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  • Internal Medicine: Characteristics You Want in This Type of Doctor

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    Having a chronic issue that just won’t resolve itself on its own is extremely frustrating. And while you may have gone to doctor after doctor, it may be time to see someone in internal medicine.

    A physician in internal medicine has more specialized education as opposed to a general practitioner. In addition, this doctor does not focus on things like pediatrics or obstetrics. The main role of this doctor is to diagnose, treat and prevent issues associated with all areas of the adult human body. So when trying to find one to fit your needs, be sure to keep a few things in mind.

    Expertise

    The whole reason for seeing a doctor in internal medicine is to get an answer to some of your most troubling health conditions. When you’ve exhausted all other options, such as family doctors or general practitioners, an internist is the next logical step. These doctors have made careers out of solving complex medical problems in adults. So be sure to explain the issues you’re having as well as make sure your internist has all your past medical history. This way, he or she can have a leg up in trying to figure out the root of your problem. In addition, a doctor in internal medicine has gone to school for at least seven or eight years, has passed a board exam as well as focused on a particular area of study, so he or she is well prepared to handle your problem, depending on what it is. For instance, if your issue deals with the heart, then you’d want to see a cardiologist. On the other hand, if you have reproductive issues, a reproductive specialist is best.

    Good Communication

    In addition to expertise, it’s essential that you have great communication with your doctor, especially when it comes to internal medicine. That’s because this doctor has the knowledge and experience to help you figure out what’s causing your issue. Yet, you want him or her to be patient and really listen to your issues. These doctors see numerous patients each day, but that doesn’t mean you should feel rushed through your visit. So when deciding on a good internist, pay attention to how he or she talks with you as well as listens. If you feel like your doctor has not given you the time you need, then you need to keep looking, because communication is key when trying to find a doctor in internal medicine.

    Timeliness

    When you’ve been referred to an internist, this means your general practitioner hasn’t had any luck figuring out what’s causing your problem. Or if he or she knows the problem, maybe they don’t know how to treat it; yet an internist will. Unfortunately, if your internist cannot see you until two months from now, then that’s a problem. Depending on your issue, you could possibly wait, but for most people, this is not acceptable. Instead, you should keep searching until you can find a specialist that can see you in a decent amount of time. Also, whenever you do find a good doctor in internal medicine and schedule an appointment, you want him or her to honor your appointment time. If you’re always waiting over an hour to see your physician, you may need to start a search for a new doctor.

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    Source by Anna Woodward

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  • Alternative Medicine Treatment of Plantar Fasciitis

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    Plantar fasciitis (PF) affects approximately two-million people in the US, of both athletic and non-athletic populations. This condition can be debilitating and significantly affect one’s quality of life in a very negative way. There are few high quality studies on this condition and the most successful treatments. Treatments range from chiropractic care, physical therapy, injections and surgeries. Fortunately this condition can typically be resolved with conservative treatment and lifestyle modifications that can prevent going under the knife. Simply put, plantar fasciitis is a strain with subsequent inflammation of the thick tissue (plantar fascia) and muscles on the bottom of the foot causing heel pain. Plantar fasciitis (PF) is characterized by biting heel/mid arch pain when first bearing weight in the morning, or after long periods of rest. The pain typically subsides within 5 minutes of walking or running, then worsens with long term activity or weight bearing. It is also associated with tired, achy feet at the end of the day and foot cramps. PF is seen in both active and inactive people, and is rarely the result of an acute injury. PF can be the result of several different factors: repetitive overuse injuries, poor fitting footwear, overtraining, structural abnormalities of the foot and improper gait mechanics. PF often becomes a chronic and/or recurring problem if not given the appropriate treatment and follow up care.

