Knee Pain: Are your legs in “knee”d of a vacation?

Many women suffer from knee pain, and in some cases it can be a serious problem.  A real housewife once said “The higher the heel the closer to god”, but unfortunately outside of Beverly Hills, the higher the heel the closer to orthopedic surgery you may be. Every year about 10 million women visit their doctor for knee pain. In many cases, women can get knee injuries without even being involved in sports or exercise.

Women often suffer from knee pain and injuries due to their anatomy. Unlike men, women have wider hips and the upper leg is curved slightly inwards, causing the knees to be closer together. This puts stress on the knees and can result in more frequent injuries if women are not careful.

Although it appears simple, the knee joint is extremely sophisticated. For you to hop up out of bed, or get your Gangnam style on, all the parts of the knee need to work together.

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The knee is made up of the patella (aka knee cap), ligaments that help the thigh and lower leg bones connect together, and ligaments that keep the knee from moving sideways. The inner knee is also full of fluid that helps keep the joint moving smoothly and cartilage that covers the top of the leg bones to provide support and lubrication as your knee moves back and forth. As you can imagine, an impact to any one of these parts can cause increased inflammation, and in turn, a lot of pain.

One of the most common causes of knee pain in women is related to the knee cap. In a normal knee, the patella has tendons that attach on the top and bottom of the patella and help it to move up and down smoothly. The patella is lined with cartilage to help it glide smoothly along the bones of the upper and lower leg. When this cartilage wears away the patella begins to grind against the bones and cause pain. This can occur with excessive exercise, strain on the front of the knee, or from activities that put prolonged pressure on the knee.

Pain in the anterior knee is also common when the muscles of the thigh are weak. These muscles help the patella to move smoothly. When there is weakness of either the inner or outer components of the thigh muscles the kneecap is more likely to deviate to one side and cause pain. Add to this exercises that put significant stress on the knee joint (running, jumping, plyometric exercises, etc.), and you can suffer from significant pain.

As activity increases, the chances of sustaining an injury to the ligaments or inner components of the knee also increase.  In many cases a sudden twisting or shifting movement at the knee while your foot is planted is all it takes to get an injury.

Here are a few ways to avoid injury:

Strengthen your thigh muscles: Quadriceps and hamstring strengthening is a common recommendation by many orthopedic and sports physicians. By strengthening these muscles, the knee cap can move smoothly and in a straight line and you can avoid pain. An easy way to do this is use the leg press with your foot turned outwards for one set and then inwards for the next. Do these movements slowly and you will isolate both the inner and outer thigh. Expect to feel the burn!

Heel-free days: We get it. It is tough to ditch your high heels. Unfortunately, constantly wearing high heels places significant stress on the front and sides of your knee. Opt for flat shoes with good support for daytime, and if you do wear heels, keep a pair of flats with you incase your knees begin to hurt while walking.

Don’t be a Hero: Many women like to push themselves, even if the pain is unbearable. If your knees are aching or burning from pain, limit or even stop your activity. Give your knees a rest, and try to ice them to bring down the swelling and inflammation you may have developed. Stopping your activity can be the difference between a minor injury and surgery if you sustain a severe injury.

Shed some pounds: Another reason to bring down your weight if you are overweight or obese- less knee pain. As you walk, the knees can feel a force of anywhere from four to six times your body weight. If you are overweight, this can be a large strain on the knees and lead to worsening pain and even early arthritis.

If you continue to suffer from knee pain despite these simple tips, visit your physician for a proper exam and further treatment.

Men’s Health: A Movember to Remember

Perhaps you’ve noticed an increase in mustaches around town this month? Maybe you’re wondering if hipsters suddenly took over the world, or why Reno 911 is having a nationwide casting call? It turns out it’s all for MOVEMBER! In case you missed the me-“mo”, November was recently changed to Movember as a way to bring awareness to Men’s Health issues. You can learn more about Movember at

In honor of Movember, we’re shedding some light on a few topics that every guy should keep up with. It turns out that about 30 percent of men (ages 18-65) have not had a physical exam this year. While some physicians may not recommend annual screenings for all age groups, it’s important to build a relationship with your physician, and even more important to get screening tests to help prevent illness down the road.  While most men may feel healthy, particularly during their 20’s and 30’s, this age group is especially notorious for letting health concerns go unaddressed.

