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Cam Newton Still Recovering From Ankle Surgery

Cam Newton AnkleThe Carolina Panthers are hoping to make another run at the playoffs in 2014, but much of their success depends on whether or not Pro Bowl quarterback Cam Newton can fully recover from an ankle operation he underwent nearly four months ago.

The Panthers report to training camp on Thursday, but don’t be surprised if Newton is limited in the early stages of camp. He’s less than four month removed from surgery to repair a damaged ligament in his left ankle. All signs point to Newton being under center when Carolina opens their season September 7, but many pundits wonder if he’ll retain the mobility he flashed during the first three years of his career.

Newton led all quarterbacks in rushing yards in 2013, and he’s tallied more rushing touchdowns over the past two seasons than any other quarterback. Coupled with the fact that he no longer has veteran Steve Smith hauling in his passes, Newton may have a tough time living up to expectations after a breakout 2013 campaign.

We’ll keep an eye on Newton once training camp gets underway at the end of the week, but it’s likely that the team will take it slow with Newton out of the gate. Carolina’s first preseason game is August 8, and although most teams trot their starters out for at least one series, we wouldn’t be shocked if Newton didn’t see his first preseason action until August 17 when the Panthers take on the Kansas City Chiefs.

Dr. Silverman comments

According to one source, the operation Newton underwent was to tighten the ligaments in his left ankle. I expect Newton to have increased confidence in his foot once his stabilized ankle is fully healed.

I’m happy to hear that Newton went under the knife. Some people may say that it’s never a good sign when a young athlete undergoes a major surgery, but I don’t view it that way. Instead of risking even more damage by playing with unstable ankle ligaments, Newton made the proactive choice to correct the issue. Too many times it seems that I’m writing about athletes who decide not to stabilize their ligaments or have their ankle instability addressed. If he has to miss a preseason game or two, so be it. This will give him the best chance to stay healthy for the games that matter.

I wish him the best of luck this season.

Related source: ESPN, CBS

War on Obesity: Mexico Bans Soda & Junk Food Commercials

Mexico Soda banMexico announced that it has banned all high-calorie food and soft drink commercials from terrestrial and cable TV in an attempt to combat the growing obesity trend.

According to the press release, the restrictions will be into effect immediately but it will not be a round-the-clock ban. Government officials say the junk food and soda commercial ban will be in effect from 2:30 pm to 7:30 pm on weekdays and from 7:30 am to 7:30 pm on weekends. Similar restrictions will also be imposed on advertisements shown at movie theaters.

The health ministry said the new ban would affect about 40 percent of commercials for soft drinks and sugar-laced goods. Only food and drink products that “meet nutritional standards,” will air during the restricted airtime.

Proponents of the restrictions say the obesity epidemic in Mexico is getting out of hand. According to official figures, 70 percent of adults and 30 percent of children in Mexico are obese or overweight.

Not The First, Won’t Be The Last

Mexico is taking great strides to combat childhood obesity, but they are hardly the first nation to ban unhealthy commercials from television. The United Kingdom, Norway and some provinces in Canada have banned junk food advertising from children’s television programming.

While they’re not the first to ban junk food commercials, Mexico’s restrictions may do more good than most. Instead of simply banning junk food and soda commercials from programming aimed at children, Mexico is banning all unhealthy ads during the time periods when most children watch TV, including a 12-hour ban on the weekends. This means advertisers won’t simply be able to move their ads from SpongeBob Squarepants to a more family orientated show like Modern Family unless it runs later in the evening.

Dr. Silverman comments

This is a wonderful move by Mexico. The country has one of the highest incidence rates of diabetes, which is brought on by a poor diet. They need to make healthy changes.

I can’t say that it will completely reverse Mexico’s obesity epidemic, but it certainly has to move the needle in the right direction. The whole world will be watching, and if the program is a success, I would be shocked if other countries didn’t institute similar regulations.

Related source: BBC

Interrupted Sleep May Increase Dementia Risk 

Sleep DementiaStruggling to get a good night’s sleep? You may be putting yourself at a greater risk for developing dementia, according to research presented at the Alzheimer’s Association International Conference 2014.

