Understanding DVTs this Holiday Season

Article by: Jennifer Clark, PA-C, MPAS

Over the river and through the woods to Grandmother’s house we go! The holiday season is here and for most everyone that means some sort of travel; whether you yourself will be making a trip, or loved ones are coming to visit you. Knowing this, it is very important to get the word out about DVTs and how to prevent them. As you read this you may be wondering, what is a DVT? A DVT is a blood clot that forms in the deep veins in the body, most commonly in the legs. DVTs affect over 2 million Americans a year, and of that 2 million, over 600,000 suffer a life threatening complication called a pulmonary embolism (PE).  A pulmonary embolism occurs when a piece of the blood clot breaks loose and travels to the lungs. This can be a life-threatening condition with approximately 300,000 related deaths a year which is more than both breast cancer and AIDS combined.

DVTs can happen to anyone, but certain things can make people more prone to developing blood clots. The following is a list of some of the most common risk factors for developing a DVT:

·         Immobility

·         Recent surgery

·         Obesity

·         Dehydration

·         Bleeding disorder/Family history of blood clots

·         Cancer

·         Pregnancy

·         Hormone replacement therapy/birth control pills

·         Recent traumatic injury

By understanding these risk factors you can be more proactive in preventing the development of a DVT. If you are traveling over the holidays make sure you make frequent stops if you are driving or get up and walk the aisle if you are flying for several hours. If possible elevate your legs. Stay hydrated with water and/or liquids with electrolytes. When traveling invest in a pair of knee high compression hose to wear during your trip, this will help improve the circulation in your legs which can help prevent a DVT.

 Recognizing the signs and symptoms of a DVT can be difficult at times, sometimes people can be relatively asymptomatic, or perhaps even attribute the symptoms they do experience to something else such as a skin infection or muscle strain. Most commonly we see that DVTs cause pain, swelling, redness and warmth the affected limb.  If you experience any of these symptoms it is important to have further evaluation. For more information on DVTs you can go to www.preventdvt.org. This is a very useful website that has a tool you can use to assess your risk for developing a DVT. I hope you share this useful information with your family and friends and I wish you the very best holiday season filled with many blessings, love, and laughter.

Thanksgiving is Upon us Again

Article by: Bud Shuler, MD, FACS

Thanksgiving is again upon us, which to many, means good food, football, and some well-deserved time off from work.  To others it is the lead in to the holiday shopping season with Black Friday’s mad rush for the best deals of the year.  Originally, according to Wikipedia, Thanksgiving began across Europe as festivals to celebrate a bountiful harvest.  Thereafter, from a traditional standpoint, we in the United States, have tied it to the Plymouth settlement and their appreciation to the Wampanoag Native Americans for help in surviving in the New World.  President Lincoln, in 1863, established Thanksgiving as a nation-wide holiday on the final Thursday in November in an attempt to bring together a warring country. Later, in 1941, President Roosevelt established the holiday earlier, on the forth Thursday, in an attempt to stimulate the economy.  Surprisingly, I have never tied Black Friday to FDR.  Thanksgiving, however, should be a time to reflect on what God has provided and a opportunity to give thanks for our many blessings. 

But what of these blessings?  Many of us in this country are on hard times.  Many of our family members, or ourselves, are without work or struggling to make ends meet.  Times seem tougher now than ever before.  But we are blessed with the ability to choose how we accept these challenges.  We should still thank our God for what we do have.  Father Steve added perspective to the elementary students at Holy Nativity’s weekly chapel service on Wednesday, and reminded them of some of the basics of why we should be thankful.  70% of the world’s population cannot read because they are unable to go to school.  80% of homes in the world don’t have running water, electricity, and indoor plumbing.  And at least 50% of the world goes to bed hungry and has no clean water source to drink.  If you have money in the bank, in your pocket, or in a jar on your dresser, you are in the wealthiest 8% of the world.  92% of the world is poorer financially.  However, to many of them wealth is not measured in homes, food, or dollars but in relationships.  Families are closer and relationships are more meaningful. 

So as we gather together during the upcoming holidays, let us each take the time to remember from where we came and who brought us to where we are now.  Let our family and friends know how much we appreciate them.   We have a short time on this earth to live and love and be thankful for what we do have.  Let’s all commit to being more thankful over this next year and focus on what we do have rather than what we don’t.  I know we will be happier.  Happy Thanksgiving.

Life is short, and we haven’t much time to gladden the hearts of those who travel with us. So let us be swift to love, and make haste to be kind, and the blessing of God almighty, be with you now and forever, Amen.   [based on the words of Henri Frederic Amiel (1821-1881)]

Gensundheit

Article by: Clark Stream, PA-C

Gensundheit is the German work for health.  When a person sneezes, Germans typically say gensundheit to wish them good health.  Another common response to an audible sneeze is “God Bless You”.  The custom to bless a sneeze reportedly began on 16 February 590 A.D., when Pope Gregory decreed that whenever someone sneezed, others should say “God bless you” in response.  During this time Rome was dealing with an outbreak of the bubonic plague.  The blessing was given in belief that the one who sneezed wouldn’t then develop the plague.  Regardless of what we say when someone sneezes, we know that the sneeze can be the start of an illness such as a cold.