Here are a few common health issues that should not be overlooked by men:

Diabetes: Usually, we think of diabetes as a disease of the elderly and obese. Unfortunately, as we consume more refined sugars and processed foods, even those who are normal weight or slightly overweight are at risk.  Our body needs energy to survive, and often this energy comes in the form of carbohydrates. These carbs are broken down into glucose, the main energy source for cells in our body. As we give the body large glucose loads or simple carbs (cupcakes, brownies, beer, etc), the pancreas pumps out more insulin to help balance our blood sugar levels. The more we do this, the larger the demand on our pancreas, until eventually it doesn’t work as well, or stops working all together. This complicated cycle is largely driven by diet and is often responsible for symptoms like daytime tiredness, headaches, weight gain, and poor memory.

In 2011 it was estimated that about 13 million men over the age of 20 have diabetes.  It was also estimated that about 79 million people (yes- you read that right!) have pre-diabetes (this includes men and women). Pre-diabetes is when the body’s glucose levels are high, but not high enough to be considered diabetes. This means your body is still struggling to adequately process sugar and your clock may be running out. Getting checked for diabetes is extremely important for all men, no matter what age. The disease can be largely prevented with diet and exercise.

Heart disease: What is heart disease anyways? Heart disease causes plaque build up and poor functioning of the blood vessels of the heart (the coronary arteries) that can lead to heart attacks and death. Despite it being well publicized that heart disease is the number one killer of men and women in the United States, many are still dying. Heart disease is responsible for about 1 in 4 male deaths every year. Although it’s shocking to think you or one of your other three golf buddies may die from heart disease, it is also largely preventable. Risk factors for heart disease include diabetes, high blood pressure, smoking, high cholesterol, poor diet, and lack of exercise. Some of these risks may have a genetic component, but can still be improved with lifestyle changes. Your physician will screen you for all of these in a thorough physical exam.

Sexual health: Although the statistics vary, some say every seven seconds, some say three minutes- no one really knows, but the reality is men think about sex often. Very often. Encompassed in these thoughts are also fears, frustrations, and unknowns. Despite having many questions, few men ever speak to a physician about these concerns. As we learned in our last article on infertility, about 30% may be due to a problem in the male’s reproductive system.  Sperm requires an optimal temperature to mature and function properly. Many things that raise the scrotal temperature can make this process less effective. Anything from getting into a hot tub, or putting your laptop near your groin can interfere. Additionally, increased alcohol intake or marijuana use can decrease sperm production and fertility.

Premature ejaculation is another common concern among men. This is actually the number one sexual concern for men under the age of 40. Many men do not address this problem with their physician, and don’t realize that there are several treatment options.

Alcohol: What do Charlie Sheen, Mel Gibson, and Johnny Depp have in common? If you guessed dark hair- you probably shouldn’t guess anymore. The reality is they all have been arrested for driving under the influence and are a small number of the large litany of male celebrities with alcohol problems. In fact, men are twice as likely to binge drink than women, and approximately 15 percent are considered alcohol dependent at some point during their lives. Many men struggle with alcoholism, and may even be in denial about the effect of alcohol on their life.

Chronic alcohol use can cause heart disease, high blood pressure, depression, and even death. Screening for alcoholism is important for men of all ages.

Depression: Although men and women suffer from depression, signs and symptoms vary greatly in men.  When an NFL team loses, we joke about the deep depression many men face, but the truth is depression in men is a serious health risk. Stress, lifestyle, and genetics all play a role in the development of depression in men. Typically, males are unlikely to bring up this topic with their physician, due to fear or embarassment. Although more women attempt suicide, sadly, more men actually complete suicide attempts. Signs of depression may include increased irritability, difficulty concentrating, lack of desire to socialize, apathy, or even increased use of television and/or computer to avoid addressing these concerns. Visit your physician to be screened for depression, help is certainly available and not all treatments require medication.

