September 2013 - Advanced Physical Medicine
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Teens, Loose Weight The Healthy Way

As young adults, concern for developing healthy habits falls somewhere behind homework, extra curriculars and what your friends think. You're in the upper half of your formative years, but you are still adjusting daily to what the world expects of you. It can be a lot to carry at times. And when your metabolism begins slowing due to factors like genetics, body image comes into play. Body image, for teens and young adults, has always been a major source of stress, and with increasing access to media that projects what we are 'supposed to look like,'  who can blame you taking it to heart.

The truth is, weight gain as young adults is an increasing trend that you should be concerned about. Studies have indicated a future of cardiovascular disease, various cancers, kidney stones, gout, hypertension and type 2 diabetes in those who consistently gain weight during teenage to early twenties development.

The most important step to take for your health, even if you area already overweight, is to stop and prevent weight gain.  Weight stabilization alone will help keep complications later in life at bay.

Important Questions To Ask Yourself

Stressed College StudentWhen approaching weight loss, there are a few important questions to ask yourself before deciding on a plan.

1. What are the main sources of stress in my life?

-Cotrisol is a hormone  produced by the body in times of stress. What cortisol does is stimulate and promote fat storage, especially in the abdominal area.

-Figuring out what is stressing you out, and finding a way to reduce that stress, is a huge step towards shedding excess fat as a teen. Life may seem a little out of control sometimes, but make sure you take a moment to relax and collect yourself.

2. What are my friends doing?

-Social influence plays a big part in developing a healthy routine. If your friends don't take care of their bodies and what they put into them, you won't have much motivation to do so either. Fad diets and quick cleanses are actually diuretics or laxatives in disguise, meaning that they will shed water weight temporarily, then as your body reacts it will come back, often multiplied. The actuality of it is, the more water you drink, the more water weight you lose by flushing your system.

-If all your friends do is complain about how the look, tell them to do something about it. Then develop better habits collectively. You are more likely to succeed together than alone.

3. What have I been eating?

-If the answer is pizza dipped in ranch for lunch and microwave dinners every day, you may want to reconsider. Mass manufactured foods tend to have a lot of preservatives added to them. Preservatives make the food last longer and look better, but also take a toll on your body, especially if your goal is healthy weight loss. Keep salts and sugars to a minimum by eating fresher items so you know exactly what you're putting into you body.

-Cut out soda and replace it with water. With that alone, you will feel and see a difference.

-Snack. Fruit, unsalted nuts other proteins are all easy to carry with you, and great to snack on throughout the day. Don't starve yourself, your brain and body need fuel. Snack so you'll be able to have smaller portions at meal times. Food and calories aren't bad, it's the type of food adding the calories that should be your concern.

A Healthy Diet is Not Enough

However, a healthy diet is the base of a healthy lifestyle. You have to start moving to complete the picture, and get the results you want. Just walking an extra 10 minutes a few times a day will make a huge difference. They key is not to focus on one or two parts of your body that you don't like, it's to go for whole body improvement. Once you're in that mindset, the parts you want to fix will improve more permanently.

Here are a few things to think about along the way:

What is Healthy? As much as we are bombarded with the image of boney women with pre-teen bodies, and men bursting with steroid muscle, in reality, not many people actually find those traits attractive. As the Cross Fit motto would say, "Strong is the New Skinny." The preference towards a healthy, well taken care of body is only increasing. Lean muscle is mass, but it's an appealing one.

Attitude is Everything. If you feel good, you look good to yourself and others. The more dedicated you are to growing as a person into a healthy adult, the more successful you are going to be. Depression has been singled out as a prominent cause of weight gain. Fight that by moving, even when you don't want to. Exercise releases chemicals that improve mood. Getting discouraged and giving up just can't be options for you anymore.

Don't Let Stress Keep You From Living Your Life. The point of changing habits isn't to give you anxiety over what you're eating or if you are seeing any difference. Having pizza with your friends isn't forbidden. It's how much you consume and how often that you control. Give yourself a break and be human. Be positive about taking care of yourself, and know that worrying too much about it is a step backwards.

Diabetes: Lower Limb Amputation, Neuropathy and PAD

We've spoken before about the problem of diabetes in America, and briefly about the complications that can occur throughout the body when the disease is not well managed. Unfortunately having diabetes raises a persons risk factor when it comes to a number of other conditions. Trouble with skin and lower limbs are just two on a list of many, but they are two complications that need to be paid attention to. High blood sugar levels lower circulation and causes nerve damage that if not monitored, will lead to amputation.

According to the CDC, more than half non-traumatic lower limb amputations in the US are due to diabetes.

