. Choi also looked into how dairy products affected patients’ gout risk. "Dairy products — particularly low-fat dairy products like skim milk or yogurt — reduced the risk of gout," says Choi. For gout prevention, your daily diet should include the equivalent of two or more cups of milk.Watch what you drink. "Coffee, including decaffeinated coffee, was associated with a lower risk of gout," Choi says. On the other hand, people who drink more alcoholic beverages, especially beer, are more likely to develop gout. Choi says that drinks sweetened with high-fructose corn syrup are also associated with an increased risk of gout.Take your vitamin C. "Vitamin C tablets — 500 milligrams per day — decrease the risk of gout," Choi says. That extra vitamin C will cause you to excrete uric acid through your urine.Maintain a healthy weight. Being overweight is a risk factor for the development of gout, so aim to maintain a healthy weight.Control medical problems. Since high cholesterol, high blood pressure, and other health problems are associated with an increased risk of gout, follow your doctor's instructions to keep these conditions under control.Consider switching medications. If you are taking a medication associated with increased gout risk, ask your doctor if switching to another drug is an option for you. If you are concerned about your gout risk, talk with your doctor. The earlier you start treatment, the sooner your pain will be under control.

By Krisha McCoy, MS
Medically reviewed by Lindsey Marcellin, MD, MPH

Medical Attention Or Been Hospitalized Because Of Wearing Trendy Shoes

LONDON, 2010 -- One in 10 women in Britain admit they've received medical attention or been hospitalized because of wearing trendy shoes, a survey indicates.

The survey of 3,000 women in Britain who wear high heels was conducted by Hotter Shoes, a British shoe manufacturer.

Nearly half of women say they have twisted their ankle because of their footwear and two-thirds admit wearing shoes that have caused them injury. The most frequently reported injuries caused by shoes were broken ankles, twisted knees, infected blisters, bunions and torn tendons.

"As a comfort shoe maker we were amazed to discover the pain and discomfort that women were prepared to endure for a pair of killer heels or an ill-fitting impulse sale bargain," Lisa McCarten of Hotter Comfort Concept Shoes says in a statement. "Nothing can ruin a day more than sore and tired feet, every person in our design and technical team works hard to ensure that our shoes are stylish and comfortable."

Type 1 Diabetes Death Rate is Falling But….

Average rate is still 7 times higher in people with the disease vs. those without it....According to a new study, death rates have dropped significantly in people with Type 1 diabetes. Researchers also found that people diagnosed in the late 1970s have an even lower mortality rate compared with those diagnosed in the 1960s.

The study's senior author, Dr. Trevor J. Orchard, a professor of epidemiology, medicine and pediatrics in the Graduate School of Public Health at the University of Pittsburgh, Pennsylvania, stated that, "The encouraging thing is that, given good diabetes control, you can have a near-normal life expectancy."

But, the research also found that mortality rates for people with Type 1 still remain significantly higher than for the general population -- seven times higher, in fact. And some groups, such as women, continue to have disproportionately higher mortality rates: women with Type 1 diabetes are 13 times more likely to die than are their female counterparts without the disease.

Insulin replacement therapy isn't as effective as naturally-produced insulin. People with Type 1 diabetes often have blood sugar levels that are too high or too low, because it's difficult to predict exactly how much insulin you'll need. When blood sugar levels are too high due to too little insulin, it causes damage that can lead to long term complications, such as an increased risk of kidney failure and heart disease. On the other hand, if you have too much insulin, blood sugar levels can drop dangerously low, potentially leading to coma or death.

These factors are why Type 1 diabetes has long been associated with a significantly increased risk of death, and a shortened life expectancy.

However, numerous improvements have been made in Type 1 diabetes management during the past 30 years, including the advent of blood glucose monitors, insulin pumps, newer insulins, better medications to prevent complications and most recently continuous glucose monitors.

To assess whether or not these advances have had any effect on life expectancy, Orchard, along, with his colleagues, reviewed data from a Type 1 diabetes registry from Allegheny County, Pennsylvania. The registry contained information on almost 1,100 people under the age of 18 at the time they were diagnosed with Type 1 diabetes.

The children were sorted into three groups based on the year of their diagnosis: 1965 to 1969, 1970 to 1974 and 1975 to 1979. As of January 2008, 279 of the study participants had died, a death rate that is 7 times higher than would be expected in the general population.