According to the Guinness World Record, a 12-year-old in England named Donna Griffiths holds the longest attack of sneezing on record.  Apparently, she sneezed for over 978 days between January 1981 and September 1983.  At first she sneezed every minute, but as the days moved into weeks and years her sneezes occurred every five minutes.

The world speed record for a sneeze is over 115 mph.  A sneeze is an irritation to the nasal mucosa that can send up to 40,000 droplets from the nose to a distance of up to 10 feet.  With the holiday season in full swing comes an increased opportunity to contract illnesses avoided so far this year.  As the temperature outside drops your chances of catching a cold increase.  You can reduce your chances by following these 6 simple steps:

1.       Cover your nose and mouth with a tissue when you cough or sneeze.
2.       Avoid touching your face with your hands as cold viruses can easily enter your body through the eyes and nose.
3.       Wash your hands with soap and water.  Alcohol based hand sanitizers are a great alternative to carry with you during this busy time since cold viruses can live up to three hours on surfaces. 
4.       Get plenty of rest.  Exhaustion can make you more susceptible to the airborne germs that multiply during the colder months.  Studies show that 6-8 hours of sleep help fend off germs that can bring down your immunity.
5.       Eat as healthy as possible while on the run this holiday season.  A balanced diet of carbohydrates, healthy fats, protein and limited processed foods are a great start.  Like always, fruits and veggies are best.  Also, plenty of vitamin C can help prevent cold
6.       Finally, if you’re the one with the cold…be polite…cover your mouth when you sneeze and wash your hands often to prevent spreading the cold virus. 

A cold is the one thing you don’t want to share this holiday season.  Gensundheit and God bless you.

Trick or Treat and Mom and Dad's Achy Feet

Article by: Jennifer Clark, PA-C, MPAS

Alright parents! October has arrived, and with it comes the joys of Halloween!  It is guaranteed to be filled with festivities from picking out costumes to stocking up on candy to parties and events and finally the big night filled with trick or treating! The average child will spend 1-3 hours walking from house to house to collect their goodies, and for most of us parents, that means we are walking with them! By the end of the night your dogs certainly may be barking! What if I told you there was a way to end the busy night with legs and feet that feel great? The answer is simple…compression hose!

                Compression hose help the calf muscles to squeeze those veins in our legs a little tighter which helps them work more efficiently, therefore improving how our legs feel.  Compression hose help reduce pain and swelling while improving our circulation. I know what many of you may be thinking; you don’t want to wear something that looks like you just walked out of the hospital….unless of course that is the look you are going for with your costume! Take relief in knowing that compression hose are much more stylish than they were in the past.  Many look like trouser socks, athletic socks or knee high panty hose, so that often times you cannot tell the difference. Some even come in fun colors. I wear knee high compression hose almost every single day and my only complaint is that I wish I would have started wearing them sooner. My legs don’t feel nearly as heavy, tired, and achy as they did before I began wearing them.

You may be wondering where to get compression hose.  They are available over the counter as well as by prescription by a provider. Often times you can find them in the pharmacy section or the sock aisle at your local store. Compression hose are also used for more serious conditions such as venous stasis ulcers, lymphedema, congestive heart failure, etc. If you have any of those conditions, I recommend you discuss compression hose with your primary care provider to ensure you purchase the correct size and graduation of compression. Typically you will find 8-15 mmHg compression hose over the counter which is fine for leg discomfort.  

So this Halloween, I hope you and your family have a safe and fun night trick or treating. Grab your compression hose on your way out! Who knows… you may even be able to incorporate them into a fun and comfortable costume!

Prediabetes, A Scary Diagnosis

Article by: Clark Stream, PA-C

Prediabetes, formerly known as boarder line diabetes, is a condition where blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. There are almost 80 million people in the United States who have prediabetes. Research has shown that long-term damage to the body, especially the heart and circulatory system, may already be occurring during prediabetes.

How to Tell if You Have Prediabetes.

There are three tests your doctor can use to determine whether you have prediabetes:

• The A1C test
• The fasting plasma glucose test (FPG)
• or the oral glucose tolerance test (OGTT).

The blood glucose levels measured after these tests determine whether you have a normal metabolism, prediabetes or diabetes.

If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT). Both are also known as prediabetes

Prediabetes is a serious medical condition that can be treated. The good news is that the recently completed Diabetes Prevention Program (DPP) study conclusively showed that people with prediabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity.  
Who should get tested for prediabetes?
If you are overweight and over age 45, you should be checked for prediabetes during your next routine medical office visit.  For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or prediabetes. These include high blood pressure, low HDL cholesterol and high triglycerides, a family history of diabetes, a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds, or belonging to an ethnic or minority group at high risk for diabetes.

What is the treatment for prediabetes?
 Treatment consists of losing weight (5-10 percent of total body weight) through diet and moderate exercise, such as walking, 30 minutes a day, 5 days a week. Don't worry if you can't get to your ideal body weight.  A loss of just 10 to 15 pounds can make a huge difference.  If you have prediabetes, you are at a 50% increased risk for heart disease or stroke.  Your doctor may wish to treat or counsel you about cardiovascular risk factors, such as tobacco use, high blood pressure, and high cholesterol.