The statistics sound extreme, and the numbers have been going down some, but they emphasize the benefits of monitoring blood sugar levels and the harm that has been done to others by ignoring them. There are two main complications that will contribute to eventual loss of toe, foot or lower limb.

Reduced Circulation:

Cuts and other injuries in the body need the oxygen and nutrients that blood carries to assist in restoring and healing problematic areas. When high blood glucose decreases circulation to the lower limbs, any physical injury is inhibited in its healing process, leaving it open to serious infection. In some cases of neglect, the infection reaches the bone and becomes gangrene.

Neuropathy:File:Ulcers, fissures, and erosions.svg

Diabetes is one of the most common causes of neuropathy. Though raised glucose levels can damage nerve fibers throughout the body, the numbness and pain tend to be more prominently felt in the lower legs and feet. With the loss of feeling, often times cuts or injuries can go unnoticed and become infected or ulcerated, a condition in which the skin and soft tissues break down, easily. It is estimated that 15% of diabetic individuals will have diabetic foot ulcer problems in their lifetime. Medical professionals believe this number to be unrealistically low, due to diabetics not reporting foot issues.

What is the likelihood of infections effecting the lower limbs?

Unfortunately, the risk of infection is higher not only because poor circulation stunts a body's healing capabilities, but also because diabetics are also prone to a variety of skin conditions. High blood sugar can lead to conditions including:

  • Carbuncles (deep infections of the skin and soft tissues beneath)
  • Boils
  • Rashes
  • Foliculitis
  • Infections around the nail
  • Bullosis Diabeticorum: blisters on the back of fingers, hands, toes,  feet and sometimes legs and forearms.
  • Digital Sclerosis: tight thick skin on the back of the hand, and sometimes toes and forehead that causes joints to stiffen and become immovable.
  • Eruptive Xanthomatosis: yellow pea-like enlargements of the skin on the back of hands, feet, arms, leg and buttocks. More prevalent in men with type 1 diabetes and high cholesterol.
  • Charcot Foot: a food deformity that least to a loss of sensation during which an undetected broken bone will cause soft tissue destruction.

When combined with neuropathy, a diabetic skin condition on the legs or feet can easily be overlooked and fester into infection. At the point at which antibiotics and debridement, the removal of affected or necrotic tissues, stop being effective,  it becomes necessary to amputate in order to prevent the infection from spreading and damaging adjacent areas of the body.

Peripheral Arterial Disease:

File:Peripheral Arterial Disease.gifDiabetes also increases the likelihood of Peripheral Arterial Disease (PAD), which occurs when blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. This condition puts a diabetic at even a higher risk of heart attack and stroke.

What connects diabetes and PAD?

Diabetics and those with impaired glucose regulation, test with high levels of C-reactive protein (CRP).

C-reactive protein (CRP): a protein found in the blood that appears when swelling is present somewhere in the body. It is often tested for after surgery or treatment for infections.

Elevated levels of CRP, which diabetics test high for, are strongly associate with the development of PAD. For one in three diabetics over 50, the reduced circulation due to high blood glucose, will lead to Peripheral Artery Disease (PAD). Other factors of the condition include smoking, high blood pressure and cholesterol, obesity, sedentary lifestyle and a history of heart disease.

If injury due to unnoticed effected tissue or the development of PAD because of high CRP levels lead to amputation, not only can it be an incredibly painful process, it also requires up to 8 weeks to properly heal. After that, extensive physical therapy and lifestyle adjustments are in order.

How can this be prevented?

The best way to prevent the possibility of amputation in the future is to take care of yourself. Keeping close watch on your diabetes by monitoring sugar levels regularly, adjusting to a more consciously healthy lifestyle and paying attention to even small injuries on your lower limbs will go a long way.

How do I know if I have fungus in my Toenail?

Many people come into the office disappointed with their toenails.  Sometimes they are using a self remedy or store bought product, and it  is not working.  Sometimes the medication prescribed by another doctor is not working.  Sometimes the condition is getting worse or spreading, and the patient does not know what to do.  Toenails can develop many changes: thickness, discoloration, pain, blood underneath, ridges, or become crumbly.  Often this is caused by fungus, which invades the nail. Fungi grow and thrive in  warm, moist places like our shoes and socks because our feet are often sweaty.  Additionally, fungal growth is common in locker rooms, pools, and gyms because of the warm environment.  

