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Aug 6, 2018 · Coping with the changes your feet undergo as you age

Most Americans will have walked 75,000 miles by the time they reach the age of 50 – the equivalent of trekking around the Earth on the equator three times.

But all this walking results in significant wear and tear on our feet.

“Regular foot care at every age is important,” said Dr. Joan Williams, orthopaedic surgeon and foot specialist at UCLA Orthopaedic Center in Santa Monica. “But understanding the changes feet undergo over time can help minimize age-related issues and pain.”

The most obvious sign your foot is aging is its changing size and shape, says Williams.  Over time, the body’s ligaments and tendons lose their strength and ability to spring back. In feet, this manifests as a decrease or ‘’falling’’ of the arch, which flattens and lengthens the foot and toes.  The result: often an increase in shoe size by a half-size or more.

“Unfortunately, many people,  especially women, don’t realize that foot size can change, so they buy the same size shoe year after year without stopping to ask, ‘do my feet hurt when I put these on?,’” says Williams.  “Shoes with a narrow toe box – and of course, high heels — can also become more difficult to wear. So wearing well-fitting and more ‘sensible’ shoes, at least most of the time, will be much more comfortable.”

Shifts in foot shape can also cause bunions, a bony protrusion on the side of the big toe that grows as the toe drifts out of position. Hammertoe, a condition that frequently accompanies bunions, is when a toe – most frequently the second toe — is pulled back and upward in relation to the other toes.

Bunions are more common among women (more than 30 percent overall suffer from them) because of their shoe-wearing habits, but men suffer from them as well. Family history often plays a role.

Bunion pain can become quite severe, making walking difficult.  “Bunion splints aren’t much help – so unfortunately, surgery is the only way to successfully reposition the toe.  Because bunion surgery “is invasive and has a long recovery time, I recommend it only if the pain is so bad it interferes with daily life,” say Williams.

Arthritis is another reality for the aging foot.  Osteoarthritis can develop after years of general wear-and-tear and stress or injury to the joints.  Approximately half of older people will develop osteoarthritis in one or more of the 33 joints in their feet, although not everyone will experience symptoms. For those who experience pain that they can’t tolerate, over-the-counter medication or other treatments may help.  Gout, a metabolic disease characterized by intense swelling and pain at the big toe joint, is another type of arthritis.

Older people with chronic conditions are much more likely to develop foot problems.  Many diabetics suffer from diabetic neuropathy, a condition characterized by the loss of sensation in the feet. If the skin of the foot breaks unnoticed, wounds can easily become infected. Circulatory problems related to heart disease can also affect the fee, and obesity places extra stress on the feet and ankles.

Unfortunately, toenail fungal infections plague up to one-third of all older people, and corns, calluses and other foot deformities also are common.

There are a number of steps one can take to lessen foot pain or mitigate the effects of deteriorating ligaments, arthritis and other foot issues.

Don’t minimize or ignore foot pain.  Many people live with foot pain or do not seek medical attention until the discomfort is too great for them to endure.  “Foot pain is never normal,” says Williams.  “If you have it, see a foot specialist so it can be diagnosed and treated.”

Consider orthotics.  Orthotics or shoe inserts can support falling arches and increase comfort.  Podiatrists offer custom-made insoles, which range from $200 to $800 a pair.  Non-custom insoles, which are not as sturdy, usually cost between $20 and $70.  Both provide support and padding for the feet, which is especially helpful for those who must stand for long periods of time or who participate in activities that put extra pressure on their feet.

Pay attention to your overall health. Monitor your feet for wounds, numbness or excessive swelling. Any of these can be symptoms of conditions that require medical treatment.

Do what you can.  Stretch for a few minutes in the morning to reduce joint stiffness. Take over-the-counter medications to help reduce pain and swelling. Lose extra weight to reduce added stress. Keep your feet clean and dry. Wear comfortable shoes whenever possible, especially when walking long distances.

“It’s important to take good care of our feet,” said Williams.  “They play a vital role in our health and well-being as we age.”

 

Jun 12, 2018 · Facts about foam rollers may entice you to try one

Photo credit: iStock

Foam rollers have become more prevalent in gyms, exercise classes and therapy clinics during the past 10 years.  Many physical therapists use foam rollers to help patients recover from injuries – and for good reason.  This flexible piece of equipment can help to increase range of motion, shorten recovery time, and enhance healing.