What is the diet for prediabetes?

The American Diabetes Association recommends plenty of fruits and vegetables, nuts, and eat more fish.  Avoiding both saturated and trans fats are a heart healthy choice.  Together, these fats can increase your total and bad (LDL) cholesterol levels while the trans fats can lower your good, (HDL) cholesterol. 

With Halloween just around the corner, can your eat candy?

Yes, if you follow some simple rules.  Beware of chocolate with trans-fat from partially hydrogenated oil.  Be warned!!  Sugar free candy is not always the best choice.  Look for artificial sweeteners and read the nutrition labels.  Candy with low fat and carbs, enjoyed in reasonable portions are your best choice.  For the prediabetic, candy does not have to be scary.

Restless Legs Syndrome: Everything you need to know from symptoms to soap

Article by: Jennifer Clark, PA-C, MPAS

Do you ever complain of an uncontrollable urge to move your legs? Or perhaps you feel what may be described as a gnawing, or pulling, maybe even a creepy, crawly sensation in your legs that seems to happen when you rest? Does it seem to improve with movement?  If so, you may be suffering from Restless Legs Syndrome (RLS), a condition affecting 1 in 10 Americans. Many people suffer from these symptoms but don’t realize that it is in fact a known medical condition.

There is a significant amount of research out there looking for the cause of this condition, and it has not been nailed down to one particular cause. It has been found to run in families, and seems to affect women more than men, especially during pregnancy. There is thought that it is also due to an imbalance of a substance called dopamine, which is a chemical that is responsible for transmitting signals between the nerve cells in the brain. Anemia and low iron levels can also make these symptoms worse. Certain medications such as antihistamines, calcium channel blockers (used to treat high blood pressure and heart disease), and antidepressants can also provoke the symptoms.  Interestingly, research has also found that a large number of patients who suffer from RLS have an underlying venous disease such as venous insufficiency where the valves in the veins are not working correctly. The patients that seem to be impacted the most by both conditions are very similar: women, individuals over 50 years old, people who have standing professions, obese individuals, and those with a family history of the condition. In our practice we have found that 80-85% of the patients that complained of symptoms of RLS improved significantly after treatment of their venous disease.  By meeting with your primary care provider and discussing your symptoms he or she can review your symptoms, medications and lifestyle habits to help make the diagnosis and search for a possible underlying cause.   Simple blood work can determine if you have conditions such as anemia or iron deficiency.

Treatment for RLS ranges from treating the underlying cause, lifestyle changes, to medications and even surgical intervention to correct venous insufficiency. Here are some lifestyle changes you can try to help alleviate your symptoms:

·         Keep a regular sleep schedule.

o   Fatigue often makes symptoms of RLS worse. Try to go to bed and wake up the same times during the day to help your body get into a routine. Also avoid falling asleep with the television or lights on.

·         Compression hose

o   Wearing during the day when you are on your feet can help improve your symptoms, especially if you have underlying venous disease

·         Exercise in moderation

o   By maintaining aerobic fitness symptoms often improve, however intense or extensive training such as running a marathon can sometimes provoke symptoms

·         Stop smoking and drinking alcohol

·         Cut back on caffeine

·         Take a multivitamin

o   Often deficiencies in magnesium, iron, folic acid, and vitamin B can cause symptoms of RLS

·         Weight loss

·         Yoga

Lastly, I would like to leave with you with an anecdotal remedy. I will forewarn you, as I do with all of my patients I tell this to in clinic, that it may sound ridiculous! Are you ready? Place a bar of colored soap at the foot of your bed underneath your fitted sheet. Some people have even placed a small bar of soap, similar to the size you find in hotel rooms, in each sock when they sleep. It is not known how or why this works, but we have found that 70-80% of our patients that try it notice significant improvement of their symptoms. I always say, as silly as it sounds, it is certainly worth the cost of a bar of soap to try!

                 

Let's Talk About PAD

Article by: Jennifer Clark, PA-C, MPAS

Peripheral arterial disease is a very common condition affecting between 8-12million Americans. This number is expected to increase even more so as our population ages. Interestingly, only about 15% of those people have been diagnosed with peripheral arterial disease (PAD), while many people continue to attribute their symptoms of leg pain to “old age.” So what is the big deal about PAD anyway? Why is this so important to prevent? The arteries in our body are responsible for carrying oxygen and nutrient rich blood from the heart and lungs to the rest of the body for the organs and tissue to use. PAD is a narrowing of the arteries which is caused by a build-up of plaque, a waxy material made up of cholesterol, calcium and fibrous tissue. When the arteries are narrowed, this decreases the amount of blood flow to the body. When we exercise our muscles demand more oxygen, and when the arteries have narrowing it prevents them from getting this oxygen they require. This can cause weakness or painful cramping in the hips, buttocks, thighs or calves that resolves with rest which is called claudication. As the disease progresses people can develop severe symptoms such as rest pain or formation of ulcers to the legs and feet. Eventually this disease can progress to the point where the artery can become totally occluded and often times patients may require amputations.

