Health Care and Bad Breath (Halitosis)

People who have bad breath can really stink up a room. The cause of their social faux pas is due primarily to poor oral health. The technical term is halitosis; but if you mention to anyone that they suffer from that particular issue, you might just get a blank stare. Most people, however, can easily identify with the term �bad breath.� In some parts of the world, the whole country might smell�likely because most of the inhabitants are living with halitosis.

According to the Academy of General Dentistry (AGD), more than 80 million people suffer from chronic halitosis, or bad breath. In most cases it originates from the gums and tongue. The odor is caused by wastes from bacteria in the mouth, the decay of food particles, other debris in your mouth and poor oral hygiene. The decay and debris produce a sulfur compound that causes the unpleasant odor.

In many people, the millions of bacteria that live in the mouth (particularly on the back of the tongue) are the primary causes of bad breath. The mouth's warm, moist conditions make an ideal environment for these bacteria to grow. Most bad breath is caused by something in the mouth, according to Colgate.
Some types of bad breath, such as "morning mouth," are considered to be fairly normal, and they usually are not health concerns. The "morning mouth" type of bad breath occurs because the saliva that regularly washes away decaying food and odors during the daytime diminishes at night while you sleep. Your mouth becomes dry, and dead cells adhere to your tongue and to the inside of your cheeks. Bacteria use these cells for food and expel compounds that have a foul odor.

In addition, bad breath can be caused by the following:
  • Poor dental hygiene � Infrequent or improper brushing and flossing can leave food particles to decay inside the mouth.
  • Infections in the mouth � Periodontal (gum) disease
  • Respiratory tract infections � Throat infections, sinus infections, lung infections
  • External agents � Garlic, onions, coffee, cigarette smoking, chewing tobacco
  • Dry Mouth (xerostomia) � This can be caused by salivary gland problems, medications or by "mouth breathing."
  • Systemic illnesses � Diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others
  • Psychiatric illness � Some people may perceive that they have bad breath, but it is not noticed by oral-health-care professionals or others. This is referred to as "pseudohalitosis."
A person may not always know that he or she has bad breath. This phenomenon is because odor-detecting cells in the nose eventually become accustomed to the constant flow of bad smells from the mouth. Others may notice and react by recoiling as you speak. More information on halitosis can be found at this site:

It is important to practice good oral hygiene, such as brushing and flossing your teeth at least twice a day, according to the AGD. Proper brushing, including brushing the tongue, cheeks and the roof of the mouth, will remove bacteria and food particles. Flossing removes accumulated bacteria, plaque and food that may be trapped between teeth. To alleviate odors, clean your tongue with your toothbrush or a tongue scraper, a plastic tool that scrapes away bacteria that builds on the tongue.

Chewing sugar-free gum also may help control odor. If you have dentures or a removable appliance, such as a retainer or mouth guard, clean the appliance thoroughly before placing it back in your mouth. Before you use mouth rinses, deodorizing sprays or tablets, talk with your dentist, because these products only mask the odor temporarily and some products work better than others.

A dentist or physician may notice the patient's bad breath while the patient is discussing his or her medical history and symptoms. In some cases, depending on the smell of the patient's breath, the dentist or physician may suspect a likely cause for the problem. For example, "fruity" breath may be a sign of uncontrolled diabetes. A urine-like smell, especially in a person who is at high risk of kidney disease, can sometimes indicate kidney failure.

Your dentist will review your medical history for medical conditions that can cause bad breath and for medications that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any symptoms, including when the bad breath was noticed and by whom.

Your dentist will examine your teeth, gums, oral tissues and salivary glands. He or she also will feel your head and neck and will evaluate your breath when you exhale from your nose and from your mouth. Once the physical examination is finished, your dentist may refer you to your family physician if systemic problems are the most likely cause. In severe cases of gum disease, your dentist may recommend that you be seen by a periodontist (dentist who specializes in gum problems).

