John Hollander, DPM
“In a large retrospective study involving over 390,000 older outpatients [ages 66 and up] undergoing minor ambulatory surgery procedures, older patients receiving prescription opioid analgesics within 7 days of discharge were 44% more likely to continue using opioids 1 year after surgery.“ This disturbing information was provided in a peer reviewed study in the Arch Intern Med journal. We are hearing time and time again that there is an opioid crisis, yet the medication is still being prescribed. Why?
There is not one prolonged study of opioid use that has demonstrated a long-term benefit to the user. “An epidemiological study by Eriksen et al. involving patients with chronic pain treated with opioids for 5 years provided compelling evidence that opioids were not a panacea for chronic pain. In fact, the patients’ quality of life failed to improve despite escalating doses of opioids over the 5-year study period. The authors concluded that ‘it is remarkable that opioid treatment of long-term/chronic non-cancer pain does not seem to fulfill any of the key outcome treatment goals, namely pain relief, improved quality of life and improved functional capacity’ . More recent studies suggest that long-term opioid use can actually retard functional recovery.”
With this ever-increasing epidemic, it is time more doctors and patients look to alternative therapies in treating pain. Advancements in medical technology have led to the development of the MLS Laser, a device that works at a cellular level. Approved by the FDA, it is readily available for doctors to use.
The MLS Laser uses certain wavelengths to penetrate the skin down to a cellular level without the need of numbing medications or incisions. When the laser is able to reach the mitochondria, it is able to provide a therapeutic result, in that, ATP (energy cells) production is increased, there is an increase in cell reproduction, an increase in oxygen transportation to cells and, a reduction in cytokines which in part cause inflammation, in addition, a resulting effect of a reduction in pain.
In fact, many well-controlled studies have confirmed the benefits of using laser therapy for improving acute and chronic pain management without the need of medications like opioids. And, additional studies have “confirmed enhanced wound healing in both diabetic and non-diabetic patients” according to the National Center for Biotechnology Information.
So why do so many doctors still over prescribe opioids? It is because they make the choice to do so over offering non-analgesic options like laser therapy. There are a few possible causes to why they make these decisions: one, while there are plenty of short-term studies for pain reduction with laser therapy, there is still very little data on long term studies, and that can make doctors nervous. Two, there is a “low reimbursement by third-party payers to the health-care providers administering these non-traditional therapeutic modalities” according to NCBI. And three, there are still some in the medical community that question the analgesic efficacy even though there are plenty of studies backing it up.
It will take a progressive and forward-thinking doctor to recognize that the benefits of laser therapy greatly outweigh the convenience of prescribing an opioid to their patients. It is up to the medical community to put an end to the opioid epidemic and start embracing non-analgesic options.
Sonoma County Foot & Ankle proudly offer MLS Laser Therapy to their patients, conveniently located at their practice. If you would like to learn more about MLS Laser Therapy, please visit our website johnhollanderdpm.com. If you would like to schedule a consultation to see if MLS Laser Therapy is right for you, please call our office at (707) 578-1222.
 Alam A, Gomes T, Zheng H, et al. : Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425–30. 10.1001/archinternmed.2011.1827
 Eriksen J, Sjøgren P, Bruera E, et al. : Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain. 2006;125(1–2):172–9. 10.1016/j.pain.2006.06.009
White F. Paul, Lazo Ofelia, et al. : Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management. [version 1; referees: 2 approved]. F1000Research 2017, 6(F1000 Faculty Rev):2161
 Ojea AR, Madi O, Neto RM, et al. : Beneficial Effects of Applying Low-Level Laser Therapy to Surgical Wounds After Bariatric Surgery. Photomed Laser Surg. 2016;34(11):580–4. 10.1089/pho.2016.4149
Foot soaks have been around for centuries with the intent to soothe the mind, body and soul. They can be made from many different items found in nature. Some are designed to relieve aching feet; some help remedy unwanted odor and others are purely to encourage relaxation and a sense of well-being. Below are a few foot soaks that you can easily make at home with many ingredients found in your cupboard.