            There are certain risk factors that make people more likely to develop PAD. This disease effects patients more commonly over the age of 50, in fact, the current statistics reflect 1 in every 20 adults over the age of 50 have PAD. Smoking or a history of smoking increases the risk of developing this condition by four times! Diabetes is a condition where the body cannot use sugar or glucose appropriately therefore there are elevated amounts of glucose in the blood. This causes the walls of the artery to become rough, which allows for plaque to form and build up within the artery. High blood pressure has a similar effect on the walls of the artery. Blood pressure is a measurement of the amount of force the blood pushes against the artery walls, the higher the blood pressure the more damage to the walls of the artery which allows for the plaque to build up. Uncontrolled cholesterol is a risk as well. Your body makes both good and bad cholesterol. LDL, also known as the “bad cholesterol” is a particle that carries cholesterol in the blood and deposits it in the arterial walls. The good cholesterol (HDL) helps to pick up excess plaquing from the artery walls. By understanding this you can see how if you have an elevated LDL and a low HDL this promotes plaque formation within the arteries. If you have any of the above mentioned risk factors or if you are experiencing symptoms of claudication then you should make an appointment with your primary care provider for further evaluation and treatment.

            Treatment for PAD begins with modifying risk factors such as the ones listed above. Controlling your cholesterol, Diabetes, and high blood pressure helps stabilize and improve arterial disease. Healthy diet and exercise along with stopping smoking benefits your body in so many ways. Walking programs often help improve the symptoms of PAD by promoting increased circulation. Various medications are also available to help improve symptoms. Interventional treatment with athrectomy and angioplasty may be required as well.

            PAD is a lifelong disease process, but early intervention and prevention can significantly improve quality of life. Knowing about risk factors and symptoms will help to identify this condition sooner so that treatment can be initiated sooner. 

When It Comes To PAD, Early Diagnosis is Key

Article by: Clark Stream, PA-C

If you are among the 24 million Americans with diabetes, you are approximately four times more likely to develop PAD than a person without diabetes.  PAD, (Peripheral arterial disease) happens when there is a narrowing of the blood vessels outside of your heart.  The cause of PAD is atherosclerosis.  This happens when plaque, a substance made up of fat and cholesterol, builds up on the walls of the arteries that supply blood to the arms and legs.  The plaque causes the arteries to narrow or become blocked.  While the primary early symptom of PAD is intermittent claudication, or leg pain while walking, the presence of diabetes reduces the likelihood of any symptoms at all.  To help prevent disability, amputation, a heart attack or stroke, early diagnosis and treatment of PAD are vital.

According to current treatment guidelines, diabetics over age 50 should undergo an ankle-brachial index (ABI), a test in which blood pressure in the ankle is measured and compared to that in the arm.  If the ankle pressure is lower than the arm pressure, a PAD diagnosis is likely. 

Patients with diabetes can greatly improve their chances of remaining PAD-free with preventive measures against cardiovascular disease, that is, controlling blood pressure (below 120/80), cholesterol (LDL below 100 mg/dl) and blood sugar (AIc below 7 percent) as well as quitting smoking.  

PAD meets modern Technology

Recent advances in technology have proved of great benefit to patients with diabetes and PAD.  In the past five years newer surgical techniques, called endovascular interventions have been used to treat patients with PAD.  By using devices like ballons, stents and atherectomy cathers to treat the plaque in the arteries, many patients are kept from having open surgical bypass procedues.  Artherectomy is a procedure in which plaque is removed from the arteries using a laser or rotational device.  With aggressive medical management, we are making the right steps toward preserving life and limb.

September is PAD awareness month. 

National medical guidelines recommend that certain individuals be tested for PAD.  Take this simple PAD quiz and make sure peripheral arterial disease doesn’t stop you in your tracks.

1.       I am under 50 years of age, have diabetes and at least one other risk factor:

a.       History of smoking

b.      Abnormal cholesterol

c.       High blood pressure

2.       I am 50 years or older and have diabetes

3.      I am 50 years or older and am a former or current smoker

4.      I am 70 years or older

5.      I have one or more symptoms of PAD:

a.       Fatigue, heaviness, tiredness or cramping in the leg muscles (calf, thigh or buttocks) that occurs during activity such as walking and goes away with rest

b.      Foot or toe pain at rest that often disturbs sleep

c.       Skin wounds or ulcers on the feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks)

If you answered yes to one or more of the above questions, talk to your health care provider about being tested for PAD.

Healthy Teachers=Healthy Classrooms

Article by: Clark Stream, PA-C

Few studies have been published on teachers’ health but most state that teaching can be a very stressful career choice.  It takes a special person with passion and a commitment to serve to choose this career in the first place.  According to the paper, “Healthy Teachers”, written by Robert Barwa, Ed.D. healthy teachers make for healthy classrooms. 

Back to school can be just as perilous for a teacher’s health as it is for students.  The active summer with outdoor activities, regular diet and exercise and relaxing time with the family are all about to come to an end.  Now that you are back into the classroom for hours with your students, keeping up your energy and maintaining your health is important.  Here are a few tips to help all teachers stay healthy during the coming school year:

Eat nutritionally.  Act like a kindergarten kid and have snack time.  Planning on a high protein and high fiber snack will not only give you more energy but also increase your mental clarity.  Carrots, grapes, apples and nuts are all good choices.

