Longevity for Lady Liberty

 

This weekend I took my family to see a New York Liberty game. In addition to be a very exciting game, I got to see my cousin Katie Smith play. It has been along time since I have seen her play. She has played professional basketball since graduating college 17 years ago. She has just celebrated her 39th birthday 2 weeks ago and has not lost a step. She was amazing. She has always been a very dedicated player with magnificent work ethic. I believe her attention to her training has allowed her to be able to maintain her high level of play over the years. So what are the concerns in an aging athlete? What can you do to prevent injury? Here are some tips.

 

First, the warm up. Warming up is stretching the muscles and ligaments. In an older athlete this may take longer and is essential to prevent injuries. Also, as we age our vascular system responds slower to exercise so we need a longer warm up period slowly increasing the exercises intensity.

Secondly we lose flexibility as we age. Loss of flexibility is a natural effect of aging that can be counteracted through a program of daily stretching. The repetitive movements involved in practicing any sport for a long period of time results in muscular imbalances that get progressively more extreme.

Next, it is much more important as we age to increase stregth training. As we age we lose muscle mass.  Most of the muscle mass lost due to the aging process is classified as type II, or ‘fast twitch' muscle fibers. These type II fibers are faster to contract and therefore give us our strength and power. In contrast Type I, or ‘slow twitch' muscle fibers are slow to contract and contribute to muscular endurance. The loss of overall muscle mass and muscle strength causes joints to bear greater stress during exercise, rather that dissipating it to surrounding muscle tissue. This extra stress to the joints commonly leads to athletic injuries such as tendonitis, ligament sprains, musculo-tendinous strains, as well as arthritis.

Lastly, take more time to recover.  Older athletes need to allow themselves more time to recover between their most demanding training sessions.

Changing the way you train can increase the longetivity of your activities.
GOOD LUCK #30! Go New York Liberty!

Dr. Alexandra "Sandie" Grulke

http://www.podiatrycarespecialists.com/

Sunblock On Your Feet?

It is time for summer and you are slathering on the sunblock. Don't forget to put sunblock on your feet. That sounds funny, but melanoma can be found on the skin on your feet. Unfortunately, the survival rates of foot melanoma is low because it can often go undetected. What you should you be on the look out for?

The common characteristics of melanoma are as simple as A B C D.   
Asymmetry meaning the shape of the lesions is not symmetrical, for example if you folded the lesion in half the halves would not line up.  Borders or the outline of the lesions is not smooth or circular but scalloped or ragged. The malignant lesion maybe several Colors or variegated.  Benign lesions tend to have just one color throughout the entire lesion. The last common characteristic of melanomas is the Diameter or size of the lesion. A diameter of about 6mm or greater, the size of a pencil eraser, has a greater chance of becoming malignant.

The most common age to develop a melanoma is in your 50's. Foot melanoma can affect men and women equally. Fair skinned with blue eyes have a higher chance of developing melanoma over other skin and eye types.  The most common areas of your feet to develop melanoma is on the soles of  your feet, between toes or under toenails.

If you notice a mole, bump, or patch on the skin  it is important to get it checked out right away.
With 40,000 new cases discovered every year,  regular inspections of your feet can catch this deadly cancer early. As a preventative measure, apply sunscreen to your feet not just the tops, but also between the toes and on the bottom of your feet as well.
 
Here's to a happy and healthy sunmmer

Dr. Alexandra "Sandie" Grulke
http://www.podiatrycarespecialists.com/

Getting Your Feet Healthy For the Summer

Here comes the warmer weather, causing many to kick off our shoes and socks and opt for flip flops or sandals. Perhaps though you have been ignoring your feet for the last several months and now need to get them in shape for flip flop and sandal weather. Here are some tips to get these feet fit for summer.

