Monday, February 27, 2012

Alzheimer's: 5 Greatest Risk Factors

Alzheimer’s disease begins at the synapse, the space where neurons connect. The biggest bad guy in this disease is a sticky protein called beta-amyloid. Either too much is made or not enough is cleared away, and as beta-amyloid accumulates, it creates a gooey clog in the synapse, preventing the neurons that meet there from communicating. As a result, the information those neurons carry can’t be transmitted or retrieved. The beta-amyloid “goo” prevents these two neurons from “talking” to each other. We notice this molecular event because we forget something.

When too much beta-amyloid causes the synapse to fail, we begin to see the symptoms of Alzheimer’s. There are many risk factors that can contribute to having too much beta-amyloid. What are these risk factors?

First, let’s imagine a seesaw-style scale and the risk factors, which each vary in weight, are being piled on one arm of the scale. When that arm hits the floor, we have Alzheimer’s.

Risk Factors

1. Age
The biggest risk factor for developing Alzheimer’s is age. For reasons we still don’t entirely understand, as we get older, we accumulate more beta-amyloid. The chances of being diagnosed with Alzheimer’s increase steadily as we age. Right now, the risk of Alzheimer’s doubles every year after the age of 65. About half of people who are 85 and older have Alzheimer’s.

2. Genetics
Another risk factor is genetics. There is a rare form of Alzheimer’s called Familial Alzheimer’s, which always begins well before the age of 65 (typically in the 40s and 50s) and runs in families, that is autosomal dominant. This means that a single genetic mutation causes the disease. Picture the seesaw scale again. Genetic mutation is the only risk factor on the scale, and the arm is sitting on the floor.
Scientists have discovered three genetic mutations that cause this early-onset Familial Alzheimer’s. All three of these mutations result in molecular changes that cause an excess of beta-amyloid.

But this type of genetic risk factor is relatively rare, accounting for only about 5%of Alzheimer’s cases. The contribution of genetic risk factors to the development of Alzheimer’s for the vast majority of cases weighs much less on the scale, tipping the arm only a little bit.

For example, ApoE4 is a known genetic risk factor for Alzheimer’s. Forty to 65% of people with Alzheimer’s carry at least one copy of this mutation. But you can have two copies of this mutation (one inherited from each parent) and not have the disease. Again, imagine the arm of the scale tipped a bit with each copy of this mutation, but the arm is still well above the floor. Likewise, you can have zero copies of ApoE4 but have Alzheimer’s. The arm of your scale would be free of ApoE4 but piled high with other risk factors that tipped the scale over, leading to expression of the disease.

3. Head Trauma
Prior experience with head trauma, especially if consciousness was lost, increases the risk of developing Alzheimer’s. Always wear a seat belt and helmets.

4. Diabetes
In a recent study out of Japan that looked at over 1000 men and women over the age of 60, it was found that people with diabetes (especially type 2) were twice as likely to develop Alzheimer’s. Researchers are now trying to understand the molecular mechanisms that link diabetes to Alzheimer’s. It’s thought that the link may be twofold.

Nerve cells require a lot of energy to do the work of communicating. They get this energy from oxygen and glucose in the blood. With diabetes, cells lose their ability to respond to insulin, the molecule that transports glucose from the blood into the neurons, and so neurons have to cope with less glucose. Diabetes also often leads to damaged blood vessels, which compromises the delivery of oxygen to the nerves in the brain. Neurons already struggling to communicate despite too much beta-amyloid may lose the battle if glucose and oxygen are deprived.

Think of the scale arm with a bunch of risk factors piled on it. It’s hovering above ground but fighting to maintain that position. Things aren’t looking good for that synapse, but it’s still managing to function. Those neurons are still able to talk to each other. We aren’t showing any symptoms of Alzheimer’s yet. Add diabetes, and less oxygen and glucose to provide the energy the neurons need, and the scale arm goes crashing to the ground. Now we have Alzheimer’s.

5. Cardiovascular Disease
Eighty percent of people with Alzheimer's disease also have cardiovascular disease. Scientists are trying to better understand the link between heart health and Alzheimer’s disease, but we do know a few things about this relationship.

Cholesterol drives the production of beta-amyloid. For a brain that is already struggling to keep beta-amyloid levels in check, high cholesterol can be a risk factor that tips the scale. Doctors prescribe statins for people diagnosed with Alzheimer’s to help keep cholesterol levels down.

Again, the neurons in your brain need a lot of oxygen to do their job. If you have high blood pressure and if you have plaques in your blood vessels, your blood vessels are less efficient at delivering this oxygen to your brain. Not enough oxygen can be the weight that tips the Alzheimer’s scale.

All the risk factors for heart disease (things like poor diet, lack of exercise) are also risk factors for Alzheimer’s. And this means that things like a healthy, Mediterranean diet (whole grains, red and purple fruits and vegetables, fish, nuts) and exercise may not only protect the heart, they may protect us from Alzheimer’s. In fact, in animal studies, exercise has been shown to clear beta-amyloid better than any pharmaceutical we know of. Think of diet and exercise as weights on the other arm of the scale.

There is currently no cure for Alzheimer’s, but understanding these risk factors offers us some good news. While we can’t do anything about getting older or the genes we’ve inherited from our parents, eating smart, keeping cholesterol levels and blood sugar low, exercising, wearing a helmet when bicycling or skiing, and wearing a seat belt in the car are among the things we can do to keep the arm of the Alzheimer’s scale from tipping to the ground.

Thursday, February 23, 2012

Seinfeld Actor Survives After Shooting Self in Head

Seinfeld actor Daniel von Bargen, who's best known for playing George Costanza's boss Mr. Kruger in the sitcom, is in critical condition after a failed suicide attempt earlier this week, TMZ reports.

The 61-year-old was in his Cincinnati apartment Monday morning when he shot himself in the head and then called for help. According to audio of the 911 tape posted on the gossip site, he told the operator, "I've shot myself in the head and I need help."

Check out the rest of today's news

The gunshot to the temple was not an accident. Von Bargen, who is a diabetic, recently learned some bad news. "I was supposed to go to the hospital and I didn't want to. So I shot myself... They were supposed to amputate at least a few toes."

Von Bargen was transported to a nearby hospital.

The veteran actor also recurred as Commandant Edwin Spangler on Malcolm in the Middle. On the big screen, he's appeared in O Brother, Where Art Thou?, The Faculty and Super Troopers.

Thursday, February 16, 2012

18 Things Your Feet Say About Your Health

Want to make a simple, ten-second check on the state of your health? Sneak a peek at your feet.

"You can detect everything from diabetes to nutritional deficiencies just by examining the feet," says Jane Andersen, DPM, president of the American Association of Women Podiatrists and a spokeswoman for the American Podiatric Medical Association.

The lowly left and right provide plenty of insightful data: Together they contain a quarter of the body's bones, and each foot also has 33 joints; 100 tendons, muscles, and ligaments; and countless nerves and blood vessels that link all the way to the heart, spine, and brain.