You will need diagnostic tests if the doctor suspects a lung infection, diabetes, kidney disease, liver disease or Sj�gren's syndrome. Depending on the suspected illness, these tests may include blood tests, urine tests, X-rays of the chest or sinuses, or other specialized testing. More information on bad breath issues can be found at this website:

According to US News & World Report, there are several kinds of natural remedies, like chewing parsley, eating herbs like rosemary or drinking black tea. The important thing is to find out the cause of your bad breath before committing to one of these remedies or picking up a bottle-of-mouthwash-a-day habit. Not only are these temporary fixes, but they could prevent you from catching serious dental or medical issues. You can find more material at this site:

Halitosis affects an estimated one in four adults, not to mention the scores of us with healthy mouths who go the extra mile to ensure that our exhales don't offend, according to Then there are those who experience the fear of bad breath -- halitophobia -- so intensely that their dentists may refer them to psychologists.

As a result, the oral hygiene industry is booming. Grocery store and pharmacy shelves are packed with a vast array of products to slay those oral odors, including gums, sprays, toothpastes and more. One of the most common products people purchase to combat halitosis is mouthwash. The British Medical Journal recommends using solutions with chlorohexidrine gluconate, which is proven to kill pesky bacteria. Rinsing with it at night preps you for a fresher-smelling morning since dry mouth that occurs when you sleep fosters bacteria production.

Not surprisingly, what you put into your mouth during the day can also influence the olfactory impact of your breath. Drinking water throughout the day is not only good for your body, but also good for your breath. It washes away bacteria and particles that prompt halitosis. Certain foods including parsley, fennel seeds and carrots can freshen your mouth as well.

Bad breath is no laughing matter, as typically you are the one laughed at if it�s your mouth. Do yourself a favor and practice good oral hygiene. If you still have problems, see your dentist or doctor to find out if your halitosis stems from a medical issue or some other reason. It pays to have �minty fresh breath.

Until next time.

Health Care and Suicide

Suicide is the end result of someone who has seen no end in sight for a particular problem. Taking your life because you seemingly feel there is no way out of an issue is not an answer�coldly, it�s an excuse. It may be a solution to your crisis that in your mind is the only way to escape; but to end your life can be tragic not only for you, but for those who know and love you. Suicide is not an acceptable answer to a question you anticipate has no other resolution.

If you are in intense emotional and/or physical pain, remember that your judgment is being clouded by that pain. If you are considering suicide, you are trying to end that pain. Please do not confuse ending your pain with ending your life. The two are very different, according to, a prevention organization.

If you are suicidal, you probably are suffering from clinical depression, bipolar disorder, schizophrenia, postpartum depression, PTSD, or something similar. And if you have something along these lines, you actually have a chemical imbalance in your brain -- and you cannot possibly think straight because of it. That is beyond your control. You are not weak. You just need some treatment. This imbalance can occur for several reasons, from genetics to a traumatic life experience, and it is extremely common for people to have this imbalance, so do not feel like you are alone. You are not.

This imbalance may be rectified in several ways, but first you need to be assessed so that the cause may be understood. I would request that you please go to a medical doctor. The doctor can determine if there is a secondary problem (such as a thyroid problem) that is causing the imbalance. If so, an appropriate medication may be prescribed to you. Next, you should visit a therapist. This will allow another assessment to occur and will also allow you to begin talking about your feelings. If the therapist determines that you need a prescription, he or she may refer you to someone who may assist you in that area. More information can be found at this website: .

According to the National Suicide Prevention Lifeline, also it can be scary when a friend or loved one is thinking about suicide. If someone you know has any warning signs you should encourage them to call 1-800-255-TALK (8255) so that the individual can find out what resources are available in his or her area. The call is routed to the Lifeline center closest to the caller�s area code. The local crisis center may have resources such as counseling or in-patient treatment centers for your friend or family member.  The Lifeline offers tips to you to help with someone who is threatening suicide:

o   Be direct. Talk openly and matter-of-factly about suicide.
o   Be willing to listen. Allow expressions of feelings. Accept the feelings.
o   Be non-judgmental. Don't debate whether suicide is right or wrong, or whether feelings are good or bad. Don't lecture on the value of life.
o   Get involved. Become available. Show interest and support.
o   Don't dare him or her to do it.
o   Don't act shocked. This will put distance between you.
o   Don't be sworn to secrecy. Seek support.
o   Offer hope that alternatives are available but do not offer glib reassurance.
o   Take action. Remove means, such as guns or stockpiled pills.
o   Get help from persons or agencies specializing in crisis intervention and suicide prevention.
Many people at some time in their lives think about suicide, according to the American Association of Suicidology. Most decide to live because they eventually come to realize that the crisis is temporary and death is permanent. On the other hand, people having a crisis sometimes perceive their dilemma as inescapable and feel an utter loss of control. These are some of the feelings and thoughts they experience:

o   Can't stop the pain
o   Can't think clearly
o   Can't make decisions
o   Can't see any way out
o   Can't sleep, eat or work
o   Can't get out of depression
o   Can't make the sadness go away
o   Can't see a future without pain
o   Can't see themselves as worthwhile
o   Can't get someone's attention
o   Can't seem to get control
Get more material about this topic at this website: .

Many times, people who are considering suicide have conflicting thoughts about how their spiritual life may be affected, especially if they are members of a certain faith. Christians can feel depressed and have suicidal thoughts also. It can happen for all of the same reasons mentioned above. The trials of life touch everyone, including Believers.  If the situation you are in is something you can't change, know that God can intervene miraculously. As hard as it may be to do, continue praying for God's help. Don't stop.

Professional help in the form of a qualified Christian counselor is one of the best ways to fight depression and thoughts of suicide. Look in the phone book and make some calls. Ask for references. A good counselor can help you get a new perspective on your problems. Get a medical check-up. Sometimes depression can be caused by a chemical imbalance or other biological factor.

Seek out a support group (starting with your church) that ministers to the area of difficulty in your life. Interacting with others who are facing similar challenges in their lives will help you feel less isolated. Force yourself to do something the next time you feel down. Inactivity only makes depression worse. Here are some things to try:

         Talk to someone. Call a friend and share your feelings.
         Take a walk. Exercise causes your blood and oxygen to circulate faster, which makes you feel invigorated. Your brain produces chemicals called endorphins that fight depression.
         Do something to help someone else. As you focus your attention on another's needs, your own cares may become less burdensome.
         Listen to music. Choose your favorite songs and sing along.
If you need ongoing support, you are encouraged to contact the pastor of your local church. With the guidance of a minister, you might also consider seeking professional Christian counseling. Here is an example of one of many national ministries that has resources to help:  The American Association of Christian Counselors, and you can call them at 1-866-611-HELP (1-866-611-4357). Much more information on this topic can be found at this website:

Regardless of your situation, suicide is fatal. If you or someone you know is struggling with thoughts to end life, seek help as soon as possible. Most people who contemplate suicide really don�t want to die; they are calling out for attention or help due to some personal crisis. If you recognize the symptoms, don�t wait to do something about preventing the taking of life into your own hands. Act sooner rather than later. In this type of case, time is only your friend when you take advantage of it.

Until next time.

Health Care and Diverticulitis

If you suffer from chronic pain in your lower left abdomen, that also may be accompanied with tenderness and some fever, you may be experiencing diverticulitis. Some people may additionally experience leukocytosis (an elevation of the white cell count in blood tests). Patients may also complain of nausea or diarrhea; others may be constipated.

According to, as a person ages, pressure within the colon causes small outpouchings (sacs) that push out from the walls of the colon. A single outpouching is called a diverticulum. The plural of diverticulum (two or more outpouchings) is diverticula. Diverticula may occur throughout the colon, but they are most common near the distal end of the left colon called the sigmoid colon. People who have diverticula in the colon are referred to as having diverticulosis. Diverticulosis is very common in adults in the U. S., and most people will eventually develop them.

Diverticula are common in the Western world but are rare in areas such as Asia and Africa. Diverticula increase with age. They are uncommon before the age of 40, and are seen in more than 40% of people over the age of 60 years in the U.S.

Most people with diverticulosis have few or no symptoms. However, when a diverticulum ruptures, bacteria (always present in the colon) spread into the tissues surrounding the colon and cause infection and inflammation�when the condition called diverticulitis finally results.