For their study, researchers tracked a large cohort of mostly male individuals to see if interrupted sleep led to an increased likelihood of developing dementia. After examining the data, researchers concluded that participants with a sleep disturbance had a 30 percent increased risk of developing dementia, and that risk jumped to about 80 percent if the patient also suffered from posttraumatic stress disorder (PTSD).

“Our results further the very interesting body of data that sleep problems do seem to be a risk factor for developing dementia,” said lead investigator Kristine Yaffe, MD. “This is a very robust finding; it is not a huge finding, but it is robust.”

Sleep Issues

Researchers noted that a large number of Americans are afflicted with some type of sleep disorder, with some of the more common conditions being:

  • Sleep Apnea
  • Insomnia
  • Poor Sleep Quality
  • Inability to Stay Asleep or Fall Back Asleep

As we’ve noted in other sleep-focused blogs, sleep is a restorative process where your brain essentially cleanses itself after a hard day’s work. Throughout your day, toxins and other molecular deteris make their way into our brain cells. Sleeps acts as a “time out” for your brain where it can flush the toxins out of its system. As one previous study put it, when you are asleep your brain is functioning just like a washing machine. It’s full of dirty particles that need to be cleansed. If you don’t sleep long enough for your brain to complete this cycle, toxic particles can build up in your brain, which can eventually lead to dementia or Alzheimer’s disease.

Dr. Yaffe added that individuals who have a family history of mental health issues should take steps to ensure they are getting the necessary amount of sleep.

“I think it is very important because of course if one could prevent dementia by treating sleep problems by, say, using CPAP [continuous positive airway pressure] for sleep-disordered breathing or by treating insomnia, this would be a really wonderful intervention to maybe prevent dementia,” concluded Dr. Yaffe. “There’s a lot of interest in this as a possible area for intervention.”

Related source Medscape

Heart Disease Study Saves Americans $37.1 Billion

Heart DiseaseA $260 million trial aimed at determining the effects of combined hormone therapy (cHT) as a prevention strategy for individuals with cardiovascular disease (CVD) has resulted in a net economic gain of $37.1 billion, according to a study published in the Annals of Internal Medicine.

When all was said and done the trial uncovered that individuals using cHT as a prevention strategy did not exhibit a reduced risk of CVD. In fact, cHT users were found to have a increased risk for complications like myocardial infarction, stroke, venous thromboembolism and breast cancer.

At the time of the study 5.5 million women were using CHT to combat heart disease. After the results were published cHT use dropped 50 percent in the first year and 5-10 percent each subsequent year as the findings were adopted by large health organizations.

Huge Savings

To determine the economic return of the study, researchers analyzed several factors and subtracted the total cost from the projected savings. Researchers believe with a 95 percent confidence interval that the project had a net economic return between $23.1 billion and $51.2 billion. They used the median of $31.7 billion as a basis for their claim.

The biggest savings came from:

• 4.3 million fewer patients paying for cHT treatment ($26.2 billion)

• 126,000 fewer projected cases of breast cancer ($4.5 billion)

• 76,000 fewer cases of CVD ($2.2 billion)

Dr. Milton Weinstein, professor of Health Policy and Management at the Harvard School of Public Medicine, said the results were astounding.

“The result of the trial was unexpected and, in a way, kind of lucky,” Dr. Weinstein said. “This one happened to be a big winner. They put their money on double zero, and it came up, and it was a great win for the American people, if not the world.”

Dr. Silverman comments

While I don’t think the results should be so closely compared to betting all your money on a single number in Roulette, this was surely a hugely expensive trial that was able to produce some incredible results.

I commend the authors for their work and hope to see similar studies on related treatments in the near future.

Sunburnt Feet: Treatment and Prevention

Sunburn feetThe summer is often filled with trips to the lake and strolls through the park, but you need to be careful when exposing your skin to direct sunlight for hours on end. Most people remember to apply sunscreen to their arms, face and shoulders, but oftentimes your feet can get overlooked. Below, we provide some tips for taking care of your feet before and after a sunburn.

Preventing Foot Sunburn

Our unofficial blog motto is “prevention is much preferred to treatment,” so we decided to talk about prevention before discussing treatment options. As we alluded to above, sunscreen is one of the best was to prevent a sunburn, but it only works if you apply it!