Unresolved foot problems can have unexpected consequences. Untreated pain often leads a person to move less and gain weight, for example, or to shift balance in unnatural ways, increasing the chance of falling and breaking a bone.

So when the feet send one of these 18 warning messages, they mean business

1. Red flag: Toenails with slightly sunken, spoon-shaped indentations

What it means: Anemia (iron deficiency) often shows up as an unnatural, concave or spoonlike shape to the toes' nail beds, especially in moderate-to-severe cases. It's caused by not having enough hemoglobin, an iron-rich protein in the blood cells that transports oxygen. Internal bleeding (such as an ulcer) or heavy menstrual periods can trigger anemia.

More clues: On fingers as well as toes, the skin and nail beds both appear pale. The nails may also be brittle, and feet may feel cold. Fatigue is the number-one sign of anemia, as are shortness of breath, dizziness when standing, and headache.

What to do: A complete blood count is usually used to diagnose anemia. A physical exam may pinpoint a cause. First-step treatments include iron supplements and dietary changes to add iron and vitamin C (which speeds iron absorption).

2. Red flag: Hairless feet or toes

What it means: Poor circulation, usually caused by vascular disease, can make hair disappear from the feet. When the heart loses the ability to pump enough blood to the extremities because of arteriosclerosis (commonly known as hardening of the arteries), the body has to prioritize its use. Hairy toes are, well, low on the totem pole.

More clues: The reduced blood supply also makes it hard to feel a pulse in the feet. (Check the top of the foot or the inside of the ankle.) When you stand, your feet may be bright red or dusky; when elevated, they immediately pale. The skin is shiny. People with poor circulation tend to already know they have a cardiovascular condition (such as heart disease or a carotid artery) yet may not realize they have circulation trouble.

What to do: Treating the underlying vascular issues can improve circulation. Toe hair seldom returns, but nobody complains much.

3. Red flag: Frequent foot cramping (charley horses)

What it means: The sudden stab of a foot cramp -- basically, the hard contraction of a muscle -- can be triggered by fleeting circumstances such as exercise or dehydration. But if it happens often, your diet may lack sufficient calcium, potassium, or magnesium. Pregnant women in the third trimester are especially vulnerable thanks to increased blood volume and reduced circulation to the feet.

More clues: Charley horses tend to rear up out of nowhere, often while you're just lying there. They can be a single sharp muscle spasm or come in waves. Either way, soreness can linger long afterward.

What to do: Try to flex the foot and massage the painful area. You may also be able to relax the muscle by applying a cold pack or rubbing alcohol. To prevent cramps, stretch your feet before you go to bed. Then drink a glass of warm milk (for the calcium).

4. Red flag: A sore that won't heal on the bottom of the foot

What it means: This is a major clue to diabetes. Elevated blood glucose levels lead to nerve damage in the feet -- which means that minor scrapes, cuts, or irritations caused by pressure or friction often go unnoticed, especially by someone who's unaware he has the disease. Untreated, these ulcers can lead to infection, even amputation.

More clues: Oozing, foul-smelling cuts are especially suspect because they've probably been there awhile. Other symptoms of diabetes include persistent thirst, frequent urination, increased fatigue, blurry vision, extreme hunger, and weight loss.

What to do: Get the ulcer treated immediately and see a doctor for a diabetes evaluation. Diabetics need to inspect their feet daily (older people or the obese should have someone do this for them) and see a healthcare professional every three months.

5. Red flag: Cold feet

What it means: Women, especially, report cold feet (or more precisely, their bedmates complain about them). It may be nothing -- or it may indicate a thyroid issue. Women over 40 who have cold feet often have an underfunctioning thyroid, the gland that regulates temperature and metabolism. Poor circulation (in either gender) is another possible cause.

More clues: Hypothyroidism's symptoms are pretty subtle and appear in many disorders (fatigue, depression, weight gain, dry skin).

What to do: Insulating layers of natural materials work best for warmth. (Think wool socks and lined boots). If you also have other nagging health complaints, mention the cold feet to your doctor. Unfortunately, however, aside from treatment with medication in the event of a thyroid condition, this tends to be a symptom that's neither easily nor sexily resolved.

6. Red flag: Thick, yellow, downright ugly toenails

What it means: A fungal infection is running rampant below the surface of the nail. Onychomycosis can persist painlessly for years. By the time it's visibly unattractive, the infection is advanced and can spread to all toenails and even fingernails.

More clues: The nails may also smell bad and turn dark. People most vulnerable: those with diabetes, circulatory trouble, or immune-deficiency disorders (like rheumatoid arthritis). If an older person has trouble walking, sometimes the problem can be traced to the simple fact that as infected nails grow thicker, they're harder to cut and simply go ignored to the point of pain.

What to do: See a foot specialist or your regular physician for care and treatment. In serious cases, over-the-counter antifungals are usually not as effective as a combination of topical and oral medications and the professional removal of diseased bits. Newer-generation oral antifungal medications tend to have fewer side effects than older ones.

7. Red flag: A suddenly enlarged, scary-looking big toe

What it means: Probably gout. Yes, that old-fashioned-sounding disease is still very much around -- and you don't have to be over 65 to get it. Gout is a form of arthritis (also called "gouty arthritis") that's usually caused by too much uric acid, a natural substance. The built-up uric acid forms needlelike crystals, especially at low body temperatures. And the coolest part of the body, farthest from the heart, happens to be the big toe.

"Three-fourths of the time, you wake up with a red-hot swollen toe joint as the first presentation of gout," says podiatrist Andersen.

More clues: Swelling and shiny red or purplish skin -- along with a sensation of heat and pain -- can also occur in the instep, the Achilles tendon, the knees, and the elbows. Anyone can develop gout, though men in their 40s and 50s are especially prone. Women with gout tend to be postmenopausal.

What to do: See a doctor about controlling the causes of gout through diet or medication. A foot specialist can help relieve pain and preserve function.

8. Red flag: Numbness in both feet

What it means: Being unable to "feel" your feet or having a heavy pins-and-needles sensation is a hallmark of peripheral neuropathy, or damage to the peripheral nervous system. That's the body's way of transmitting information from the brain and spinal cord to the entire rest of the body. Peripheral neuropathy has many causes, but the top two are diabetes and alcohol abuse (current or past). Chemotherapy is another common cause.

More clues: The tingling or burning can also appear in hands and may gradually spread up to arms and legs. The reduced sensation may make it feel like you're constantly wearing heavy socks or gloves.

What to do: See a physician to try to pinpoint the cause (especially if alcohol addiction doesn't apply). There's no cure for peripheral neuropathy, but medications from pain relievers to antidepressants can treat symptoms.

9. Red flag: Sore toe joints

What it means: Rheumatoid arthritis (RA), a degenerative joint disease, is often first felt in the smaller joints, such as the toes and the knuckles of the hands.

More clues: Swelling and stiffness usually accompany the aches. This pain tends to be symmetrical; for example, it happens simultaneously in both big toes or in both index fingers. RA develops more suddenly than degenerative arthritis, and attacks may come and go. Women are almost four times more affected than men.

