Sunday, July 29, 2018

Diabetes and Surgical Risks

Elevated blood sugars increase the risks of adverse outcomes after surgery according to recent study cited in "Clinical Diabetes", summer 2018.  Special attention therefore must be paid to these patients both before and after surgery.  Compared to patients with normal blood sugar, patients with diabetes have an increased risk of mortality 6 months after surgery, and elevated risks of complications that require additional hospitalization.  Studies reveal that the higher the blood sugar, the higher the risk of adverse outcomes.  For those with diabetes in need of surgery, it is very important to consult with the physician controlling diabetes, to determine the best plan to keep the blood sugar control to prevent adverse outcomes.  Ways of decreasing blood sugar levels are losing weight and being physically active.  Losing weight can be achieved by eating smaller servings, try calorie-free drinks or water instead of regular soft drinks or juice,choose baked, grilled, and steamed foods instead of fried, eat more vegetables, whole grains, and fruit, and avoiding high fat toppings.  Walking whenever possible; walk every day for 30 minutes, 5 days a week or split the 30 minutes into two 15 minute or three 10 minute walks.  Try strength training by lifting light weights two to three times a week.  Talk with your health care team about ways to achieve your goals using meal planning, physical activity and medicine.

Below is a link for information related to surgery and diabetes.

Ways to Combat "White Coat Syndrome"

Recently, I read an article the "Sentinel" newspaper written by Vashti Harris about a lecture given by two family practice physicians, Dr. Farrah Fong and Dr. Karen Lin about " White Coat Syndrome".
White Coat Syndrome is an expression for fear of going to the doctor or feelings of anxiety when seeing a doctor.  Up to 20% of the population suffers from this fear.  Many develop this fear as children, who associate going to the doctor with getting vaccinations or other unpleasant things.  Later in life, some people carry over a dislike or distrust of doctors, medical treatments, or body examinations.  There is also fear of diagnosis of a serious illness, and guilt about unhealthy behaviors.  As a result, many people choose the internet over doctors.
Because of the constraints of our healthcare system, doctors are compelled to see many patients in a limited amount of time.  This makes it difficult to build a trusting doctor-patient relationship.  News and internet stories, lawsuits and commercials report about medical errors, along with medication issues and recalls.  This has increased distrust toward the medical community as well.
It is important, according to the doctors lecturing on the topic, to identify exactly what he or she is worried about.  Then one must confront these anxieties and deal with them rationally.  Patients can also find out how they can better control their condition to alleviate feelings of helplessness.  During an appointment, patients should make sure they have their worst concern addressed, and ask for clarification if the don't understand what the doctor is telling them. They should ask for written instructions or resources.  If a patient is afraid or uncomfortable with his or her doctor, they may consider seeking out a new doctor who they could better talk to.  Taking a family member or a close friend to an appointment can often provide support or comfort to the patient.

Low Back Pain


If the foundation of a house is unsound, eventually the upper levels will collapse.  The same is true with the human body.  If one's foot structure is deficient, and there is insufficient support, muscles and tendons may strain to maintain the body in proper alignment.  Eventually, the muscles tire and the upper joints compensate; first the ankles, then the knees, hips and finally the lower back.
Low back pain can be caused by tightness and inflexibility of the muscles of the back of the leg.  This may be a result of the strain from poor foot support.  Low back spasms may result from tight muscle groups.

Exercises to strengthen the abdominal muscles and stretch the lower back muscles are important.  But the pain may not resolve completely if the cause has not been recognized and addressed.
An orthotic or a high quality arch support should provide a good foundation to prevent muscle strain or upper joint pain.  This improved support may actually alleviate some types of low back pain.  If you suffer from low back pain, consider a good foot evaluation.

Evan Kelner, DPM