Sanitize and immunize.  Hand sanitizer and hand washing are both great ways to prevent the spread of germs.  Having a box of tissue nearby is another way to keep germs at bay.  Lysol type sprays are your best friend.  At the end of the day, spraying the door handles and other frequently touched objects can help everyone stay healthy.  Getting a yearly flu shot has been shown to keep teachers healthy and in the classroom.

Exercise your body.  Regular exercise helps reduce stress and improve you immune system.  If you cannot make it to the gym, try parking your car away from the school entrance.  The extra distance of walking will help keep you fit and trim.  One teachers website stated if you’re a high school teacher and your students like you, park in the student lot.  At most schools that lot is at least a mile from the front door!

Take care of your feet and legs.  Teachers consistently put stress on their feet and legs with prolonged standing.  Wearing shoes with good arch support is important.  With over 40 million Americans having varicose veins, a high percentage of patients are teachers, hairstylists and nurses.  Heavy, achy, tired, cramping and swollen legs are often caused by prolonged standing.  Wearing graduated compression stockings, knee high, are the first step to making your legs feel great.

Sleep at least 7-8 hours per night.  It is just as important for teachers to get enough sleep as it is for students.  Being well rested will help you combat illness and stress.  If restless legs keep you up at night, short walks, elevation and compression hose use during the day will help reduce symptoms.  If you cannot get to sleep, let me know…I have a 20^th Century Russian History book that if read, even just a few pages…will put the hardest insomniac to sleep.

Laugh often.   Humor is infectious. The sound of roaring laughter is far more contagious than any cough, sniffle, or sneeze.  Laughter also triggers healthy physical changes in the body.  Humor and laughter strengthen your immune system, increases endorphins, boost your energy, diminish pain, and protect you from the damaging effects of stress.  Best of all, this priceless medicine is fun, free, and easy to use.

Lymphedema, The Epidemic That no one Talks About

Article by: Clark Stream, PA-C


What is lymphedema?  Lymphedema is swelling that is caused by damage to the lymphatic system resulting in an accumulation of fluid in the tissues under the skin.  The word lymphedema is broken down into 2 words; Lymph, a colorless to milky colored fluid in your body and Edema, which means swelling.  Most often the swelling is in the arm(s) and/or leg(s).

Types of Lymphedema (There are two types of lymphedema.)
Primary lymphedema occurs without any known precipitating cause, and is due to inadequate or non-functional lymphatic vessels. Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels. In the United States the most common causes are surgery involving the lymph nodes, radiation therapy, trauma, and cancer. It is most often seen following surgery for cancer of the breast, pelvic area, and resections for lymphomas and melanomas.

Signs and Symptoms of Lymphedema
Extremities with lymphedema develop a chronic inflammatory condition stemming from the accumulation of fluid, resulting in fibrosis (hardening) of the tissues.  As lymphedema progresses, mobility can be severely impaired and joint movement often becomes restricted and painful.  This unhealthy state often leads to recurrent infections because the high protein lymph fluid is a good growth media for bacteria and fungi.  Each subsequent infection can further damage the already impaired lymphatic system

Treatment for lymphedema
The aim of treatment is to increase function by preventing further progression of the swelling.  Treatment should begin as soon as lymphedema has been diagnosed by your physician, with a certified lymphedema therapist.  Treatment can be effective even for people who have had lymphedema for many years.

Components of treatment:
The best and most effective treatment for lymph edema is Complete Decongestive Therapy (CDT).  It involves the following:

1.    Manual Lymphatic Drainage (MLD) is a gentle manual technique to move the fluid out of the affected area.

2.   Compression Therapy:  Compression bandaging is an essential component of lymph edema management to decrease the excess fluid, and help to soften the tissues.  After treatment, a compression garment can help maintain results.

3.     Exercising according to recommended CDT protocols can help stimulate the lymphatic system and get the fluid moving.                                                                 

4.     Meticulous Skin and Nail Care for the affected limb is crucial to keep skin healthy and protect against infections.

5.     Good Nutrition and plenty of water is important.  Eat lots of fresh fruits and vegetables.  Controlling weight is essential because being overweight can make the condition worse.

The LIVESTRONG foundation started by seven-time Tour de France winner Lance Armstrong announced its endorsement of H.R. 4662, the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 introduced by Congressman Larry Kissell (NC-08). This bill will require Medicare to offer fair treatment coverage for Americans afflicted with primary and secondary lymphedema.  The National Lymphedema Network has called lymphedema “the epidemic no one talks about.”  For further information you can look online at www.lymphnet.org or search for “Lymphedema in the News” on Facebook.

Spider Veins at the Beach

Article by: Jennifer Clark, PA-C, MPAS

There is no arguing that the state of Florida is one of the premiere vacation destinations in the United States, with over 80 million tourists visiting our sunshine state in 2010 and the numbers of tourists for 2011 are ever increasing! We are fortunate enough to live on one of the most beautiful coasts in the world, and while most of us can’t wait to get to the beach and enjoy our beautiful waters, others are not so eager to throw on the swimsuit, fearing embarrassment due to unsightly spider veins! Interestingly, while 80 million people visited our state in 2010, the same amount of people in the United States have problems with their veins! Often times this can impact our quality of life and detour us from enjoying the things we normally like to do, whether it is due to symptoms of venous disease or the appearance of spider and varicose veins.