When the researchers broke the mortality rate down by the time of diagnosis, they found that those diagnosed later had a much improved mortality rate. The group diagnosed in the 1960s had a 9.3 times higher mortality rate than the general population, while the early 1970s group had a 7.5 times higher mortality than the general population. For the late 1970s group, mortality had dropped to 5.6 times higher than the general population.

The mortality rate in women with Type 1 diabetes remained significantly higher, however, at 13 times the rate expected in women in the general population.

In addition, blacks with diabetes had a significantly lower 30-year survival rate than their white counterparts -- 57 percent versus 83 percent, according to the study.

Although Orchard said it isn't clear why women and blacks have higher-than-expected mortality, Barbara Araneo, director of complications therapies at the Juvenile Diabetes Research Foundation, said that both discrepancies have been found in other research, and that one theory is that blacks may have a greater genetic susceptibility to heart disease or high blood pressure. And, for women, she said previous research has shown that, "women with diabetes lose their innate protection against [heart disease], similar to the loss sustained in postmenopausal phases of life." But, she said, it's not clear how diabetes causes this loss.

The overall message of the study, however, is a positive one.

"The outcome of this study shows that diabetes care has improved in many ways over the last couple of decades, and as a result people with diabetes are living longer now," said Araneo, adding, "Managing and taking good care of your diabetes is the surest way to reduce the risk of developing complications later in life."

"What we're seeing now is incredibly encouraging, but it's not necessarily the full story yet," said Orchard, who noted that improvements in diabetes care should continue to lower mortality rates in people with Type 1 diabetes.

Half of U.S. Could Have Diabetes or Prediabetes within Ten Years

More than half of Americans will have diabetes or be prediabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion if current trends go on unabated, according to analysis of a new report released last week by health insurer UnitedHealth Group Inc....

Diabetes and prediabetes will account for an estimated 10% of total health care spending by the end of the decade at an annual cost of almost $500 billion -- up from an estimated $194 billion this year, according to the report titled "The United States of Diabetes: Challenges and Opportunities in the Decade Ahead." (See this week's Tool for Your Practice.)

The average annual health care costs in 2009 for a person with known diabetes were about $11,700 compared with about $4,400 for non-diabetics, according to new data in the report drawn from 10 million United Healthcare members.

The average annual cost nearly doubles to $20,700 for a person with complications related to diabetes, the report said.

Diabetes, which is reaching epidemic proportions and is one of the fastest-growing diseases in the United States, currently affects about 26 million Americans. Another 67 million Americans are estimated to have prediabetes, with more than 60 million unaware that they have the condition, according to UnitedHealth.

The 52-page UnitedHealth report also focuses on the growing obesity epidemic as that condition is a leading cause of diabetes.

The authors of the report contend the skyrocketing cost forecasts are not inevitable but only if the crisis is tackled aggressively, including early intervention to prevent prediabetes from becoming diabetes.

"Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early on and prevent this devastating disease before it's too late," Deneen Vojta, senior vice president of the UnitedHealth Center for Health Reform & Modernization, said in a statement.

The report also focuses on obesity and its relationship to diabetes. Being overweight or obese is one of the primary risk factors for diabetes, and with more than two-thirds of American adults and 17 percent of children overweight or obese, the risk is clearly rising. In fact, over half of adults in the U.S. who are overweight or obese have either prediabetes or diabetes, and studies have shown that gaining just 11-16 pounds doubles the risk of Type 2 diabetes and gaining 17-24 pounds nearly triples the risk.

"What is now needed is concerted, national, multi-stakeholder action," Simon Stevens, chairman of the UnitedHealth Center for Health Reform & Modernization, said in a statement. "Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models." Stevens added.

If solutions for tackling the epidemic offered in the report were adopted broadly and scaled nationally it could lead to cost savings of up to $250 billion over the next 10 years, according to the UnitedHealth analysis.

