Cowtown Marathon Teaches RunDoc to respect the Distance!

Cowtown Marathon kicked my butt! I'll admit it. I have again been humbled. It happens to all of us from time to time. I thought I was in good enough shape even though I had been lazy in my training lately. Too many things to do, not enough time. I was taught again to respect the distance. Yesterday's Cowtown Marathon in Fort Worth, TX was typical of the marathons I have run in the last two years: Freezing (25 degree wind chill factor), 30 mph wind in your face half the time, and added killer, rolling hills to the mix. I have not had good race karma. I thought White Rock Marathon in December was bad, but this was much worse and very hilly. For the record, I HATE COWTOWN! The last time I had run this race was in 1999. My peeps talked me into running it again because the Austin Marathon weekend timing didn't fit the schedule and this was closer to home. Never again....But truly it was not all the race's fault. It was poorly organized with random water stops and almost no spectators, but that's not why I had a bad day. I've been traveling too much, hadn't run enough (only one 20) and was mentally and physically tired. My absolutely wonderful running peep, Dr Steve Buksh, ran the whole way with me and should get a huge reward for not killing me when I started whining then ultimately crying (yes, that bad of a day). My hamstrings went into a seizure at about mile 16 from all the hills and we walked a good 2 or 3 miles. By 23 miles, I could barely run and looked like an epileptic. Definately not my day...but the lesson learned is to respect the distance. No matter how many times you have run 26.2 miles, it is still a formidable task and not for the weak or unprepared. The marathon humbled me yesterday and I learned my lesson....always respect the distance.

Now we can talk about delayed onset muscle soreness tomorrow when I can barely walk :)

Run Happy ....and respect the marathon or she will beat you into submission!

Funky Toenails? New Laser Treatment Kills Fungus!

My nails are thick, yellow and seem to have something growing underneath them. I’m not a dirty person, how did this happen? Many of my running friends have the same nasty toenails but say the treatment can be worse than the problem! Is this true? What about the new laser I have heard about?

Toe nail fungus strikes across class, ethnic, age and hygiene lines. In fact, one study showed that almost 50% of people over the age of 40 have experienced some type of toenail fungus. Fungal infections are incredibly common, but are more prevalent in athletes (due to toenail trauma) and the infirmed (due to a decreased immune response).

The typical athlete’s foot fungus, called a dermatophyte, is the same fungus that infects your toenails. Fungus loves a moist, dark environment like in your shoes, between your toes. The affected toenails can have a whitish superficial infection or a yellow to brown discoloration under the toenails that seems to destroy the nail as it grows. Long standing fungal toenail look like thick, brownish-yellow mountains growing on the end of your toes. The thickness makes them painful and susceptible to a secondary bacterial infection (paronychia). This infection can be quite dangerous and has been linked to gangrene in diabetics.

How is toenail fungus diagnosed? Diagnosis of onychomycosis can only be made by a toenail biopsy. Your podiatrist can take a small piece of the leading nail and send it for a special stain that shows the fungus. A PAS stain is usually faster and more accurate than a fungal culture, because often the fungus does not grow in the laboratory. Do not assume you have onychomycosis. Psoriasis and other skin disorders as well as chronic trauma can look like fungus. Also, a melanoma under the nails can mimic fungus, but can be deadly if there is a delay in diagnosis. If you suspect you have toenail fungus, don’t delay, see your podiatrist today!

How can I prevent toenail fungus? 1. If you get regular pedicures, bring your own instruments or go to a spa that sterilizes their instruments in an autoclave (like our spa, Health Steps).
2. Clean your toenail clippers with alcohol before you use them if you do your own toenails and make sure to replace Emory boards and orange sticks regularly.
3. We also recommend you regularly clean your shoes with either antibacterial spray like Lysol or even better an antibacterial with an antifungal like Mycomist at least once a month and dry them with a hairdryer.
4. Changing socks regularly (even a few times a day if you have sweaty feet) and keeping your feet clean and dry is also helpful.
5. Keep your athletic shoes dry and also change them regularly. If you exercise regularly, buy your athletic shoes a half size larger than your street shoes so you won’t bash your toenails as your feet swell with exercise.

How is toenail fungus treated? There is a lot of misinformation out there about toenail fungus. I have never told my patients to use white iodine, Vic’s Vaporub or organic cornmeal soaks on their toes. There is no evidence that it works.

Topical therapy should have some penetration of the nail plate like Formula 3 (my favorite), organic tetre oil, Nailstat or prescription (now generic Penlac) ciclopirox nail lacquer. This should be coupled with a nail treatment plan from your podiatrist.

If this doesn’t work after several months, oral medication, like terbinafine (generic Lamisil) or itraconazole (generic Sporonox) may be needed, but these have serious side effects.

There is now a new option for treatment that includes a painless laser procedure to kill the fungus in the toenail with usually one treatment! Think about it, one 30 minute treatment by a painless laser and 6 to 9 months later, the toenails have grown out normal! Too bad we can’t figure out how to make them grow faster! The new PinPointe FootLaser has given us a much better treatment option for eradicating toenail fungus. Unfortunately most insurance companies deem it cosmetic so they don’t cover it, but if you think about all the hassles, copays and the risk of side effects; the toenail laser looks like the best option for most patients.

