Healthoughts

Healthoughts compiled by Jon Nalick

Illustrations by Diane Bigda.

foot notes

Countless thousands of Americans wake up feeling fine every morning, hop out of bed and take their first steps to—

“OWW!”

That cry, prompted by a stabbing pain in the heel of each foot, stems from a common condition known as plantar fasciitis—a tearing of the flat band of tissue known as the plantar fascia that stretches from the underside of the heel to the base of the toes.

David B. Thordarson, M.D., professor of orthopaedic surgery and chief of the Keck School of Medicine’s Foot and Ankle Surgery Service, says, “Typically, the pain is especially bad during the first few steps in the morning or later in the day after a long period of standing. But usually, as people walk, they stretch their feet and calves, which places less stress on the plantar fascia.”

Thordarson says the people who suffer from plantar fasciitis are usually those who are overweight and people who are long-distance runners, because both groups place a higher-than-usual strain on the tissue. Losing weight or easing up on a training regimen can help relieve the symptoms, although not necessarily cure the problem, he says.

The good news is that 95 percent of patients respond to conservative treatment, which includes stretching the feet and calves in the morning, wearing arch supports and icing the feet at night (interestingly, soaking the feet in warm water has a similar beneficial effect).

If the conservative approaches fail, more aggressive treatments are available. These include ultrasound treatments, cortisone injections, boots worn at night to maintain feet in a stretched position, casts to hold the feet in place while the plantar fascia heals or, ultimately, surgery.

If people suspect they might have plantar fasciitis, Thordarson recommends seeing a physician.

And watch out for that first step—it’s a doozy.

 

sun struck

The notion that sun exposure today can promote skin cancers decades from now may suggest to Americans in their 60s and older that additional exposure at their age cannot hurt.

As reasonable as that idea may seem, however, it is misleading, says dermatologist David Sawcer, M.D., Ph.D., assistant professor of medicine at the Keck School of Medicine. Many older Americans increase their outdoor activities after retirement and may not appreciate the potential harm they do to their skin.

“Sun exposure at any age damages the skin,” Sawcer says. “Your risk of cancer depends on how much damage you’ve accumulated from sun exposure and how long you’ve had it.”

For example, he says, a little bit of damage acquired at a young age and carried for decades can be as much a problem as a lot of damage acquired much later in life.

And although it is hard to say proportionately which is worse, it is clear that both the total length of time a person’s skin has been damaged and the severity of the damage play major roles in predisposing a person to skin cancer.

The evidence suggests that developing skin cancer is a multi-stage process in which accumulated sun exposure gradually pushes a person into successive stages.

“If I enter stage one at age 10, I may have 70 more years to accumulate the damage needed to push me into stages two, three and four. But if I enter stage one at age 80, I’d have to be exposed to a lot of sun to race through the successive stages,” Sawcer says.

Because of variations in genetics and other factors, people generally cannot know how far along they are in the process, so even at advanced ages, additional accumulated sun exposure may be enough to trigger skin cancer. Sawcer recommends regular dermatological screenings, with a frequency based on each individual’s family and personal history.

weaning off nicotine

For smokers ready to kick the habit, nicotine replacements that help combat cravings can make the effort a little easier—but they may not be for everyone.

May Mak, Pharm.D., assistant professor of pharmacology at the USC School of Pharmacy, says that people who have previously suffered heart attacks or arrhythmias should avoid nicotine-loaded gums, lozenges, patches and nasal sprays because all of them can boost the risk of a subsequent heart attack.

Following instructions about how and when to use nicotine replacement products is also important. For example, acidic foods and drinks sharply reduce the amount of nicotine absorbed from gums and lozenges. And people who continue to smoke while they are using nicotine replacement products could suffer physical symptoms such as nausea, vomiting, tremors, sweating and anxiety.

Mak says people wean themselves off tobacco much more successfully when they couple their treatment with eight or more sessions with a healthcare provider first. “Quitting smoking is a great idea,” she says, “but buying a product over the counter without sound medical advice is often just a waste of money.”

sore subject

The next time you get those annoying little white canker sores inside your mouth, relax—because it may be stress that is causing them.

Charles Shuler, D.M.D., Ph.D., the George and Mary Lou Boone Chair in Craniofacial Molecular Biology and associate professor at the USC School of Dentistry, says that although the precise reason the sores appear is unknown, they appear to arise when the body’s own immune system misfires in a localized area and begins attacking normal tissue.

“Canker sores are very common, and studies relate the incidence of these ulcers to stress. In fact, we have epidemics of canker sores among students at exam time,” he says.

Canker sores are small ulcers of the oral mucosa, about 3-6 millimeters wide, which occur only on the moveable tissues of the mouth. Many people find relief from the pain using over-the-counter remedies that either numb the nerve tissue that the sore exposes or provides a physical barrier to protect the nerves.

While these products ease the symptoms, they do not actually speed the healing process. Shuler jokes that patients are sometimes told that “without treatment the sore will heal in seven to 14 days, and with treatment, they will heal in one to two weeks.”

Joking aside, he notes that USC participated in a clinical trial of Aphthasol, which led to its FDA approval as the only drug to treat canker sores. The prescription drug is an immune-system regulator and significantly speeds healing.