Curbing the Diabetes and Prediabetes Epidemic

By the year 2020, 52% of adults in the U.S. could be prediabetic or diabetic, up from about 40% today according to a new report....
The report recommended strategies for curbing these costs, particularly lifestyle interventions and programs to increase medication adherence. Instituting such programs could save as much as $250 billion over 10 years, including $144 billion in savings for the federal government, authors of the report estimated.
Simon Stevens, executive vice president of UnitedHealth Group, and chairman of the Center for Health Reform & Modernization, said in a statement, "Our new research shows there is a diabetes time bomb ticking in America, but fortunately there are practical steps that can be taken now to defuse it."
"What is now needed is concerted, national, multi-stakeholder action. Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models."
Weight loss among individuals prone to prediabetes is one area targeted in the report. "Our simulation suggests that a five percent weight loss (the target recommended by the American Heart Association) could reduce prediabetes gradually, leading to a 10% reduction by 2020," the authors wrote. Some reduction in conversion to diabetes also would occur, they suggested.
In addition, the report said that if all of the recommendations were enacted, increases in workplace productivity and increased wages resulting from the health improvements would be worth an estimated $239 billion over 10 years.
The report, "The United States of Diabetes: Challenges and Opportunities in the Decade Ahead," (See this week's Tool for Your Practice.) produced for November's National Diabetes Awareness month, offers practical solutions that could improve health and life expectancy, while also saving up to $250 billion over the next 10 years, if programs to prevent and control diabetes are adopted broadly and scaled nationally. This figure includes $144 billion in potential savings to the federal government in Medicare, Medicaid and other public programs.

Key solution steps include lifestyle interventions to combat obesity and prevent prediabetes from becoming diabetes and medication control programs and lifestyle intervention strategies to help improve diabetes control.
Solutions:

The United States of Diabetes: Challenges and Opportunities in the Decade Ahead focuses on four categories of potential cost savings over the next 10 years:
• Lifestyle Intervention to Combat Obesity: There is an opportunity to reduce the number of people who would develop prediabetes or diabetes by nearly 10 million Americans, through public health initiatives and the wider use of wellness programs to combat obesity.
• Early Intervention to Prevent Prediabetes from Becoming Diabetes: Evidence from randomized controlled trials and UnitedHealth Group's own experience demonstrates that the use of community-based intervention programs -- such as the UnitedHealth Group Diabetes Prevention Program (DPP) in partnership with the YMCA -- could reduce the number of people with prediabetes who convert to diabetes by an additional 3 million. The DPP is based on the original U.S. Diabetes Prevention Program, funded by the National Institutes of Health (NIH) and the CDC, which demonstrated that with lifestyle changes and modest weight reduction, individuals with prediabetes can prevent or delay the onset of the disease by 58 percent.
• Diabetes Control through Medication and Care Compliance Programs: Better management of diabetes through improved medication and care compliance programs can help control the disease and reduce complications, such as UnitedHealth Group's Diabetes Control Program (in partnership with community pharmacists).
• Lifestyle Intervention Strategies for Diabetes Control: The wider use of public-private partnerships to develop the infrastructure to scale nationally the promising learnings of the Look AHEAD Trial.

NBA bans its first pair of shoes due to 'unfair advantage'

Though no NBA player actually professed an interest in buying these special Athletic Propulsion Labs vertical-influencing basketball shoes, you have to wonder if there are a series of floor-bound big men, the league over, that just had their Tuesday ruined by David Stern.

This is a press release, and not an actual report from the frontlines, but it's an interesting turn nevertheless.

The NBA has actually banned some shoes (which can be yours for only $300!) due to an apparent "unfair competitive advantage," which will no doubt send the sales of these Athletic Propulsion Labs' duds through the roof. I hope Messrs. Stern and Adam Silver bought some stock in this company before they made it infamous.

[Related: Basketball team faces 'desperate' shoe shortage]

To the release!

For the first time in its 64-year history, the National Basketball Association (NBA) has banned a new line of shoes based on the league's rule against an "unfair competitive advantage" that increases a player's vertical leap. The league's ban on Athletic Propulsion Labs' Concept 1 confirms the company's claims that the shoe, with its Load ‘N LaunchTM Technology, performs as advertised. No professional player will be allowed to wear the product in games for the upcoming 2010-2011 NBA season.

This action comes on the 25th anniversary of the NBA's ban on Nike's Air Jordan shoes, albeit for reasons of their colorful appearance rather than any performance advantage.

