As we watch the devastation in Japan unfold, we are becoming more aware of the dangers of radiation. Remembering Chernobyl, many of us recall the nuclear disaster that affected much of Russian and Western Europe. These are serious nuclear accidents, but can we be exposed to radiation every day? How much is too much and what is it doing to our body?
Radiation is everywhere. Bananas, pistachios, and kitchenware all have radioactive particles. You cannot avoid being exposed to some levels of radiation every day. The amount is so small that it is not harmful to your body. Radiation exposure is measure in sierverts. Death is the result of exposure of 5,000 mSv and radiation poisoning is secondary to about 1,000 mSv. A banana contains 0.0001mSv. Smoking 1.5 packs a day exposes you to 13mSv/ year. The limit for nuclear power plant workers is 20mSv/year. The lowest clearly carcinogenic level is 100 mSv/year.
That is your everyday life but what about the hospital. X-rays and CT scans are sources of radiation. They are important diagnostic tools that allow physicians to see inside of your body without cutting you open. I take x-rays of most of my patients to better understand the biomechanical structure of their foot. X-rays are also an important tool during foot surgery. Am I putting my patients in radiation danger? An extremity x-ray exposes a patient to about 0.001 mSv. This is equivalent to the radiation you are exposed to in 3 hours of a normal day. A CT scan can be potentially more dangerous with exposures about 10 mSv. Some studies suggest about 2% of all cancers can be linked to over exposure due to multiple CT scans.
What should you do? It is important to understand that these diagnostic tests are often necessary to make appropriate diagnoses and treatments. These tests are safe when used properly. An MRI has no radiation exposure. Though there are more contraindication with use of an MRI because it can disrupt a pacemaker and the picture is distorted if metal implants are near the area of interest. If you are having a bad year and are seem to be in and out of the doctor’s office and having many tests, you should have a conversation with your doctors about radiation exposure. When you start to have multiple CT scans a year, there is a concern of excess radiation exposure. Very few people fall into this category.
Knowing the dangers of radiation, many safely protocols are set in place to limit exposure. In the hospital and in our daily lives, our radiation exposure is kept to a minimum. Unfortunately, nuclear disasters do happen. As danger lingers, our thoughts are with Japan.
Friday, April 15, 2011
Friday, March 11, 2011
Foot Surgery Nearly Kills Serena Williams???
Less than a year ago, Serena Williams underwent foot surgery. She was in cast, walking boots and crutches for some time after the injury. She recently underwent surgery for a life threatening condition. Did her foot surgery have anything to do with her blood clot?
Pulmonary Embolisms are most often the result of a blood clot that has traveled from the blood vessels through the heart and then to the arteries of the lung. The blockage causes shortness of breath, chest pain, and can be life threatening. The clot typically originates in the deep veins of the leg. These clots are also known as a DVT. Blood clots can form in anyone, but are most likely to occur after immobilization, in the elderly, or those that have a family history of blood clots. Those who smoke, are overweight or take birth control are also at an increased risk. The risk of having a pulmonary embolism is greater in high risk large orthopedic cases such as hip surgery. The risks of a DVT after foot surgery is less than 1% and the risk of a pulmonary embolism is even less.
Why is there a risk of a DVT or pulmonary embolism after foot surgery? It is common to be immobilized after foot surgery. While in a casts, surgical boots and crutches, your lower leg is generally inactive. The calf muscles are an internal pump to move blood back to the heart. If the leg is immobile, the body has to work harder to move the blood. If there is an insufficiency in blood movement, there is a higher risk of a blood clot. Not only did Serena have recent surgery, but she has also been doing a lot of traveling. Sitting on a plane for hours will only worsen a blood clot.
Linking the surgery to Serena William’s blood clot is hard to do. The surgery was some time ago and there may be other risk factors that we are unaware of. It does demonstrate that even healthy, young individuals may be at risk of a blood clot. It is important to take certain precautions to prevent clots before they happen. If you are at high risk of a blood clot, your doctor may prescribe medication after foot surgery to help prevent blood clots and pulmonary embolism. The risk is still very low, below 1%, but the results can be serious if not treated promptly.
