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Glycomark Study

Glycomark announced a study at the American Diabetes Association Scientific Sessions 2019. Aveon Health participated in the study from 2015 to 2018 in which 92% of patients treated with an SGLT-2 inhibitor reported a Glycomark result averaging 1.2µg/mL. These extremely low Gycomark results are not an indicator of poor glycemic control but rather an indication of medication adherence, achieving the desired effect by eliminating glucose in the urine.

 

The Glycomark test has been used by clinicians of Aveon Health for the past 8 years. Upon founding Aveon Health in 2014 our clinicians kept using these tests to understand and control our patient’s glucose levels.

 

Read the full article here 

http://classifieds.usatoday.com/press/new-clinical-study-data-show-the-glycomark-test-helps-confirm-compliance-and-appropriate-response-to-sglt-2-inhibitors/

Migraine and Headache Awareness Month

June is migraine and headache awareness month. Did you know that headaches are one of the most common reasons why patients visit primary care? There are a number of causes of headaches and a variety of treatment options to meet the needs of individual patients. The Center for Disease Control reports approximately 20% of Females and 10% of Males report having a severe headache in the last 3 month. If you or a family member suffer from chronic headaches, make an appointment with Chantelle for an evaluation and to create an individualized treatment plan.

Osteoporosis

May is Osteoporosis Awareness month. Osteoporosis causes decreased bone density or strength, which leads in an increased risk in fractures. Although osteoporosis is more common in women, men can have osteoporosis as well. Routine screening is recommended for at risk patients. Keeping your bones healthy throughout life is essential. You can learn more about osteoporosis here : https://www.cdc.gov/features/osteoporosis/

If you have questions regarding bone health, or would like to get your screening, contact our office for a visit.

 

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ADOLESCENT HEEL PAIN (Severe’s disease)

Activity induced heel pain is children is usually a self-limiting condition and often resolves in time. However, during that time, the owner of that pain does not have to suffer. Avoiding physical activities with piers stunts growth at many levels often finding the child sitting on the couch in front of the TV or electronic video screen. Avoiding sports at any level, taking medication or suffer the agony of d’feet is no longer necessary. While heel pain from Sever’s disease may years to resolve on its own, there is immediate relief awaiting the child with this debilitating condition.

While many have postulated a variety of causes of Sever’s Disease, from hormone deficiencies to who knows what, the primary cause of pain in the back of the heel in growing children, is in fact a torqueing of the growth plate between the ages of 7 and 14. With boys more effected than girls, the common finding is excessive side to side movement of the heel on contact and thru forefoot loading prior to the propulsive phase of walking or running at a time when the Achilles’ tendon is pulling on the heel from above. The force of the side to side movement at heel strike coupled with the pull from the tendon above loosens the interface between the growth plate (apophysis) and the actual body of the heel known as the calcaneus. It is labeled self-limiting because the growth plate eventually closes, and the two segments become one solid bone. A classic sign of excessive motion is the top of the heel tilting toward the mid-line of the body in stance as viewed from behind.

Treatment for this condition is straight forward. Every attempt is made to maintain the heel in a vertical position with a few degrees of motion to allow for adaptation of the heel to the ground and help the body avoid the impact shock to the leg and low back. A competent lower extremity exam usually will reveal the primary cause of the excessive heel motion and once established, either a pre-fabricated orthotic or a custom made functional orthotic placed in the shoe prevents the excessive side to side motion and the inflammation and pain stops in a few days without the need for analgesics or anti-inflammatory medication. Rest and ice are almost always unnecessary with most children returning to all activities of choice without re-occurrence of the pain.

Aveon Health
Steven E. Tager, DPM, FAAPSM
Scottsdale, AZ 85255
(480) 300-4663

Skin Cancer Awareness Month

May is skin cancer awareness month. Arizona is always sunny, so it is especially important to make sure your protect your skin using SPF 30+ daily. See the information below regarding how to spot skin cancer. If you have a changing or concerning skin lesion, make an appointment for a full skin check. We offer dermoscopy and skin biopsies for our patients to ensure efficient and appropriate treatment.

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Sleep Awareness Month

May is sleep awareness month. Many individuals suffer from lack of adequate sleep for a number of reasons. Sleep is essential for our overall health. See the statistics below from the American Sleep Association. Contact your Aveon health care team to help you get better quality sleep.

Sleep-and-Sleep-Disorder-Statistics-ASA-500x369Sleep and Sleep Disorder Statistics

The Agony of D’Feet

Plantar Fasciitis

Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length. This leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle. Often manifesting as a dull to sharp ache and possibly a burning or stretching sensation, the commonly occurs after a night’s sleep when fascial band is suddenly stretched and pulls on the heel upon arising. The heel pain may lessen or even disappear but is temporary at best with it returning after prolonged rest or extensive walking.

With the human foot of the 26 bones, the heel bone being the largest, it truly is an architectural marvel. There are 33 joints and a network of more than 100 tendons, muscles, and ligaments. Is it any wonder how it can do the things it does and keep us afloat?

The heel bone (calcaneus) and the plantar fascia are married to one another. Life has a way of pulling them apart. In this case, the cause is other than marital discord. This discord occurs in the foot between these two entities caused by the mechanical separation of the two known commonly as plantar fasciitis (PF).