What to do: A full workup is always needed to pinpoint the cause of any joint pain. For RA, there are many medications and therapies that can minimize pain and preserve function, though early diagnosis is important to avoid permanent deformity. (In the feet, the toes can drift to the side.)

10. Red flag: Pitted toenails

What it means: In up to half of all people with psoriasis, the skin disease also shows up in the nail as many little holes, which can be deep or shallow. More than three-fourths of those with psoriatic arthritis, a related disorder that affects the joints as well as the skin, also have pocked, pitted nails.

More clues: The nails (fingers as well as toes) will also thicken. They may be yellow-brown or have salmon-colored patches. The knuckle nearest the nail is also likely to be dry, red, and inflamed.

What to do: A variety of medications can treat both psoriasis and psoriatic arthritis and can restore the nail bed surface in many cases, especially if treatment begins early.

11. Red flag: Being unable to raise the foot upward from the heel

What it means: "Foot drop" (also "drop foot") signals nerve or muscle damage that can originate well north of your feet -- as far as your back or even shoulder or neck. Certain chemotherapy drugs can also cause trouble lifting the front part of the foot while walking or standing.

More clues: There may be pain and numbness as well, though not necessarily. Sometimes the pain is felt in the upper leg or lower spine, where a nerve is pinched (by damage or a tumor). In some cases, the foot drags when the person walks. It's rare for both feet to be affected.

What to do: Report this serious symptom to your doctor. Foot drop can be completely reversible or permanent, depending on its cause and treatment.

12. Red flag: Dry, flaky skin

What it means: Even if your face or hands tend to be powdery-dry, don't dismiss this skin condition on your feet. You don't have to be a jock to contract athlete's foot, a fungal infection that usually starts as dry, itchy skin that then progresses to inflammation and blisters. When blisters break, the infection spreads.

(The name comes from the moist places the fungus thrives -- places athletes tend to congregate, such as locker rooms and pools.)

More clues: Athlete's foot usually shows up between the toes first. It can spread to the soles and even to other parts of the body (like the underarms or groin), usually due to scratching.

What to do: Mild cases can be self-treated by bathing the feet often and drying them thoroughly. Then keep the feet dry, including using foot powder in shoes and socks. If there's no improvement in two weeks or the infection worsens, a doctor can prescribe topical or oral antifungal medication.

13. Red flag: Toes that turn patriotic colors

What it means: In cold weather, Raynaud's disease (or Raynaud's phenomenon) causes the extremities to first go white, then turn blue, and finally appear red before returning to a natural hue. For reasons not well understood, the blood vessels in these areas vasospasm, or overreact, causing the tricolor show.

More clues: Other commonly affected areas include the fingers, nose, lips, and ear lobes. They also feel cool to the touch and go numb. Women and those who live in colder climates get Raynaud's more often. It typically shows up before age 25 or after 40. Stress can trigger Raynaud's attacks, too.

What to do: See a doctor about medications that can widen blood vessels, which reduces the severity of attacks.

14. Red flag: Feet that are really painful to walk on

What it means: Undiagnosed stress fractures are a common cause of foot pain. The discomfort can be felt along the sides of the feet, in the soles, or "all over." These fractures -- they often occur repeatedly -- may be caused by another underlying problem, often osteopenia (a decrease in optimum bone density, especially in women over age 50) or some kind of malnutrition, including a vitamin D deficiency, a problem absorbing calcium, or anorexia.

More clues: Often you can still walk on the broken bones; it just hurts like heck. (Some hardy people have gone undiagnosed for as long as a year.)

What to do: See a foot doctor about any pain. If, for example, you've been walking around Europe for three weeks in bad shoes, your feet may simply be sore. But a 55-year-old sedentary woman with painful feet may need a bone-density exam. An X-ray can also reveal possible nutritional issues that warrant a referral to a primary care provider.

15. Red flag: Toes that bump upward at the tips

What it means: When the very tips of the toes swell to the point where they lose their usual angle and appear to bump upward at the ends, it's called "digital clubbing" or "Hippocratic clubbing" after Hippocrates, who described the phenomenon 2,000 years ago. It's a common sign of serious pulmonary (lung) disease, including pulmonary fibrosis and lung cancer. Heart disease and certain gastrointestinal diseases, such as Crohn's disease, are also associated with clubbing.

More clues: Fingers can be clubbed as well as toes. It can happen in just some digits, or in all.

What to do: Treatment depends on the underlying cause, so report this serious symptom to a doctor. (Physicians are also well trained to look for clubbed digits during exams.)

16. Red flag: Shooting pain in the heel

What it means: Plantar fasciitis -- a fancy name for inflammation of a band of connective tissue (fascia) running along the bottom (plantar) of the foot -- is abnormal straining of the tissue beyond its normal extension.

More clues: The pain starts when you take your first steps in the morning and often intensifies as the day wears on. It's usually concentrated in the heel (one or both) but can also be felt in the arch or in the back of the foot. Running and jumping a lot can cause it, but so can insufficient support. You're at risk if you go barefoot a lot or wear old shoes or flimsy flip-flops, have gained weight, or walk a lot on hard surfaces.

What to do: If pain persists more than a few weeks or seems to worsen, have it evaluated by a podiatrist. Stick to low shoes with a strong supportive arch until you get further advice and treatment (which may include anti-inflammatory drugs and shoe inserts).

17. Red flag: "Phee-uuuuw!"

What it means: Though smelly feet (hyperhidrosis) tend to cause more alarm than most foot symptoms, odor -- even downright stinkiness -- is seldom a sign something's physically amiss. (Whew!) Feet contain more sweat glands than any other body part -- half a million between the two of them! And some people are more prone to sweat than others. Add in the casings of shoes and socks, and the normal bacteria that thrive in the body have a feast on the resulting moisture, creating the smell that makes wives and mothers weep. (Both sexes can have smelly feet, but men tend to sweat more.)

More clues: In this case, the one olfactory clue is plenty.

What to do: Wash with antibacterial soap and dry feet well. Rub cornstarch or antiperspirant onto soles. Toss used socks in the wash; always put on a fresh pair instead of reusing. Stick to natural materials (cotton socks, leather shoes) -- they wick away moisture better than man-made materials. Open up laced shoes after you remove them so they get a chance to fully air out; don't wear them again until they're fully dry.

18. Red flag: Old shoes

What it means: Danger! You're a walking health bomb if your everyday shoes are more than a couple of years old or if walking or running shoes have more than 350 to 500 miles on them. Old shoes lack the support feet need -- and footgear wears out faster than most people think, foot specialists say.

More clues: Blisters (too tight), bunions (too narrow), heel pain (not enough support) -- if you're having any kind of foot trouble, there's at least a 50-50 chance your shoddy or ill-fitting footwear is to blame.

Older people are especially vulnerable because they fall into the habit of wearing familiar old shoes that may lack support, flexibility, or good traction.