                This then raises many questions: What are the symptoms of venous disease? How can I prevent spider veins and varicose veins from forming? How can I get them to go away? To understand the answers to these questions let us first discuss what exactly veins do and what happens when they stop working correctly. Veins are the vessels that return blood to the heart once it has circulated through the body. They are a tube with one-way valves that open and close to help move the blood in the proper direction. If these valves stop functioning correctly, the blood can flow backwards and pool in the vein, a condition called venous insufficiency. This causes the veins to enlarge and people can develop symptoms of heavy, tired, achy legs with numbness, itching, cramping, swelling and burning.  These enlarged veins fall into three groups: spider veins, reticular veins and varicose veins. Spider veins are visible on the surface of the skin as red, blue or purple lines. Reticular veins are visible as well and have a bluish discoloration and are larger than the spider veins.  Varicose veins are even larger and deeper and often look like bluish bumps under the skin, and sometimes become large and ropey.

                There are many methods that can prevent these veins from forming. Exercise is of the upmost importance, as it helps increase circulation. Along the same lines, maintaining your ideal body weight helps prevent the formation of varicose and spider veins by reducing the amount of pressure on the valves in the veins. Avoiding prolonged standing or sitting for extended periods of time helps as well. This is much easier said than done in many cases since most jobs require us to stand or sit for many hours during the day. If you are required to stand for several hours then make an effort to shift your body weight frequently and invest in a pair of knee-high compression hose, they not only help prevent development of varicose veins, but they also make your legs feel good. Shoes can also make a difference. Try to avoid wearing high heels which can constrict venous blood flow, a lower heeled shoe can actually tone the calf muscle which in turn helps improve blood flow. If you sit most of the day, then get up and walk around frequently. Elevation while you are sitting or lying down helps the blood travel back up to the heart. Lastly, to help prevent spider veins on the face from excessive sun exposure, wear sunscreen while outdoors. If you try these methods and still develop signs and symptoms of venous disease, there are treatments available for venous insufficiency as well as for the cosmetically displeasing spider veins which are listed on our website www.arteryandveins.com.  Now grab your beach gear and head out to those beautiful beaches on our Emerald Coast!

When is it okay to be Stationary?

Article by: Clark Stream, PA-C

As we age we tend to accept a more stationary way of life.  Immobility and inactivity can lead to serious health problems.  Fortunately, there is a simple and easy to use solution for those with mobility issues…A little invention called the Stationary Bike.

 

Stationary exercise bikes are a fun and safe way to get regular exercise.  There are many styles of exercise bikes.  For those who cannot sit on an exercise bike, a floor bike, often called a pedal exerciser can be used.  These small mini cycles allow the patient to sit in a comfortable chair with arms, or even in a wheelchair while exercising.  They are often used in rehabilitative and medical centers.  The pedal exerciser serves as a useful tool for decreasing the amount of time you sit sedentary. 

The pedal exerciser consists of a small metal frame and two pedals.  It is a light device, usually weighing less than 15 lbs.  Most units have straps on the pedals to secure your feet or hands so they do not slip during exercise.  Some pedal exercisers are basic pedaling machines with no electronic components.  Other pedal exercisers include an electronic monitor that provides feedback about your workout, such as time, distance, calories burned and speed.  Pedal exercisers can be used on a table top as an arm exerciser or on the floor to exercise the legs.  Convenient tension control knob allows a broad range of pedal resistance for a progressive exercise program.

Stationary pedal exerciser workouts are low impact and ideal for individuals with bone or back problems.  If you have osteoporosis, working out on a stationary bike can help reduce pain and delay bone degeneration long term.  Pedal exercisers are a great alternative for patients who have numbness in their feet, balance issues or who are prone to falls.

The stationary pedal exerciser provides a good cardiovascular workout.  It also strengthens muscle in the thighs and legs.  It improves flexibility and promotes good balance and posture.  These are physical benefits that can help patients stay strong, healthy and mobile.

Several senior studies show that working out on a stationary bike or pedal exerciser can enhance mood, promote better sleep and increase energy levels.  Burning calories on a pedal exerciser can help patients lose weight or avoid gaining unhealthy extra pounds.

How difficult is it to start a regular exercise program?  Not at all, just place the pedal exerciser on the floor, place your feet into the pedal straps and begin rotating the pedals forward.  You can get a great workout watching TV, reading the Lynn Haven Ledger or listening to music. 

Pedal exercisers can be found locally at medical supply stores, several pharmacies and online.  They start at around thirty dollars.  They are an affordable way to get your exercise program started.  And remember, being stationary does not mean you have to give up your quality of life.

Treating Leg Veins; Everything you Need to Know

Article by: Jennifer Clark, PA-C, MPAS

Approximately 60% of American citizens suffer from venous disease. These Americans often complain of heavy, tired, achy legs with possible swelling, numbness, restless leg syndrome, muscle cramps, and burning. Many will develop large, ropey varicose veins and some people even develop skin changes and ulcers.  Often times these symptoms can be improved with conservative management such as compression hose, exercise, weight loss, and elevation, however the underlying problem remains, and that is venous insufficiency.