Causes

While Plantar fasciitis (PF) may have a variety of causes, it is often misunderstood by those who profess knowledge of this often-debilitating condition because the biomechanical function is poorly understood. Picture a tripod holding a large surveyor’s camera with heavy rubber bands connecting each leg. The greater the weight from above the more the legs dig into the supporting surface. When the legs can’t support the superincumbent weight, the legs begin to give, and the rubber bands begin to stretch…until they tear. That gives a clear picture of what happens in the foot when this architectural marvel can no longer hold the weight above.

Most foot specialists agree that plantar fasciitis is generally attributed to faulty mechanical malfunction (patho-mechanics) of the weight bearing bones in the foot. Any significant shift of one or more of the strategically positioned weight bearing bones supporting the body weight from above, can cause the structure to “give” stretching the plantar fascia, placing excessive stress on the soft tissues attached to the heel. As the fascia stretches beyond its capacity, like a rubber band under tension holding the tripod, the fibers become inflamed. With enough force exerted by the stretch, the fascia begins to tear and, in some cases, completely ruptures. As the stretched tissue pulls away from its attachment to the periosteum (the bone producing lining covering all bone) it bleeds, elevates and calcifies, forming new bone labeled a “heel spur”. With enough ground reactive force against the foot from below (like concrete or tile floors) combined with the malfunction of the foot above, the heel can crack creating a stress reaction enough to cause a stress fracture.

How it happens

The term pronation describes a normal motion of the foot characterized as an inward rolling movement directed toward the mid line of the body. This is an essential motion that permits the weight bearing bones to “unlock” and adapt to the ground below. This unlocking mechanism is also a primary shock absorber. As the foot breaks down with excessive pronation, the PF stretches beyond its capacity and the symptoms of plantar fasciitis begins. In contrast, if the foot fails to sufficiently pronate, the shock absorbing mechanism is now eliminated and the unabsorbed impact force is generated into the heel on up the leg and into the back. Repetitive unrelating shock of this nature may not only cause the heel to crack, but more often than not, the patho-mechanics plays a major role in knee, hip and back injury.

Why some and not others? Heredity may play a role. Parents, grandparents etc. provide us with genetic predispositions like eye color, hair, body type etc. The same thing occurs in the foot. While most do not experience symptoms of PF until later in life, the condition can manifest itself at any age depending on the intensity and frequency of the activity as well as the structure inherited. Clearly, we might be able to blame our ancestors. Did the Neanderthal walk on tile and concrete? Probably not. Do shoes sufficiently protect us from concrete and tile? For many, the answer is a yes. For others, who experience mechanical deficits in their feet, the answer is a big NO.

A simple and inexpensive diagnostic test utilizing ultra sound will confirm the diagnosis of PF. This quick test is performed in our office rather than obtaining the more costly MRI.

Treatment

There are many different treatment options by many providers professing to offer relief. In addition, night splints, special socks, shoes, deep tissue massage along with drugs and literally dozens of therapeutic modalities like shock wave therapy, PRP stem cells and in some cases, surgery involving cutting of the plantar fascia.

In this practice, we look at the patient’s overall structure, who owns it and what they do with it. Then, of paramount importance is how the owner’s structure functions. The severity of the pain coupled with the patient’s life style often dictates the type of treatment. Experts agree that the underlying pathomechanics needs to be addressed. While oral anti-inflammatory medication is often prescribed and steroid injections for relief of pain and inflammation are common, our practice is to determine the underlying cause. Understanding the patho-mechanical function of the human foot and the leg above and how they work together influencing its function is the key to a success outcome. Stretching exercises can be of additional value especially if proper technique is employed along with sufficient frequency. It is only good medicine to determine the cause of PF rather than simply treating the symptoms. Controlling the pathomechanics and restoring normal function is our prime objective from the onset.

Once the underlying abnormality is identified and how the ground reactive force (GRF) interfaces with the foot and leg, treatment options and alternatives are discussed. Functional orthotics are to feet much as glasses are to eyes. A properly designed, pathology specific orthotic can often completely restore normal or near normal function eliminating the PM. Once that objective is achieved, the human body has a chance to heal itself and pain and inflammation of the PF subsides on its own. Given the high quality of the custom functional orthotics used in our practice, relief can be achieved for as much as twenty years without the need for replacement.

Steven E. Tager, DPM, FAAPSM
Aveon Health
Scottsdale, AZ 85255
480.300.4663

Brain Injury Awareness

Brain injuries are a common cause of morbidity and mortality in the United States and around the world. Injuries can happen to anyone at any age. Traumatic brain injuries include those from falls, sports injuries, motor vehicle accident, or domestic violence. Non-Traumatic brain injuries include those from strokes, seizures, tumors, infectious causes, and drug abuse. If you have concerns about a possible brain injury, or have previously suffered from one, speak to your Aveon provider to learn more about managing the injury and further complications.

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Supplements Risk and Benefits

Many patients are looking to supplements to improve their overall health. While there is a need for supplementation in some patients, over use or inappropriate use of supplements can have harmful effects. Unlike prescription medications, the supplement market has minimal regulation and oversight, allowing for companies to fly under the radar while selling ineffective or tainted products.

Using supplements that undergo testing for quality and safety is essential. A recent study reported that almost half of the vitamins patients buy off the shelf do no contain what they claim to. If you have questions regarding the quality and safety of your supplements, discuss your concerns with your Aveon provider.

Overuse of certain products can have harmful effects. More is  not always better. Recent data suggests that overuse of B12 vitamins is linked to lung cancer. At the same time, patients who have a true deficiency may need additional supplementation due to absorption concerns such as those who are diabetic or individuals who have undergone gastric bypass.

As always, you should discuss the use of all over the counter medications and supplements with your licensed health care provider.

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