Wednesday, February 15, 2012

The Health Dangers of Obesity

The obesity epidemic is taking a toll on our national health. All those extra pounds cause wear and tear on the body and set the stage for serious medical conditions, from diabetes to stroke.

Obesity takes a huge toll on the body and put you at risk of serious health conditions, ranging from sleep apnea to diabetes to stroke. Losing weight can reverse many of the problems that obesity creates.

Understanding how major health conditions are associated with obesity is often the first step in recognizing the value of losing even some of the extra weight you’re carrying.

Obesity, Heart Disease, and Stroke

Obesity is linked to cardiovascular diseases, such as heart disease and stroke, in 70 percent of diagnosed cases. Hardening of the arteries, also called atherosclerosis, is 10 times more frequent in people who are obese. Heart-related issues connected to obesity include:

High cholesterol. Studies have shown that the higher your body mass index (BMI), the higher the levels of total cholesterol; this is particularly true in women, but is also the case for men. Cholesterol levels rise even more for people who carry most of their excess weight in their belly. Eating an unhealthy diet leads to obesity and often high cholesterol levels.

Stroke. Too much fat in the body, especially saturated fat and cholesterol, builds up plaque in the arteries and can lead to stroke, explains registered dietitian Jim White, RD, spokesperson for the American Dietetic Association, and owner of Jim White Fitness & Nutrition Studios in Virginia Beach, Va.

Hypertension. Obesity doubles the risk of hypertension, or high blood pressure. Also related to heart disease, hypertension occurs in 26 percent of obese individuals. Obesity creates more cells and tissues that need blood and oxygen — and your heart and circulatory system must work harder to deliver them. This extra effort can increase blood pressure, leading to hypertension. Losing weight and maintaining a healthy diet can undo much of the damage caused by these conditions.

Obesity and Other Serious Health Conditions

Obesity has been associated with many other illnesses, either as a cause or a trigger for worsening symptoms:

Diabetes. Obesity is strongly correlated with diabetes. Nearly 90 percent of type 2 diabetics are overweight, as too much weight can lead to insulin resistance. Losing weight can help to manage and even prevent type 2 diabetes by making it easier for the body to use the insulin that it produces and regulate blood glucose levels.

Cancer. Research shows strong evidence of a relationship between some cancers and obesity, such as colon cancer, endometrial cancer, and breast cancer. As many as 51 percent of new cancer cases diagnosed in women are linked to obesity; the number is 14 percent for men. Although it's not understood how obesity increases the risk of developing certain cancers, evidence does show that losing weight can help to prevent many cancers.

Sleep apnea. This is a dangerous condition that causes breathing to temporarily stop during sleep. A big risk factor for sleep apnea is obesity, as excess weight taxes the respiratory system and makes breathing more difficult. Losing just 10 percent of your body weight can cut down on pauses in breathing during sleep.

Osteoarthritis. Arthritis risk increases as much as 13 percent with every two pounds gained. The increase of developing osteoarthritis is increased four times for women who are overweight; men who are overweight have five times the risk. Obesity places excess strain on the joints, leading to additional wear and tear and ultimately osteoarthritis.

Gallbladder disease. As many as 30 percent of all gallbladder surgeries are attributed to obesity. Obesity "causes disruption in the whole gallbladder," says White, by forcing it to work harder to process more fat. Obesity also leads to excess cholesterol, which boosts the risk for gallstones. Less weight puts less strain on the gallbladder.

Fatty liver disease. The specific connection between obesity and fatty liver disease isn't really understood, so it's hard to know how many cases are linked to obesity. But those with diabetes and pre-diabetics are at an increased risk of fatty liver disease. Maintaining a healthy body weight can manage blood sugar for those with diabetes and also reduce fat build-up in the liver.

GERD. Overeating doesn’t just contribute to obesity, but also to gastroesophageal reflux disease (GERD), says White. Excess weight increases pressure inside the stomach, which can push acids up into the esophagus and worsen GERD symptoms — although it doesn't actually cause GERD. Losing weight can reduce pressure and minimize GERD symptoms.

Gout. Gout is a condition in which uric acid (waste that the body produces) builds up in the joints and tissues in the body. Obesity increases the risk of gout simply because there are more cells and tissues producing uric acid, which can lead to the build-up. Getting rid of excess weight can reduce uric acid production and manage gout.

Depression. Depressed individuals are at double the risk of obesity of their non-depressed peers. People who are overweight or obese can have self-esteem issues, says White. They may feel bad about themselves for overeating and ashamed or embarrassed, all leading to depression. Getting regular exercise, eating a healthy diet, and losing weight can ease symptoms of depression.

Losing just a few pounds — even 5 percent of your body weight — can have a significant impact on your health by reducing your risk of developing many of these diseases.

Sunday, February 12, 2012

High heels ‘are to blame for flat feet’

Vanity sizing for shoes as women’s feet get fatter

London - it is a discovery that might leave high-heel fans feeling a little flat.

Sky-high shoes could be to blame for flat feet, according to a study.

Scientists claim that high heels are the reason women are more likely to develop the agonising condition than men - and say their risk is increased further if they spend a lot of time standing up.

But before you resign yourself to a lifetime of sensible footwear, the researchers also say they are close to finding a cure.

The scientists, from the University of East Anglia, believe that flat feet come about when tendons in the feet are weakened by proteins that occur naturally in the body.

This causes the arch of the foot to fall, which can lead to excruciating pain and difficulties walking.

And they say their discovery could lead to the development of new drugs to combat these proteins, called enzymes, and stop them weakening the tendons.

Around 3.5 percent of the British population are thought to be affected by flat feet.

The condition is more common in women over 40, but it also runs in families and many sufferers are born with it.

Dr Graham Riley, who carried out the study, said that high heels did not properly support the feet, which caused the tendons to weaken. He also warned that women who wore heels were particularly at risk if they spent large chunks of the day standing up.

High heels alter posture and increase pressure on the ball of the foot. Repeated wear is already known to strain the hips, knees and thighs, as well as increasing the risk of conditions such as osteoarthritis, hammer toe, back problems, bunions and corns.

At the moment, flat feet can be treated by wearing insoles or supportive devices inside the shoe. In some cases, patients have surgery to reshape their feet.

Despite the breakthrough, the scientists say it will be at least a decade before drugs for the condition are available.

But they claim that in future treatments could be developed for other common conditions of the feet such as Achilles tendonitis, which causes heel pain.

Dr Riley, whose study is published in the Annals of the Rheumatic Diseases journal, added: “Our study may have important therapeutic implications since the altered enzyme activity could be a target for new drug therapies in the future.

“We have shown that similar changes also take place in other painful tendon conditions such as Achilles tendonitis, so this advance may ultimately result in an effective alternative to surgery for many patients.”

Professor Alan Silman, medical director of Arthritis Research UK, said: “Foot problems are an important and not sufficiently recognised cause of pain and disability in the elderly.

“Ageing changes to the supporting tendons contribute to these problems and this research represents a first step to successfully unravelling some of the complex biochemistry that regulates tendon disorders.”