You don’t have to be recovering from a procedure or injury to appreciate their usefulness.  Anyone who experiences muscle soreness from stress, poor body mechanics or a workout can benefit from using a roller.

“Foam rollers are under-utilized and under-appreciated,” says Christopher White, physical therapist and manager of outpatient rehabilitation at Ronald Reagan UCLA Medical Center. “This versatile piece of equipment not only can help lengthen muscles before or after exercise, it can also relax and soothe aching muscles.”

Foam rollers work by breaking up adhesions that form in muscles or tendons.  They also loosen trigger points (muscle “knots”), which feel like a sensitive spot in your soft tissues.  Your body weight is what helps the roller target specific muscle areas.

“The rolling motion loosens, relaxes and lengthens muscles in much the same way as a kneading massage does,” Christopher says. “Rolling is generally not as intense or targeted as a deep-tissue massage, but that can depend on how much pressure your trigger point is willing to endure.”

Christopher, who uses foam rollers with many of his patients, is upfront about what to expect. “If you already have a roller, you likely have a love/hate relationship with them,” he says. “The rolling process can be uncomfortable, and the body positions needed to utilize them correctly can be awkward. But you’ll ultimately feel the benefits.”

Choosing a Foam Roller

Foam rollers come in a variety of lengths, widths and densities.  Choosing the right type of roller can help maximize the effects and reduce discomfort, so it’s important to try out a few before deciding which one to purchase.

Density

Along with using the rollers correctly, density is a prime factor in how effective a roller is at trigger-point release. Low-density rollers provide less intense pressure, providing a more comfortable rolling experience.  Medium-density rollers provide more pressure because they are less flexible. High-density rollers provide the most pressure, but give muscles the fullest stretch.

Size

Long rollers (36 inches) are versatile and a good choice for your first foam roller.  They provide more stability than shorter rollers, and are more effective when used on larger muscles such as quadriceps or hamstrings.

Short rollers (12-18 inches) work best on calves and other smaller muscles, and are the perfect size for travel.

Diameter

The majority of foam rollers are six inches in diameter, making it easier to comfortably roll your body onto it and then keep the rolling motion under control.

While most rollers are smooth (and best for new users), some come with surface texture that can intensify pressure on targeted areas.  New to the market are vibrating foam rollers.  The added sensation of the vibration distracts your muscles from the uncomfortable pressure of the roller, which lessens the sensation of pain.  This type of roller, has also been shown to increase range of movement after only a few uses.

The standard foam rollers similar to those in gyms and physical therapy clinics ranges from $8 to $30;  vibrating rollers can cost $70 or more.  Rollers can be purchased online, at most medical supplies stores and usually at places that sell hand weights, exercise bands and yoga mats.

“Foam rollers may look like something you see in a swimming pool, but if utilized correctly, they can offer a lot of long-term benefits,” Christopher says.  “They reduce stress, improve posture, decrease muscle soreness and generally make you feel more mobile, which are all important components of injury prevention and overall good health.”

Jan 5, 2018 · How to have a healthy new year with diabetes: 5 tips

New Year's resolutions for diabetics

Let’s be honest. Nearly everyone has a health-related resolution for 2018. But with diabetes a growing epidemic and one of the leading causes of death in the country, it is especially important that diabetics – already more than 10 percent of the population — make a commitment to improving their health this year.

“Diabetes doubles the risk of cardiovascular disease and can cause kidney failure, blindness and other serious health conditions – and even death,” says Dr. Susan Ahern, endocrinologist at UCLA Health Ventura. “Proper management of the disease can make a real difference in the overall health and well-being of people with diabetes. Even small changes can be meaningful as long as they are made consistently.”

