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Arthroscopic meniscal débridement

Arthroscopic meniscal débridement

May not help patients with degenerative meniscal tears.Arthroscopic meniscal débridement is a commonly performed procedure in patients with degenerative meniscal tears. A recent study reports that arthroscopic surgery did not result in a significant improvement in pain scores in the short term or in the long term. An article written by Moin Khan, MD and others published August 25, 2014 in the CMAJ reviewed 805 patient outcomes for function and pain relief. The study compared surgery with: exercise or physical therapy; NSAIDS plus exercise; steroid injections; or control groups without meniscal débridement (sham treatment).

The authors conclude that the evidence suggests there is no benefit to arthroscopic meniscal débridement for degenerative meniscal tears in comparison to nonoperative treatments or sham treatments in middle-aged patients with mild or no accompanying osteoarthritis.

Informed patients along with their physicians need to carefully weigh the anticipated benefits against the possible harms when considering treatment options.

http://www.cmaj.ca/content/early/2014/08/25/cmaj.140433.full.pdf​

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Skin Cancer

Skin Cancer

Skin cancer is the most common form of cancer, and is often thought of as minor. There are two types, basal and squamous cell carcinomas, which are easy to treat. Malignant melanoma however, is very difficult to treat and can cause cancer in other body parts. Prompt and early detection is imperative in treatment of skin cancers. Be sure to monitor your skin using the ABCDE system.

A: Asymmetry-one side of a mole doesn’t match the other, B: Border-edges are ragged, notched or blurred, C: Color-is not even through out or color merges into the surrounding skin, D: Diameter-any larger than a pencil eraser is of concern, E: Evolution-any change in size, surface, shape or color. Use sun screen daily and avoid any prolonged exposure, especially mid-day to help reduce your risk.

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Infant Immunizations

Infant Immunizations

Immunization in infants and children has become a hot topic of conversation. Some believe the shots can cause developmental disorders such as autism in children. They find security in believing that the immunizations are not necessary because the diseases they address have been all but eradicated in this country.

It’s not that these diseases no longer exist, but we have created communal immunity due to the immunization schedule. Therefore, as more and more people choose not to give their children shots the diseases can return to our communities. Research continues to provide data that there is no link between immunizations and autism spectrum disorders. All medical foundations continue to recommend that these shots be given to all children.

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Gardening is a common hobby that is stressful to many body parts such as knees, back, shoulders and neck.

Gardening is a common hobby that is stressful to many body parts such as knees, back, shoulders and neck.

Here are a few tips on how to reduce stress on the body when working outside.
• Warm up first by walking and stretching.
• Alternate positions or activities often.
• Sit on a bucket or stool instead of bending over.
• Use a wheelbarrow as much as possible.
• Plant in elevated potters so that you don’t have to kneel so close to the ground.
• Use proper body mechanics when lifting or pulling anything. Your power should come from the legs, not the back.

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Recovery is an important, and often overlooked part of an exercise routine

Recovery is an important, and often overlooked part of an exercise routine

It is required to allow your body to be healthy to make physical gains. Stretching is required to maintain flexibility of muscles and should be done before and after an exercise routine. Maintaining proper hydration and nutrition is important to refuel the body after exercise.

Cross training is alternating the type of exercise or body parts that you are strengthening. This allows for parts of your body to rest and recover while you exercise others. Lastly, sleep is mandatory to help your body maintain its best function. It is not beneficial to get up early to exercise if you have had less than 7-8 hours of sleep.

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Soreness is an expected response to vigorous exercise

Soreness is an expected response to vigorous exercise

We need to be able to differentiate it from pain, which can have a negative impact of fitness. Muscular soreness is a sign that you are working to your threshold, which will help you make gains. Pain however, is a negative sign that you are passing that threshold, and possibly causing injury.

“No pain no gain” is not the motto that you want to follow when exercising. Muscle soreness often peaks at 24-72 hours and is lessened by light repetitive movement such as biking. Pain is present despite rest and feels more sharp. If it continues longer that 1 weeks you should seek medical advise, and possibly physical therapy.