Saturday, February 11, 2012

Walk Your Way to Fitness

A regular walking workout can benefit your overall health. Find out why fitness walking is so important and how you can get started.

If you’re like most people, you walk just under three miles every day in the course of your normal activities. Now it’s time to get a little more purposeful. The Centers for Disease Control and Prevention, the American College of Sports Medicine, and the Surgeon General all agree that at least 30 minutes of brisk physical exercise is good for your health, and walking is one of the easiest forms of exercise to get.

Some of the many benefits of a regular walking workout include:

Cardiovascular health. Fitness walking strengthens your heart, improves your circulation, and lowers your blood pressure. A study published in The New England Journal of Medicine evaluated 73,743 postmenopausal women enrolled in the Women's Health Initiative Observational Study and found that women who walked briskly 2.5 hours every week reduced their chance of heart disease by 30 percent.

Bone health. As a weight-bearing exercise, walking can stop some of the bone loss of osteoporosis and may slow down arthritis.

Weight loss. A regular walking workout burns calories. If you walk 4 miles four times a week, you can walk off about a half-pound of fat every month. Weight loss combined with a healthy diet can also decrease your risk of type 2 diabetes.

Mental health. Studies show that fitness walking reduces stress and improves your overall sense of emotional well-being. A regular walking workout can help you enjoy deeper, more restful sleep, which may decrease your risk for anxiety and depression. How to Start Your Walking Workout

The speed and distance of your walking workout are not as important as the time you spend walking at a brisk pace. If you have any health issues talk to your doctor first and find out what is a safe pace for you. Start gradually and walk only as far and as long as is comfortable. Follow these fitness walking guidelines:

Work up to at least 30 minutes of brisk walking a day. Warm up by walking at your normal pace for about 5 minutes and then pick up the pace for about 15 minutes. While you walk, swing your arms and maintain good posture. Take long strides, but don't strain yourself. Slow down at the end of your walk and do some gentle stretching. Every week you should try to add about 5 more minutes to the brisk part of your walking workout until you can get it to over 30 minutes.

Keeping Up the Pace

Once you have decided to start walking for fitness, it's important to stick with it. The benefits of your walking workout take place and are maintained only over time. Here are some tips to keep you going:

Wear comfortable shoes. One sure way to lose interest in your walking workout is having sore feet. Take some time to get the right shoes. Your walking shoes need to fit your foot and the type of arch you have. Remember that your feet change over time. As you get older you may need more padding, more support, and more room, so have your feet measured regularly. It’s best to get your feet measured at the end of the day when your feet are larger; try on shoes with the socks you would wear for walking; and walk around for a while in the store before you buy.

Cultivate companionship. Walking with somebody else is safer, less boring, and more motivating. Many communities have walking groups you can join or you could start your own group. Walking with a friend or partner, taking along your dog, and making your walking workout a time you look forward to can help you stick with it.

Stay hydrated. Drinking enough water is an important part of a walking workout. Remember that you lose water through sweat even in cooler weather and that you don't start to feel thirsty until you’re already starting to become dehydrated. Drink about two cups of water before you start and another cup about every 15 minutes. Don't wait until you get thirsty.

Count the miles. Setting goals and keeping track of your progress can be a good motivator. You can set weight loss goals or mileage goals. Use a pedometer to measure the number of steps you take during your walking workout and keep track of your progress.

Friday, February 10, 2012

High price of wearing heels

For a quarter-century, Catherine Ange has worked as a seller of high-end furniture at the Atlanta Decorative Arts Center. Before computers became a mainstay of the job, a typical day could find Ange bending down, standing on tiptoe or moving furniture across 22,000 square feet of showroom space — all while wearing shoes with a 3- to 4-inch heel.

“I thought, ‘I feel so good in these heels. I can sell anything. I am invincible,’ ” said Ange, 47, of Buckhead. Her feet, unfortunately, were not so resilient.

By the time she reached her 30s, Ange was feeling the pain — a sharp, stabbing pain in the ball of her foot. She tried alternating heels and flats, but soon even flats were uncomfortable. She went to a doctor for injections of anti-inflammatories. Eventually, the only thing left to treat her Morton’s neuroma — a condition that causes thickening and pain in the nerves between the toes — was surgery.

After four surgeries in three years, heels are a thing of the past. “It is no laughing matter when you can no longer wear your Chanel pumps,” said Ange, who mostly wears custom orthotic inserts in her boots or sturdy tennis shoes.

The kind of debilitating foot pain that Ange experiences is a common problem for high heel wearers, particularly women who have been wearing heels for many years.

About 25 percent of women older than 40 have severe foot problems related to shoe choice, said Katy Bowman, a biomechanics expert and author of “Every Woman’s Guide to Foot Pain Relief: The New Science of Healthy Feet” (BenBella Books, $17). The problems can range from short-term issues such as blisters and calluses to long-term structural damage to the feet or body, such as shortening of the calf muscles.

“There are a lot of people trying to work themselves out of foot pain,” said Bowman, whose book helps women understand the mechanics of the foot and explains how to transition from heels to more sensible shoes.

“We know barefoot is natural, but you can’t just take off your shoes and start running,” she said.

Bowman’s advice includes exercises to help ward off foot troubles — at least for a while, because some women seem unable to resist the lure of high heels.

“No matter what I say, they are going to [wear heels],” said Dr. Jay Spector, of Northside Podiatry, who advises wearing no more than a 2-inch heel ... ever. Serious foot pain related to high heels can develop in as little as one night or a few weeks, he said. If you must wear high heels, Spector said, wearing them for shorter periods of time, then switching to a shoe with a lower heel can help.

Margaret Lisi of Midtown, a marketing manager who’s in her mid-40s, learned just how quickly heels can hurt when a pair of new gray pumps did a number on her feet.

“I felt like my feet had been cut open,” said Lisi, describing the pain. “I walked out of my building to go home and didn’t even make it across the street. I took the shoes off and tiptoed all the way to my car.”

The next day, Lisi shoved her scarred feet into a pair of boots. “[My feet] were like little loaves of bread rising in the warm environment of my cowboy boots,” Lisi said.

Women may take such isolated experiences lightly, but anyone who consistently wears heels can experience more severe problems over time, said Dr. Jason Morris, of Primera Podiatry, a new practice opening in February that offers advanced podiatry services such as a laser center and medical foot spa.

“The most common problem for patients who wear high heels daily or more than two to three times per week is thinning of the fat pad at the ball of the foot,” Morris said.

The abnormal positioning of the foot in high heels creates pressure on the ball of the foot, which thins the protective layer of fat and leads to a painful condition called metatarsalgia, he said.

Morris uses a new treatment — an injection of the filler Sculptra — to replace the fat pad and plump the area. The treatment can last 12 to 18 months, he said.

Morris also has treated heel wearers for stress fractures and another problem, bunions, which are caused by weakening of ligaments that hold the foot bones together. Bunions are genetic, but wearing heels can speed their development, Morris said.