If you are planning on spending a day in the sun without shoes, make sure you lube up before you go out, and reapply every 4-6 hours, especially if you’ll be in a pool or lake.

It can be easy to remember to pack the SPF 30 when you’re headed to the lake, but summertime is also sandal season for many people. Sandals usually leave a good portion of your feet susceptible to burns, so switch up your footwear regularly. It may be painful to put your socks on Monday if you spent the whole weekend outside in sandals!

In summary, the two best ways to prevent foot sunburn is to:

1. Wear sunscreen.

2. Limit your sandal use, especially during days with a lot of direct sunlight.

Treating Sunburnt Feet

Burnt feet are no fun. They can make normal activities like walking, running or wearing shoes unbearable, so follow the above tips to prevent burns. In the unfortunate event that you suffer burns to your feet or toes, take steps to alleviate the pain.

Remember, feet can be sunburnt even if they aren’t red. Since the skin on your toes is more sensitive, any of the following can be signs of sunburn.

  • Pain
  • Swelling
  • Peeling
  • Blisters
  • Discoloration

If you end up with sunburn on your feet, run your feet under cool water. After you’re done soaking you feet, apply a lotion or gel that contain aloe to the area. Aloe is a plant substance that helps soothe and treat burns, so stock up if you live in a particularly sunny area.

When you’re out of the sun, limit your sock wearing when possible. This will allow your foot to “breathe” better and the sock won’t irritate your sensitive skin. Keep your feet out of sunlight for 24-48 hours after a burn, and if your symptoms worsen, seek medical attention.

So enjoy the weather this summer, but always make sure you protect your feet!

Demi Lovato Suffers Another Ankle Injury 

Demi Lovato is again nursing a sore foot after twisting her ankle while running last week.

If you think this story sounds familiar, you’re right. Lovato suffered a fractured foot last February after slipping on some freshly cleaned hardwood floors. Contrary to what you might expect, Lavato’s most recent injury didn’t occur on the same foot that she previously injured. She hurt her left foot while jogging and broke her right foot on the hardwood floor.

Lovato tweeted out a picture of her most recent injury to her followers.

Her next tweet read, “Didn’t even notice until now, so it’s not THAT bad but if you are a Lovatic, I thought you’d be amused.” We wouldn’t call ourselves Lovatics here at Silverman Ankle & Foot, but we’re certainly interested in the ailing feet and ankles of Hollywood’s biggest stars.

Dr. Silverman comments

This injury is much less severe than her previous in which I supposed she suffered a distal fibula fracture. Apparently the injury wasn’t severe enough to prevent her from attending the UFC fight over the weekend, as her next set of tweets show her near the octagon.

Lovato was likely just the victim of a misstep, but if she continues to roll either ankle she may want to consult a specialist, especially if it occurs on her right foot. That could be an indication that her fracture didn’t heal quite as expected. Considering how much she is one her feet while she preforms, she isn’t going to want to tolerate a nagging foot injury.

It sounds like she’ll be fine, and I hope this is the last we hear of her foot problems.

Related source:

Blame Your Fat Brother For Your Obesity

Overweight siblingsA new report suggests that you can blame your fat brother or sister for your increased risk of developing love handles, according to new findings by researchers at the Mongan Institute for Health Policy.

While it is known that a person’s risk of obesity increases if they have family members who are obese, there has been little study of which family members impact the risk the most. To better understand this phenomenon, researchers analyzed data from over 10,000 individuals and nearly 2,000 families. After analyzing physical activity, demographic information and aspects about food environment, researchers concluded:

• A person’s obesity risk is more than doubled if they have an obese sibling compared to an obese parent.

• That risk is even greater if the siblings are of the same gender.

• In families with only one child, an obese parent more than doubled the child’s risk of obesity.

• In two-child families, having an obese sibling was associated with more than a five times greater risk of obesity than if the sibling was not obese.

• In two-child families where both children are the same sex, if the older sibling was obese, the youngest daughter was 8.6 times more likely to be obese while the youngest son was 11.4 times more likely to be obese.

Lead author Mark Pachucki said he was surprised by the findings.