Athletic Propulsion Labs (APL) was notified by a senior NBA official who stated, "League rules regulate the footwear that players may wear during an NBA game. Under league rules, players may not wear any shoe during a game ‘that creates an undue competitive advantage (e.g., to increase a player's vertical leap).' In light of that rule...players will not be permitted to wear the APL shoes during NBA games."

[Rewind: Trainer banishes Nike shoe]

Shoe companies, for decades, have promoted a sort of "unfair competitive advantage" through their shoes, from PF Flyers to the most recent set of Derrick Rose(notes)-brand adidas that we'll showcase here at BDL later this afternoon. But this is the first time that the NBA has borderline endorsed one brand of shoe being better than another, even if they won't allow its players to run in it.

How Can Special Shoes & Insoles Help the Patients' Feet?

Special shoes can be prescribed to comfortably fit and protect your sensitive feet or can be specially made to fit softly around your feet or feet that have changed shape. These special shoes help protect your feet. Along with shoes, custom insoles can be made to perfectly fit your feet to protect them while wearing the special shoes. Medicare and other health insurance programs may pay for special shoes. Talk with your doctor about how and where to get them. Very often your doctor can take a scan of your foot to have the special insoles custom made for your feet. He or she may also be able to provide the special shoes for you at the same time.

Dinner Ideas for Type 2 Diabetes

You can create great dinners when following a diabetes diet. Substitute healthier ingredients for traditional ones and enjoy many of your favorite meals.
By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH

To control type 2 diabetes, you must watch what you eat to keep your weight at a healthy level and avoid complications. But eating doesn't have to be a boring chore just because you have diabetes.
You can enjoy many healthy and tasty dinner choices. In fact, by keeping a few simple tips in mind and being creative, few meals are totally off-limits, even with diabetes.
Diabetes Diet: Start With Meal Planning
The name of the game with diabetes diet management is portion control — watch your portion sizes to avoid overeating. Advance planning helps, too. Spend a few minutes every weekend deciding on your meals for the following week and keep these strategies in mind:
• Eat more whole grains and starchy vegetables. Limit fats and sweets. Eat moderate amounts of lean meats, low-fat milk and dairy products, non-starchy vegetables, and fruit.
• Be creative when cooking by making substitutions. For example, use fat-free milk instead of whole milk and trans fat-free margarine instead of butter.
• Choose whole grains and brown rice over white or enriched bread or pasta products.
• Cook with healthy oils, like canola or olive oil.
• Cut back on salt, which can raise blood pressure.
• Avoid fried foods and foods in heavy sauces.
• Limit alcohol. One drink per day for women and one to two drinks per day for men is okay, but always consume alcohol with food.
Diabetes Menu: Healthy Dinner Ideas
Here are six easy dinners that will fill your tummy and still keep your blood sugar levels in check:
• Meatloaf, mashed potatoes, and green beans. You can eat this classic "comfort food" meal, but keep it diabetes-friendly with a few smart substitutions. Use ground turkey instead of ground beef. When making the mashed potatoes, use fat-free milk instead of whole milk and trans-fat-free margarine instead of butter. You could also use fewer potatoes by folding in pureed cauliflower. Steam the green beans and season with a little salt and pepper, then top with a few almonds rather than a pat of butter.
• Chicken, brown rice, and steamed broccoli. Grill boneless, skinless chicken breasts or bake a whole chicken (don't eat the skin). Marinate the chicken in Italian dressing before grilling or season it with your favorite herbs before roasting it in the oven.
• Baked red snapper and mixed veggies. This dinner is a snap. Wrap a fish filet together with sliced vegetables — try a blend of zucchini, garlic, red peppers, onions, fennel, and tomatoes — with a drizzle of oil in parchment paper. Place in a 450 degree oven for 20 minutes or until the fish is opaque and flakes easily. Serve with a whole-grain side dish of fast-cooking couscous or quinoa
• Pasta your way. Although people with type 2 diabetes have to be careful about the amount of carbohydrates they eat, pasta can still be a safe dinner choice. As with bread, whole-grain pasta is better than enriched pasta. Avoid heavy cream sauces like Alfredo, and stick to tomato-based sauces or olive oil and garlic. You can add chicken, shrimp, or fish to your dish for protein — even lean meatballs or turkey meatballs are allowed.
• Chili. When you make it yourself, chili becomes a very healthy choice. Start with ground turkey or extra-lean ground beef, or go vegetarian with beans only ‐ black beans and kidney beans. Add lots of diced vegetables to the pot, such as garlic, onion, red, green, and yellow bell peppers, and zucchini. Use no-salt canned tomatoes and low-sodium beef broth. Instead of serving the chili topped with traditional sour cream and cheese, use low-fat yogurt or fat-free sour cream, crumbled pecans, and cilantro. Serve with a garden salad with low-fat or non-fat salad dressing and whole-grain crunchy bread.
• Asian stir-fry. Make your own version of your favorite restaurant dish. Prepare your vegetables — any combination of green beans, broccoli, carrots, onion, snow peas, red and green peppers, and baby corn — then sauté in low-sodium soy sauce and garlic. Mix in chicken, shrimp, or tofu to add protein to your meal. Serve over brown rice or whole-grain noodles.
Limiting sweets doesn't mean eliminating them. You can indulge your sweet tooth every now and then. Here are some tasty dessert ideas:
• Fresh fruit with low-fat topping
• Fat-free frozen yogurt
• Lower-fat cookies, such as ginger snaps, vanilla wafers, and graham crackers
• No sugar-added pudding or frozen fudge bars
Always keep portion size in mind so that you don't overdo the sweets. Even the most decadent desserts can be enjoyed in very small amounts on occasion.

