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Plantar Fasciitis

Do you spend a lot of time on your feet at work? Do you have flat feet, or very high arches? If so, you are at a higher risk for plantar fasciitis. The condition typically starts gradually with mild pain at the heel bone often referred to as a stone bruise. If left untreated, plantar fasciitis may become a chronic condition and you may not be able to perform your normal activities. It can also cause additional problems with your knees, hips and back because it can change the way you walk.

What exactly is plantar fasciitis?

Plantar fasciitis (PLAN-tur fas-e-I-tis) is the inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. This condition commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Other risk factors for developing this issue include:

  • Age: Plantar fasciitis is most common in people between the ages of 40 and 60.
  • Certain types of exercise: Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and dance aerobics — can contribute to an earlier onset of plantar fasciitis.
  • Faulty foot mechanics: Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re standing and put added stress on the plantar fascia.
  • Obesity: Excess pounds put extra stress on your plantar fascia.
  • Occupations that keep you on your feet: Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.

How do you treat it?

Most people who have plantar fasciitis recover in a matter of months with some simple therapies, as long as they don’t delay treatment.

Medications
Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) can help relieve pain and inflammation. You should use the medications as directed. These medications can be hard on your stomach so it’s important to take with food and not take for longer periods of time as recommended.

Therapies
Stretching is the best treatment for plantar fasciitis. It may help to try to keep weight off your foot until the initial inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe a non-steroidal anti-inflammatory medication such as ibuprofen or naproxen. Home exercises to stretch your Achilles tendon and plantar fascia reduce the chance of recurrence. Physical therapy, devices and self-therapy options include:

  • Physical therapy: Working with a physical therapist can provide relief for symptoms. She can specify a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot. Simple home exercises can also help stretch your plantar fascia, Achilles tendon, and calf muscles.
  • Night splints: Your physical therapist or doctor may recommend wearing a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
  • Orthotics: Your doctor may prescribe off-the-shelf heel cups, cushions or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly. We carry supports in our store that you may want to try before having custom orthotics made.
  • Maintain a healthy weight: This minimizes the stress on your plantar fascia.
  • Wear supportive shoes: We love them, but we should avoid high heels and buy shoes with a low to moderate heel, good arch support and shock absorbency. It’s also important to not go barefoot, especially on hard surfaces.
  • Don’t wear worn-out athletic shoes: Replace your old athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after about 500 miles of use.
  • Alternate exercises: Instead of walking or running, try a low-impact sport, such as swimming or bicycling.
  • Apply ice: Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.

 

Sources: Mayo Clinic, NIH, and U.S. National Library of Medicine

National Infant Immunization Health Week

Did you see the story out of Australia a couple of weeks ago about the pregnant mom who did not get the whooping cough vaccine, contracted the disease, and then passed the disease on to her daughter? The baby has been in intensive care for weeks, and at times turned from red to black in color. Pretty scary stuff! And, it could have been easily prevented.

She described herself as a very healthy, organic and fit woman who had no complications during her pregnancy and no deficiencies. “[But] even me, the bulletproof lady who has never been to a doctor, traveled the world and felt healthy got whooping cough,” she said.

While this mother had no intention of contracting the disease herself, and passing it along to her infant, the effects are still the same.

This woman, like most people in the developed world, have never seen how dangerous these diseases can be. There is also a lot of conflicting and often inaccurate information about the safety of vaccines. These could be some of the reasons she chose not to get the vaccine herself. However, vaccines are one of the biggest health success stories in the United States.

Vaccines help develop immunity by imitating an infection. This type of infection, however, does not cause illness, but it does cause the immune system to produce T-lymphocytes and antibodies. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. These minor symptoms are normal and should be expected as the body builds immunity. Once the imitation infection goes away, the body is left with a supply of “memory” T-lymphocytes, as well as B-lymphocytes that will remember how to fight that disease in the future. However, it typically takes a few weeks for the body to produce T-lymphocytes and B-lymphocytes after vaccination. So, it is possible that a person who was infected with a disease just before or just after vaccination could develop symptoms and get a disease, because the vaccine has not had enough time to provide protection.

Even though a person may get vaccinated as an infant, they may need another dose of the vaccine as they get older. For example, some vaccines may need more than one dose to build up a more complete immunity. For example, the vaccine that  protects against meningitis needs two or three doses over time. The same applies to the Tetanus vaccine.