Foot Soak for a Queen- the name says it all
- 4 cups warm water
- ¼ cup mint leaves
- ¼ cup chamomile tea mix
- ¼ cup rosemary leaves
- 1 Tbsp sea salt
- 1 tsp fresh grated ginger
- 10 drops tea tree oil
- 1 Tbsp grape seed oil (or olive oil)
Pour all of the ingredients (except grape seed oil) into a bowl large enough to soak your feet. Soak your feet for up to 30 minutes. After soaking, use a pumice stone to help remove dead skin cells from your heels. Finish your foot soak for a queen by massaging grape seed oil into the skin.
An Orange Pick Me Up- a great mid-day soak
- 4 cups warm water
- 1 cup Epsom salt or sea salt
- Orange peels of 1 orange
- Juice of 1 whole orange
- 5 drops of vanilla essence
- 1 Tbsp coconut oil
Using a large bowl or basin, pour Epsom salt into warm water and mix. Sprinkle orange peel into water, along with orange juice and vanilla essence. Soak for up to 20 minutes. After soaking, pat dry your feet. Apply Coconut oil to your feet and massage in thoroughly.
Foot Cooler- soothes tired, hot, stinky feet
- 6 cups hot water
- ¼ cup mint leaves
- 1 cup white vinegar
- 3 Tbsp sea salt
- 1 tsp cucumber seed oil or 1 cucumber sliced into disks
- ¼ tsp mint, lemon or lime essence
Using a large bowl or basin, mix mint leaves and sea salt into hot water for 2 minutes. Add remainder ingredients into water. Soak feet for 10 minutes. Rinse off with cool clean water and pat dry the skin. Apply your favorite foot moisturizer and massage in thoroughly.
Lavender Honey Soak- relax and unwind after a long day
- 4 cups warm water
- 1 cup sea salt or Epsom Salt
- ¼ cup honey
- 5 drops lavender essential oil or 1 cup dried lavender
- 1 Tbsp fresh rosemary leaves
- 2 Tbsp coconut oil
Using a large bowl, mix all ingredients together. Make sure salt and honey fully dissolve. Soak your feet for up to 30 minutes. Take in slow deep breaths and take note of the fragrance you smell and the warmth on your feet as you unwind for the night. After soaking, remove feet from bowl and pat them dry. Massage feet with coconut oil. You could even add a drop of vanilla into the oil for an extra delight to your senses!
Whether you’ve lived with diabetes for most of your life or have just recently been diagnosed, diabetes burnout is real and it could happen to you! By learning how to recognize the symptoms of burnout and tricks to putting a halt to them, you can prevent getting yourself into risky life-threatening situations.
What is Diabetes Burnout?
Every day you have a routine you need to follow- count your carbs, check your sugar levels, take your medicine, visit your doctor and more. That is a lot that you have to do in your day-everyday. When you suddenly don’t want to do these “chores” anymore, the routine gets old, you slack on taking your insulin, you cancel your doctor appointments, or you stop self-care, that is diabetes burnout. Experiencing diabetes burnout can also cause anxiety and stress and lead to life threatening situations.
What does diabetes burnout look like?
There are many ways to experience diabetes burnout including: strong negative feelings towards diabetes, feeling isolated or alone with diabetes, avoiding some or all of your diabetes management tasks and self-care, feeling controlled by diabetes or, feeling like you have lost control of your diabetes.
What are the tools that one can use to combat diabetes burnout?
Don’t be perfect: Everyone wants to have the exact “perfect” number for them and while it is good to strive for “happy” numbers, it’s just not practical to be perfect. It is OK to be a little above or a little below your target numbers once in a while. Try to stay within your healthy range but recognize that life happens and just try to do your best.
Set mini goals: If it all just seems to feel like it is too much, take one step at a time. Set yourself mini goals or tasks such as, checking your blood sugar after every meal or going for a short walk at the end of your day.
Ask friends and family for help: They may not fully understand what it is like to be diabetic, unless they are diabetic themselves, but by including your family and friends in your struggles and achievements with diabetes, they can then be able to help cheer you on and provide emotional support when days are tough. Also, educate your friends and family by making them aware of the comments they say to you. Their comments may have been said with good intentions, but in all reality, they can make you feel discouraged or isolated- let them know!