First, start with an at home pedicure. Soak your feet in a lukewarm water to soften the skin and nails. Remember, if you are diabetic, have someone else check the temperature of the water. Remove any dirt out from under your nails. Then cut your nails straight across to reduce the chance of creating ingrown toenails. Do not cut your cuticles. They help keep germs away from your skin and nails.

 

Next, examine the parts of your feet that experience the most friction (such as your heels, the sides of your feet and big toe) as they will feel the most callused. The easiest way to soften these rough patches is by first soaking your feet in warm water and exfoliating skin that is extra dry. After you towel your feet dry, use a pumice stone on the callused areas. If your feet are extra-callused, you may have to repeat this process for a few days to notice results. After you’re done, it is important to apply a lotion over the dry patches of your feet to allow your skin to re-absorb moisture. Watch out for over the counter corn/callus removers. These are medicated with salicylic acid which can eat away both good skin and callus which can cause open sores and ulcerations if used inappropriately. These should never be used on diabetics.

If you have noticed some thickening or color changes to your nails over the winter, you may have the start of a toenail fungal infection.  There are now topical anti-fungal medications that can be used as a base coat before using regular nail polish is applied, to help prevent and treat toenail fungus. Get it checked out by your local podiatrist.

With these simple tips you can whip your feet into shape for whatever the summer may bring.

Dr. "Sandie" Grulke
http://www.podiatrycarespecialists.com/

Marathon bombing brings out the best in Americans

It is hard to understand how yesterday's tragedy could have happened. Yet despite the horrifying scenes, you hear the good stories of people helping people. On the radio and TV we are forced to relive the terrifying scenes but now more and more stories of herioc events are being told. One such story is of a podiatrist who the Doctors at Podiatry Care Specialists all know, and the student doctors of his that assist at the finish line, all jumping in to help the wounded.

Dr. Palamarchuk, a podiatrist from Temple University School of Podiatric Medicine, has taken students to the Boston marathon for 28 years. A tent is set up for the end of the race for those runners suffering from foot and ankle issues to be treated. Most of the runners would be treated for simple blisters and ankle sprains. Not this year. They were located half a block from the explosion site. Dr. Palamarchuk and his students ran to the victims aid. They were able to triage patients. Taking the lead from the medical doctors in the area, they were able to treat some of the victims and move them out of the area. He was quoted in an article for NBC 10 to say "Everyone treated. It's just quick, grab whatever you can. They reacted quickly and took the lead of the medical doctors. It was a good effort. I was proud of them."

Dr. Palamarchuk

What should have been a exciting day turned into a horrifying events but yet these stories of good continue to prove the strength of the American people. As Fred Rogers stated "When I was a boy and I would see scary things in the news, my mother would say to me. Look for the helpers. You will always find people who are helping."


http://www.podiatrycarespecialists.com/

Kobe Bryant Achilles Rupture

Kobe Bryant, from the suburbs of Philadelphia, has suffered a season and possibly career ending injury. While playing basketball, he ruptured his Achilles tendon. The Achilles tendon is the thickest and strongest tendon in the body.  A rupture is a devastating injury and can be a career ending injury for some. In basketball, Charles Barkley and Shaquille O'Neal both had Achilles tendon concerns and ended their careers early.  In baseball Ryan Howard suffered one, but he has been back to playing baseball full time.

To get back into activity, it can take anywhere from 9 months to a year for a full recovery. Kobe has already said that he is looking forward to returning and playing once he is healed from this. He will undoubtedly get a lot of physical therapy during his postoperative course.

For more information please visit our website

http://www.podiatrycarespecialists.com/

Kevin Ware Louisville Basketball Leg Injury

By now everyone has heard of Kevin Ware, the unfortunate basketball player who landed while trying to block a shot and fractured his tibia. It is not the play that has made the news but the type of injury that he sustained that has gotten such attention. His injury has been likened to the injury sustained by Joe Theismann, a career ending injury for the quarterback of the Washington Redskins. Both players sustained not only a fractured tibia but an open fracture which means the fractured bones have penetrated the skin and are exposed. How could this happen? What does this mean for Kevin Ware's future?

