Choosing the right athletic shoe.

The choice of the best athletic shoe hinges on a number of factors, including the chosen activity, a person's body structure, and cost. For a large percentage of regular exercisers, the activities engaged in will be walking, running, or court sports. As one would expect, shoe manufacturers have developed specific shoes for each of these activities. Obviously, you could walk in a running shoe or run in a shoe designed for walking. However, particular features among the various types of shoes may make one more appropriate than another.

Running Shoes - Running shoes are designed with the idea that the user is moving forward with little side-to-side motion. As a result, they are generally inappropriate for sports that require lateral (side-to-side) motions. Since runners impact the ground with three times their body weight with each step, it is important that running shoes have adequate cushioning and shock absorbing qualities. Specific running shoe types include "motion control" (best for runners with "fallen arches") and heavily cushioned shoes that are best for runners with a high arch, often associated with a relatively inflexible foot. Runners who strike with their heel or mid-foot should look for less built-up heels, while those who land on the ball of their foot need a more built-up heel.

Fitness Walking Shoes - Proper fitness walking shoes have highly flexible soles designed to allow the foot to roll easily from heel to toe. Since there is not as much impact involved with walking as compared to running, the requirement for cushioning is less. Some walking shoe designs are designed for style, comfort, or workplace use rather than fitness walking. If unsure of the intended purpose of the shoe, buying a running shoe may be a better bet. If looking at running shoes, walkers should choose one with a lower heel, since walkers strike with their heels first.

Cross-Trainers - These shoes are designed to meet the requirements of many activities including court sports, weightlifting, and aerobics. The soles of cross-training shoes are wide and stable to provide considerably more side-to-side support than walking or running shoes. They provide a moderate amount of cushioning, primarily at the heel and forefoot of the shoe, and the cushioning is dense, which enhances the shoe's overall stability. The upper portion of most cross training shoes is taller in order to provide better ankle support. While they may be appropriate for fitness walking, cross-trainers are not recommended for those who primarily run for fitness, as they do not provide proper cushioning for repetitive impact.

Tips for Finding the Right Shoe

1. If you're going to participate in a particular sport on a regular basis (2-3 times a week or more), you should choose a sport-specific shoe.
   


2. Consider going to an athletic shoe specialty store to get an expert opinion on the right shoe for the chosen activity and the best fit. This is particularly true if you are starting a new sport, coming back from an injury, or have had problems with your current shoes.
   


3. Don't be lured into buying athletic shoes based on the colors or style. With athletic shoes, form should follow function.
   


4. Shop late in the day or following a workout when your feet are their largest.
   


5. If you're already a runner, bring your current running shoes with you to the store. The salesperson can look at the wear on the bottom of your running shoes to get some more insight into your running style.
   


6. Bring the socks that you intend to wear when working out with you when buying new shoes. If you wear orthotics or custom-fit insoles, bring them with you also. You need running shoes that are roomy enough to accommodate these.
   


7. Have the salesperson measure both feet with a Brannock device while you're standing. This will provide measurements of the heel-to-toe length, the arch length (heel to ball of the foot) and the width. Sometimes overlooked, the heel-to-ball measurement is important in correctly aligning the arch of the foot with the arch of the shoe.
   


8. Feet are rarely the same exact size, so you should buy for the larger foot.
   


9. Properly fitted athletic shoes should be immediately comfortable without requiring a break-in period. Characteristics of a proper fit are that the shoe will grip firmly with no heel slip with walking or running. There should be approximately a thumbnail width of distance between the toes and end of the shoe.

Once you have the proper shoe, follow the advice of one of the largest athletic shoe manufacturers and "just do it".

If you have any questions regarding athletic shoe choice, please log into your account and send us your question. We are glad to help.

Pleurisy

What did Catherine the Great, Benjamin Franklin, and Elvis Presley have in common? Each of them is believed to have suffered from pleurisy. In all likelihood, some of you have had this painful condition also. The word "pleurisy" comes from a Greek word that refers to the "side of the body". Pleurisy involves inflammation of the tissue layers (pleura) lining the lungs and inner chest wall. When these inflamed layers rub together, particularly when taking a deep breath or coughing, it causes chest pain.

What causes pleurisy? A viral infection, such as the flu, is the most common cause of pleurisy. However, a number of other conditions can be responsible including:

• Bacterial infections of the lung, including pneumonia and tuberculosis


• Pulmonary embolus, a blood clot that goes to the lungs


• Lung cancer


• Autoimmune diseases including Lupus and Rheumatoid Arthritis


• A chest injury , such as bruised or broken ribs


• Gastrointestinal disease, such as pancreatitis or infection in the abdominal cavity(peritonitis).

How do you know if you have pleurisy? The main symptom of pleurisy is pain in the chest, usually only on one side. This pain is worse when you take a deep breath in or cough. Most people describe the pain as "sharp or stabbing" but it can be dull or aching also. The pain is usually better if you take shallow breaths or lie on the side that hurts. Depending on the underlying cause, other symptoms include shortness of breath, cough, and fever or chills. In most instances, the chest pain is what causes people with pleurisy to seek medical attention.