Relate through support: Reach out to fellow diabetics for tips and tricks and as a safe place to speak your frustrations. Many others have been in the same boat and they will have ideas to help you get back on track. It is also a great way to support others like you.
Tell your doctor you’re burned out: Reaching out to your doctor about feeling burned out is a good thing. By doing so, the two of you can set up a new plan of action and new goals that are attainable for YOU!
To read or not to read that is the question: If you are lacking motivation, try reading a book or article or support page for encouragement and to help you bust out of feeling burned out. If you find yourself reading too much on diabetes take a break from it- disconnect from reading on the topic- instead, focus on activities that make you feel good like crafts, outdoor adventures or volunteering.
As Scott Coulter, writer for Diabetes Self Management said, “Diabetes is a tricky thing. It will always have the capacity to frustrate us, irritate us, scare us, and make us mad, but if we know how to work with our feelings we can avoid serious burnout, or at least catch it early and reverse it.”
If you think you may be experiencing diabetes burnout, talk to your doctor. Don’t put it off, you are worth the time and you deserve to be happy!
Dry skin and callus build-up tend to occur for a few reasons. The skin on our feet sweat, especially when they are hot, and this sweat can cause the skin to dry out. When we walk barefoot, it is often on a rough surface such as concrete, sand or dirt, all of which can cause little abrasions on the surface of the skin, leading to a rough texture. Exposure to other elements such as the sun, ocean water or pool water can also have a drying affect.
So, how do we prevent or treat these symptoms? There is a combination of a few things that we can do each day to help our feet look and feel soft.
Wash & Moisturize Daily: By washing your feet, you are removing the debris from earlier in the day that was causing your skin to be scratched. Using a moisturizer formulated for thicker skin will assist in bringing moisture back to the feet.
Stay Hydrated: Showing signs of dry feet can often be a tell tale of dehydration. Drink 6-8 glasses of water each day and increase that amount when you are physically active and the outside temperatures are warmer.
Soak: If you are treating dry feet, give them a soak in warm water with Epsom salts for about 15-20 minutes. Epsom salt helps loosen up the dry skin. Follow your soak with a quality moisturizer.
Exfoliate: After your regular shower or a good long soak, exfoliate your feet to help remove the dry skin build up, also known as calluses, with the use of a pumice stone and a stiff bristle brush.
Maintain: Keep your feet looking good and feeling soft by applying moisturizer on a daily basis. If you need more help with moisture, try applying a moisturizer designed for feet and then putting on cotton socks while you sleep.
If you need additional assistance in maintaining happy and healthy feet, give our office a call. We can schedule an appointment to discuss your foot related concerns and help you find a solution. Our offices are open Monday-Friday and our phone number is (707) 578-1222.
While we do have our regular wine and cheese festivals at different times of the year, June 25th marks the National Wine and Cheese day. So, to help you celebrate locally, we have generated a list of a few of our favorite wine and cheese spots.
Ty Canton Vineyards. If you are a fan of big bold reds like Cabernet Sauvignon or Malbec, you will want to stop at Ty’s. He prides himself on using the very fruits produced in his vineyards to inspire his distinct flavors.
Wellington Cellars. Family run, hand-crafted small batch winery. They offer most styles of wines. The constant trend that seems to occur when others visit, is that they all end up obtaining a wine membership- that’s how good it is.
Kunde Family Winery. With five generations of wine production, the Kunde’s remain humble while providing an exquisite selection of fine wines. The view at this property is breathtaking and there is plenty of lovely sitting areas to enjoy it with your glass of wine.
Muscardini Cellars. As you head south on highway 12, you’ll see their cute brick red building lined with yellow trim, on your right-hand side. Rosé and reds are what they focus on mainly, but they do offer a white wine and a bottle of grappa! They offer friendly service and comfortable patio seating if you’d like to stay for a bit. It’s also dog friendly!
Joe Matos Cheese Factory. You can’t get anymore local than Joe’s Cheese. The cows, ducks and smells of cheese greet you upon arrival. There is nothing fancy here. Just a small “shop” where you can enjoy a generous sampling of their one type of cheese- St. Jorge Cheese.