As we say good-bye to another Movember, let’s help a Mo-Bro out and encourage him to pay attention to his health and speak with his physician today!


Persistent Cough: The Houseguest That Overstays Its Welcome

If you’ve ever been that person with the constant cough in a quiet room, you know the feeling. Of course you try to suppress it, and it gets worse.  A few stares and a sip of water later you’re wondering why you still have this cough when you don’t even feel sick!

Just like memories of your last relationship, lingering coughs can be hard to get rid of.  In many cases, you may not even know what’s causing it. Hopefully you’ll be able to put away your SARS mask and learn about a few common reasons you might be coughing.

Generally, people cough in order to protect their airways and lower lungs from irritants and damage. However, several other illnesses can also cause prolonged cough. As it turns out, not all coughs are created equal. If your symptoms last for less than three weeks, this is considered an acute cough. Coughs lasting three to eight weeks are classified as sub-acute coughs, and finally those lasting longer than eight weeks are considered chronic.

Four common causes include GERD (acid reflux), postnasal drip, asthma, and respiratory infections.  Each of these is detailed below:

GERD: Coughing can occur in up to forty percent of patients with GERD. Although you already know plenty about GERD, you may not know that in many patients with acid reflux, their only symptom is a cough.  When stomach acid hits the lower esophagus, a cough reflex is generated and can linger despite not having any other symptoms of GERD. In many cases, this can be resolved by a trial of an acid-reducing medication and a few lifestyle changes.

Postnasal drip: Secretions and mucous often collect in the back of the throat. Typically these are very thin and can drain from the nasal passage without you even noticing. In some cases, however, the mucous accumulates in the back of your throat and irritates your upper airway. This is called postnasal drip (PND).  One of the most common causes of PND is an allergy (this may be seasonal or triggered by a specific irritant). In both cases, the body reacts to these irritants by increased mucous production. As the drainage gets backed up in your throat, you often begin to cough. Inflammation of the sinuses can also contribute to PND and present as an acute or sub-acute cough. You may want to try an allergy medication if you suspect that PND is causing your cough.

Asthma: Although commonly mentioned, asthma often goes undiagnosed. Asthma is a condition that causes swelling and constriction of the lowest parts of the respiratory tract. This can cause significant coughing, wheezing, and difficulty breathing. Recent studies suggest that asthma is the second-leading cause of chronic cough in adults. Irritants, allergies, and even exercise can provoke lower airway swelling and cough. Certain individuals with diseases like eczema may also be more prone to developing asthma.

You may have outgrown your high school jeans, but beware of having a childhood asthma diagnosis and thinking you’ve outgrown it. Certain studies suggest childhood asthma may be outgrown later in life; however, some adults may still present with milder symptoms of coughing and wheezing when specific triggers are present. Your personal physician can help diagnose you with asthma and provide guidance for a treatment plan to help you breathe better and improve or eliminate your cough.

Respiratory Infections: In the days of Facebook, Twitter, BBM, and texting, URI may have lots of meanings. For most physicians, however, upper respiratory infections (URI) are often synonymous with cough. Many of these URI are caused by viruses and may take up to three weeks to resolve. Other respiratory infections caused by bacteria (and treated with antibiotics) may also cause persistent cough long after other symptoms have completely subsided. These are termed post-viral or post-infectious coughs. Some studies suggest that these coughs can last an average of eight weeks after the illness has resolved. The inflammation following a URI is thought to make the upper airways more sensitive and lead to chronic coughs. This symptom is easily treatable once it is identified. Your physician may need to give you an inhaled medication to calm the inflammation.They may also suggest other treatments depending on the severity of your cough.

One last cause of cough worth mentioning is Pertussis.This is a bacterial infection that has returned to the scene with a vengeance! It has been responsible for numerous deaths of both adults and children. Pertussis can cause a significant cough that often has a deep sound (hence the name: “whooping” cough). Many people also develop such a severe cough that they may vomit. You can prevent Pertussis by getting vaccinated. Speak to your physician about your most recent immunizations and Pertussis booster (it’s one shot combined with tetanus). This is one pain in the butt (or arm) that’s definitely worth getting.

