So, you have made the commitment.  The commitment to exercise and get yourself in tip-top shape.  You started running. You bought running shoes and are all set to go.  Your first run goes well, you went further than you thought, almost a full mile. You are proud and excited, you can do this!  And you do it, every day for a week.  But then, it starts ….a pain and soreness in your shin.  The pain is enough that you can’t keep running.  You didn’t bump it against anything; you see no redness, no bruising, and no swelling.  What it is?

While stress fractures to the tibia (leg bone) do happen after starting running programs and if you run long distances, the most common cause of pain in the front of the leg along and near the ‘shin bone’ is shin splints.  Shin splints can be defined as pain and discomfort in the leg from repetitive running on hard surfaces or overuse use of the muscles that bring up the foot.

Aching, throbbing or tenderness along the inside of the shin or directly on the shin are the most common symptoms associated with shin splints. The pain is felt when the area along the tibia (shin) where muscles attach becomes inflamed. While more appropriately named periostitis, we will continue with the more common term known as shin splints. Another symptom is pain when you press on the inflamed area. Shin splint pain is most severe at the start of a run, and sometimes will go away during a run once the muscles are loosened up.  On the contrary, a stress fracture of the tibia, shinbone, will hurt all the time.

The shin splints can  result from tired or stiff calf muscles putting too much stress on tendons, which become strained and torn. Overpronation of the foot aggravates this problem, as does running on hard surfaces,  and running in stiff shoes.

Beginning runners are the most susceptible to shinsplints for many reasons, but the most common is that they’re using leg muscles that haven’t been stressed in the same way before. Another reason beginning runners develop  shinsplints  is because of poor choices in running shoes or running in something other than running shoes. Those runners who have started running again after long layoffs are also at a higher risk of developing  shinsplints because they often run too far initially on return.

Rest is the best treatment, with a slow return to normal activity so long as the pain is no longer present. Reducing the inflammation is key and can take from 2-3 days up to 2-3 weeks.  Ice to the area two to three times per day, a course of anti-inflammatory medications, and stretching and strengthening exercises are useful along with rest. Some athletes who develop shin splints have flat feet (excessive pronation) which exacerbates the strain on the leg muscles.  In such cases, the runner should obtain orthotic support, in conjunction with the strengthening and stretching exercises.

Finally, think about your running form.  Are you leaning forward too much? Are you slouching? If you are doing any of these you may be putting too much strain on your muscles

If, after following the above recommendations, the pain continues, it is possible that micro-fractures may form in your tibia; these are stress fractures. You  won’t have a  sudden break, just a gradual increase in pain until it becomes quite severe. If you have extreme shin pain, see a doctor for an x-ray.

Shin splints are extremely common among beginning runners, whose enthusiasm for their new sport has over-stepped the limits of their legs. Take a look at your running program; you may be doing too much too soon.

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Dr. Lori Lane is a founder and owner of LA Podiatry Group. With two offices in Wellington and West Palm Beach, Dr. Lane and her team of 6 physicians provide comprehensive foot and ankle care to residents of Palm Beach County at two offices, located in Wellington and West Palm Beach,  six area hospitals, numerous nursing homes. LA Podiatry Group accepts most insurances and is happy to serve your foot and ankle needs.

Meet Dr. Lori Lane Hansen!

Dr. Lane is a podiatric surgeon with offices in Wellington and West Palm Beach, Florida and been providing podiatric services to the residents of Palm Beach County for 20 years. She received her Bachelor of Science Degree from Texas State University and is a graduate of Barry University School of Podiatric Medicine. Dr. Lane is Board Certified by the American Board of Wound Management and has developed a passion for wound healing and Diabetic Limb Salvage over the course of her 20 year practice. She is actively involved in all aspects of advanced wound healing, including being Principal Investigator on several clinical trials for the development of wound healing products and medications. She is on staff at several local hospitals and Wound Care Centers. Dr. Lane also has served and continues to serve on several hospital and community healthcare related committees that strive to better the delivery of healthcare to Palm Beach County Residents.

Stay tuned for a new article next week!

Shingles is a painful, blistering, skin rash typically found on the back and sides of the chest( but can occur anywhere on the body, including the scalp face and genitalia). The rash is classically located on one side of the body and follows the nerve dermatome around from the spine.

It is caused by the herpes zoster virus, the same virus that causes chickenpox. After a chickenpox infection, the virus becomes inactive but remains in the nerve tissue. Years later, the virus may reactivate as shingles. Stress, cancer, or other medical problems can trigger an outbreak. In some cases shingles pain may linger after the rash has cleared . This is called post herpetic neuralgia, a long-standing sometimes disabling condition.

Treating it early, especially within the first 72 hours of onset, can significantly reduce the incidence of post herpetic neuralgia.