“It’s well known that diet and physical activity are key determinants of obesity among both adults and children; and prior research has shown that parents have a direct impact on children’s eating habits through shopping and preparing meals and on their exercise by encouraging and facilitating access to activities,” said Pachucki. “I went into this study expecting that, given parents’ oversized roles in their children’s lives, parental obesity would have a stronger association than a sibling’s obesity; but I was wrong.”

Pachucki believes the findings suggest that younger siblings take a lot of behavioral cues from their siblings, and that poor eating or exercise habits of one sibling can directly and indirectly affect the other. He concluded by saying that he wanted to run a similar study on a larger group to better determine causation.

Dr. Silverman comments

This study is very interesting. I went into the study with a similar mindset. Since parents are most likely doing the shopping and food prep, one would think that an obese parent would increase the likelihood of an obese child more than that of an obese sibling, but the data shows that it’s not the case.

Big brothers and sisters should make it a point to practice healthy eating habits, for their sake and for their younger sibling’s sake.

Related source:

50 People Die Daily From Prescription Painkiller Overdose

Drug OverdoseA disturbing report from the Centers for Disease Control and Prevention suggests that on average, nearly 50 people die each day in the United States from a prescription drug overdose.

In a statement about the CDC findings, Dr. Robert Wah, president of the American Medical Association, said the key to addressing the overdose issue “must include a strong emphasis on increasing access to substance abuse treatment and prevention efforts across the nation.”

“This new data will help provide states and public health authorities with important information that can be used to reduce the crisis of prescription drug abuse, diversion, overdose and death,” he added.

In their report, the CDC said some states have been successful in curbing the number of overdose deaths by attacking the problem on two fronts. First, the CDC notes that some states have passed legislation that has made it harder for so called “pill mills” to operate. Other states are also making it easier for EMTs and medical professionals to have access to the drug naloxone, which has been effective in reversing the effects of an overdose when administered at the right time.

Despite the advances in preventing prescription drug overdose, nearly four dozen people are still losing their lives every day. Dr. Wah said the AMA is continuing to work with other organizations to address the issue.

“We recognize that this is a multipronged problem and have long-advocated for an evidence-based, public health approach to address this crisis,” Dr. Wah said. “We continue to work with national organizations such as the National Governors Association to advance such an approach.”

The CDC provided a list of recommendations that they believe will reduce the number of prescription overdoses, including:

  • More educational opportunities for physicians.
  • Increased prevention efforts, including improved access to support tools at the point of care.
  • Wider implementation of drug take-back programs.
  • Improved overdose prevention measures, including access to naloxone.

Dr. Silverman comments

Prescription drug overdose is an agonizing problem. It’s so terrible to hear of people dying from overdoses of prescriptive medication, especially when these types of medication can do so much good.

As a surgeon, I have to deal with patient’s postoperative pain appropriately. Currently, the only reliable means to manage this pain is postoperative narcotics. This can be complicated and challenging. With new technology, hopefully pain can become easier to manage with long-term nerve blocks that provide extended analgesia (numbness) after surgery. This will reduce or even eliminate the need for postoperative narcotics.

Related source: AMA

Do I Need Knee Replacement? Maybe Not, New Study Finds

Total Knee ReplacementA recent study published in Arthritis and Rheumatism suggests that one in three total knee replacement operations may be unnecessary, leading authors to call for a more stringent patient selection criteria.

For their study, researchers conducted a five-year analysis of 205 patients who underwent a total knee anthroplasty (TKA) because they were classified as high risk for knee osteoarthritis. 60 percent of the patients were women, and the average age was 66.9 years old.

Using the Escobar system of knee arthroplasty classification that marks operations as appropriate, inconclusive or inappropriate on the basis of patient symptoms, functional status, extent of arthritis, age, mobility, stability and history of treatment, researchers were able to get a better understanding of the success of the surgery. After putting the data through the Escobar system, researchers found:

  • 44% were appropriate
  • 34.3% were inappropriate
  • 21.7% were inconclusive.

Dr. Daniel Riddle, lead researcher of the study, said he hopes the findings help reduce the number of inappropriate and unsuccessful knee replacement surgeries.