    Some contributing factors to the development of plantar fasciitis:

    Structural abnormalities: Plantar fasciitis is very commonly seen with pes planus (pictured left), or flat footed individuals. As you can see, this individual’s medial arch is almost flush with the ground. This can create strain on the plantar fascia. Severe injuries resulting in the need for surgical fusion of the foot can also create strain on the plantar fascia. In these cases of severe structural abnormalities, orthotics are typically indicated. Rehabilitation including foot strengthening exercises, chiropractic manipulation and soft tissue techniques can relieve pain and help to alleviate strain on the tissues and resolve flair ups. We use custom orthotics from Foot Levelers in our office. Using a 3-D scanner, we can have custom orthotics made to support the full structure of your foot.

    Poorly fitting footwear: Wearing improper footwear over time can lead to PF. If a shoe doesn’t fit your foot properly, your gait is altered during any weight bearing activity. This has an effect on the entire kinetic chain and can ultimately cause strain on the plantar fascia. The strength and flexibility of your foot will determine your best type of footwear.

    Overtraining: Can be a huge contributor to PF. What many athletes, weekend warriors and the like tend to overlook is the importance of recovery in their training regimens. If your tissues don’t have optimal nutrition, rest and repair time they start DEgenerate rather than REgenerate. Especially when it comes to long distance running, or quick sprints, the feet have a lot of demand.

    Nerve Impingement: Plantar fasciitis can be a symptom of sciatic nerve impingement. The sciatic nerve is the thickest nerve in your body. It originates from your lumbosacral plexus of nerves typically L4-S1/S2 with some individual anatomical variation. Although this nerve is commonly blamed for all radiating leg pain, it is only responsible for pain along its trajectory down the posterior aspect of the leg and foot. In some impingement cases, the pain can skip the back of the leg altogether and go straight to the foot. Impingement along any portion of the nerve can result in pain, but it doesn’t have to be in the leg. If there is enough impingement along this nerve, any added pressure, say forced dorsiflexion of the foot when standing or walking, can be just the right tension to create exquisite foot pain. Our bodies are always trying to protect our nervous system; reflexively the muscles surrounding the nerve will tighten in an attempt to avoid any further stretch or tension of the nerve. Ultimately, this leads to inflammation of the plantar fascia and the surrounding muscles.

    Other Factors:

    Systemic Inflammation: Though general systemic inflammation is typically not the cause of plantar fasciitis, it will increase your symptoms. For this reason we strongly encourage our patients to eat an anti-inflammatory diet specific to their needs. We also understand no one is perfect or eats perfect all the time, which is why we encourage an 80/20 approach; eat clean 80% of the time and use the other 20% to indulge. Curcuminoids, like those found in turmeric are great to help blot down inflammation in acute cases of plantar fasciitis.

    Alternatives to conservative care:

    Cortisone or steroid injections are very commonly given for Plantar fasciitis. In some really tough cases this can absolutely be necessary to “put out the fire” that is the inflammatory cascade, to get you out of pain initially. We never recommend looking at this option as a cure. Cortisone is a very powerful anti-inflammatory that alleviates pain without correcting the underlying issue, potentiating further injury and recurrent episodes. Another option is surgical intervention. In some cases, surgery is the best option for a particular case. We prefer to exhaust conservative treatment options before travelling down this avenue. A study on an overweight and obese population (43 total) suffering with plantar fasciitis for an average of 34.8 months, were given decompressive surgery to the nerve to the abductor digiti minimi with partial plantar fascia release and tracked over a 4-year period. It was found that 75.6% of patients were in deed pain-free or had only mild pain post-surgery (pain decreased from an 8.5/10 to a 2.5/10). However patient satisfaction post-surgery was only 48%.

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    Source by Ann Barter

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  • Healing Knee Injuries: A Few Helpful Exercises

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    The knee is one of our most crucial body parts. It plays an important part in our overall body fitness. That is the reason Knee injuries are usually of grave concern as knee injuries have the potential to significantly impair an individual’s mobility or put in plain words- ability to walk or run.