Pulmonary Embolisms are most often the result of a blood clot that has traveled from the blood vessels through the heart and then to the arteries of the lung. The blockage causes shortness of breath, chest pain, and can be life threatening. The clot typically originates in the deep veins of the leg. These clots are also known as a DVT. Blood clots can form in anyone, but are most likely to occur after immobilization, in the elderly, or those that have a family history of blood clots. Those who smoke, are overweight or take birth control are also at an increased risk. The risk of having a pulmonary embolism is greater in high risk large orthopedic cases such as hip surgery. The risks of a DVT after foot surgery is less than 1% and the risk of a pulmonary embolism is even less.
Why is there a risk of a DVT or pulmonary embolism after foot surgery? It is common to be immobilized after foot surgery. While in a casts, surgical boots and crutches, your lower leg is generally inactive. The calf muscles are an internal pump to move blood back to the heart. If the leg is immobile, the body has to work harder to move the blood. If there is an insufficiency in blood movement, there is a higher risk of a blood clot. Not only did Serena have recent surgery, but she has also been doing a lot of traveling. Sitting on a plane for hours will only worsen a blood clot.
Linking the surgery to Serena William’s blood clot is hard to do. The surgery was some time ago and there may be other risk factors that we are unaware of. It does demonstrate that even healthy, young individuals may be at risk of a blood clot. It is important to take certain precautions to prevent clots before they happen. If you are at high risk of a blood clot, your doctor may prescribe medication after foot surgery to help prevent blood clots and pulmonary embolism. The risk is still very low, below 1%, but the results can be serious if not treated promptly.
Tuesday, February 15, 2011
Jennifer Grey Has Foot Surgery
Jennifer Grey of Dirty Dancing and Dancing with the Stars Fame just had surgery to remove a neuroma. If you remember, she consistently complained of foot pain during the show. Neuromas are very common in dancers.
A neuroma is a thickening of a nerve and can occur anywhere in the body, even the foot. Morton’s neuroma describes a neuroma of a specific location in the foot, between the third and fourth metatarsals. This is located on the balls of foot between the third and fourth toes. Clinicians may refer to this benign growth as a tumor. In medical terms this is a correct description but this is not an indication of cancer. The enlarged nerve is benign meaning it will not become invasive or become cancerous. In essence, a neuroma in the foot is really a pinched nerve, where the adjacent bones press on the nerve. Thus, the nerve gets inflamed and very painful. Dancing on the balls of your feet is definitely a cause for this type of neuroma.
Though a morton’s neuroma is not a medical emergency, it can cause severe pain and impede on your daily life. Some patients describe the pain as walking on a marble, but the most often complaint is a burning, sharp pain. Tingling and numbness is also common.
It is thought that the nerve becomes enlarged due to repetitive irritation or pressure. Over time, this irritation leads to a neuroma and pain. Wearing shoes that are tight, too small, or with a heel can aggravate the pain because it causes increased irritation. The pain may also be caused by running or other sports. Flexing and relaxing your toes causes compression on the nerve, and the balls of your foot takes on the most weight during walking or running. Since this is the area where the neuroma is located, doing such activities can elicit a lot of pain.
The podiatric physician will take x-rays of a patient with such pain to rule out a fracture or other foot disorders. The doctor will also attempt to elicit the pain by squeezing the foot. This will not only cause pain, but there the doctor will also hear a clicking sound due to the neuroma shifting between the bones.
There treatment ranges from conservative treatments to surgery. Like all treatment plans, surgery should be a last resort for when all other treatments fail. The pain may be greatly reduced by changing shoe gear, but this is often not enough. It is very common for your podiatric physician to prescribe a custom orthotic. Many patients find relief by not only wearing orthotics but also wearing a pad under the balls of their foot. A podiatric physician can properly fit and provide such padding. Non-steroid anti-inflammatory drugs, such as Advil, can also be used to help reduce the pain but should not be used long term. Your doctor may also suggest a steroid injection which has a greater effect on relieving the pain. Stretching, massages, and icing has also shown to relieve pain.