Varicose veins: Live with it or treat it?

Varicose veins may look ugly but for a lucky majority who develop them, their appearance will be the only cause of concern. Distended and dilated, these veins appear just below the skin and can create a spider web pattern of blue and purple lines that make sufferers self- conscious. But for a small percentage, varicose veins can cause itching and pain, and even lead to wounds that make some form of treatment necessary.

The good news is that treatment – both surgical and non-surgical – has proven effective time and again, says Dr. Rezni Cassim, Vascular and Transplant Surgeon and lecturer at the Professorial Surgical Unit at the National Hospital.

As you read this, approximately five litres of blood is wending its way through your system. Travelling along an intricate system of veins and arteries, the blood circulates throughout your body. The arteries carry the blood from your heart out to your body, and the veins carry the blood from your body back to your heart. The blood travelling along your arteries is a rich red, an indicator that it is full of oxygen. The blood travelling back along your veins, on the other hand, is much darker because your body has extracted the oxygen in the blood. That’s why veins look purple or blue.

“Going down is easy, high arterial pressure and gravity sends the blood down,” says Dr. Cassim, speaking of the movement along the arteries. Going up, on the other hand, is a fight against gravity and is helped by a system of valves in the veins. “The venous system is designed in such a way that there is a one way flow, with valves stopping the blood from flowing back and defects in the valves are the cause of most problems. " Such defects can appear anywhere, from groin to just above ankle, and cause varicose veins. A malfunctioning valve can create a long column of blood, resulting in what is known as venous hypertension. The venous hypertension may cause varicose veins and its complications.

Dr. Cassim explains that the condition is most often familial, appearing in a member or members of the same family. Aside from the hereditary component, varicose veins can be aggravated by pregnancy. The body has dual systems of veins – one is deep seated and other superficial. If the deep veins are blocked, those just under the skin must cope with a greater load and can develop varicose veins.
An arteriovenous fistula can cause varicose veins in places like your arms. Arteriovenous fistuli represent abnormal connections or passageways between an artery and a vein. In a healthy system, blood flows from arteries, into capillaries and then into veins. An arteriovenous fistula however, can cause the blood to bypass the capillaries and flow directly from artery into vein.

They fall into two categories: congenital fistula which a person may be born with and acquired fistula which develop after birth and may have been caused by trauma/surgery. A big fistula can allow a large volume of blood, under high pressure to flood the vein. The latter, not having been designed to channel so much blood with high pressure, becomes distended. Apart from these there are other rare secondary causes for varicose veins.

Many of Dr. Cassim’s patients are young people. For younger patients, the appearance of the veins is often embarrassing. “The younger they are, the more concerned they tend to be,” says Dr. Cassim, adding that aside from such cosmetic concerns, 90% of his patients will not have any problem. But varicose veins can cause complications. You can have swelling of the legs, because of the pressure, itchiness of the leg, eczema, pain, pigmentation and ulcers (wounds). “When inadvertently traumatised the veins may bleed heavily, and patients should immediately apply pressure to prevent further blood loss,” says Dr. Cassim, emphasising that bleeding should stop in approximately 15 minutes.