Remember, no matter how you treat fungal toenails, it takes at least 6 to 12 months for the toenails to grow out completely. Relapse is also common, so it’s important to play offense (treat the fungus) and defense (try to prevent the fungus) at the same time.

Inspiration From New Runners!

Inspiration From Newbies!

This morning I got to spend a few minutes with a new group of hopeful marathon runners who had joined the local Team-in-Training Program raising money to fight Leukemia and Lymphoma. It was 35 degrees and I had to drag my 2 year old with me because of life's bad timing :) I was not in the greatest of moods when I got there, to say the least.

My bad mood cloud almost instantaneously lifted and my mood changes 180 degrees! What amazed me is that you could almost palpate the hope and joy in this group. A cold Saturday morning at 7am and they are laughing, joking and supporting each other in this endevour. These types of moments always reinforce the realization that it is the journey, the miles on the pavement, the friends and peeps we run with who support us, laugh and cry with us, that make marathoning such an uplifting pursuit....a growth experience for all...not the race itself, but the journey to get there.

I applaud everyone who got up this morning, laced their running shoes and headed out the door to run with their peeps.....

Happy Valentine's Day! Here's to the love of the run.......

Painful Blisters on The Run

Painful blisters often plague distance runners. Blisters, as we all know, are caused by friction. Repeated rubbing of damp skin creates more friction than dry skin. Reduce dampness as well as the rubbing, and you'll reduce blistering.
So we all know that to prevent blisters, you need to minimize friction. This begins with shoe selection. Shoes should fit comfortably, with about a thumb's width between your longest toe and the end of the shoe. Remember that this is often your second toe, not your great toe! Narrow shoes can cause blisters on the great toe and little toe. A shallow toe box can lead to blisters on the tops of the toes, while loose shoes can create blisters on the tips of the toes. Shoes that are too big can cause sliding of your foot which can blister the soles as well as the tips of your toes.

Always try on shoes in the afternoon or evening, because feet tend to swell during the day. Walk or run around the store before buying them and then wear the shoes around the house for 1 to 2 hours to identify any areas of discomfort. It often helps to break in shoes by wearing them for 1 to 2 hours on the first day and gradually increasing use each day.

Socks can decrease friction between the feet and shoes. Coolmaxx or synthetic moisture wicking socks or even special double-layered socks can minimize shearing forces. These can wick moisture away from the skin more effectively than wool or cotton can, further decreasing the likelihood of blisters. You can also carry extra pairs of socks to change into if your socks become too damp on a long run.

Another preventive measure is to use padded insoles or moleskin to decrease friction in a specific area. Drying agents can also help. Foot powders and spray antiperspirants are inexpensive ways to decrease moisture. For severe sweating, there are prescription antiperspirants you can get from your physician that provide even more effective drying.

A study of West Point cadets revealed a more than 50% decrease in blisters in those cadets that used spray antiperspirant before running, but many experienced some skin irritation; so test the antiperspirant on a patch of your foot before trying this on the run.

A thin layer of petroleum jelly or Body-Glide can also be applied to the feet to decrease friction. Conditioning the skin by gradually increasing activity tends to lead to formation of protective calluses rather than blisters.

Blisters are a fact of life in distance runners. Almost one in three marathon runners experience blisters at some point in their training.
So how should a blister be treated?

1. If the blister is small and not painful, leave it alone! Place a small band-aid or piece of moleskin over it to protect it and treat the cause so it will not become bigger.
2. Large or painful blisters that are intact should be drained without removing the roof. This is a biological barrier and helps with healing. First clean the blister with alcohol or antibiotic soap and water. Then heat a pin over a flame until the pin glows red, and allow it to cool before puncturing a small hole at the edge of the blister. Drain the fluid with gentle pressure, then apply an antibiotic ointment and cover the blister with a bandage. Change the dressing daily—more frequently if it becomes wet, dirty or loose.
3. Once your blister has been drained, you should treat it as an open wound. Dress it daily with a bandage. Keep it dry and clean for a couple days and if you engage in the activity that caused it in the first place before it heals, take care to provide extra padding and secure the area to prevent any rubbing that may irritate the wound. Change the dressing anytime it becomes moist or soiled and keep an eye out for infection.

When should I see a doctor for a blister?If you experience increased redness, swelling, pain, or green or yellow discharge you should take it to your physician immediately to make sure it's not becoming infected.

Bottom line: blisters are a common annoyance for many runners. These tips should help you conquer this pesky problem before it slows down your run.

Run Happy! And hopefully blister free!

Got Heel Pain? Video Blog

RunDoc discussed heel pain and its many causes as well as treatments



For more information on adult heel pain, click here!

For more information on pediatric heel pain, click here!

Cold Weather Slowing Your Runs?

In Texas, the saying goes that if you don’t like the weather; wait 5 minutes, it will change. This week alone it’s been 70 degrees and 24 degrees. No wonder the whole world is sniffling. Personally, I hate the cold. I’m a tiny person so I’m very cold intolerant. My bike goes inside on the trainer when the weather hits 40 degrees and I look like an Eskimo running. How do we keep motivated during the winter? Things seem to change for me when it’s cold outside. It seems much harder to get out of bed, much harder to run out the front door and a whole lot harder to finish a long run.