    But, knee injuries are not only the culprit that makes the knee inactive or defective. There are various systemic conditions, specifically few bone diseases like arthritis(osteoarthritis) that also significantly affects the knee joint. However, irrespective of the reason causing knee defects/injuries, exercises play a vital role in the healing process. In fact, Exercises play much more important role than medications in fast recovery from the knee injuries and disorders. In this article, though, we will focus on few extremely helpful exercises that facilitates the fast recovery process from knee injuries. But, before diving further deep into the topic, let’s get ourselves acquainted with knee injuries, its types & causes in brief.

    To start with, knee is made up of the following components- bone, ligaments, fluid & cartilage. Muscles & tendons present in the knee joint helps the part to stay mobile. Understandable, when one of these structures get injured/hurt or is affected due to any systemic conditions/diseases, knee defect/injuries occur.

    Knee injuries are characterized by extreme localized or overall pain, swelling, redness and causes severe impairment in walking activities.

    Knee injuries can be caused due to any accidents, sports activities or by simply awkward twisting of any one of the ligaments or tendons present in the knees. Treatment procedures for knee injuries usually contains a blend of medications & physical therapies( which mainly includes exercises), but in few cases surgical interventions ( such as knee replacement surgery) becomes necessary. In those cases, exercise becomes the only route to recover.

    Some of the major knee injuries include but are not limited to-

    a. Anterior cruciate Ligament (ACL) injuries- Very common in people who are very active in sports such as- soccer, basketball. It usually occurs due to the drastic direction change of the knees which in turn injure the ACL which is one of the connecting ligaments between shinbone & thighbone.

    b. Fractures- It is the second most common cause for knee injuries. Apart from injuries, fractures can also be caused due to osteoporosis which gradually weaken the bones.

    c. Torn Meniscus

    d. Knee bursitis

    e. Patellar tendinitis usually affects the avid runners, skiers, cyclers, etc.

    Knee injuries can also be caused by some other body conditions like- excessive body weight which puts pressure on the legs, to be precise on the knees, dislocated kneecap (which can be treated through a knee replacement surgery), gout, rheumatoid arthritis, due to relapse or getting hurt on a previous knee injury site, due to decrease strength and flexibility of the muscles (may be caused by any number of reasons) and last but not the least due to participation in any type of dangerous sports.

    However, irrespective of signs, symptoms & causes, healing from knee exercises with relatively fast and naturally involve exercises. Types & sets of exercises depends on the nature, severity & type of knee injury and must be prescribed and authorized by the caregiver. Additionally, those exercises can only be done under guidance & supervision of a trainer. Here are few example of relatively simple knee exercises, that usually helps in healing knee injuries.

    Exercise 1-Leg straightening & stretching.

    Lie on your back preferably on a hard. Flat surface. Next, bend your one knee and place the foot on the flat surface. Then, straighten the other leg and raise it in air at the level of the bended knee. This makes the quadricep muscles of the thigh work and puts put very little or negligible strain on the knees. To get the best results, the exercise should be repeated daily 10-15 times in two-three sets. It is recommended to start with low frequency initially and gradually increase the frequency and number of sets gradually and slowly.

    Exercise 2- Hamstring exercises

    This exercise is relatively simpler than the other ones and can be done anywhere, anytime. This simple and easy exercise is known to benefit the knee joint b strengthening the hamstring muscles that are present in the back portion of the thigh and are important for proper knee joint functioning.First, stand on a flat surface, preferably on the floor. Then slowly raise heel of one let as close as possible to one’s butt and is required to stay/hold in that position for 25-30 seconds. Later, with practice the duration can be increased to even 1 minute. Then, repeat the same with the other leg. This exercise is also commonly known as “Hamstring curls”.

    This exercise should be done minimum 15-20 times a set for 4-5 sets daily.

    Exercise 3- Squats

    Squat is known to be extremely beneficial exercise for knee injuries. The position required to perform this special exercise, work up the knee muscles and charge them up leading to fast healing from the injuries. This exercise is an advanced form of knee exercise.