Because these diseases still circulate around the world and in the United States, any vaccine-preventable disease can strike at any time. These diseases include whooping cough, chickenpox, Hib (a cause of meningitis), and influenza. These diseases, as well as the other vaccine-preventable diseases, can have symptoms that range from mild to severe and life-threatening. In most cases, there is no way to know beforehand if a child will get a mild or serious case. For some diseases, one case is enough to cause concern in a community. An example is measles, which is one of the most contagious diseases known. This disease spreads quickly among people who are not immune.
Some people believe that naturally acquired immunity—immunity from having the disease itself—is better than the immunity provided by vaccines. However, natural infections can cause severe complications and be deadly. This is true even for diseases that most people consider mild, like chickenpox. It is impossible to predict who will get serious infections that may lead to hospitalization. Vaccines, like any medication, can have side effects. The most common side effects are mild. Although many of these diseases are rare in this country, they do circulate around the world and can be brought into the U.S., putting unvaccinated children at risk. Even with advances in health care, the diseases that vaccines prevent can still be very serious – and vaccination is the best way to prevent them.
We also offer vaccines for adults at our stores, including:
  • Zostavax (shingles vaccine)
  • Pneumovax (pneumonia vaccine)
  • Influenza (flu shots)

Be sure to stop by one of our stores and pick up a Vaccination Fact Sheet so you can learn more about the timing of vaccines and their benefits— and talk to one of our pharmacists if you have any questions.

 

Sources: The CDC and BBC.

Focus on MS

Multiple Sclerosis (MS) is an immune-mediated disease in which the body’s immune system attacks the myelin in the central nervous system. Myelin is the fatty, protective coating that insulates the nerve fibers in the central nervous system.  When the nerve fiber is damaged or destroyed, it causes disruption in the nerve impulses traveling to and from the brain and spinal cord. More than 350,000 people in the United States and 2.5 million worldwide have been diagnosed with MS. While we don’t know exactly how one contracts this disease, it is thought to have genetic ties along with environmental factors.

 Common symptoms of MS include:
  • Fatigue
  • Numbness or tingling in the face, body or arms and legs
  • Muscle weakness
  • Pain (50% of patients experience chronic pain)
  • Dizziness and vertigo
  • Vision problems
  • Bladder problems
  • Bowel problems
  • Sexual problems
  • Cognitive changes
  • Emotional changes (including depression)

There are several medications on the market that are called Disease-Modifying Drugs. These drugs can help manage the disease by suppressing the immune system so it doesn’t attack the myelin, and slows the progression and prevent relapses.

The following U.S. Food and Drug Administration (FDA)-approved disease-modifying agents reduce disease activity and disease progression for many people with relapsing forms of MS, including relapsing-remitting MS, as well as secondary-progressive and progressive-relapsing MS in those people who continue to have relapses.

  • Injectable medications
    • Avonex (interferon beta-1a)
    • Betaseron (interferon beta-1b)
    • Copaxone (glatiramer acetate)
    • Extavia (interferon beta-1b)
    • Glatopa (glatiramer acetate — generic equivalent of Copaxone 20mg dose)
    • Plegridy (peginterferon beta-1a)
    • Rebif (interferon beta-1a)
  • Oral medications
    • Aubagio (teriflunomide)
    • Gilenya (fingolimod)
    • Tecfidera (dimethyl fumarate)
  • Infused medications
    • Lemtrada (alemtuzumab)
    • Novantrone (mitoxantrone)
    • Tysabri (natalizumab)

Interferon drugs and Copaxone (both protein drugs) are considered to be very safe. These work by preventing the immune system from attacking the nerves in the brain and spinal cord. While not a cure, they can decrease flare-ups and delay (and possibly prevent) disability.

Due to the nerve damage in the central nervous system, there are many other problems that can occur as a result of the disease. These medications can treat the following symptoms:

  • Muscle stiffness and spasms: muscle relaxants such as tizanidine(Zanaflex) and baclofen (Lioresal), or sedatives like diazepam(Valium) and clonazepam (Klonopin)
  • Fatigue: amantadine (Symmetrel), modafinil (Provogil), armodafinil (Nuvigil), and methylphenidate (Ritalin)
  • Depression: antidepressants such as fluoxetine (Prozac), sertraline(Zoloft), and bupropion (Wellbutrin)
  • Bladder problems: oxybutynin (Ditropan) or tolterodine (Detrol)

By working closely with your doctor, you will find the treatments that work best for you. For questions about your medications, talk to your doctor or pharmacist.