This injury was caused by the amount of weight placed on his tibia, the weight bearing bone of the lower leg, and then angle in which he was landing. The tibia snapped like a pencil causing the fracture to pierce through the skin. What can make these such concerning injuries are a number of things. First has the blood supply been disrupted at the level of the fracture? Second,  has there been nerve damage? Has the skin been compromised, will the skin be too damaged to repair and need skin grafts to heal over the bone? Lastly, with the bone exposed there is a concern of developing an infection. For all these reasons an open fracture is considered a surgical emergency. The blood supply and nerves must be evaluated and repaired if necessary. Antibiotics must be immediately started. The bone must be stabilized. The time to treatment is extremely important in these cases. "The Golden Hour" is the period of time after an injury is sustained that prompt medical treatment will result in the best outcomes from the injury.

Example of rod used in repair

For Kevin, immediate medical treatment allowed him to receive antibiotics to prevent infection. His doctors were able to set the fracture and place a long metal rod within the bone. His wounds were washed out and closed. He has a long road of recovery ahead of him but the prompt treatment he received will hopefully allow him back to the basketball court next year.

Dr. Alexandra 'Sandie" Grulke
http://www.podiatrycarespecialists.com/

Doggie EHR

Ironically over the weekend, my lovable happy idiotic yellow lab hurt his foot. I looked at his paw but I could not see any obvious reasons for his foot pain. He began limping on Saturday night but by yesterday morning he wasn't putting any weight on it at all, so I called the vet. When we entered out vet's office, which thankfully we haven't done for over 6 months, I noticed some rather big changes. First, they took a picture of him. Immediately they uploaded his picture into a computer. They took notes of his complaints, symptoms, history of injury and weight and typed into their laptop as part of his digital chart. After his examination, she typed her finding into his chart and then took some digital x-rays. We examined these together, luckily no breaks, but then the images were uploaded into his chart. At the end of our visit, he was diagnosed with a simple sprain and I was given electronic instructions in which I was told to rest his paw and avoid stairs and running. We were checking out they asked me for my email so that they could connect his chart to a "puppy portal". This would allow us to have access to his medical  record via the Internet. This is exactly the direction health care is migrating towards.

Currently the government is encouraging doctor's office to move to a digital patient record, or Electronic Health Record (EHR). The goal of moving this way is to better track patients progress, track data over time, monitor preventative screenings, and its use as an important tool in patient safety and quality of care. Research has actually proved there are tremendous benefits of documentation, viewing, test ordering, prescribing etc. in regards to patient care and safety. So why doesn't every doctor's office have these systems yet? EHR systems, by itself, is a huge financial burden with an average cost of $24,000 per physician of up-front cost. These costs will continue to spiral with the addition of hardware, computer stations and servers , IT support, back up systems, and security. Also, there is a large amount of EHR vendors, each one with their own terminology. With these large variances of systems, data exchange between EHR providers/health institutions can be difficult. Often, lab values or x-rays need to be manually added to the digital record because of an incompatibility between the one facilities EHR and the physician's EHR. Eventually, patients and medical professionals who are authorized to do so, will be able to assess these records via the Internet. These records will be stored in a secure storage on the Internet called a Patient Portal, such as Microsoft Health Vault TM. This allows doctors and hospitals to access this information urgently, especially in cases where the patient is unable to communicate pertinent medical history, allergies or current medications.

There are many obstacles before we are able to get everyone on board and all systems able to comminucate. However, as you can see the benefits are great. At Podiatry Care Specialists, PC,  we have been using EHR since October 2010. For the most part, it has been a seemless transition and as our practice grows and we open new office locations, it has enabled us to quickly and efficiently access our patient's records no matter which office they are being seen. 

By the way, my dog is not following his printed instructions.

Dr. Alexandra 'Sandie" Grulke
http://www.podiatrycarespecialists.com/