Fungal nails can get worse if untreated.  However, the only way to know for sure if a nail is fungal is to take a biopsy or piece of nail and send it for testing.  Usually, the report comes back and states that there is indeed a fungus in the nail.  Then, topical or oral medication is prescribed to treat the condition.  There are risks, benefits, and different success rates for the different medications, and these are discussed prior to treatment.  Sometimes biopsies come back and show that a toenail exhibits changes just from trauma.  This can be caused by repetitive pressure from running, tight shoegear, or a job that requires repeated movements of the toes and foot.  There are treatments that can improved the appearance and thickness of the toenail, even if fungus is not present.  Additionally, changes in shoegear are helpful, such as buying shoes that are not too tight, have a wider or higher toebox, or have softer material over the toes.  

 What should I expect from a nail biopsy?

 A piece of nail must be cut off as far back as possible on the toenail.  The procedure usually does not require anesthetic.  Antibiotic ointment and a band aid my be necessary after the piece of nail is removed. 

 If you have changes to your toenail, make an appointment today at Advanced Physical Medicine.  Dr. Bender is a foot and ankle specialist with thirteen years of private practice experience in Chicagoland.  Dr. Bender was an instructor at William Scholl College of Podiatric Medicine for nine years and recently left teaching to devote her full attention to her private practice.  Dr. Bender was an ice skater for 19 years, and this resulted in many problems with her feet.  After three foot surgeries, she know how it feels to have foot pain!  Schedule your appointment today!  708-763-0580 Oak Park and 773-776-3166 Chicago/63rd

Preparing For A Marathon

Philippides, the courier behind the legendary origin of the race, was reported to have run from Sparta to Athens and back bearing news of victory over the Persians in the Battle of Marathon.

A feat of endurance, to say the least. File:Phidippides.jpg

Today, there's less patriotic urgency and a few more clothes involved, but we owe thanks to Philippides for what has now become a traditional challenge for the every-man/woman willing to take on the 26.2 mile race.

Fortunately for us, we have a little more time for planning and preparing our bodies than he did, when it comes to that long haul. Marathons require commitment and dedication from us. But what exactly does that mean when it comes to training, nutrition and all together health? Theories and opinions always seem to be changing as more research is taken into account by nutritionist, biologists and running trainers. More sports drinks, high-fat diets and low carb loading, specific fats and high carb diets. What's worth paying attention to? For every runner, especially first time marathoners, the advice across the board can become very confusing to interpret.

That's why we recommend sticking with the tried and true basics when it comes to the foundation of your training.

The Basics of Marathon Training

Runners cross the finish line of the 35th Marine Corps Marathon
Make sure you are healthy.

    • Before taking on any large challenge, talk to a doctor and make sure your body (heart, lungs, liver etc.) can handle it. If there's a problem, that should be your priority, not intensive training. If you're given the green light, make a conscious effort to stay that way. Be conscious of the weather to stay dry and warm after a workout. If this means grabbing a dry shirt before leaving the gym to avoid a chill, do it.
    • Listen to your body. Your body is going to signal you if something is wrong. Toes bleeding? Back aching? If it hurts now, imagine how that pain will inhibit you at mile 20. You may need new shoes, or more core work to support your weight.
  • Protect your body when training.
    • Everything that can chafe will. Inner thighs, under arms, nipples. The least bit of friction, from skin against skin or poorly planned clothing, can cause a whole range of discomfort. Talk to someone about prevention methods, such as lubricating products, strategically placed bandages and choosing breathable material over cotton, BEFORE you experience chafing, not after.
  • Monitor your sleep.
    • On average, doctors now recommend between 7-9 hours of sleep for a healthy body. But you are in training, so your body needs longer to rest and heal. For aerobic, or endurance, training at least 8 hours, if not 9-10, is essential for a body to recover mentally and physically.
    • It's not enough to get a good night sleep the night before the race, it's probably not going to happen anyway, you are too excited. Sleep needs to be regular and restorative in the days and weeks prior.

Have a Flexible Training Plan

    • Set a plan and goals for yourself that you can follow the weeks and months before the race. Make sure the goals are realistic, and the plan has the ability to be adjusted to your personal needs. No schedule is ever going to be perfect, so being able to fidget with schedules and timing a bit will reduce stress and help you stay on a productive track without feeling defeated.
  • Use Periodization.
    • Periodization, or training cycles, are incredibly important in endurance training. Upping intensity daily without rest or variation, is going to overwhelm your body. Here's an example of how to used periodization in your weekly training:

  • Practice Negative Splits.
    • What this means is train yourself to start off slow for your long runs. The event you are training for is a marathon, not a sprint. Cover the second half of your distance for the day at a faster pace than the first half.
    • Stay relaxed and pay attention to your form. How you run is just as important as the pace you keep. Shoulders down, arms relaxed, and body upright.
  • Taper down intensity 4 weeks before the race.
    • The general recommendation, after periodic training, is to taper down the intensity of your workouts by a percentage each week, allowing your body to rest before the big event.
    • The last 4 weeks before a race should taper from your normal pace (100%) as follows: week 4= 80%, week 3= 60%, week 2= 40%, week 1= 25%
  • Remember stretching and core training.
    • Studies show that yoga adds core strength and flexibility that can reduce injuries and improve a runners performance.
    • Be gentle, and don't over-stretch, especially before running, which can have a negative effect on a runner.