Physical therapy can also help many patients. Learning specific exercises, strengthening exercises, aquatic therapy and yoga, specifically designed for the patient, can help meet their needs. If the patient has lost some physical ability, a cane, walker, or other assistive device can make it easier to get around.

Local event:

The Wilmington Walk MS will be held on April 30 at 10 a.m. (check-in at 9:00) to raise awareness and funds for a cure for multiple sclerosis. The 4-mile walk will be around Greenfield Lake. The event is free, but donations are welcome!

You can register to walk individually, as part of a group, as a virtual walker, or as a volunteer.

Drinks, food, and entertainment are provided at this child and pet friendly event. Rain or Shine!

Register at www.walkMScarolinas.org or call 1-855-372-1331. The event is sponsored by the nonprofit Greater Carolinas Chapter, National MS Society.

April is Autism Awareness Month

April is Autism Awareness Month and although there is no known specific cause or cure, it’s important to educate parents since early diagnosis can be an important factor in treatment.

Autism Spectrum Disorder (ASD) is defined by the American Psychiatric Association’s Diagnosis and Statistical Manual of Mental Disorders (DSM-5) as “a single disorder that includes disorders that were previously considered separate — autism, Asperger’s syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified”. Autism spectrum disorder is a serious neurodevelopmental disorder that impairs a child’s ability to communicate and interact with others. It also includes restricted repetitive behaviors, interests and activities. These issues cause significant impairment in social, occupational and other areas of functioning.

More than 200,000 cases of autism are diagnosed each year, and according to Autism Speaks, it’s four to five times more common in boys than in girls. An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States. ASD occurs in every racial and ethnic group, and across all socioeconomic levels.

Though signs and symptoms are usually noticed between the ages of 2 and 3, children with ASD may seem different even from birth, especially when compared to other children their own age. They may become overly focused on certain objects, rarely make eye contact, and fail to engage in typical babbling with their parents. In other cases, children may develop normally until the second or even third year of life, but then start to withdraw and become indifferent to social engagement.

Social impairment characteristics include:

  • not responding to their name
  • avoiding eye contact
  • only interacting with others to acheive a specific goal
  • lack of understanding of how to play with others
  • preferring to be alone
  • difficulty understanding the feelings of others
  • difficulty talking about their own feelings
  • delayed speech or lack of speech (about 1/3 are non-verbal)
  • fluent speech, but backward and in appropriate
  • lack of understanding of non-verbal cues such as waving good-bye
  • speaking in flat, robot-like, or a sing-song voice, but only about a few favorite topics

Repetitive and behavior characteristics include:

  • flapping arms
  • rocking side to side
  • twirling
  • preoccupation with a particular part of a toy, like the wheels of a truck
  • obsession with a particular topic such as a train schedule or airplanes
  • anger or emotional outbursts if there is a change in routine, a new place or overly stimulating environment

Treatment:

Though there is no cure from ASD, therapy and behavioral intervention designed to meet the specific needs of the individual can help improve the quality of life for the individual. With early intervention, symptoms can improve with age and individuals can overcome some obstacles. Highly structured and intensive skill-oriented training sessions and speech therapy can help children develop social and language skills. Part of the challenge over time is that during adolescence, some people with ASD may become depressed or experience behavioral problems, and their treatment may need some modification as they transition to adulthood.  In addition, family counseling for the parents and siblings of children with ASD often helps families cope with the particular challenges of living with a child with ASD. Depending on the severity of the disorder, individuals may be able to work and live independently as adults.

A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception.

Medications:

While medication can’t cure ASD or even control symptoms, there are some that can help with related symptoms such as anxiety, depression, and obsessive-compulsive disorder. Antipsychotic medications, such as Risperidone or Quetiapineare, are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity in people with ASD. Parents, caregivers, and people with autism should use caution before adopting any unproven treatments.

 

 Sources: Autism Speaks, CDC, Mayo Clinic and National Institute of Neurological Disorders and Stroke