Bunion surgery landed Michele Caplinger, senior executive director of the Atlanta Chapter of the Recording Academy, in the operating room just over a year ago. After more than 20 years wearing 3-inch heels on a regular basis, Caplinger had developed painful bunions on both feet.

“The pain was gradual, but I would literally end up in tears an hour into wearing a pair of heels,” Caplinger said. “In my line of work, I have many events, and I have to dress up, so I was constantly in pain.”

She went to foot doctors at least once a year and all recommended surgery, but Caplinger was terrified. When Caplinger met Dr. Perry Julien, the pain had become unbearable. She consented to surgery and has since been pain free.

The experience made Caplinger more thoughtful about her footwear choices but not quite ready to leave heels behind. “I am back in heels,” she said. “I do find myself in better-made, more reasonable shoes. That is an easy choice to make when vanity is not a priority.”

Wednesday, February 8, 2012

'Fat Chefs' and Diabetes: An Occupational Hazard?

Paula Deen's not alone. The new show 'Fat Chef' follows a dozen kitchen pros as they try to drop the pounds and reclaim their health.

FRIDAY, Jan. 27, 2012 — Have you ever heard the expression "Never trust a skinny chef?" Paula Deen isn't the only kitchen pro who's struggled with obesity — or with diabetes. Many men and women who make their living in the food industry, whether they're professional chefs, restauranteurs, caterers, or bakers, have issues with weight and compulsive eating. A new show, Fat Chef, which premiered on the Food Network this week, focuses on 12 of them as they embark on a 16-week plan to lose weight and get in shape.

One of the Fat Chef participants, 36-year-old Michael Mignano, is a bakery owner and pastry chef who was diagnosed with type 2 diabetes in 2009 after his weight reached 500 pounds. He told ABC News Nightline, "I allowed the stresses of work and life to just compound and just literally eat me alive," adding that when his blood sugar was finally checked by a doctor, it was "to the roof." But after four months eating lean protein and fiber and working out, Mignano has lost 100 pounds — going from a size 6X chef jacket down to a 2X. He also says he's "cured his diabetes" and hasn't taken any medication in three months.

Another Fat Chef participant, 41-year-old Ally Vitella, didn't know she had type 2 diabetes until she underwent a check-up for the show. Vitella, who weighed 345 pounds, says that her excess pounds affected her catering business, leaving her physically unable to carry equipment to her clients' locations. She told the Associated Press, "I was eating hors d'oeuvres for lunch and dinner. I would scoop up half a tray of food and eat it.…We cook things you're supposed to eat once in a while, but I was eating them every day." After doing the show, she's lost nearly 60 pounds and dropped from a size 28 to a size 16.

Another chef interviewed by the AP, Art Smith, was diagnosed with diabetes three years ago and says he reached 325 pounds on a diet of refined sugar and caffeine. Although he isn't one of the show participants, Smith, who was a former chef for Oprah Winfrey, has now lost 118 pounds and now runs marathons.

Mignano acknowledges the dangers of his chosen profession, telling the AP, "You have this abundance of food all around you…You're constantly tasting, working late hours, eating late." But the chef whose signature recipe is a "candy bar" loaded with caramel, nuts, and chocolate has no plans to find another line of work. "I love what I do, so for me to get another job and replace my profession is unfathomable," he told Nightline.

What can you do if you're surrounded by tempting, rich food all day long and need to watch your weight? One thing that may help is practicing mindful eating, which focuses on quieting the mind and tuning in to the body's hunger and fullness signals — both of which can stop that automatic hand-to-mouth motion. A recent study in the Journal of Nutrition and Education Behavior found that using mindful eating techniques when eating out helped women lose weight, even when they weren't trying to.

Tuesday, February 7, 2012

5 Best Reasons to Drink Water

Of all the food and beverage choices you face every day, what's calorie-free, virtually cost-free, and, oh yes, essential to keeping you alive? Plain ol' water. But those aren't the only reasons to drink it.

"Water drives basic body performance," says Beth Reardon, director of nutrition for Duke Integrative Medicine, part of the Duke University Health System. "All of the systems in the body require water for proper functioning, and so do 90 percent of all chemical reactions in the body."

Here are the top five reasons to quench your thirst with water.

It will help you de-stress
Why: Being sure to sip water throughout a stressful day can soothe stress-induced symptoms as diverse as headaches, tense muscles, fuzzy thinking, a pounding heart, and low energy. That's because stress taxes all your basic body systems -- and when you're dehydrated, the effects are magnified.

Given that more than half your body weight is water, Reardon says, "just a 2-percent reduction in hydration has a dramatic impact on energy levels and cognitive function." And dehydration further raises levels of cortisol -- the "stress hormone."
Water won't wash your stressors away. But it can provide you with more energy, ease tension, slow breathing, and reduce the strain on your heart.

Water-drinking tip: "Eight by eight -- eight 8-ounce glasses a day -- is a good general rule of thumb," Reardon says, "but it's a myth that's the magic amount for everyone, because there are so many variables." The "right" amount for you depends on factors including your age, your activity level, your health level, medications you're taking, and the weather. So how do you know if you're drinking enough? Follow your thirst, and know that you're on the right track if you have straw-colored urine, Reardon says.

You'll lose weight

Why: In a 2010 study of adults aged 55 to 75, drinking two 8-ounce glasses of water before meals was associated with almost four pounds more weight loss in 12 weeks than in a control group who ate a similar diet but didn't have the pre-meal H20. Participants drank an average of 1.5 cups of water a day before the study.
In part, the Virginia Tech researchers say, water is filling, so you feel fuller and eat less. An earlier study found those who drink water before meals consume an average of 75 fewer calories per meal. (Make that twice a day over a year, and that could add up to 14 pounds!) The Virginia Tech scientists also believe the water drinkers began swapping this zero-calorie beverage for sodas and other caloric beverages.

What's more, when you're well hydrated, your body is working closer to maximum efficiency -- enhancing aspects of weight loss, like digestion and muscle function, when you exercise.

Water-drinking tip: For variety's sake, try flavoring your water. Drop some fruit into a pitcher and let it sit a few minutes -- lemons, oranges, watermelon, and berries all work well. Or let an herbal or flavored green tea bag steep in unheated water to accent the taste.

You'll be less apt to get sick

Why: Hydration keeps your mucus membranes in top working order -- they're gatekeepers to the natural defense system that helps keep out germs such as cold and flu viruses. When these tissues dry out, germs can more easily penetrate to the nasopharynx, where the nasal passages and mouth meet. And if you catch a bug anyway, the severity of your illness is more likely to be lower if you've been drinking a lot of water.

Water is an especially smart health move when you're traveling. Most commercial planes fly at elevations between 30,000 and 35,000 feet, where humidity is 10 percent or lower. That means you're breathing dry air in a tight space filled with germs from dozens of people. Water keeps your mucus membranes moist -- and your defenses high -- even in that challenging situation.