Shingles usually starts as itching and pain on the skin that develops into blisters. The rash often wrapping around one side, from the middle of the back to the front of the chest. The blisters form which gradually break open, ooze and crust over. Other symptoms include insomnia, nausea and fatigue, weakness ,depression and anxiety, very similar to flu symptoms . The full rash forms in about a week or so ,blisters break open and form scabs that sometimes leaves scars after healing. The whole process takes 2 to 3 weeks and may last up to 10 weeks. For some people the rash barely develops. It’s unclear why some people have worse symptoms or develop post herpetic pain, but age and stress may be factors. Cancer or other immune deficiencies increase the risk for widespread zoster.  Approximately one in 100 people get shingles in any given year. People over 50 and those who never had the chickenpox vaccine are more likely to develop shingles. Shingles is also more common in people with cancer and those who take immunosuppressive drugs such as cortisone.

 

If you do develop early symptoms of shingles ( tingling, blistering rash) see your doctor. Treatment with antiviral medications early on can reduce the spread of the rash and help prevent the pain and post herpetic neuralgia. If you can’t see a doctor, treat the itching with calamine lotion, anti-itch cream’s and antihistamines. Oatmeal baths may also help. Take acetaminophen or nonsteroidal anti-inflammatory such as ibuprofen. And remember the rash will be made worse by scratching the blisters or sores ,and wearing tight clothing.

Zoster vaccine(zoster vaccine live)

Zostavax is a vaccine that is used for adults 50 years of age or older to prevent shingles (also known as zoster).

Zostavax does not protect everyone, so some people who get the vaccine may still get shingles.

You should not get Zostavax if you’re allergic to any of its ingredients, including gelatin or neomycin, have certain conditions that weaken your immune system, take high doses of steroids or are pregnant or plan to become pregnant. You should not get Zostavax to prevent chickenpox. Talk to your healthcare provider if you plan to get Zostavax at the same time as Pneumovax 23( the pneumococcal vaccine polyvalent) because it may be better to get these vaccines at least four weeks apart.

Zostavax contains a weakened chickenpox virus. Tell your healthcare provider if you will be in close contact with newborn infants, someone who may be pregnant and has not had chickenpox or been vaccinated against chickenpox, or someone who has problems with their immune system. Your healthcare provider can tell you what situations you may need to avoid.

Zostavax works by helping your immune system protect you from getting shingles. If you do get shingles even though you have been vaccinated, Zostavax may help prevent the nerve pain that can follow shingles in some people. Zostavax is given as a single dose by injection under the skin.

Please follow up with your PCP for further information or discussion. The Zostavax vaccine is offered by many of the local pharmacies as well and is paid for through your insurance.

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Dr Jeffrey M Bishop , Board Certified Family Medicine Physician. Retired from active practice. Presently involved in several entrepreneurial activities. Provider for the largest Telamedicine company in the US.

There has been a lot of controversy about PSA testing lately: should it be done? Should we completely quit it? Should Doctors offer this?

To solve some of these problems, let me analyze the issue step by step.

PSA is a substance that is exclusively produced in the prostate. It is not an exclusive marker for cancer, it is more a marker of “insults” to the prostate: cancer, trauma, infection, sexual intercourse, etc.

This is the reason why an “elevated” PSA (or more than a value of 4 ng/dl) does not directly tell us that there is cancer. The approximate chances of cancer (at a PSA level of 4-10) are about 20%, but the aggressive cancer chances are about 3%. Such numbers make most urologists recommend a prostate biopsy.

We believe it is an important maker due to an interesting fact: In the pre-PSA era approximately two thirds of patients that presented with prostate cancer were metastatic and non-curable. Today, probably more than 80% of patient are curable upon presentation.

The problem comes when PSA can lead to diagnosis of prostate cancers that may not need treatment (clinically indolent cancers) right away. This, according to some groups, can lead to unnecessary anxiety in the patient population. I believe that no unnecessary anxiety is generated if the diagnosis and treatment plans are discussed and explained to patients and their families.

We do recommend Prostate cancer screening. The question is not whether to do it or not. The question is how often and when to start it.

The point becomes how often to screen for prostate cancer. There is data suggesting that (depending on PSA values) the screening should start at the age of 50 (in individuals with no family history of risk factors). If the initial value is very low, the repeat test could be done in another 2-3 years. We recommend to make that decision in a conversation with a urologist. The screening should include PSA and Digital rectal exam.

If a patient had ever a diagnosis of prostate cancer and received treatment, then the frequency of PSA testing has to be coordinated with the treating physician (urologist, radiation oncologist, oncologist, etc)

If you are in the adequate patient population, we believe you should be part of a screening protocol. We strongly recommend that patients take an active role in this and bring up the discussion with their primary care physicians and urologists.

This discussion must include the risks and benefits of obtaining a PSA and the risks and benefits of a potential biopsy. All of this should come together with an understanding about the biology of the Prostate Cancer.

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Palm Beach Urology is a full service urologic practice established in Palm Beach County in 1986.  We are proud to offer our patients world-class, state of the art urologic treatment in their own community.  The hallmark of the practice is a devotion to patient care by specialists who are dedicated to providing the residents of this area with the very best in medical care and access to the latest in medical technology, including urologic robotic surgery.  The physicians of Palm Beach Urology take pride in surrounding themselves with a caring and well-trained staff that treats each patient with compassion and the utmost care.  We have offices in Wellington, Palm Springs, Boynton Beach, Jupiter and Belle Glade to conveniently provide services to our patients.  For more information, please check our website at www.palmbeachurology .com or call 561-790-2111, to schedule an appointment.