“These complications present a reason to treat varicose veins,” he says, “the diagnosis itself is very simple.”

The ulcer is one of the most unpleasant complications, simply because it can take so long to heal. Dr. Cassim has seen patients who have struggled with one for 10 years. “We use a technique called strapping to treat it – it’s a special way of putting pressure on the ulcer to heal it – but that can also take 3 to 6 months to heal,” he says, adding, “All this can be prevented at an early stage.” If you have varicose veins with pigmentation, itching or skin changes, consider it your cue to seek medical advice.

Though varicose veins are simple enough to treat, what doctors are worried about is the possibility of an underlying secondary cause. “If there is a sudden onset of varicose veins, it is better to seek treatment,” cautions Dr. Cassim. However, if you’ve had varicose veins for several years and experienced none of these complications, and do not want treatment for cosmetic concerns, you can choose to leave them untreated.

For those who are interested in non-invasive treatment for complications, Dr. Cassim recommends the wearing of a graduated pressure stocking during the day. The stockings help to force the blood upwards. At night, keeping the legs elevated will encourage healthy circulation. These must become the habits of a lifetime if they are to be effective. Exercising, losing weight, and avoiding long periods of standing can also help. For those who are self- conscious, however, wearing a stocking might not seem like a viable solution.

Doctors seeking to treat varicose veins can choose to do a duplex scan to identify the malfunctioning valves in the vein. There are many invasive methods to treat varicose veins. Dr. Cassim describes the process as akin to getting a haircut – except the time scale differs radically. The varicose veins can recur in 60% of patients in 6 to 8 years. Of course, 40% will be recurrence free. Doctors often employ minimally invasive techniques such as sclerosant injection, foam therapy, or laser ablation to treat these veins.

Other patients, more interested in a long term solution, will opt to have the veins completely removed in an operation. It includes “vein stripping” and the surgery occurs under anaesthesia. Because so much of the blood flows through the deeper veins in the legs, the superficial veins can usually be removed or ablated without serious harm. In the end, it’s the patient who makes the choice, says Dr. Cassim, adding that each approach has its advantages and disadvantages.

Diet for Hypertension and Cardiovascular Disease?

Q: What's a good diet for a 45-year-old male who has hypertension, cardiovascular disease, and is overweight?

— Diane, Indiana
A:
The DASH diet is the best diet for these conditions and has been tested and proven to lower blood pressure and lipid levels. DASH stands for Dietary Approaches to Stop Hypertension and is really one of the only diets based on sound science. It calls for lean protein, low-fat dairy, lots of fruits and vegetables, and whole grains — and about 25 percent of its total daily calories come from mostly good fats, like olive and canola oils. The DASH diet is recommended by NIH (National Institutes of Health) and NHLBI (National Heart, Lung, and Blood Institute) to reduce blood pressure and maintain a good weight. So this in fact is the perfect diet for someone who is overweight and has hypertension and cardiovascular disease. It is very similar to other healthy diets that the government recommends, and is very easy to follow because it calls for making sure you give yourself a certain number of servings of lean protein, fresh fruits and vegetables, whole grains, and low-fat dairy per day. There are Web sites available that will teach you how to know how many servings of each food you need per day based on your body weight, but in general the DASH diet recommends nine servings of fruits and vegetables per day, two to three servings of low-fat dairy and protein, and five to six servings of whole grains

Foot Care Is Essential With Diabetes

From inspecting your feet for sores to keeping your skin dry, proper foot care is essential when you have diabetes. Practice these tips to reduce the risk of infection and protect your feet.

You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.

1. Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says Dr. Weaver. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.

2. When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Weaver. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.

3. Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. At CKPA we advise looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.

4. Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.

5. Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” When the skin has excess moisture it will break down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can use Ameriglel lotion to moisturizer and help prevent dry, cracked skin — just avoid putting it between your toes.


6. Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.

7. Wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at Central Kansas Podiatry Associates, or you can visit with Dr. Weaver for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is slow healing and to help prevent..

8. People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.

9. The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Dr. Weaver. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,”

10. “There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Dr. Weaver. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.

11. Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to call us and come see Dr. Weaver before your next regularly scheduled check-up.