How is pleurisy diagnosed? Because the pain associated with pleurisy is so characteristic, the doctor often suspects the diagnosis just by talking to the patient. Along with the pain, a rough, grating sound known as a "friction rub" (click to hear what this sounds like) can often be heard when a stethoscope is placed against the chest. This sound is produced when the normally smooth tissue layers of the lung become inflamed and roughened. Depending on the suspected underlying cause, other tests including x-ray, computerized tomography (CT scan), and thoracentesis (removing fluid from the pleural space with a needle) may be performed.

How is pleurisy treated? Treatment depends on what is causing the pleurisy. When a viral infection is responsible, taking an anti-inflammatory medication, such as ibuprofen may be all that is necessary. If pleurisy is due to pneumonia, an antibiotic is usually required. Hospitalization and treatment with blood thinners is usually necessary when pulmonary embolism is the cause of pleurisy.

When should someone with pleurisy see the doctor? Diseases that cause pleurisy range from minor to life threatening, however, certain symptoms warrant prompt medical attention. These include:

• High fever, shaking chills, and a cough that produces thick green or yellow sputum


• Shortness of breath


• Intense, persistent chest pain


• Leg swelling which could indicate the presence of a blood clot

Is self-care at home ever appropriate for pleurisy? In cases in which pleurisy follows a viral infection, such as a cold or flu, self-care measures are usually all that is necessary. These measures include taking an anti-inflammatory medication such as ibuprofen (Motrin, Advil, others) or naproxen (Aleve) to reduce the pain and inflammation, "splinting" the chest by lying on the side that hurts, and avoiding exertion or other activities that would cause labored breathing.

If you have any questions regarding Pleurisy, please log into your account and send us your question. We are glad to help.

Lessons Learned from Our Clients

Oftentimes doctors know the answer to their patient's question right off the top of their head. However, sometimes a question can require a little more digging to uncover the correct answer or information that a patient needs. With a wealth of authoritative medical information available at our finger tips, it is possible to find an answer to the most esoteric medical questions. In my correspondence with our clients over the past 10 years, I have occasionally been challenged by a question for which I am not certain of the answer. The following are just a few of these challenging questions that required a bit of research on my part, but taught me something in the process.

1) Toxicity of air fresheners — "I have heard that air fresheners could affect one's reproductive health. Is this true?"

Concerns have been expressed regarding a class of chemicals (phthalates) that have been, and may still be, contained in air fresheners. According to the State of California, five types of phthalates, including one commonly found in air fresheners, are known to cause birth defects and reproductive harm. These adverse effects were observed in experiments with laboratory animals, but have raised concerns as to whether exposure to phthalates represents a potential health risk to humans also. Presently, human toxicity data have not been sufficient for evaluating the occurrence of reproductive effects following phthalate exposure. Despite disagreement with some research data released by the Natural Resources Defense Council (NRDC), SC Johnson, a major manufacturer of air fresheners (Glade® and Oust®), has pledged to remove these chemicals from their products by 2012.

2) Wedding Ring Rash — "Over the past couple of months, my skin has been getting very irritated by wearing my wedding ring. According to my husband it is made of white gold. The rash wraps around the top of my finger, located only directly under the band. Any thoughts?"

It is generally thought that gold is an inert metal that rarely causes an allergic reaction. ''White'' gold, however, is an alloy of gold and nickel or palladium. Since palladium is considerably more expensive, nickel is used more commonly in making white gold. About one person in eight has an allergic reaction to the nickel in some white gold alloys when worn over long periods of time. This was almost undoubtedly what was responsible for the writer's rash.

3) Electronic cigarettes — "I have heard that using "e cigarettes" is a safe method for helping me quit smoking. Can you comment on this?"

Electronic cigarettes, also called "e-cigarettes" are products designed to deliver nicotine to the user in the form of a vapor. Most are battery-operated devices that contain cartridges filled with nicotine, flavor and other chemicals. When heated, an atomizer converts the contents of the cartridge into a vapor that is inhaled by the user. The vaporized nicotine, like the nicotine in cigarettes is highly addicting. Additionally, studies performed by The U.S. Food and Drug Administration found that some e-cigarette devices also deliver vaporized carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze. While the Federal Drug Administration (FDA) has sent warning letters to several manufacturers of e-cigarettes and expressed its intention of regulating these products as drugs, electronic cigarettes remain available for purchase. Until further evaluation, it would be best to stick with safer products developed for smoking cessation, such as nicotine patches, gum or nasal spray.

4) Shrimp-related headache — "I was curious if shrimp is a migraine trigger? I had some fresh shrimp last night & woke up this morning with a horrible migraine."

Shrimp is indeed thought to be a migraine trigger. Some sources cite the sulfites in shrimp as the responsible chemical, whereas in those with shellfish allergy, iodine seems to be the culprit. If shellfish is responsible for causing headaches, it is generally a good idea to also avoid other crustaceans such as lobster and crab.