Water-drinking tip: Bring an empty water bottle with you to the airport that you can fill for free once you're past security. Or buy the biggest bottle you can right before you board, and aim to finish it by flight's end. Don't hesitate to ask the flight attendant for refills while you're in the air.
Water, the Drink of Longevity

You'll be more comfortable

Why: It doesn't matter if the water you sip is hot or ice-cold. The act of drinking it will keep you warmer on a cold day -- and cool you off on a hot one.
"Your internal thermostat works better when you're well hydrated," Duke nutritionist Beth Reardon says. "Water helps regulate body temperature."

The body's temperature-regulating system, governed by the hypothalamus in the brain, is constantly picking up information that allows it to make adjustments to maintain a fairly steady core temperature. Hot sun? You'll sweat to cool down. Hatless in snow? The hypothalamus will know you're losing heat through your head and work to produce extra energy, such as shivering.

But these mechanisms work less well if you're dehydrated – and dehydration is a common risk for people of all ages, in winter as well as summer. In cold weather, for example, you lose water vapor through your breath. And many people tend to drink less water in cold weather because they don't think they need it as much as on hot, sunny days.

Water-drinking tip: Start by swapping out one soda, cup of coffee, or high-calorie hot chocolate a day with an equal amount of water. Carry a bottle of water with you all day long as a visual reminder to pause and sip. Sip more when you're physically active, whether in water, snow, or any weather condition.

It will help regulate your blood pressure

Why: In 2010, the American Red Cross discovered that when blood donors were given 16 ounces of water to drink before giving blood, there was a 20 percent drop in fainting after the procedure. That was an important finding for them, given that many of those who faint then chalk blood donation up as a bad experience and never return to give again.

It's not entirely clear what mechanism is at work. But the Red Cross was inspired to conduct a study after researchers at Vanderbilt University noticed that drinking water activated the parasympathetic nervous system -- related to the "fight or flight" system that makes you more alert, elevates blood pressure momentarily, and boosts energy. Fainting after donating blood is often connected to a drop in blood pressure, and they theorized that the water would counter that effect.

(Not drinking enough water on a regular basis can also raise blood pressure. That's because dehydration causes blood vessels to constrict as the body strives to conserve water that it loses through perspiration, urination, and breathing. When blood vessels constrict, however, the heart pumps harder, bringing blood pressure up.)

Water-drinking tip: Start your day with a glass of water for a simple energy boost that remedies any dehydration that may have occurred overnight. Keep a filled glass or bottle on your nightstand or an empty one next to the bathroom sink.

Saturday, February 4, 2012

Striking a balance: Foot orthoses in DPN (Diabetic Peripheral Neuropathy)

Preliminary research suggests that impaired balance in patients with diabetic peripheral neuropathy (DPN) may improve with proprioceptive stimulation from foot orthoses.

Postural instability is common in patients with diabetic neuropathy, said David Levine, DPM, CPed, who is in private practice in Frederick, MD.

“Balance issues occur as we age, but add in diabetes and other medical conditions and balance becomes even more of an issue,” he said.

There have been concerns that the soft materials used in orthoses often prescribed for patients with DPN may reduce somatosensory input on the foot’s plantar surface and reduce postural stability. But a study from the Netherlands suggests this concern may be unwarranted.

In the September 2007 Pros­thetics and Orthotics International, researchers from the University of Groningen in the Netherlands pub­lished a study assessing 30 patients with DPN (aged 37-82 years) and 10 healthy controls (aged 27-51 years).

Postural stability was evaluated in a shoe without insoles, a shoe plus flat insole with a low Shore A value (15°), and a shoe plus flat insole with a higher Shore A value (30°). Researchers performed assessments in four conditions: eyes open, eyes closed, and these conditions with and without a dual task (mental arithmetic).

Patients had significantly increased postural instability compared with controls (p < 0.05) and with eyes closed compared with eyes open (p < 0.05); the latter finding was more pronounced in patients with DPN. No significant effects were found for insoles or dual tasks for the total group or for insoles in the DPN group.

Another study from the same institution published in the July 2008 Journal of Rehabilitation Research & Development investigated the effects of vibrating insoles on standing balance in 17 patients with DPN and 15 individuals without diabetes or impaired sensation.

Participants stood for 60 seconds on vibrating insoles placed on a force plate. Vibrations were not perceptible to participants. Investigators assessed effects of the insoles under four conditions: eyes open, eyes closed, and these conditions with and without a dual task.

Vibrating insoles improved standing balance in subjects with neuropathy when attention was distracted, the condition most often associated with impaired balance and falls in real-world settings. Researchers found no effects of vibration on balance in healthy participants.

A 2006 Boston University study published in the Annals of Neurology found that vibrating insoles significantly reduced postural sway in 15 patients with diabetic neuropathy, 15 patients with stroke, and 15 healthy elderly control subjects.

The evidence is still preliminary, however, a point noted in a review published in July in the Journal of Geriatric Physical Therapy. Res­earchers at Children’s Hospitals and Clinics of Minnesota reviewed six articles on interventions, including vibrating insoles, used to minimize balance dysfunction in people with DPN. Apart from lower extremity strength­ening exercises, which re­ceived a fair recommendation, all interventions lacked evidence to either support or disprove their effect on balance in DPN.

Some practitioners aren’t sure that the value of orthoses for patients with DPN involves balance, which, in addition to reduced proprioception, can be affected by vision problems, weakness, or medication side effects.

“I see orthoses as more of an aid for protection, cushioning, and prevention of diabetic foot complications rather than for helping balance,” said Dennis Janisse, CPed, president and CEO of National Pedorthic Services in Milwaukee, WI.

Orthopedic issues may also be balance mediators that can be addressed orthotically.

“Combinations of leg length discrepancy and peripheral neuropathy are issues that shouldn’t be overlooked. Many of these patients may also have had a joint replacement, which quickly adds a lot of factors that can make ambulating even a short distance a challenge,” Levine said.

Footwear selection, he noted, can also affect balance.

“Assessing footwear is an important step to take before starting to think about orthotics,” Levine said. “Prescribing a shoe with a wider base of support might be all that’s necessary. If an orthotic device is made for a poorly supportive shoe or a shoe that doesn’t fit well, the orthotic won’t help. The shoe, after all, is the ultimate orthotic.”

Friday, February 3, 2012

Debunking myths: Compression hosiery

Myths abound in discussions about healthcare (just think chicken soup). But when it comes to the use of compression hosiery, some tales can be debunked easily.

The benefits of compression hosiery include improved blood circulation for patients with varicose veins, or achy swollen feet—especially helpful for those with diabetes.

Traditionally, home medical equipment (HME) and durable medical equipment (DME) companies have dispatched representatives to practitioners’ offices to educate them about the availability of products. Typically, these reps leave behind a locally printed prescription pad for physicians, a scenario that leads to the first big myth.

Myth 1: Compression stockings require a prescription.

By law, no prescription is re­quired. Practically speaking, though, many pharmacies require a pre­scription for higher-level compression hosiery. Compression levels range from 10 to 30 mm Hg and above; compression above 10 to 15 mm Hg falls into the higher range.

“Most pharmacies won’t dispense higher-level compres­sion hosiery without a prescription,” said Marybeth Crane, DPM, of Foot and Ankle Associates of North Texas, in Grapevine, TX.