In addition, cyrotherapy, a prodedure that freezes the nerve, and allows the patient to immediately ambulate in their regular shoes, is a very effective method to eliminate the pain from a neuroma. In most cases today, surgical removal is not necessary because of this procedure
If the pain has increased due to physical activity, it is suggested to take some time off from the activity to allow your foot to rest and heal. It may be better to take on activities that cause less impact on the foot. Excises’ such as swimming or bicycling may be good alternatives.
Neuromas are not life threatening, but they do cause alterations in your life. You should consider wide toed shoes with plenty of room for your toes to wiggle. The pain most often subsides with conservative treatment, but in rare cases surgery is necessary. Unfortunately, the procedure removes the entire nerve and will leave numbness of the effected toes. Thus, you and your podiatric physician should try to avoid surgery if possible.
A neuroma is a thickening of a nerve and can occur anywhere in the body, even the foot. Morton’s neuroma describes a neuroma of a specific location in the foot, between the third and fourth metatarsals. This is located on the balls of foot between the third and fourth toes. Clinicians may refer to this benign growth as a tumor. In medical terms this is a correct description but this is not an indication of cancer. The enlarged nerve is benign meaning it will not become invasive or become cancerous. In essence, a neuroma in the foot is really a pinched nerve, where the adjacent bones press on the nerve. Thus, the nerve gets inflamed and very painful. Dancing on the balls of your feet is definitely a cause for this type of neuroma.
Though a morton’s neuroma is not a medical emergency, it can cause severe pain and impede on your daily life. Some patients describe the pain as walking on a marble, but the most often complaint is a burning, sharp pain. Tingling and numbness is also common.
It is thought that the nerve becomes enlarged due to repetitive irritation or pressure. Over time, this irritation leads to a neuroma and pain. Wearing shoes that are tight, too small, or with a heel can aggravate the pain because it causes increased irritation. The pain may also be caused by running or other sports. Flexing and relaxing your toes causes compression on the nerve, and the balls of your foot takes on the most weight during walking or running. Since this is the area where the neuroma is located, doing such activities can elicit a lot of pain.
The podiatric physician will take x-rays of a patient with such pain to rule out a fracture or other foot disorders. The doctor will also attempt to elicit the pain by squeezing the foot. This will not only cause pain, but there the doctor will also hear a clicking sound due to the neuroma shifting between the bones.
There treatment ranges from conservative treatments to surgery. Like all treatment plans, surgery should be a last resort for when all other treatments fail. The pain may be greatly reduced by changing shoe gear, but this is often not enough. It is very common for your podiatric physician to prescribe a custom orthotic. Many patients find relief by not only wearing orthotics but also wearing a pad under the balls of their foot. A podiatric physician can properly fit and provide such padding. Non-steroid anti-inflammatory drugs, such as Advil, can also be used to help reduce the pain but should not be used long term. Your doctor may also suggest a steroid injection which has a greater effect on relieving the pain. Stretching, massages, and icing has also shown to relieve pain.
In addition, cyrotherapy, a prodedure that freezes the nerve, and allows the patient to immediately ambulate in their regular shoes, is a very effective method to eliminate the pain from a neuroma. In most cases today, surgical removal is not necessary because of this procedure
If the pain has increased due to physical activity, it is suggested to take some time off from the activity to allow your foot to rest and heal. It may be better to take on activities that cause less impact on the foot. Excises’ such as swimming or bicycling may be good alternatives.
Neuromas are not life threatening, but they do cause alterations in your life. You should consider wide toed shoes with plenty of room for your toes to wiggle. The pain most often subsides with conservative treatment, but in rare cases surgery is necessary. Unfortunately, the procedure removes the entire nerve and will leave numbness of the effected toes. Thus, you and your podiatric physician should try to avoid surgery if possible.