Bohemian Creamery. While goat, cow and water buffalo milk are personally transported from the local dairies to the creamery, by the owner, all of their cheeses are made in shop. If you are looking for something extra special in both accessibility and flavor, this is the place. You won’t be able to find her cheeses in the store, so stock up while you’re there and don’t forget to order the sampler plate!
Vella Cheese Co. Located in an old cobble stone building resides a shop full of tasty cheeses. Hard cheeses and soft cheeses, all kinds of Monterey Jack Cheeses and more! There are even horses next door to look at while you enjoy your snack!
Weirauch Farm & Creamery. Sheep milk and jersey cow milk are what make up the beautiful rounds of cheese offered here. Another local farm and creamery that proudly promotes the welfare of their animals and also partners with their community through food banks and local organizations that support small agriculture.
*This is not a paid endorsement or advertisement for wine or cheese. These are simply our opinions.
Did you know that we offer our patients nail polishes that were developed by podiatrists? We carry the nail polish line Dr.’s Remedy. It is a wonderful product line that was designed with the health of the nail in mind. Dr.’s Remedy polishes are vegan and formaldehyde free that come in a variety of subtle and vibrant colors. If you are someone that suffers from dry brittle nails or experiences toenail fungus you should give this polish a try because it contains garlic bulb extract which is a natural fungus deterrent!
Even if you do not suffer from brittle nails or fungus, you will still benefit from these polishes. They contain tea-tree oil, lavender, wheat protein and vitamins C and E; all of which help to hydrate the cuticle and improve the appearance of dry nails.
Dr.’s Remedy is the best nail polish alternative for anyone that wants healthy, pretty nails without the harsh chemicals. For more information and color options please visit: http://www.remedynails.com/
Give us a call or stop by our office today to purchase your own Dr.’s Remedy nail polishes. (707) 578-1222.
The Santa Rosa Marathon is just around the corner and many runners are busy training for it. It can be difficult to run and train well when you’re suffering from bunion pain. These pesky bulges rub against your footwear, as well as, change the way you push off your feet when you run. The good news is that you can perform the following stretches for bunion pain to alleviate your symptoms:
• Big Toe Towel Stretch – Loop a towel around your big toe and pull it back toward yourself. At the same time, push against the towel with your toe.
• Object Pick-ups – Try to pick up marbles or other small objects from the ground and put them in a cup using just your toes.
• Big Toe Stretch – Sitting with your foot in front of you and your heel touching the ground, pull your big toe out to the side, away from its neighbors. Hold it for a few seconds, then relax. Repeat ten times.
• Toe Spreads – With your feet flat on the ground, spread your toes apart as wide as you can and hold them there for a second. Then, relax and repeat ten times.
You may still need to make other accommodations for your feet. Taping your digit so it stays correctly aligned or using toe separators can help keep your foot in the right biomechanical position and prevent pain. You’ll still need shoes that have sufficient support and a wide enough toe box.
Don’t let discomfort keep you from training for the big race or enjoying your daily routine. Try some stretches for bunion pain before and after you run. If the pain is still too much to maintain your normal activities, contact John D. Hollander, DPM in Santa Rosa, CA, for more information or an appointment. Call (707) 578-1222 or use our online request form to reach us.
You might enjoy taking off your shoes and kicking back at the Russian River, but if you suffer from foot odor others around you might not like it as much. Taking care of smelly feet doesn’t have to be difficult or overwhelming. It is a fairly simple thing to do that just requires a little extra care.
Your feet tend to sweat more than any other part of your body. When you mix this excess perspiration and a confined, moist environment (like your shoes), the combination can be quite stinky. People who are on their feet all day or wear the same shoes without giving them time to air out, are more likely to suffer from this condition, also known as bromodosis. For extreme odor problems, it’s important to make sure that a fungal infection or athlete’s foot isn’t the cause of your smelly feet.
To prevent foot odor there are a few things you should keep in mind. Shoes take about 24 hours to completely dry out, so don’t wear the same pair two days in a row. Even a little bit of excess moisture can cause an unpleasant smell. To help keep your feet dry you can use an antibacterial foot powder or an antiperspirant. Also, always remember to wear socks. Specifically, wear a pair made of synthetic material that wick away moisture from your skin. If your feet already smell, there are different soaps that can get rid of the odor in a few days. If you would like help selecting the right over-the-counter product, we do carry many in our office that are available for purchase and we would be more than happy to help you.