Patients, however, can get lower-level compression hose that work very well without a prescription, said Bill Meanwell, CPed, of the International School of Pedorthics in Broken Arrow, OK.

Most patients can use 10- or 15-mm Hg hosiery without a problem, but using higher levels of compression requires more knowledge on the part of the patient, said Bret Ribotsky, DPM, a podiatrist in private practice in Boca Raton, FL, and founder of www.PodiatricSuccess.com, a website featuring audio interviews with prominent podiatrists. If 10 to 15 mm Hg is not effective, patients should see a practitioner for further guidance, Ribotsky added.

“It’s a good idea to have a physician to pick out the compression level,” he said.

Myth 2: Compression stockings are appropriate only for certain patients.

“The only people who don’t need compression stockings are giraffes,” Ribotsky said. “Gravity is your enemy, so you might as well use the stockings.”

Almost all individuals can benefit from compression, said Crane, especially patients with diabetes, as long as they have adequate arterial circulation.

“I wear compression stockings in the operating room to help with leg fatigue,” she said.

Professional athletes are taking advantage of compression wear to improve performance and recover faster from injuries, according to Crane and Meanwell.

“If you have absolutely zero edema, and you have an excellent venous system, well, maybe the compression hose aren’t necessary,” Meanwell said.

Myth 3: The risks of compression hosiery outweigh the benefits.

“Ridiculous,” Crane said. “A patient with severe vascular disease should not use compression wear, but otherwise it’s not dangerous.”

In fact, said Meanwell, “the risk of not wearing them and developing a blood clot or pooling of blood in the foot is definitely a major risk.”

There are no risks if the hose are properly fitted, he added.

“The compression hose must be properly and professionally fitted and professionally selected [probably by the specialist at the pharmacy],” he said, adding that it’s best to measure the legs in the morning before they expand and swell.

Myth 4: Your patients can’t afford compression stockings.

“I think it’s all about making them a must rather than a should,” Ribostsky said. “You have to tell a compelling story. You might ask, ‘Do you want to take your grandkids to Disney World without your legs hurting?’”

Myth 5: Your patients won’t wear compression hosiery even if you prescribe them.

It’s true that compression hose can be intimidating to patients, Meanwell said.

“It’s like a wrestling match with yourself,” he said. “If you’re not a flexible person by nature, you would be worried that you’d find yourself in a video on YouTube putting on these hose. They can be quite taxing.”

But these issues can be addressed through patient education and the use of assistive devices to help with donning and doffing.

“If you need the strong compression but can’t get them on, then start with the light compression,” Ribotsky said. “A little compression is better than nothing

Wednesday, February 1, 2012

Have high-heel hangover? Here's help

High heels push the pelvis forward, shifting body weight and loading the small bones and tissues of the forefoot. Hello bunions, fasciitis and hammer toes.

Photograph by: Wayne Cuddington, PNG Merlin Files, Vancouver Sun

We often talk about the post-holiday hangover: the sluggish feeling we get from all the food and drink consumed. But there is another hangover many women experience. It starts in the feet and works it's way up. We're talking about the high-heel hangover.

We all know that high heels are bad for our feet, but there are so many fabulous heels out there and they sure can dress up an outfit and make our legs look great. So we often ignore the obvious and pretend that a well made, well fitting pair of heels is the answer.

Maybe we don't wear them every day, but during the holiday season, with parties every other day, we donned them more often than usual.

And now we are suffering the high-heel hangover.

"Foot health is a really big issue for people over the age of 40, to the point where one in four can't really walk without foot pain," says U.S.-based bio-mechanics expert Katy Bowman, author of Every Woman's Guide to Foot Pain Relief.

According to Bowman, who is also the director of the Restorative Exercise Institute in California, foot pain is the canary in the coal mine of human health. Jimmy Choos and Manolo Blahniks are the poison.

"Your foot pain is like an early indicator of the state of everything," she says. "Every other ailment of the body, from your body composition to even something like depression, all of those ailments are affected by physical mobility. But more than that, foot pain tells us that our knees, hips and back are at risk.

Most of us totally ignore our feet. We may exercise all the other parts of our bodies, but do nothing south of the ankle. Many of us can't spread our toes, fewer still can lift each toe individually.

That is where the problem begins, says Bowman. "The feet are just breaking down under the weight of the body because there is no muscle to resist it."

Then we mess with our posture by wearing high heels.

If we are standing with perfect posture, our pelvis is in the middle of a vertical line from our head to our heels, which as the densest structure of the foot are the best equipped to take our weight, says Bowman.

But when we wear heels, we push the pelvis forward positioning our weight over the front of the feet and loading the small bones and tissues of the forefoot. Hello bunions, fasciitis and hammer toes.

Wearing heels also causes the calf muscle to shorten, which in turn causes a cascade of problems, including knee and hip osteo arthritis. Research has shown people who have worn high heels regularly for more than 20 years have calves 13-per-cent shorter than everyone else.

"That is what causes the knee osteo arthritis, because the calf muscle attaches above the knee joint so the tighter the muscle the less joint space your knee has."

Even low heels can do the damage, says Bowman, adding there is no such thing as a sensible heel, except "in same way as there is a sensible cigarette." If we must wear heels, we should treat them like we treat dessert, she says.

"There is a consequence that comes with eating a lot of desserts and there are steps you can take to mitigate the effects. The same thing goes with high heels.

"If you are going to wear them, instead of trying to come up with a healthier way to do so, you want to come up with another daily habit or habit you cultivate every time you wear them that undoes some of the permanent tissue changes so that you don't have to deal with the full effects of wearing them."

These habits should include stretching, strengthening and wearing flat, flexible footwear or bare feet the rest of the time. Fifteen minutes of exercise a day is enough to protect your feet, says Bowman, and no fancy equipment is needed.

So avoid the hangover. Limit your time in heels and mitigate the damage they do. Here are four basic exercises that anyone can do, even as they watch TV or work at their desk.

Calf Stretch: Put your hands on a wall, place one foot in front of the other and keeping both heels on the ground, bend the front knee until you can feel the stretch in your back calf. Hold 30 seconds. A second calf stretch can be done on stairs; hang one heel off the stair until you can feel the stretch. Hold 30 seconds. Switch.

"A calf stretch is what anyone who wears any shoes should do, because even your general athletic shoe is technically 1½-2 inches (3.8-5 cm) in the heel, so that is a high heel, too," says Bowman. "So calf stretch, calf stretch, calf stretch."

Toe spread: Sit in a chair and rest your feet on an ottoman or low table. Spread your toes so that there is a space between each one. Repeat. (if you can't do this, start with wearing pedicure spacers).

Toe lift: Standing straight, lift your big toes off the ground while keeping all the other toes on the ground. Then lift the other toes one by one.

Tennis ball massage: While seated, roll a tennis ball under your feet to stretch your plantar fascia. If your feet are inflamed or tired, roll your foot over a bottle of water that has been frozen.