Most physicians embrace the challenge of making a rare diagnosis or answering a difficult question. Here, we also take your questions and concerns seriously. We may not always know the answer immediately, but we are committed to doing the necessary research to provide you with the most up-to-date, accurate information possible.

If you have any questions regarding any of these topics or just questions you have about other health related topics, please log into your account and send us your question. We are glad to help.

"Earache" or Ear Infection?

Many ear infections cause earache, but not all earaches are caused by an infection. This is an important distinction, since antibiotics are often needed to treat ear infections, but are not required for earaches that are not caused by an infection, or even for certain types of ear infection. Let's look at several conditions that can cause earaches.

Causes of earache: The pain of earache results from inflammation and swelling of the structures that make up the ear, including the external ear canal, the tympanic membrane (ear drum), and the middle ear. One of the most common causes for mild earache is a buildup of fluid in the middle ear in association with a viral upper respiratory tract infection, such as the common cold. Even if the trapped fluid behind the eardrum is not infected, the pressure causes it to bulge and throb. As with other manifestations of a cold, mucus in the middle ear and associated earache usually clears on its own. On occasion, however, mucus in the middle ear along with blockage of the tube that drains the middle ear (Eustachian tube) sets the stage for the development of a bacterial infection. This is called acute otitis media and is the most common cause for an earache that requires antibiotics.

Another fairly common cause for earache, particularly in the summer when swimming is a common pastime, is otitis externa, or "swimmer's ear". Bacteria that cause swimmer's ear are able to grow and multiply easily in the warm moist environment of the external ear canal. Like bacterial otitis media, swimmer's ear, is treated with antibiotics, although they are usually delivered topically (ear drops) rather than by mouth.

Inflammation of the ear drum, known as myringitis, may be due to localized infection or trauma. Local trauma to the ear drum can occur from damage by a foreign object like a Q-tip or paper clip used to remove wax or an insect. The ear drum can also be ruptured, a condition known as "barotrauma", from changes in pressure due to scuba diving, flying in an airplane, or due to an explosion or very loud noise. A less common cause for earache is "referred pain" from some other condition, such as tooth decay or temporomandibular joint dysfunction.

Distinguishing minor earaches from ear infections: A question that arises commonly, particularly in children, is how to tell an earache, such as one caused by a viral upper respiratory tract infection, from the more serious bacterial middle ear infection. Here are a few clinical clues to help tell these two apart:

• The pain produced by acute otitis media is generally more severe and persistent than that caused by a viral infection.
  
• Serious ear infections are usually associated with fever, sometimes as high as 104 degrees F.
  
• Fluid draining from the ear, particularly if it is yellow or green, often indicates that the eardrum has ruptured, a feature suggestive of bacterial otitis media.


• Hearing loss or vertigo (a sense of spinning) indicates that there may be a more serious problem than simple earache.

When one or more of these features are present, it is important to see a doctor for evaluation.

Diagnosing an ear infection: When an ear infection is suspected, the doctor examines the ear with an instrument called an otoscope. Through the otoscope, the ear canal and ear drum can be inspected. If an ear infection is present, the eardrum may be red or bulging. The doctor can also check for the presence of fluid in the middle ear by blowing a small amount of air against the ear drum and watching for movement. If fluid is present, the eardrum will not move back and forth. Another diagnostic tool for evaluating eardrum movement is called tympanometry.

Self-care of earaches: Although there are numerous "home remedies" described for treating simple earache, such as placing slightly warmed olive oil in the ear canal, the safest treatment is to apply a warm, moist cloth over the affected ear and take a mild analgesic such as acetaminophen or ibuprofen. In certain cases, physicians may prescribe ear drops containing benzocaine (e.g. Auralgan) which works by numbing the sensory nerves of the ear drum.

Preventing ear infections: The following steps can help prevent earaches or ear infections:

• Avoid exposure to second-hand smoke. This has been shown to cause thousands of ear infections in children each year.
  
• Ear infections may occur after a case of the flu which can be prevented with an annual flu shot.
  
• Avoid putting objects in the ear such as a paper clip or hair pin. Even cotton-tipped swabs can irritate or damage the skin of the external ear canal.
  
• Use a drying agent in the ears after bathing or swimming. Commercially available products to prevent swimmer's ear include Swim Ear and Star Otic. "Homemade" ear drops can be made by mixing one ounce each of white vinegar and isopropyl (rubbing) alcohol.
  
• Control allergies. Inflammation and blockage of the Eustachian tube caused by allergies is a contributing factor to ear infection.
  
• Mouth breathing or snoring in children may be caused by large adenoids which can contribute to recurrent ear infections. In this case, an examination by an otolaryngologist for consideration of surgery to remove the adenoids may be necessary.
  
• If bottle feeding your baby, avoid bottle propping which can cause formula and other fluids to flow back into the Eustachian tubes.

If you have any questions regarding earaches or ear infections, please log into your account and send us your question. We are glad to help.