Eat Consciously

    • What a proper training diet consists of has been widely debated. High carbohydrates, low carbohydrates? There will always be differing opinions. Regardless of method choice, what's important is maintaining balanced physical health.
  • Weight is a factor.
    • Maintaining low body fat percentage is essential to boosting pace and endurance.
    • If the percentage of carbs you consume is too high and from a negative source (fried foods, sweets etc.) the more weight from fat your legs and back are going to have to manage as you run. There's a reason the record-setting runners are lean. They don't have any unnecessary body mass holding them back.
    • Most trainers agree that your BMI (body mass index) should be on the lower side of normal for ideal running fitness.
  • Artichoke, artichoke flower, peppers, cabage, DSCF1617

  • Choose the right foods.
    • Easily digested carbs are where the power is. If you're on a carb-free diet, and plan to run a marathon without energy depletion or "hitting a wall" before the last 5-6 miles, you're not being realistic. The amount of carbs needed daily, is going to be dependent on the amount of training done. So be careful not to overload when it's not necessary.
    • The most common cause of "hitting a wall" in the last stretches of the race is glycogen depletion. Glycogen is a fuel derived from dietary carbs which is stored in small amounts in the muscles and liver. It is essential to endurance challenges, and should be stored and conserved through good pacing and high quality food consumption.
      • High-quality foods: fresh, non-starchy vegetables such as quinoa and artichokes. Fruits, as with veggies, fresh not frozen. Also stick to lean meats and fish, Greek yogurts, whole grains, nuts (almonds over peanuts) and seeds.
  • Hydrate.
    • There's nothing more important than keeping your body hydrated as you train. Dehydration will not only decrease your energy drastically, but can lead to heat-related injury to your body. It's a marathon, you are outdoors running and you are sweating. Replacing bodily fluids is essential to avoid exhaustion and possible heatstroke.
    • Learn to drink and run. You will need those little Dixie cups, so your body needs to know how to handle fluids on the go. Start practicing.
    • Alcohol and caffeine aren't the greatest ideas during training. The first dehydrates you while the second raises your heart rate, and they both disrupt sleep patterns.
  • Nothing new before the race.
    • The last thing you want to do is eat something your body isn't entirely comfortable with the night before a race. Your body should be in rest mode, which includes your intestinal tract. Grabbing a spicy tuna roll or hitting your favorite Mexican restaurant can wait a few days. Nothings worse than attempting 26.2 miles with an angry stomach. Stick to what you know you can handle.

source: 2009-01-20 00:33 Hammer of the Gods27 721×451× (45336 bytes)Now, if you haven't already done so, start planning and training! And above all else, remember that getting through this challenge is all about attitude. Stressing out, losing sleep and pushing yourself too hard isn't worth it. Running a marathon today is about personal achievement, and if you can't find joy in your daily accomplishments, what else is there? Even Philippides was carrying good news.

Runners…Do You Get Blood Under the Toenails?

Runners frequently develop blood under the toenails, expecially the second toenail because this toe is usually our longest toe. This condition is called a subungual hematoma.  Often, there is minimal pain in the area, but if the toe and nail are sore, it may be necessary to drain the blood from under the nail or remove the toenail.

Why does this happen?  Friction and pressure over the toenail allow a subungual hematoma to develop.  There are several causes for this condition:  repetitive microtrauma (hitting the end or top of the shoe continually), running downhill, shoes that are too small, rubbing on seams of socks, or toes that are contracted (hammer toes) and grip with running.

If you have this condition, call Dr. Bender for an appointment at Advanced Physical Medicine Oak Park (708-763-0580) or Chicago/63rd (773-776-3166).  She is a foot and ankle specialist who has been in private practice since 2001


Developing A Healthy Routine

Let's face it. People today are nothing if not busy. If you stop and look around, the majority of us are walking quickly, focused on some form of communication or mobile media device we feel naked without. Even when we travel, we each, on average, bring along at least two forms of mobile electronic equipment. (Confession: I had my laptop with me on a cruise through the Bahamas. There was no internet, but somehow leaving it behind felt wrong.) But busy isn't bad. It's the bad habits that we develop to deal with being busy that are hurting us.