“The goal was not to necessarily suggest that knee replacement surgery is done inappropriately in this country, rather, the intent was to characterize the extent of variation in the key characteristics of patients who eventually undergo a procedure. This has never been done in the US to this extent before,” said Dr. Riddle. “It is our hope that characterizing this extent of variation will aid policy makers, and particularly clinicians who are directly involved with these patients, to begin to consider if one can reduce the amount of variation.”

Dr. Jeffery Katz said he agreed with Dr. Riddle’s assertion that total knee replacement might not be the best course of action for patients with mild symptoms, “but before we accept that a third of TKRs performed in the US at present are inappropriate, we should think carefully about whether ‘appropriateness’ can be judged without considering the prevailing values that patients and the larger society attach to functional deterioration and preservation.”

Although total knee replacement is usually only pursued after nonsurgical options such as weight loss, medications and physical therapy have failed, researchers want to develop a more comprehensive assessment tool to ensure patients don’t undergo an inapprotiate knee replacement.

Dr. Silverman comments

This was a great study to do, especially considering that 10 percent of patients with total knee replacement surgery hurt afterwards for unknown reasons. Identifying patients who are more appropriate candidates for the procedure will hopefully cut down on this complication.

It is troubling that the number is so high, although it’s not too surprising considering people are so interested in walking without pain. This may lead them to pursue an unnecessary surgery. But the onus is also on the doctors. Some doctors may incorrectly believe the knee joint is the source of the pain when it’s a secondary pain. Only when secondary causes of the joint pain are identified by a full evaluation and are corrected is a total knee replacement appropriate. Patients need physical therapy, and again, the pain may not actually be starting in the knee. Identifying the true source of pain is key.

The hip and the muscles that extend from it are great masqueraders of knee pain. For example, an overly tight IT band can cause severe medial joint pain. Similarly, problems along the obturator nerve along the inside of the hip can cause medial knee pain. Any lower extremity problem that causes leg external rotation (twisting the foot out towards the side) can cause either anterior knee pain or medial knee pain.

Those particular problems can be addressed quickly with nonsurgical options. It is unfortunate that some patients don’t have their true symptoms recognized until after total knee replacement.

Related source: Medscape

4 Tips For a Safe Fourth of July

4th of July SafetyFourth of July Eve is upon us, and that means many people will soon be making the trek to cottages and holiday barbecues. The three-day holiday can be fun-filled and relaxing, but it can spiral out of control quickly if you’re not careful. Below are four tips for staying safe this 4th of July.

1. Fireworks Safety – Some people say that the Fourth of July just isn’t complete without a fireworks show, but it’s important to use caution when playing with explosives. Don’t let anyone who has been consuming alcohol light off any fireworks, and make sure you are a safe distance away from people and buildings. Always supervise children when fireworks are present, even if they are just playing with Sparklers or Smoke Bombs. Pour water over any fireworks that appear to be “duds.” Stomping on them or kicking them is a quick way to get a ticket to my operating table.

2. Alcohol Awareness – This brings me to my next point, alcohol safety. Before you start ringing in the holiday with some spirits, make sure you have a plan, especially if you’re at a bar or out boating. Always make sure you have a safe ride home, and do not get behind the wheel if you’ve had too much to drink. The Fourth of July has statistically been the deadliest holiday on Minnesota roads. Please, celebrate our nation’s independence responsibly.

3. Swimming Safety – Many Minnesotans use the holiday weekend to get out to the lake, but a fun afternoon on the water can turn tragic without prior proper planning. Make sure all children know how to swim, and make sure you keep an eye on them while they are in the water. Smart adults also know that point #2 and #3 don’t mix. A late night swim after a few beers may sound appealing, but you’re asking for trouble. Read up on our previous post on drowning for more tips on how to stay safe in the water.

4. Sun Smarts – The weather forecast in Minnesota is gorgeous, so make sure you pack the SPF 30. I know you want to come back to the office with a little color, but you certainly don’t want to come back with melanoma. Apply sunscreen regularly when out in the sun, and make sure you find a way to stay cool. Grandparents, young children and pets are all at a heightened risk for sun poisoning or heat stroke. Be mindful of other people’s comfort when ringing in the holiday outdoors.

That’s all for today. Have a great weekend, and stay safe!