    First, one need to stand straight against a wall or a sturdy, flat and hard surface. Secondly, after standing, one needs to spread their legs apart in line with their shoulder-width. Next, bend very lowly keeping your back straight against the wall/surface. Hold on to that position for 15-20 seconds. But, if one feels uncomfortable, it is recommended to immediately stop doing the exercise.

    It is usually good for the knees if done regularly 10-12 times in 3-4 sets/daily.

    Exercise 4- Calf raising exercise

    Stand with back facing to a chair / sturdy table. One can also stand in front of a wall. Get your hands on the wall surface if needed for supporting your body weight without straining the knees. Then, slowly raise your heels as high as possible by you. Hold on to the raised heel position for 10-15 seconds and then slowly, very slowly lower your heels in the normal position.

    Repeat the exercise daily 10-15 times for at least 3 sets.This exercise helps the knee to get in better shape and help to recover fast from injuries.

    Exercise 5- Step ups exercise

    Very common and extremely helpful exercise for knee injuries.

    One can use staircase for this one or can also use a raised but flat platform. Keeping one’s pelvic level steady, put one foot on the raised level and then slowly bend your knee and then raise your knee. Next, repeat this exercise with the other foot.

    Recommended daily 10-15 times for 4 – 5 sets. Once comfortable and well-practiced, one can raise/increase the height of the platform gradually. The above mentioned are few very easy and simple exercises that are known to benefits knees recovering/healing from injuries. But, one should always remember that of doing any of knee exercises makes you uncomfortable or increases pain, swelling of the knees, then stop exercising immediately and consult your doctor/trainer/care provider without further delay. Staying alert and cautious are the keys.

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    Source by Gagan Deep

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  • Are Your Exercises Preventing Your Back From Healing?

    Are Your Exercises Preventing Your Back From Healing?

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    When in pain, are there exercises that hurt your back?

    The short easy answer is “Yes”! Exercises that you do on a regular basis may actually harm your back if you have recently injured it or are in significant pain. Many patients continue there usual exercise routine while even in a “flare-up” or after a injury. This might actually slow the normal healing time of your back pain. For the sake of being brief, I will discuss lower back pain, but some of the basic principles can be applied to most areas of joint pain. A proper low back diagnosis is recommended prior to continuing or changing your workout program.

    Back pain while bending forward (flexion-intolerant).

    This is a very common type of lower back pain. The pain will be worse when leaning forward and you might have pain into the buttocks or thighs. Any symptoms radiating further or including changes in bowel or bladder changes, see your doctor ASAP. Many common stretches involve flexion of your lower back. It is paramount to avoid this motion in the beginning stages of a back injury. Many patients will simply not improve until they stop this exercise.

    Exercises to avoid with a flexion type low back injury.

    First, avoid all exercises that bend your back forward at the waist. These include crunches, toe touches, and seated forward bends. Any exercise that involves a forward posture is not recommended. Some of the other exercises to avoid with a flexion injury are:

    Bike reading while leaning forward.

    Toe touches while standing or seated.

    Any back lying abdominal exercises.

    Pulling of one or both knees to the chest.

    Seated leg presses.

    Lying on your back and pulling a knee up while doing trunk rotations.

    Hurdler’s stretch.

    Many or at least a couple of these have probably been advised by your chiropractor or physical therapist. If you have the type of low back pain I described, try staying away from these for a couple weeks and see if it helps. After recovery, these exercises are totally fine to resume.

    Our chiropractic office in Rapid City, SD offers relief and guidance for this and many other ailments or injuries. Dr Gruba is also a licensed acupuncturist in Rapid City.

    There is often no need to suffer from chronic lower back pain. I recommend starting with a proper diagnosis and treatment. It is always best to take an active approach at home, which includes necessary stretching and exercises. But, with poor guidance, your back pain can be a long term problem and may even alter your future.

    To Your Health,

    Greg Gruba DC

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    Source by Greg S Gruba

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