Monday, February 14, 2011
Smoking Costs Dollars, Legs, and Now Your Job!
With the economy slowly recovering, every smoker is faced with the financial burden of their bad habit. Many still push out the dollar signs for their nicotine. Others are paying a different price for the many cigarette breaks. Smokers are 16 times more likely to have peripheral vascular disease or PVD. This disease leads to decreased blood flow, painful limbs, chronic ulcers, and amputations. But wait there is more. The job market is a little smaller for smokers as many companies are adopting anti-smoking policies.
Hospitals and medical businesses are turning away smokers. Part of the interview is screening your smoking habits and some go as far as instituting a nicotine urine test. Why the crackdown on smokers in the workplace? With health care dollars a growing concern for many employers, they are trying to cut their losses anywhere possible. It is estimated that the average smoker cost greater than $3,000 more to employ than the non-smoking counterpart. This is attributed to the higher health care costs and the lost productivity due to those many cigarette breaks.
29 states, with the help of strong lobbies, have adopted laws that prohibit smoking discrimination. Still many large health institutions have adopted the policy. The Cleveland Clinic has been hiring non-smokers since 2007. Also not hiring smokers is the American Lung Association, The American Cancer Society, and the World Health Organization.
Do you need any more reasons to stop smoking! Smoking continues to be leading cause of preventable death. One in five Americans still smoke. We have all heard the dangers of smoking from cancer to cardiovascular disease, but did you know smoking is bad for your feet? I hesitate doing any surgery on smokers. Got a bunion? If you smoke, you are at higher risk of non-healing, infection, and many other complications. Nicotine causes your blood vessels to constrict and decreases the amount of oxygen and nutrients delivered to your tissues. Years of smoking causes years of damage to your feet and legs.
Too many of my patients come in with ulcers due to poor circulation A number of my patients are missing toes because the blood flow was so poor it could not keep the toes alive. Smokers have thinning skin and are on the verge of losing their legs. Cigarettes will cost you your pocket book, cost you your legs, and now may cost you your job. Quit while you are ahead, because it will get worse the longer you puff.
Hospitals and medical businesses are turning away smokers. Part of the interview is screening your smoking habits and some go as far as instituting a nicotine urine test. Why the crackdown on smokers in the workplace? With health care dollars a growing concern for many employers, they are trying to cut their losses anywhere possible. It is estimated that the average smoker cost greater than $3,000 more to employ than the non-smoking counterpart. This is attributed to the higher health care costs and the lost productivity due to those many cigarette breaks.
29 states, with the help of strong lobbies, have adopted laws that prohibit smoking discrimination. Still many large health institutions have adopted the policy. The Cleveland Clinic has been hiring non-smokers since 2007. Also not hiring smokers is the American Lung Association, The American Cancer Society, and the World Health Organization.
Do you need any more reasons to stop smoking! Smoking continues to be leading cause of preventable death. One in five Americans still smoke. We have all heard the dangers of smoking from cancer to cardiovascular disease, but did you know smoking is bad for your feet? I hesitate doing any surgery on smokers. Got a bunion? If you smoke, you are at higher risk of non-healing, infection, and many other complications. Nicotine causes your blood vessels to constrict and decreases the amount of oxygen and nutrients delivered to your tissues. Years of smoking causes years of damage to your feet and legs.
Too many of my patients come in with ulcers due to poor circulation A number of my patients are missing toes because the blood flow was so poor it could not keep the toes alive. Smokers have thinning skin and are on the verge of losing their legs. Cigarettes will cost you your pocket book, cost you your legs, and now may cost you your job. Quit while you are ahead, because it will get worse the longer you puff.
Wednesday, December 22, 2010
Is Rex Ryan a Frustrated Podiatrist?
A video was just released showing Rex Ryan, the NY Jets football coach and his wife, depicting Rex of having a foot fetish. It is this video that made me think of the endless times I get asked, “Dr. Wishnie, why did you become a podiatrist? Do you have a foot fetish?”