Many doctors believe that seeds and nuts that are eaten can get caught in the opening to a diverticulum and increase the chance of rupture and developing diverticulitis. There is insufficient scientific evidence that seeds and nuts promote diverticulitis, however, to support dietary restrictions. More information can be found a this site:

According to the National Institutes for Health (NIH), scientists are not certain what causes diverticulosis and diverticular disease. For more than 50 years, the most widely accepted theory was that a low-fiber diet led to diverticulosis and diverticular disease. Diverticulosis and diverticular disease were first noticed in the United States in the early 1900s, around the time processed foods were introduced into the American diet.

Consumption of processed foods greatly reduced Americans� fiber intake. Diverticulosis and diverticular disease are common in Western and industrialized countries�particularly the United States, England, and Australia�where low-fiber diets are common. The condition is rare in Asia and Africa, where most people eat high-fiber diets.Two large studies also indicate that a low-fiber diet may increase the chance of developing diverticular disease.

However, a recent study found that a low-fiber diet was not associated with diverticulosis and that a high-fiber diet and more frequent bowel movements may be linked to an increased rather than decreased chance of diverticula.

Other studies have focused on the role of decreased levels of the neurotransmitter serotonin in causing decreased relaxation and increased spasms of the colon muscle. A neurotransmitter is a chemical that helps brain cells communicate with nerve cells. However, more studies are needed in this area.

Studies have also found links between diverticular disease and obesity, lack of exercise, smoking, and certain medications including nonsteroidal anti-inflammatory drugs, such as aspirin, and steroids.

Scientists agree that with diverticulitis, inflammation may begin when bacteria or stool get caught in a diverticulum. In the colon, inflammation also may be caused by a decrease in healthy bacteria and an increase in disease-causing bacteria. This change in the bacteria may permit chronic inflammation to develop in the colon. More material on this malady can be found at this website:

Your doctor will start your diagnosis by talking to you about the symptoms that you�re experiencing and your medical history. Your doctor will also perform a physical exam, checking for any pain in the abdomen. A blood test might also be ordered to find out if your white blood cell count is higher than normal, which would indicate an infection. Your doctor might also order a computed tomography (CT) scan (which uses computer-guided X-ray images) to find out if you have diverticula that are infected, according to HealthLine at this website:

According to the American Society of Colon and Rectal Surgeons, Increasing the amount of dietary fiber (grains, legumes, vegetables, etc.) - and sometimes restricting certain foods reduces the pressure in the colon and may decrease the risk of complications due to diverticular disease.

Diverticulitis requires different management. Mild cases may be managed with oral antibiotics, dietary restrictions and possibly stool softeners. More severe cases require hospitalization with intravenous antibiotics and dietary restraints. Most acute attacks can be relieved with such methods.

Surgery is reserved for patients with recurrent episodes of diverticulitis, complications or severe attacks when there's little or no response to medication. Surgery may also be required in individuals with a single episode of severe bleeding from diverticulosis or with recurrent episodes of bleeding.

Surgical treatment for diverticulitis removes the diseased part of the colon, most commonly, the left or sigmoid colon. Often the colon is hooked up or "anastomosed" again to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in about three weeks. In emergency surgeries, patients may require a temporary colostomy bag. Patients are encouraged to seek medical attention for abdominal symptoms early to help avoid complications. More info can be located at this site:

While the reason is not exactly known, there is some evidence that links smoking & stress to symptoms becoming worse. Other factors that increase risk of diverticulitis are disease in the genes, gallbladder disease, obesity & coronary artery disease. The best steps you can take in treating diverticulitis have to do with your lifestyle.

A high fiber diet has been shown to be protective against diverticular disease. You'll need at least 20 to 35 grams of fiber a day to help prevent problems from diverticulosis. Consume fresh fruits and vegetables, cereals that are high in fiber and bran. Be sure to drink plenty of pure water each day, as a high fiber diet will not be effective without adequate water consumption.