Hopefully you learned a little more about what could be causing your persistent cough. As always, speak with your personal physician about your symptoms. These are just a few of the most common causes of cough. Your doctor can provide a detailed treatment plan specifically for you.

Constipation: When It’s Not Just The 405 Freeway That’s Backed Up

Austin Powers, the International Man of Mystery, might still be wondering “Who does number two work for?”, but understanding your bowel movements (BM) shouldn’t be a mystery. Although it doesn’t top the list of hot topics at happy hour, every year more than 2 million Americans visit their doctor due to constipation.

Constipation is typically defined as less than three bowel movements per week. For some, this may be frequent enough while others might feel significant discomfort at this rate. Common symptoms of constipation include straining, lumpy or hard stools, a sensation of incomplete stool removal after defecating, feeling of rectal blockage, or only being able to have soft/loose stools after using laxatives. Constipation frequently occurs because of slow evacuation of stool from the colon, or infrequent bowel movements. In many cases changes in lifestyle and diet can provide significant relief of symptoms (more about this later).

Although uncomfortable, constipation is not usually a serious medical problem. In some cases, however, a medical professional should address your symptoms. If you have any of the following symptoms, you may have a more serious gastrointestinal problem and should see your doctor as soon as possible:

• Blood or mucous in your stool

• Unintentional Weight loss of greater than 10 pounds in the last 3-6 months

• Severe Abdominal Pain

• Very thin stool (about the thickness of a pencil)

• Greasy or oily stool

Here are a few tips to help you get things moving:

Check your Meds: Several medications are known to cause constipation and could be wreaking havoc on your routine. Meds like iron, anti-inflammatories, and prenatal vitamins can all cause constipation. Review your medications with your physician and see if any of them may be responsible for your symptoms.

Get Regular: Although having a bowel movement isn’t an Olympic sport, your body requires significant training to alleviate constipation. Try to use the bathroom within 15-30 minutes of waking up. This is when your colon is most active and can help you push out stool. Another time to consider a BM is about half an hour after a meal. Both the brain and GI tract work together to signal the body to push your food along. This can be an easy time to empty your vault.

Change your Diet: It’s easy to make bad choices from time to time (ahem, Kristin Stewart), especially when it comes to food. Unfortunately, foods high in oil, fat, preservatives, and dairy can worsen constipation. Reducing or eliminating these foods can help decrease constipation. Increasing fiber in your diet can also help improve constipation. This means eating more fruits, vegetables, and whole grains. Aim to consume about 25 grams of fiber daily. If this is hard for you, consider a fiber supplement or powder you can mix with water.

Drink More Water: Consuming enough water is important because adequate hydration helps eliminate hard stool. Frequent consumption of soda and coffee can worsen constipation. This is because their diuretic effects eliminate the water necessary to keep stool soft. If your bloodstream is a fountain of diet coke, try to take in more water throughout the day to improve your BM’s.

Get Moving: Even though we’ve made huge strides in technology, watching the 100- meter dash doesn’t mean you’re exercising! Regular exercise for at least 20 minutes a day has been shown to significantly improve and eliminate constipation. Exercise has also been shown to help women develop regular bowel schedules and reduce abdominal pain and bloating.

Let your body and bowels adapt to change. Make an effort to implement some of these tips, and see how you are feeling after two weeks. If you are still struggling with constipation, make an appointment with your personal physician for a detailed exam.

Back Pain: You Can Do It, Just Don’t Put Your Back Into It!

It turns out almost nine out of ten adults will suffer from back pain at some point in their lifetime. So if you hurt your back from long hours in high heels, a Groupon Pilates class, or from carrying your baby, today’s article may help you get “back” on your feet.

Although back pain is a common problem, particularly amongst women, acute back pain has many origins. Often times it can be attributed to obesity, weak abdominal muscles, injuries, or trauma.  Additionally, those with osteoporosis or decreased levels of vitamin D often suffer from back pain.

Most cases of pain will resolve on their own without much intervention from a physician or medications. Typically pain lasts for 2-6 weeks with complete resolution after this time.  In many cases, a minimal movement of twisting, bending, or heavy lifting can trigger an acute attack of pain. That means you don’t have to log an hour of Zumba at the gym, even unloading the dishwasher can trigger back pain if you’re not careful!