Let me first answer that as simply as, absolutely not. I usually tell my patient, “Do you think a gastroenterologist has a butt fetish?” Then I ask, “What body part is beautiful? At least the foot is an external appendage that I don’t have to go digging into any holes.”
Well, why did I become a podiatrist? Podiatrists see many different types of patients. We see patients ranging from the age of infancy to the geriatric. On one day I can see both an 18 month old baby and a 104 year geriatric. I can see patients with sports injuries, like ankle sprains, Achilles tendinitis, fractures and dislocations. I see runners who don’t want to stop running, no matter how bad their foot hurts. Then I see little old ladies who remind me of my grandmother.
As you can see, I love the diversity that podiatry offers. I also love the fact that I can usually get people feeling better immediately. See, when you are not feeling well and you go to your family physician, they say, “Take this pill and you will feel better in a week.” Then the patient asks, “Hey doc, what happens if I don’t take the pill.” The doctor answers. “Then you will feel better in seven days.”
A lot of people are afraid of going to the doctors. They are afraid of the pain that might be inflicted upon them. Then what happens if they delay in making an appointment? The pain and the problem usually worsen. In podiatry, we can treat a problem many different ways. If a child comes in with a plantar’s wart, we usually use a topical medication to kill this virus. We usually don’t have to use any needles or do any cutting. If you have a corn, which is dead skin on a toe due to a deformity called a hammertoe, we can trim it painlessly. The patient leaves the office immediately feeling better. If you suffer from heel pain, we can tape the foot and give medication to relieve the pain. Many times we need to give an injection but then the patient is walking out the office feeling ten times better.
Getting patients better quickly and seeing almost immediate results is very satisfying. Podiatry is a wonderful profession and with millions of active baby boomers turning 65 on a daily basis, podiatrists will be very busy and will be an extremely necessary profession for many years to come.
Hey Rex, if this football coaching doesn’t work out, I can help you get in touch with my podiatry school professors.
Let me first answer that as simply as, absolutely not. I usually tell my patient, “Do you think a gastroenterologist has a butt fetish?” Then I ask, “What body part is beautiful? At least the foot is an external appendage that I don’t have to go digging into any holes.”
Well, why did I become a podiatrist? Podiatrists see many different types of patients. We see patients ranging from the age of infancy to the geriatric. On one day I can see both an 18 month old baby and a 104 year geriatric. I can see patients with sports injuries, like ankle sprains, Achilles tendinitis, fractures and dislocations. I see runners who don’t want to stop running, no matter how bad their foot hurts. Then I see little old ladies who remind me of my grandmother.
As you can see, I love the diversity that podiatry offers. I also love the fact that I can usually get people feeling better immediately. See, when you are not feeling well and you go to your family physician, they say, “Take this pill and you will feel better in a week.” Then the patient asks, “Hey doc, what happens if I don’t take the pill.” The doctor answers. “Then you will feel better in seven days.”
A lot of people are afraid of going to the doctors. They are afraid of the pain that might be inflicted upon them. Then what happens if they delay in making an appointment? The pain and the problem usually worsen. In podiatry, we can treat a problem many different ways. If a child comes in with a plantar’s wart, we usually use a topical medication to kill this virus. We usually don’t have to use any needles or do any cutting. If you have a corn, which is dead skin on a toe due to a deformity called a hammertoe, we can trim it painlessly. The patient leaves the office immediately feeling better. If you suffer from heel pain, we can tape the foot and give medication to relieve the pain. Many times we need to give an injection but then the patient is walking out the office feeling ten times better.
Getting patients better quickly and seeing almost immediate results is very satisfying. Podiatry is a wonderful profession and with millions of active baby boomers turning 65 on a daily basis, podiatrists will be very busy and will be an extremely necessary profession for many years to come.
Hey Rex, if this football coaching doesn’t work out, I can help you get in touch with my podiatry school professors.
Sunday, December 5, 2010
Dr. Wishnie is Finally Legal!