Studies have also shown physical activity, specifically jogging or running, to protect against symptomatic diverticular disease. For naturopathic or holistic options to control or limit the inflammation that may lead to diverticulitis, find a lot of material on the subject at this website:

Diverticular disease is stressful, and painful. However, there are steps you can take to lessen the impact of it as you grow older. Lifestyle, diet, and preventive medicine can help you live with this medical condition. See your doctor right away if you experience symptoms that may be causing you abdominal discomfort. Don�t delay treatment, and make dietary changes that can help you deal with diverticular problems.

Until next time.

CA Doctors Bailing on ObamaCare Patients?

Recently I saw some numbers for reimbursement rates on the spiffy new Obamacare 'stuff' from a large insurer in California. 

For CPT code 99213 (routine office visit)

Old Legacy Network pays doctor: $71.00
New Off Exchange Network pays doctor: $66.00
New Exchange Network pays doctor: $45.50

Article published today in the Visalia Times and Tulare Advance-Register.  

Doctor Networks Opt Out of New Plans

Insurance agents and doctors agree � call your doctor before the end of open enrollment (March 31) to confirm whether your doctor accepts your new plan. The alternative, they say, is boarding what can become a frustrating insurance merry-go-round.

 To add insult to injury, her doctor � whom she�d seen for years � informed her that his  office no longer accepted individual Blue Cross insurance plans, regardless of whether they were purchased from Covered California or not

 In many cases, private physicians who don�t practice in a federally qualified, hospital-owned or rural clinic are only paid $20 per patient visit � hardly enough to cover the cost of electric bills, front office staff, rent, supplies or malpractice insurance, Sine said.

Before open enrollment for 2014 ends in 2 weeks, be sure to check with your doctors and make sure that they accept the plan you have enrolled in for this year.


Health Care and Spring Fever

When the flowers start to bloom and the trees begin to bud, the end of Winter and the beginning of Spring is near. Have you ever been so depressed or have feelings of being cooped up like a caged bird as you await the arrival of warmer temperatures and milder weather that you can hardly stand it? You just want to run outside without worrying about freezing to death from all the blustery winds and snow of the colder months. You seem like you are going to burst if you don�t get some fresh air and enjoy the outdoors without the fear of frostbite.

According to the Los Angeles Times, Spring fever, that reputed and seemingly infectious malady that strikes when the days lengthen and temperatures begin to climb, has been blamed for feverish bouts of house-cleaning, restless behavior in the classroom, distraction in meetings and love struck dazes. Some scientists think spring fever is more than just a colloquialism -- they think it's a constellation of symptoms brought about by hormonal changes in the body.

In winter, the body secretes high levels of melatonin, a hormone that governs sleep-wake cycles. Come spring, the increasing amount of daylight is registered by light-sensitive tissue in the eye, which signals the brain to stop secreting so much melatonin. As the hormone's levels drop off, greater wakefulness results. On the other hand, levels of another chemical, serotonin, rise in spring. This mood-elevating neurotransmitter may be at the root of the giddiness, energy boost and enthusiasm that characterize spring fever. More information can be found here:

Just as your bare legs are soaking in the sun, your brain is busy processing the bright light as well. The increased sunshine signals the body to produce less melatonin, which plays an important role in sleep, as noted above. There's more daylight, so people have more energy, sleep a little less. Some would argue it's not just hormones at work, but that there's another possible reason people are happier the more time they spend outdoors on a sunny day: It's likely you're logging extra hours exercising.

Although there is little evidence that spring turns people to romance, according to studies done by the UNC School of Medicine. As warm weather returns, �People feel better. They have more energy. That would make them prone to a relationship.�

Several studies have found seasonal variation in sperm counts, with the lowest sperm concentrations occurring during the hot summer months. Other research suggests that in the United States, there is a small peak in births in February and March, indicating conception the previous spring. But more babies are born in August and September, and they would have been conceived in the darkness of winter.

         Warm weather is a great incentive to exercise outdoors. �Twenty to forty minutes of exercise most days of the week is a terrific baseline.�

         But as you spend more time outside, make sure to stay well-hydrated. To reduce your exposure to pollen, which can affect people with allergies and asthma, exercise in the early morning. Plants open up and flower as the sun comes up.