Most back pain is described as aching pain in the lower back and buttocks. Occasionally this pain may radiate down the legs as well. This is called sciatica or sciatic pain because the pain is caused by pressure on the sciatic nerve (a nerve that begins in the lower back and goes down the back of the legs). You may also feel occasional sharp or stabbing pain, particularly when you twist or bend. This may be due to inflamed muscles or irritation of nerves around the lower back.

There are a few symptoms that should never be taken lightly.  If you or someone you know develops back pain and weakness in their hips or legs this could be an emergency. Additionally, if any bowel or bladder incontinence or urinary retention is present you, should seek medical attention immediately before any permanent nerve damage is done. Finally, back pain with fever or back pain in any patients with cancer should always be considered an emergency.

When treating your pain, the best place to start is by using heat or cold packs in the area. Many people find relief from alternating both temperatures. Also try a medication like Ibuprofen, which is an NSAID (non-steroidal anti-inflammatory drug) that can decrease inflammation and help alleviate pain. Avoid bed rest! It may be tempting to sit in bed and watch re-runs of “Saved by the Bell” all day while you are recuperating, however many studies suggest that bed rest lengthens recovery time and may even lead to worsening injuries.  If you have not had relief or are experiencing worsening pain, visit your doctor. He/she may decide you need more time with the same treatment or consider a stronger medication or muscle relaxant. Don’t be alarmed if your doctor doesn’t order an x-ray.  A recent study showed that imaging studies like x-rays and MRI’s done for acute back pain are rarely abnormal and often create unnecessary costs and radiation for the patient.

Use good form: Make an effort to always bend from the knees and waist together rather than bending over only from the back.  As fun as it was to practice that “Bend and Snap” from Legally Blonde, you may want to tuck that skill away to keep you pain free.

Focus on strengthening your core muscles. Your abdominal muscles work together with the back muscles to anchor and support the spine. Working your core and maintaining good posture will also help reduce your pain and eliminate future injuries.

Give your High Heels a Break: High heels may look great, but often times a very high or thin heel can put a significant amount of pressure on the lower back. If your shoes are like this, consider wearing them for only a small period of time.  High heels can also cause women to lean forward to help re-distribute their weight, which can aggravate existing back injuries.

So the next time you’re at the gym, or rocking out to Carly Rae Jepsen’s latest hit, think about protecting your back, or you’ll be sitting on your couch waiting for your doctor to “call you..maybe?!”.

Acid Reflux: What’s The Word on GERD?

Some things just make our stomach turn- whether it’s watching an episode of “Hoarders”, doing an INSANITY workout, or catching up with LiLo’s latest plastic surgery debacle, acid reflux can be a real disaster.

What causes Gastroesophageal Reflux Disease (GERD)? There are several factors that play into women experiencing symptoms of acid reflux. Amongst Americans, more than twenty five percent of all adults suffer from GERD and greater than ten percent have symptoms every day.

The environment in the stomach is extremely acidic compared to the rest of the body. When this acidic content comes up from the stomach to the lower portion of the esophagus, you may begin to feel the burning and pain of acid reflux. At the junction between the esophagus and the stomach there is a small sphincter (this acts similar to a door) that stays closed to keep acid out of the esophagus. If this “door” malfunctions, or is hit by a significant amount of pressure from the stomach, a person experiences acid reflux. Occasionally, this sphincter may relax at the wrong time and also cause symptoms of GERD. 

Like your good friend Kim Kardashian in her blonde wig, GERD symptoms may be unrecognizable. Symptoms such as chest pain, nausea, persistent cough, or hoarse voice can all be associated with acid reflux. If you are experiencing chest pain, however, don’t tell yourself it’s heartburn, you should have a cardiac evaluation by a physician immediately.