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Exercise helps manage the pain associated with arthritis

Exercise helps manage the pain associated with arthritis

arthritisSome people think that people with arthritis shouldn’t exercise, or even that forceful exercise such as running can cause arthritis.  This is a myth.  Exercise is one way to help manage the pain associated with arthritis.  It just requires performing a routine that is beneficial rather than irritating to your joints.

The goal is to do a program that allows for strength and endurance in a way that is less than body weight. This is best done sitting or laying, and aquatic exercises are always beneficial for this population.

ergonomics

Ergonomics is the study of people’s efficiency in their work environment.  Sitting at a computer is the most common problem in a work or home setting.  Ideally, the top of the computer screen should be at eye level and down. It needs to be close enough that you don’t lean forward to see it well.

The arms should be down at your side and supported there by arm rests.  Your feet should be able to rest flat on the floor.  The chair should have proper lumbar cushion and support so that you maintain an upright posture.

 

back

The most common area of pain is in the low back, or lumbar spine.  The general diagnosis of degenerative spine problems are a common reason for back pain.

This is often seen in the older adult population, and sometimes includes leg pain. This set of conditions required a flexion based exercise program, which helps to open up the spine and decrease the amount of pressure in the area.

Extension exercises should be avoided and walking for exercise should be limited, as it is a common aggravating factor.  See a Physical Therapist for a specific plan that can help reduce these symptoms and return you to functional activities.

 

r7_fasciitis-1Plantar fasciitis is inflammation of connective tissue in the arch of the foot, and causes pain with standing. Pain is often worst in the heel first thing in the morning, as the tissue is tightest then.

It is imperative for people with this diagnosis to wear proper shoes that provide good arch support.  The plantar fascia needs to be stretched and the foot and ankle strengthened so that it has proper mechanics.

 

greater troch

 

Pain on the side of the hip is often caused by greater trochanteric bursitis.  This is an inflammatory condition of the bursa(a fluid filled sack) that is on the outside of the hip.  It causes pain with side sleeping and repetitive motions like walking or stair climbing.

The muscles in this area are commonly weak, and need to be strengthened to  stabilize the pelvis.

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Sleeping Positions Impact

Sleeping Positions Impact

Sleeping can have a large impact on how you feel in the morning or even for the entire day.  Sleeping on your back with your legs elevated is the most beneficial position for people across the board.  It allows the spine to stay in a strait line, and does not cause increased pressure on any body parts.

On the other hand, sleeping on your stomach is the worst.  It requires an extreme amount of neck rotation and often people’s arms are above their heads, causing pinching at the shoulders.  If laying on your back(supine) cannot be tolerated, side-lying is second best.  This position however, requires the use of a pillow between the legs to decrease pressure on the hips.

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Are you at risk of falling?

Are you at risk of falling?

BLOOD PRESSURE MEDICATIONS AND FALL INJURIES

Falls in the elderly may account for as much as 33% of the deaths in this country. According to a recent article in JAMA, the risk of falling is even higher if you are taking blood pressure medication. There are many reasons why people fall, including osteoporosis, Parkinson’s disease and most commonly balance disorders. According to this study, taking multiple medications, not only for blood pressure but other co-existing illnesses also increase the risk of falling.

JNC 8 (Joint National Commission on Hypertension) recently stated that a blood pressure reading of 150/90 is not an acceptable goal in patients older than 60. Many physicians like myself do not believe in these new guidelines but I think they were made in order to allow patients to be on less medications and decrease the risk of blood pressure dropping too low, thereby causing less dizziness and falls. Of course higher blood pressures increase the risk of stroke or heart attack.

In Florida, patients have to be aware that the heat and humidity make it imperative to maintain hydration.

Even though the government wants physicians to practice “cookbook” medicine, the practice has always been and always will be an art. Every patient is different and so should their treatment programs.