Since specific resolutions make follow-through more likely, Ahern suggests five ways that people with diabetes can improve their health this year:

  • Know your hemoglobin A1C number and commit to maintaining it. The hemoglobin A1C test reflects your average blood sugar levels during the previous three months. If your number is above the recommended 7 percent, there are actions you can take: decrease your carbohydrate intake, increase physical activity, or adjust your diabetes medications with the help of your endocrinologist. The key is recognizing that you play an active role in your disease management.
  • Cut portions in half. Many diabetics have already made positive changes to their diets such as eliminating soda and cutting out simple carbohydrates. Now try a next step — consider eating only half the portion of your meal several times a week, or at least when dining out. Drinking a glass of water after you finish half of your meal and then waiting 5 minutes can often make you realize that you are already satisfied. Try it and see.
  • Stay current on yearly screenings. Call your doctor’s office to schedule your annual diabetic retinopathy eye screening and kidney function tests. At home, check your feet regularly for sores or wounds that are not healing well. Call your doctor if you see or feel anything unusual.
  • Be consistent about blood sugar checks. Blood sugar numbers taken two hours after meals can be both eye opening and helpful. If yours aren’t in the ideal range, don’t be hard on yourself. Instead, vow to use the information as a tool to change behavior: modify your diet or take some vigorous 20-minute walks. You will most likely see the benefits in future blood sugar readings, which will motivate you to continue your more healthy behaviors.
  • Visit your endocrinologist. Because every patient is different, it’s important to partner with your doctor to determine what the best path to disease management is. For some people, the cost of diabetes medications is a big burden, so other strategies may need to be considered. For others, weight loss, avoiding injections, heart protective options or avoiding low blood sugar may be key factors to consider.

“Your endocrinologist wants to help create a diabetes management plan that works for you,” says Ahern. “We are invested in your good health and want to do all we can to ensure your success.”

Visit our website at UCLA Endocrinology, Diabetes & Metabolism for more information and to schedule an appointment with a UCLA endocrinologist.

 

Jun 15, 2017 · Give the gift of good health to the man in your life this Father’s Day

Men are 80 percent less likely than women to see a healthcare professional regularly, according to federal statistics. They are also more likely to die from eight of the top 10 causes of death in the U.S., and more than twice as likely to say they’ve never had contact with a doctor or health professional as an adult.  Ever.

With those sobering statistics, Dr. Jesse Mills, director of The Men’s Clinic at UCLA, has a suggestion – give the man in your life the gift of better health this Father’s Day.

First, make a commitment to talk to him about his health.

According to Dr. Mills, men are more likely – and more willing – to talk with family members about health issues if family members express their concerns in supportive and positive ways.  If he tries to dodge your questions, find out why he is reluctant, and emphasize how important his good health is to you.

“No matter how healthy – or unhealthy – a man is, my first suggestion to family members is to encourage the man in their life to take 30 minutes, three times a week to focus on medical and psychological health. That will help him stay healthy and reduce his risk of life-threatening diseases,” suggests Dr. Mills.

That means:

  • 30 minutes or longer of exercise daily at least four times a week. According to the Centers for Disease Control and Prevention, only 20 percent of American adults get adequate exercise.
  • 30-minute nap. Sleep deprivation affects every aspect of a man’s life, including fertility.  A nap – as well as eight hours of sleep each night – is important.
  • 30 minutes of quiet meditation, reflection or other form of relaxation, such as reading, hitting golf balls or watching sports. Approximately one in 10 men suffer from depression or anxiety, but fewer than half seek treatment.
  • 30 minutes to eat dinner with the family in a relaxed environment that encourages social connection.
  • 30 minutes of sex – it’s exercise, relaxation and connection; all good for health.

Additionally, if your loved one has not been to a medical professional for three to five years, make an appointment for a physical within 30 days of Father’s Day.

Men need screening for a variety of health issues and risk factors.  While it depends on their age and family history, most should be tested for prostate cancer, diabetes, their risk for cardiovascular disease and urologic health. In addition, doctors may need to discuss obesity, alcohol intake and possible psychological issues, before creating a treatment plan.

Moreover, all men should have a colonoscopy after the age of 50, since colon cancer can be cured if detected in its early stages.

“You’d be surprised, when a man is actually in a doctor’s office, and is asked questions in a supportive, non-judgmental way, he is a lot more forthcoming in discussing health issues– and then more likely to take a more proactive role in his future health,” says Dr. Mills.

This Father’s Day, tell the man in your life to take 30 minutes three times a week to focus on his health. Make an appointment for him to see a healthcare professional if it’s been longer than 5 years, especially if he’s over 45.

“Then point out that seeing a doctor will most likely extend his life – and give you more years to enjoy him,” says Dr. Mills.

Dec 12, 2016 · Safety, kindness and a watchful eye are needed for older holiday guests

Most of us enjoy the time we spend with friends and family over the holidays. But for many older adults, get-togethers can be especially stressful, confusing or even perilous when they are out of their regular environment and routines.