                We treat this condition now by closing down the problematic vein with a minimally invasive procedure called endovenous ablation. During this procedure, heat produced by a laser or radiofrequency causes the vein to shrink down on itself and it eventually be reabsorbed by the body. By eliminating the vein that is not working correctly, the symptoms go away. This procedure has an excellent result with over 97% efficacy after one year.  While this procedure is minimally invasive, there are some potential risks which are important to be knowledgeable of when deciding to pursue treatment.

                When closing the veins with ablation it is required to insert a catheter into the vein that is heated to provide treatment. There is a risk of penetrating the wall of the vessel by doing this. This can cause a collection of blood underneath the skin called a hematoma which will resolve over time. By using ultrasound to ensure proper positioning of the catheter this can easily be avoided. There are nerves that run in close proximity to the veins in the leg, one of which becomes very superficial towards the ankle, another becomes very close to the vein at the back of the knee. These nerves can be damaged if the ablation is performed too far down the leg or too close to the one behind the knee, which is why these areas are avoided. When the vein closes down after ablation, often the nerves can become irritated and patients may experience numbness to the inner thigh or the back of the calf that usually resolves in one to two months. 

                                During the ablation, numbing medicine is injected around the veins to provide anesthesia. After the procedure patients may develop bruising from this that will resolve in one to two weeks. Sometimes the treated vein can become inflamed, a condition known as phlebitis. The skin may become red and tender to the touch with what feels like a knot directly under the surface. This often resolves with warm compresses, anti-inflammatory medications, and elevation.  And, with any procedure there is a risk for developing an infection. We use sterile technique which makes this risk very low.

One very serious complication is the formation of a clot in the deep veins of the leg, also known as a DVT or Deep Vein Thrombosis. The national risk for DVTs after ablation is about 3%. Hormone replacement therapy and oral birth control pills can increase this risk, therefore by following recommendations to discontinue these medications 4-5 days prior to treatment can help reduce likelihood of clot formation.  We also recommend avoiding physical inactivity after treatment. The development of a DVT is very uncommon, yet a very real concern which is why we recommend a DVT ultrasound several days after ablation treatment to ensure a clot has not formed, and if one has formed then we can initiate treatment promptly. 

  In medicine it is vitally important that our patients have a full understanding of not only their medical condition, but the treatment options and potential complications associated with the recommended treatment. Our goal is to ensure we do everything possible to help our patients make an educated decision about whether or not to pursue endovenous ablation for treatment of venous insufficiency.

Electronic Cigarettes

Article by: Clark Stream, PA-C


There is a new product on the market that has been changing the way people smoke. It’s called the “e-cig”. This new device consists of a battery, an atomizer (heater), and a cartridge that is filled with a liquid nicotine solution called eliquid. Every time you take a puff, the battery powers the atomizer which rapidly heats up the eliquid inside the cartridge. The liquid turns into a vapor that the user inhales. The vapor is tar free, odorless, 2nd hand smoke free, and carbon monoxide free. May manufacturers of this product claim the e-cigs as a revolutionary development for smokers that allow a customizable smoking experience.

The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. The FDA is concerned about the safety of these products and how they are marketed to the public,” said Margaret A. Hamburg, M.D., commissioner of food and drugs. ENDS are not approved by the FDA as smoking cessation devices.

Can e-cigs help you stop smoking? 

Over the years, several of my friends and family members have tried everything from patches, prescriptions, quitting cold turkey and plenty of nicotine gum. Unfortunately, very few have become non-smokers. For years working in cardiovascular and vascular surgery, I have preached to the smoking patient how important it is to stop smoking. Will e-cigs become one of the many tools used to help patients stop smoking? Findings suggest that e-cigarettes may hold promise as a smoking-cessation method and that they are worthy of further study using more-rigorous research designs.

The reason I am writing about this topic …I was recently surprised when my mother and sister told me they we able to quit smoking with the help of the e-cig. I asked them how difficult it was to stop and they said with the e-cig, it was easy. This is an answered prayer.

A recent internet survey in 2010 was conducted to assess the profile, usage patterns, satisfaction and perceived effects among users of electronic cigarettes ("e-cigs"). Visitors of websites and online forums were dedicated to e-cigarettes and to smoking cessation. There were 3587 participants (70% former tobacco smokers, 61% men, mean age 41 years). The median duration of electronic cigarette use was 3 months, users drew 120 puffs/day and used 5 refills/day. Almost all (97%) used e-cigarettes containing nicotine. Daily users spent $33 per month on these products. Most (96%) said the e-cigarette helped them quit smoking or reduce their smoking (92%). Reasons for using the e-cigarette included the perception it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%). Most ex-smokers (79%) feared they might relapse to smoking if they stopped using the e-cigarette. Users of nicotine-containing e-cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non-nicotine e-cigarettes. Conclusions of this survey showed that e-cigarettes were used much as people would use nicotine replacement medications: by former smokers to avoid relapse or as an aid to cut down or quit smoking. Further research should evaluate the safety and efficacy of e-cigarettes for administration of nicotine and other substances, and for quitting and relapse prevention.