In some cases, GERD is a sign of a more serious problem. If you are experiencing trouble swallowing, loss of appetite, weight loss, or pain in your stomach or throat something more complex may be going on. Gastric ulcers, esophageal and gastric cancers, and anatomical problems with your esophagus may present as severe GERD. Your doctor can help evaluate your situation with a careful history and exam. If any of these are suspected and you have tried medications or lifestyle changes (we will talk about this below), your physician may recommend you see a Gastroenterologist for further studies or evaluation. This is a specialist who deals specifically with medical problems related to the stomach, intestine and digestive system.

What are some ways to reduce GERD? Lifestyle changes are always the first and best place to start. It turns out not only is binge drinking bad for your heart, but excessive amounts of alcohol can worsen acid reflux symptoms. High intake of fat is also associated with increase in GERD symptoms. Additionally, if you smoke, your acid reflux can be much more severe- this alone is a great reason to quit smoking. Increased intake of citrus fruits, juice, chocolate, and spices are also known to exacerbate acid reflux. Also keep in mind that pregnancy can significantly increase acid reflux, so try to sit upright after meals and consider smaller meals and snacks throughout the day if you are pregnant.

Hopefully all this info hasn’t left a sour taste in your mouth! If you are experiencing symptoms of GERD speak to your physician. He or she may give you a trial of a medication to improve your symptoms and review your diet and lifestyle to help you make changes.

Headaches: More than Just a Head Case

Headaches can be a real mystery- whether you’ve been stressed at the office or you’ve been busy “Whipping your hair back and forth” like Willow Smith, we all get them. Headaches can mean different things for different people, but they are usually defined as any type of pain in the head or neck region, and can last for a variable amount of time depending on what is causing them.  When you think of your own headaches, it’s important to consider a few things: how long do they last, how long have they been going on, what triggers them, are they related to other things in your life (stress, sleep, diet, etc.), and what does it take to make them go away.

Migraine Headaches: These are headaches that can be pounding, severe, and even debilitating. They may last for a few hours but some persist for up to 3 or 4 days. Typically they are throbbing or pounding and can affect your vision, make you nauseated, or feel sensitive to light or sound. These can sometimes be hereditary, and children can also get them.  Migraines usually respond well to modifications in triggers (if you know what they are), or medication that is taken immediately after the onset of your headache. If you wait until the headache is pounding and you’ve barfed up your lunch, it might be too late to see the effects.

Tension or Stress Headaches: These are common amongst both men and women. These headaches are often described as a band of pressure around the head, often accompanied by an aching feeling in the neck and back muscles. As the name implies, they can be brought on by stress at work or home, depression, hunger, or even abnormal posture (if you’re stooped over your desk all day, your $1,000 ergonomic chair can only help you so much).  For many of you, your days usually end after 12 hours in high heels and a business suit, or after chauffeuring your children to soccer and ballet. You don’t have to wait until you realize you forgot to pay your water bill to know that you are stressed. Make an attempt to reduce your stress by prioritizing your “to-do’s” and don’t kill yourself if you don’t finish everything in one day.

Lifestyle:  Always eating on the go, getting very little sleep, or drinking significant amounts of caffeine (or trying to cut back) could all be a cause of your headache. You may think Spicy Cheetos are saving you at 3pm when you crash, but in reality packaged foods usually contain significant amounts of sodium and preservatives, which are both linked to increased blood pressure and headaches. Lack of restorative sleep can also lead to headaches throughout the day. Additionally, make sure you are well hydrated. If water never hits your lips, until you’re sweating at spin class, you are depriving your body of essential hydration that can keep you energized and potentially headache free. Dehydration alone can be a common culprit of recurring headaches.

Medications: All pills aren’t created equal. Even vitamins or natural supplements can contribute to headaches. Medications such as birth control pills, blood pressure medications, antibiotics, and even prenatal vitamins can all cause headaches. If this is the only addition to your routine since your headaches started, speak to your personal physician about adjusting your medications.

Hopefully you don’t have a headache now after reading all that info! But this is the most important part! There are a few symptoms that should not be taken lightly. If you are experiencing any of these, speak to your personal doctor immediately:

  • The headaches wake you up from sleep at night
  • You have a fever along with your headache
  • You are experiencing the most severe headache you have ever had in your life
  • You are requiring more than the recommended dosage of over-the-counter pain meds and your headache still has not improved at all