The biggest problem: We are going too fast.

  • Commute fast
  • Eat fast
  • Talk fast

Why? Because we overload our agendas, and rush to get it all done.

What we don't seem to see, is that the quick pace we've adopted is counter productive. The more we add, the less we actually get done.

[caption id="attachment_1722" align="aligncenter" width="553" caption="It's silly, but there's a lot of truth in it."][/caption]

The Solution is in the Small Things.

Small changes in our lives can make all the difference in the world. Here are some suggestions on how to develop a new, more conscious, pace.

Add Some Movement to Your Life

We're not talking a marathon later today, but standing up and letting some blood circulate every hour or so, can prevent a whole range of bodily ills.

  • Walk around a bit.

Thirty minutes of exercise can sound daunting, but breaking it up into three 10 minute walks is not a bad way to get there. It all adds up, and makes a bigger difference in energy level and mood than you might think. Park further away, walk instead of riding the bus for two stops, nothing drastic.

Enjoy Your Meals

Taking the time to decompress, and gather your thoughts in the middle of the day, allows your brain to organize and gain perspective that is lost when we microwave a noodle dish, sit at a desk and pound the keyboard, fork hanging from mouth. Attractive.

File:No cellphone.svg

  • Put Down Everything. Yes, phone too.

No work at the table. Which means there should be an actual table involved in this scenario. Get rid of distractions like smart phones and paperwork, and look at what you're putting in your body. If it looks and tastes like sludge, you're either on some cleanse, or you are actually consuming something indefinably terrible. Stop it. You deserve better. Now that you're paying attention, you have more control over your diet. Not only focusing, but enjoying what you eat at a more leisurely pace gives your body time to tell you that you're full, allowing you to eat less than your normally rushed meal would have you consuming. The best part is that your mind has had time to rest enough that you feel satisfied, and able to continue with your day.

Treat Your Body With Respect

Until science can make us bionic (would be so awesome by the way), we need to treat the bodies we have nicely.

  • Ease up on thFile:"Jenny on the job - Gets her beauty sleep" - NARA - 514682.jpge abuse.

The body reacts to what's put in it. Fill it with saturated fats, sugars, tobacco smoke and hard liquors and it will make its opinion known. It's not just a hangover or heartburn for a day, the heart, lungs, liver etc. are feeling the long term negatives from inconsiderate abuse.

  • Sleep easy.

Getting enough sleep can not only help you focus the next day, it also gives your body and mind time to repair, reducing the risk of cardiovascular and other diseases. Erratic sleep schedules can affect the type of rest your body gets, limiting the time spent in essential deep sleep. Setting an approximate bedtime isn't just for kids. Developing a routine sleep schedule is part of a healthy life at any age.

Work to Reduce Stress

  • Talk to people. Anyone.

Getting out of your head can be a nice break, and a big relief. If you work a job at a quiet desk, or spend your whole day wrangling kids, your brain is craving some peer socialization. It needs balance.

  • Develop a support group.

If everything you think or worry about is kept to yourself, unnecessary stress is created that will begin to manifest itself physically. A support group isn't necessarily strangers meeting because of a commonality (although that can be a really helpful setting for specific problems), it's a Thursday morning coffee or friday night cocktail with a trusted friend with whom you are free to talk about anything and everything, just to get it out.

  • Smile.

Sounds ridiculous, but studies have shown that smiling for no reason actually improves your mood. Smile the moment your get out of bed, and start off your day with a lighter step. Finding something to smile about really isn't that hard (look around you, seriously, you're fantastic), but even when you don't see it, do it anyway. I'm not kidding. Try it right now, I'll wait...

Focus on Someone Else

Sometimes, it's not all about you. Focus on someone or something else outside of yourself (not your family and not your friends, there's stress and drama there). Find something else that needs help, and give back.

    Hold my hand 

  • Volunteer.

Give your time to a local shelter (animal/people, you pick), and actively dedicate a chunk of time to others. There are bodies needed everywhere that can read to a kid, paint over graffiti, or simply show some much needed love to a neglected puppy. The redemptive act will not only get you outside your own bubble, it also reduces stress and gets you moving and active (see above and repeat).

A healthy routine, when treated as an ever evolving process full of small, meaningful changes, does more than just trim some fat or build endurance. It enriches our quality of life as a whole. Slowing down and consciously changing our patterns in life is about the lasting, long term effects made possible step by step.

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