What products should people who want to quit smoking use? 
There are a number of FDA-approved smoking cessation aids, including nicotine gum, nicotine skin patches, nicotine lozenges, nicotine oral inhaled products, and nicotine nasal spray that are available for smokers to use to reduce their dependence on nicotine.  Free help is available to all smokers who want to quit at 1-800-QUIT-NOW or by visiting www.smokefree.gov⁴.  Florida has several web sites including, www.floridaquitline.com, www.tobaccofreeflorida.com, or www.floridahealthcares.com .

A Fun Way to Stay Healthy in the Summer Heat

Article by: Jennifer Clark, PA-C, MPAS

May 2011

Summer is here and it is going to be a hot one! We have all been told many times over how important cardiovascular exercise is for our health, but lets be honest, the hotter it gets, the more we all seem to find an excuse to forego our exercise routines.because after all the heat makes it way too hard! So instead, we go through the drive through at our favorite fast food restaurant, grab an extra large milk shake and go home and lay on the couch in the air conditioning. As great as this may sound, it is not the healthiest way to avoid the heat. Most every Panama City resident would agree, there is no better way to combat the scorching heat as getting in the cool and refreshing water. What if there was a way to enjoy the water and exercise at the same time? There is! Water aerobics is a great way to cool off and provide our bodies with the cardiovascular exercise that is so important to a healthy lifestyle. Despite how fun this may sound, often people still find reasons why they feel they would not be able to perform this exercise. Lets take a minute to discuss some of those common excuses, the benefits of water aerobics, and why you CAN do it.


I cant do that because I am way too old!


Water aerobics knows no age! In fact, the older you are, the more benefit you are likely to receive. The water provides buoyancy and support making it much easier to exercise as compared to more traditional methods. In fact, the water actually supports up to 80% of our body weight making it much easier for elderly individuals.


But....I have a bad back and knees and exercise just hurts!


This is a non-weight bearing activity and it is easy on the joints making it ideal for people who suffer from joint pain or who are injured. It allows the joints to move throughout a much wider range of motion without pain. 


WellI have terrible balance and can hardly walk, let alone get in the water!


The resistance of the water increases core strength and improves muscular endurance and balance so it is beneficial in multiple ways.




I think that it will be a waste of time, I dont think it will do much to help me lose weight


Actually quite the contrary! Water aerobics actually burns fat more effectively than many land exercises, keeping the heart rate lower which allows increased fat burning. It is also a huge calorie burner, helping you to burn from 450-700 calories in an hour! 


Physical fitness is so important for us allit helps build our muscles and increases the blood flow through the legs which helps improve our circulation. Water aerobics is a fun and effective way to exercise and is available at multiple locations throughout town. It is also easy enough to do in your own pool; there are multiple routines available for download on the internet and inexpensive water resistance weights are sold at many stores locally as well as online. So get out of the heat and into the pool and start enjoying a fun way to improve your quality of life!

Stepping into the New Year with a Walking Program

Article By: Clark Stream, PA-C

January 2011

Millions of Americans make New Year’s resolutions to become fit and lose weight.  With good intentions, most of us do not reach our goals.  No matter what your age or level of fitness, starting a walking program is one of the easiest and most affordable forms of exercise.  A regular fitness program with walking will not only keep your body fit, but it can also reduce your risk of diabetes, high blood pressure, arthritis, heart disease, cancer, dementia and Alzheimer’s disease.  According to the American Heart Association, exercise therapy with walking is the best treatment for claudication, (leg pain and cramping with walking).  Walking has become one of the most popular ways to say fit.

Before starting any new exercise program it is always recommended that you first consult with your primary care provider.

Beginning your Walking Program

The best way to start is slow and easy.  The best time to start walking is today.  Just walk out the door and walk around your neighborhood for 10 minutes.  That’s it.  Do this every day for a week and you are on your way to better health.  Add five minutes to your walks with a goal of 30 minute walks 3-5 days per week.  Be sure to drink water before, during and after your walking.  Warm up by walking slow for the first few minutes.  Try adding some flexibility movements while warming up, like ankle and arm circles or hip and shoulder twists.  Now that you are warmed up you should walk at a normal pace.  Your breathing should not be labored.  A good rule of thumb is…If you can’t talk you are walking too fast, if you can carry a tune you are walking too slowly.  At the end of the walk you need a slower pace to cool down.  Your heart rate and breathing will slow down as you prepare for the final stage of your walking program…stretching.  Taking time to stretch after every workout will help prevent injury and allow you to increase your walking distance with time.  Basic calf, hamstring and lower back stretching should be done after each walk.  Don’t forget your shoulders and neck with gentle range of motion stretches.

Keep track of your time, distance and occasionally record you weight loss, heart rate and blood pressure readings.  Walking with a friend makes the physical activity a social activity that will help you stick with it.  Physical activity will add more energy to your life, by increasing your metabolism and helping you sleep better.  Walking can help you lose weight, reduce mental stress and improve memory. 

Go on, step up and begin a walking program…It’s the best way to improve your quality of life, for the life of your legs.