In our practice, in conjunction with KAIZEN TOTAL WELLNESS, we are committed to preventing falls. Not only to we offer computerized balance testing but our physical therapy department, under the guidance of Dr. Jill Rose, who is one of only a handful of certified balance therapists in Sarasota-Manatee, has been very successful in not only improving balance but also muscle and bone strength.

Please contact our office for more information.

MAXhealth Lakewood Ranch and Dr. Mishner   941-747-2090

Kaizen Total Wellness  941-315-6182

 

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Regulate supplements: Herald Tribune Editorial Dec. 27, 2013

Regulate supplements: Herald Tribune Editorial Dec. 27, 2013

As our patients and readers of the Kaizen Total Wellness blog already know, I have been on this bandwagon for years! Supplements are often useless, not regulated properly, and generally not beneficial!! Much has been written lately confirming my opinions – and the following editorial in the Herald Tribune states it thoroughly and clearly!

A portion of this editorial has been printed here. To read the entire editorial, go to this link:http://www.heraldtribune.com/article/20131227/OPINION/312279997?p=1&tc=pg

Published: Friday, December 27, 2013 at 1:00 a.m.
Last Modified: Thursday, December 26, 2013 at 6:10 p.m.

 

Dietary supplements, whose makers make health-related claims ranging from mundane to miraculous, are a $32 billion industry in the United States.

Yet, since a deregulation law was passed in 1994 and signed by then-President Bill Clinton, supplements that include potent drugs or fillers largely escape inspection by the Food and Drug Administration — until users become sick or die.

Emerging evidence

New data — released last month and reported Sunday by the New York Times — suggests that dietary supplements account for nearly 20 percent of drug-related liver injuries in hospitalized patients. That percentage is up from 7 percent a decade ago.

The Times told the story of a 17-year-old Texas boy who had taken a concentrated green tea extract, purchased at a nutrition store and labeled as a “fat burner.” The boy’s liver had sustained so much damage that a transplant was required.

Since the Dietary Supplement Health and Education Act was passed nearly two decades ago, physicians, researchers and the FDA have steadily reported adverse reactions and issued warnings about supplements. For example:

• In November, the Times reported that Canadian researchers used DNA testing to check the ingredients of 44 bottles of popular supplements sold by 12 companies. In one-third of the bottles, the tests showed not a single trace of the herb listed on the bottle label. Others were mixed with filler ingredients not listed on the label.

• In April, U.S. regulators found that “workout-booster” and “fat-burning” products sold as Jack3d and OxyElitePro contained a stimulant called dimethyamyamine (DMAA). The stimulant was linked to heart problems, high blood pressure and at least five deaths (reporting remains sketchy and likely underestimates the problems).

• In 2011, investigators found Pai You Gho — a weight-loss supplement from China that contained two drugs, including a suspected carcinogen — on store shelves, even though the product was recalled in 2009.

• In 2009, the FDA issued a public warning about the “Xtreme” line of body-building products, which improperly contained synthetic steroids. StarCaps, made in Peru and promoted as an all-natural weight-loss supplement, was found to contain bumetanide, a potent diuretic. Hydrocut, another supposed fat burner, was recalled after the FDA linked its use to liver and muscle damage and heart problems.

At the time, the FDA warned that 70 brands of pills illegally contained prescription-drug ingredients.

• In 2004, the FDA banned the use of supplements containing ephedra, a class of natural, amphetamine-like substances found in plants. Unfortunately, the ban didn’t occur until after the administration cited “substantial evidence of harm,” based on a study that showed “more than 16,000 adverse events associated with the use of ephedra-containing dietary supplements, including heart palpitations, tremors and insomnia.”

The dangers of such products made national headlines in February 2003 when a Major League Baseball player — attempting to lose weight during spring training — died after using ephedra three times per day. (Ironically, after 2004, Hydroxycut created a whole line of “ephedra-free” products.)

For the rest of the editorial, you can find it in the Dec. 27,  2013 edition of the Herald Tribune or click on this link:

http://www.heraldtribune.com/article/20131227/OPINION/312279997?p=1&tc=pg

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