Call Dr. John Hollander at 707-578-1222 to schedule an appointment in our Santa Rosa, CA office. Don’t let smelly feet leave you feeling uncomfortable or embarrassed. Call us today and we will help you get rid of your foot odor once and for all!
Did you know that our bodies are made up of 70% of water? How amazing is that? Ensuring that our bodies are properly hydrated allows for us to function properly inside and out! While there is no agreed upon amount of water we should be consuming each day, the Mayo Clinic states, “if you drink enough fluid so that you rarely feel thirsty and produce 1.5 liters (6.3 cups) or more of colorless or light yellow urine a day, your fluid intake is probably adequate.”
So what benefits does drinking water offer our bodies that would encourage us to drink more of it? Here is a list of several ways in which water benefits our bodies:
- Maintains Regularity. Staying hydrated keeps the colon functioning properly and helps move undigested foods along. A great way to start a sluggish bowel movement is by drinking a full glass of water when you wake up!
- Improves Skin Complexion. There’s a reason why your esthetician tells you to drink water after your appointment. Staying hydrated provides moisture to the skin, keeping it from becoming dry, stiff and wrinkly. Increasing water intake also helps flush out toxins and bacteria, which is a common cause of acne.
- Aids in Weight Loss. Studies have found that by increasing your water intake, you may lose weight. The reasoning behind this, is that you are replacing or reducing your intake of sugary or calorie rich beverages with water, which has zero calories. And in addition, by increasing your water intake you are also less likely to be hungry.
- Natural Lubricant. Water is important to our body functions, such as blood production and flow, it lubricates our joints and assists in repair of damaged tissues by allowing cells to transport to the site more efficiently.
- Energy Booster and Relieves Fatigue. “Since your brain is mostly water, drinking it helps you think, focus and concentrate better and be more alert. As an added bonus, your energy levels are also boosted!”
- Aids in Flushing out Toxins. By staying hydrated, our body has the power to flush out toxins we ingest and absorb throughout our days through either sweating or excreting through our urine. An easy trick to see if you are drinking plenty of water is to look at your urine. Your urine should be clear or a light yellow. Darker colors of urine could indicate dehydration or other complications.
- Prevents and Ends Headaches. Most headaches are commonly caused by dehydration. You can help prevent them by staying hydrated.
Try increasing your water intake by an additional cup per day and slowly increase each additional cup per week, until you consume about 64 ounces of water per day. I’ve found that my body is the happiest around this number. If you are a taller person, exercise frequently or work in warm conditions, you may want to increase you water intake. Now it’s time for me to get another glass of water.
Sarah Del Buono, Virtual Marketing Director
You’ve been going about your afternoon as normal and when you finally decided to wind down for the day. You take your shoes off, put your feet up and then you stretch your feet and- ouch! The top of your foot feels sore and tight. Why? This could be a sign of Extensor Tendinitis!
The foot has several tendons that run from the toes, up to the ankle and beyond. These tendons allow for the foot to flex up and down. Sometimes, the pressure of shoe laces on top of the foot or poor arch support can put stress on these tendons. When one or more of the tendons in our foot becomes overused or stressed, they become inflamed, thus causing Extensor Tendinitis.
If you think you may be experiencing Extensor Tendinitis rest your feet. Take off your shoes and socks and put your feet up. Allowing your foot to rest can assist in recovery. You may even want to apply an icepack wrapped in a dish towel, to the top of your foot for 10 minutes to help reduce any swelling. If your foot is uncomfortable, you may also want to take an anti-inflammatory such as ibuprofen (please consult with your doctor first).
After your pain has resided, you may need to perform foot stretches to help prevent future occurrences. Toe raise exercises are a perfect example of stretches one may need to perform.
While Extensor Tendinitis is the most common form of ‘top of the foot pain’, there may be other conditions that mimic the same symptoms: metatarsal stress fracture, atypical gout and degenerative arthritis. If you are finding that rest and icing are not helping with your foot pain, seek medical attention from your podiatrist.
If you are in need of medical attention for your foot, call our office to schedule an appointment at (707) 578-1222. Let us help you put your best foot forward!