         Resume outdoor exercise gradually to avoid injury.

         Take steps to avoid too much sun, which can lead to skin cancer. To reduce your risk, try wearing protective clothing and staying indoors during the brightest part of the day.

For some however, spring fever can mean the opposite-a loss of energy with the onset of spring (�spring tiredness�), according to this site: Spring fever cannot be classed as a diagnosed illness, rather it is a phenomenon that seems to be caused by a change in the seasons. People usually experience symptoms from mid-March to mid- April.

The most common symptoms are weariness even with enough sleep, a sensitivity to changes in the weather, dizziness, irritability, headaches, and sometimes aching joints. Your hormone balance may play a role in this. Possibly your �happiness hormone�: seratonin which relies on daylight for production depletes over the winter, which allows the �sleep hormone�: melatonin to have more effect. In the spring your hormones readjust with more daylight. Temperature and food can also affect �spring fever�.

According to Scientific American, clearly, there are marked correlations between moods, behavior and the lengthening days of spring, but the precise cause for our renewed energy remains elusive. The evidence for spring fever remains largely anecdotal. But, just as Seasonal Affective Disorder (SAD) has proved sadly real, spring fever edges away from science fiction, even if it is not quite science fact. More info can be found at this site:

 As the weather gets warmer and sunnier in the spring, the opposite happens: body temperature goes up, blood pressure goes down, and the feel-good hormone serotonin begins to dominate. The problem is that the transitions between these different stages don�t always go smoothly. In any case, hormonal imbalances take place that can cause all sorts of physical and mental responses. Some experts say that spring fever or spring fatigue are a bit like having a � hangover� after a period of dormancy, perhaps a lighter version of what hibernating animals go through , according to Timi Gustafson R.D., a registered dietitian, newspaper columnist, blogger and author of the book �The Healthy Diner � How to Eat Right and Still Have Fun� .

Because your experience of seasonal changes has become so much mitigated through artificial light and heating, your natural reactions may be even less predictable. The effects of seasonal changes on the body�s equilibrium are stress-producing, says Karina Seizinger, a homeopath and yoga teacher who recommends taking a number of measures for the treatment of spring fatigue symptoms. Among them are eating a healthy, balanced diet consisting of lots of fresh fruits and vegetables, drinking plenty of water, exercising, exposing the body to sunlight and engaging in calming practices like yoga and meditation. More info on this topic can be found at this site:

So, when you start to feel like you are experiencing the symptoms attributed to Spring fever, then take time to review where you are physically and mentally to adjust. If you are not affected, check your blood pressure.

Until next time.

It's ALL Obama Care, People!

There sure is a lot of confusion out there about individual & family coverage in California (and elsewhere).

Quite simply, it's all Obama Care.  There are two channels to purchase coverage but all of it complies with the ACA by law.  They are not separate markets, just separate channels within a market with some variations in terms of carriers and subsidies.

One, you can purchase your coverage from the exchange (Covered CA) if you want to get some money from Obama to subsidize your premiums/benefits and you are eligible for help.

Two, you can pay the full boat yourself and purchase outside of Covered CA in the private market.  Those plans must still comply with the ACA standards and must at least offer 'mirrors' of the exchange (Covered CA) plans (there can be extras in the private channel but they still have to meet metal and ACA standards).

It all comes down to only where the premium $$ are coming from.  Otherwise, all plans are part of a single market risk pool and all plans must comply with  ACA requirements.

On March 31 Open Enrollment closes for the year and you cannot purchase a policy unless you have a qualifying event outside of open enrollment, on exchange or off exchange.  

The exchange is where you get some of Obama's money, the private market is where you spend you own money.  Otherwise, they are no different.  Networks are identical as well for those carriers selling on-exchange (who also must sell the same plans in the private market).

A true private non-ObamaCare market does not exist in California for individual & family coverage.  