Today Marks the 21st Anniversary for
Family Foot & Ankle Specialists
We would like to thank all of our incredible patients as we celebrate our 21st anniversary! We have met so many amazing people through the years, many of which were patients when we first started. We have seen each other through a lot; marriages, children, grandchilren, birthdays and more. You are more than just patients to us, you are considered a special part of our family!
We hope you continue to grow with us for many years to come. Wishing everyone a safe holiday season,
The Doctors & Staff Of Family Foot & Ankle Specialists
Friday, December 3, 2010
Roethlisberger’s Shoe Made Out of Steel After Foot Injury.
The Pittsburgh Steelers will be taking a bit hit with Roesthlisberger’s foot. Originally reported as a foot sprained, some press releases are now reporting that the Steeler’s Quarterback has a broken bone in the foot. The official release from the Pittsburgh Stealers states that Roethlisberger injury is an aggravation of an old injury where scar tissue is present. So, is he going to play on Sunday?
It is believed that the Steeler’s Quarterback broke his fifth metatarsal bone. This bone is a long tubular bone located on the outside portion of the foot. The fifth metatarsal fractures are a highly researched topic and there are variable ways of treating this injury depending on the location. The majority of fractures in this bone can be treated conservatively with casting and rest. Occasionally, the fracture location or dislocation requires surgery and screw fixation.
Considering, that Ben has persisted that he will be playing on Sunday, we can assume this is a minor fracture that does not require surgery. He is currently ambulating in a walking boot and has been on light practice this week. The Steeler’s trainer stated that the Quarterback will be wearing a special shoe with metal plates protecting the injured area.
The fifth metatarsal is a common fracture site in athletes especially dancers. This is due to the extensive pivoting and jarring on the bone and surrounding tendons. Because of the bone’s location and soft tissue attachments, it does not take a traumatic event to break the bone. Simply landing on the foot wrong can cause such an injury. Recovery of most fractures in this area is easily treated with rest and decreased activity. Protection ambulation with a walking boot often all that is needed to make a full recovery.
When you are a professional athlete and have a record of 8-3, the rules of treatment are different than the average person’s. Winning games, egos, and pressure will push you in a direction that is not always the most beneficial for your body. It is probable that Roethlisberger’s foot break will not debilitate him or prevent him from throwing touchdown passes. It is also probable that his injury can worsen and the long term consequences of poor healing in the foot can mean chronic pain. Playing a a professional foot game in a metal shoe is not necessarily resting the injury.
It is believed that the Steeler’s Quarterback broke his fifth metatarsal bone. This bone is a long tubular bone located on the outside portion of the foot. The fifth metatarsal fractures are a highly researched topic and there are variable ways of treating this injury depending on the location. The majority of fractures in this bone can be treated conservatively with casting and rest. Occasionally, the fracture location or dislocation requires surgery and screw fixation.
Considering, that Ben has persisted that he will be playing on Sunday, we can assume this is a minor fracture that does not require surgery. He is currently ambulating in a walking boot and has been on light practice this week. The Steeler’s trainer stated that the Quarterback will be wearing a special shoe with metal plates protecting the injured area.
The fifth metatarsal is a common fracture site in athletes especially dancers. This is due to the extensive pivoting and jarring on the bone and surrounding tendons. Because of the bone’s location and soft tissue attachments, it does not take a traumatic event to break the bone. Simply landing on the foot wrong can cause such an injury. Recovery of most fractures in this area is easily treated with rest and decreased activity. Protection ambulation with a walking boot often all that is needed to make a full recovery.
When you are a professional athlete and have a record of 8-3, the rules of treatment are different than the average person’s. Winning games, egos, and pressure will push you in a direction that is not always the most beneficial for your body. It is probable that Roethlisberger’s foot break will not debilitate him or prevent him from throwing touchdown passes. It is also probable that his injury can worsen and the long term consequences of poor healing in the foot can mean chronic pain. Playing a a professional foot game in a metal shoe is not necessarily resting the injury.
