Thursday, October 20, 2011

Post Mortem Question

A friend of mine just died in a car crash. It was a terrible crash and evidently not survivable under any circumstance. The cause of death was confusing to us, 'uncal herniation causing respiratory arrest'. What does this mean?
Jim S.
Jim, so sorry about your friend. An 'uncal herniation' is merely describing a situation in the head where pressure builds up, usually from bleeding (in the case of trauma), and this pressure forces the brainstem down into the formen magnum, and when this happens our brains can no longer instruct the lungs/ diaphragms to breathe, so breathing stops and the person dies. THIS link is a pretty good one to describe this process in more detail. Again, so sorry to hear about your friend. 

Doc 1

Wednesday, October 5, 2011

Plantar Fasciitis and its Consequences (pending question)

I was diagnosed with Plantar fasciitis June 2010. The doctor gave me some excersises to do and then said stay off of it as much as possible. So I spent the summer not really over stressing my foot and doing the excersises. 
I'm a teacher and school started in September and I'm back on my feet and it's still sore. Sore enough that it takes me a while to get down the stairs in the middle of the night to get to the bathroom. Again this summer I didn't do much walking or over excert myself but I kept busy. 
So now I'm gaining weight because I'm trying to keep the foot from getting worse. So this September after all summer of being a slouch (again more or less) I got back on the treadmill and am running again. but it really really agravates the foot. I can't keep babying this foot it's been long enough so I just run through the pain. The first ten minutes are pretty painful and then it smooths out. But when I sit later it's very, very stiff. I'm told theres nothing else to do for this other than Aleve.  I can't take Aleve every day it upsets my stomach.
I own the treadmill and can't afford a gym membership. We also have a great bike trail nearby and I bike that as well but it doesn't tone like running does. Is there anything else I can do and why doesn't this get better? I would think after a year and a half it should have improved somewhat.  Am I missing something? I'm a 55 year old woman who is about 30 lbs overweight which I can get off but just need to be active. I have no other illnesses. It may sound trivial and not dramatic enough for your blog but it's really starting to get to me. 
Thanks for your input.
Dear Renee, 
Doc1 here, and this is a great question. I think my friend Doc2 can add some to this but you have clearly failed to improve with the conventional therapy for plantar fasciitis. 
In my current practice I see tons of young folks with this problem. Recently I learned that our friends in Podiatry have a new weapon against this sometimes debilitating problem and it is borrowed from the Urologists. It's called ECSWT (extra corporeal shock wave therapy), and uses focused sound waves to promote healing of the inflammation in the plantar fascia. 
This therapy, by report from patients of mine who have had it, can be dramatic and curative. So, I would recommend seeing a Podiatrist to see if this might be an option for you 
Also, a more traditional therapy which DOES work but can only be done once or twice is injection of steroids into the plantar (bottom) surface of the foot. 
In any case, take a good look at the Mayo Clinic link I sent and look how many options for treatment there are. There is hope and there's more to do for you. Time to step up the treatment regimen. 
Will let Doc2 weigh in (no pun intended) on the weight issue.