Health Care and Plantar Fasciitis

People who have plantar fasciitis typically experience terrible foot pain on the bottom of their foot. Often, the pain can be excruciating to the point of someone having the inability to walk without difficulty. Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

 This type of health problem of the heel and plantar surface of the foot is characterized by inflammation, fibrosis, or structural deterioration of the plantar fascia of the foot. The plantar fascia is a thick fibrous band of connective tissue that originates on the medial tubercle of the heel bone and extends along the sole of the foot towards the toes and supports the arch of the foot. The condition is often caused by overuse of the plantar fascia, increases in physical activity, weight or age. Chronic cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, according to the Journal of the American Podiatric Medical Association.

Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Approximately 10% of people have plantar fasciitis at some point during their lifetime. It is commonly associated with long periods of weight bearing and is much more prevalent in individuals with hyperpronation (flat feet). Among non-athletic populations, it is associated with obesity. Plantar fasciitis pain is usually felt on the underside of the heel and is often most intense with the first steps of the day.

Those with plantar fasciitis often have difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle) due to tightness of the gastrocnemius muscle or Achilles tendon. Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling.

In general, plantar fasciitis is a self-limiting condition, according to the Association of American Family Physicians. Unfortunately, the time until resolution is often six to 18 months, which can lead to frustration for patients and physicians. Rest was cited by 25 percent of patients with plantar fasciitis in one study as the treatment that worked best. Athletes, active adults and persons whose occupations require lots of walking may not be compliant if instructed to stop all activity. Many sports medicine physicians have found that outlining a plan of �relative rest� that substitutes alternative forms of activity for activities that aggravate the symptoms will increase the chance of compliance with the treatment plan.

It is equally important to correct the problems that place individuals at risk for plantar fasciitis, such as increased amount of weight-bearing activity, increased intensity of activity, hard walking/running surfaces and worn shoes. Early recognition and treatment usually lead to a shorter course of treatment as well as increased probability of success with conservative treatment measures. More info can be found at this website:

According to the National Institutes of Health,your health care provider will usually first recommend:

Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation

         Heel and foot stretching exercises
         Night splints to wear while sleeping to stretch the foot
         Resting as much as possible for at least a week
         Wearing shoes with good support and cushions

Other steps to relieve pain include:

         Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days.
         Try wearing a heel cup, felt pads in the heel area, or shoe inserts.
         Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your health care provider may recommend:

         Wearing a boot cast, which looks like a ski boot, for 3-6 weeks. It can be removed for bathing.
         Custom-made shoe inserts (orthotics)
         Steroid shots or injections into the heel

Sometimes, foot surgery is needed. Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain. More material on this subject can be found at this site:

What if your symptoms of plantar fasciitis do not resolve with time? As stated above, simple treatment measures will usually work in the treatment of plantar fasciitis. These treatments include anti-inflammatory medication, shoe inserts, and stretching exercises. In cases where a good effort with these treatments fails to provide adequate relief, some more aggressive treatments may be attempted. These include cortisone injections or extracorporeal shock wave treatments.

Although surgery may be recommended for extreme cases, there can be problems that result. Some of the complications of surgery for plantar fasciitis include:

Over release of the plantar fascia: When your surgeon releases the plantar fascia, it is important to only release about 30-50% of the fascia. Release of more of the plantar fascia during surgery may cause a flat foot deformity due to the loss of the arch of the foot. Flat foot after surgery can lead to chronic problems that may be as bad as the plantar fasciitis.

Nerve injury to the foot: There are small nerves that travel just adjacent to the plantar fascia. These nerves, even with protection, may be damaged during surgery to release of the plantar fascia. Because of this, a small percentage of patients may have pain or numbness in areas of the foot following plantar fasciitis surgery.

While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery. This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery. More info can be located at this site:

As noted, plantar fasciitis is a painful problem, but there can be relief. It just won�t happen overnight. The first thing to do is to see your family doctor and then get a recommendation to see a specialist for treatment. Most people suffering from the malady get over in time, but a few have chronic issues. The key is to not postpone treatment, and be consistent with what the diagnosis has prescribed.

Until next time.


New Medicare cards are coming starting in April

The Centers for Medicare & Medicaid Services (CMS) will start mailing redesigned Medicare cards to beneficiaries in Washington state aft...