Raising awareness of issues and situations that may arise with older guests can help make the holidays more pleasurable – and safer – for everyone.

To that end, Dr. David Reuben, chief of geriatrics at UCLA Health, offers the following advice:

First, be prepared. “The number one thing to be concerned about regarding the well-being of an older person is a fall,” says Reuben. “Falls often lead to injury or even broken bones, both of which can compromise a person’s mobility for the rest of their life.”

If you are having older guests to your home for the holidays, make sure steps are cleared, floors are covered by non-slip rugs and hallways can be easily navigated. Also try to make sure that cats, dogs and small children don’t get underfoot. Extending a steadying hand or arm can be a great help, too.

Second, pay attention. Holidays are often the one time a year when you can assess an aging loved one’s emotional and mental well-being, so make sure you ask them how things are going – and be observant of what they don’t say.

“It’s the things that are out of character that should be of concern,’’ says Reuben. Is your usually well-groomed aunt looking disheveled? Has she lost weight or are there other behaviors that seem unlike her?  They might be signs of memory problems, early dementia or depression.”

There may be other signs of deteriorating cognitive abilities.

“It’s normal to sometimes call a person by the wrong name, but it’s a cause for concern when a relationship or national history is forgotten,” says Reuben. “If your mother doesn’t recognize the woman sitting across from her as her niece, that’s a red flag.” Another cause for concern is an older person who repeats the same question or story many times over a short period.

If your gut tells you something isn’t right, you should take action.

“Unless there’s an obvious health problem, skip the emergency room. The best thing is to make an appointment for a full check-up with the person’s regular doctor – someone who knows them and is aware of their health issues,” says Reuben. “If there’s resistance, tell them an annual check-up is a perfect New Year’s resolution.”

If you can, go with them to the appointment. If not, consider calling their doctor to share your concerns, which might include vision, hearing, mental health, mobility, or cognitive changes.

Third, be kind. Older people often get overwhelmed in large gatherings and may withdraw from activities. They also may tire easily. Bearing this in mind, you might suggest a rest, move to another room for some one-on-one time, and limit the noise level when you can.

Find time to really engage with older guests. Ask how they’ve been, what they’ve been up to, what they might be concerned about. It’s easy to overlook people when they are tucked in a corner. Remember to include them: ask them to share a holiday memory, such as receiving a favorite gift or participating in a family tradition as a child.

“Whether or not you observe a problem, be patient with older relatives and friends,” says Reuben. “Make sure everyone enjoys the spirit of the holidays.”

Oct 25, 2016 · UCLA Breast Cancer Surgeon Sorts Out the Facts: Is that Double Mastectomy Really Necessary?

When Angeline Vuong, 27, was diagnosed with cancer in one breast earlier this year, her first reaction was “A DOUBLE MASTECTOMY. NOW. ”  Turns out, she’s far from alone: a recent JAMA study of 190,000 breast cancer cases in California between 1998 and 2011 found a six-fold increase in the percentage of women with early-stage cancer in one breast who were choosing double mastectomies.

But are they necessary?   And do they reduce your risk of a second cancer?

The answers to these and other questions regarding double mastectomies may surprise you:  if you have breast cancer in one breast, removing your other breast will not increase your chances of survival.  It won’t help you live longer, and it doesn’t decrease a woman’s chance of metastatic disease, when the cancer spreads from the breast to the lymph nodes, lungs or bones.

Dr. Deanna Attai, UCLA Health breast surgeon and Angeline’s doctor, says every patient is different, and that ultimately the choice to get a double mastectomy is complex and up to patients, their families and their doctors.  But most women don’t know the facts about double mastectomy risks – and they should be aware of them before making a decision.

“For women who take Tamoxifen or other estrogen blockers, the risk of developing a whole new cancer in the other breast may be as low as five to ten percent, which means that if you have that breast removed, you’re doing an aggressive surgery that 90 to 95 percent chance you don’t need,” says Dr. Attai.  “That’s worth considering.”

After discussing surgery, risks, side effects and treatment options with Dr. Attai, Angeline ultimately decided to have only one breast removed, saying that she wanted to keep her healthy breast as long as possible so that she would be able to look down and see that feminine part of her still there as well as have the option of breast feeding in the future.   She sums up her decision by saying “You can always have another mastectomy, but you can’t have your breast back.”