In spite of my obvious aversion to cold temperatures, I have trained for years all winter long. In Texas, this means crazy temperature swings. As a teen, in Rhode Island, it meant bitter cold and snow. In fact, I can remember as a high school cross country runner racing in snow and ice and wearing shorts (like an idiot). Training in the cold can make you tougher, but take some advice and dress for the elements. Thank God they finally invented cold weather gear that does not weigh a ton and make you look like you are ready for skiing, not running!

The real goal of cold weather running is to maintain motivation, not get too cold and not get too hot. Easier said then done! One solution to this is to just head indoors and stick to the treadmill. I absolutely despise running on treadmills much more than running in the cold, so unless it’s raining; I’m outside. In addition to the boredom, the repetitive motion of the treadmill can put you at risk for other injuries such as stress fractures. It’s best to have some variety.

The key to staying comfortable and cold weather condition is to be prepared for changing temperatures. Dress in layers and don’t be afraid to overdress. Wear a hat and gloves. I even pull out chemical finger warmers if it’s really cold. If it all possible try to run small loops somewhere near your car or a place where you can discard layers if you start to get hot. You don’t want to be nine miles from home and running with hat in hand, sweating with two jackets tied around your waist.

If you are overloaded with too many layers, you can just as easily overheat when it’s 30° outside. This will make you nuts because you will lose the energy needed to finish your run, just like a hot day, and you may become soaked with sweat be more prone to thermal injury such as frostbite. As soon as your run is over, do not stand around outside. Immediately change into dry clothing. Your core body temperature will drop precipitously immediately after a run. This is why they always shroud you in a blanket at the finish of a marathon, even when it’s hot outside.

Aside for making sure that your temperature is regulated, there are special environmental considerations when running outside in winter. If it happens to snow where you run, you obviously have to watch your step. Be very careful running on ice. Running on snow is easy, but ice will put you on your back before you know it. If you’re lucky it’ll just be an embarrassing fall, but you can get seriously injured this way.

Always wear a hat to keep your head warm. This can be a baseball-style cap, but once it gets colder than about 40° however, you will likely have to switch to a knitted cap that will do a better job of keeping your head warm. It likely goes without saying that you should avoid natural materials such as cotton, that retain moisture and can put your risk of getting too cold. Always use synthetic materials.

As a general rule, you can get away with shorts or tights and a long sleeve T-shirt when it’s in the 50s. If it drops down into the 40s, you need to add a hat, gloves and an additional layer on top. A vest is a nice addition. Once it gets down into the 30s, it’s better to stick with tights or pants and wear three layers on top, as well as hat and gloves. If you’re brave enough to run when it’s in the 20s, you might also want to wear a jacket on top of your many layers. Unless you really like to torture yourself, or live in Alaska, it’s probably better to just stay inside when the temperature drops into the teens.

Keep in mind, your body can become acclimatized to colder temperatures if exposed to them often. However, for people like most of us who are only rarely exposed to cold temperatures, they’re more likely to be a poor judge of when frostbite or other cold injuries are starting to set in. Use common sense. Texas weather is nutty, so the layered look is a must this time of year!

Walking Program to Kick Start New Year's Resolution

Many of our patients, much like their estimated 75 million obese neighbors, are stuck in a never-ending, life-threatening cycle: Obesity aggravates the pain in their feet; sore feet make it almost impossible to exercise for weight loss; and without exercise, their weight continues to increase which puts them at risk for worsening of diabetes, heart disease, high blood pressure, stroke and other life threatening diseases.

It’s the New Year and more than 50% of New Year’s resolutions have something to do with weight loss. This includes a resolution to exercise on a regular basis. Do not let foot pain thwart your resolution to exercise! The best way to break the pain cycle is to seek help from your podiatrist. Often simply placing you in the correct shoes with arch supports or custom foot orthotics will decrease your foot pain and fast track your resolution to exercise.

Many of our patients have not exercised in years, so they have many questions on how to get started. Before starting any program, it is important to discuss exercise with your doctor to see if you have any restrictions due to heart disease, diabetes, or arthritis. Get a physical! It’s a great way to start off the year. After your physical, visit your podiatrist to discuss your foot and ankle aches and pains.

There is no perfect exercise program for anyone, but if you are more than 20 pounds overweight, I recommend you start with a walking program that also has a strength and flexibility component worked in. What does that mean? Start with walking, not running, and add stretching and a little weight training to balance your program. If you need help with program specifics, consult a personal trainer or physical therapist.

Walking really is the easiest and least expensive exercise program that can be done indoors or outdoors; and this can progress to a running program as you lose weight and get healthier.

Did you know that inactivity is the second leading preventable cause of death in the United States, second only to tobacco use?

Need more motivation? Here are six great reasons other than the obvious physical fitness improvements to start a walking program:

1. Walking prevents type 2 diabetes. The Diabetes Prevention Program showed that walking 150 minutes per week and losing just 7% of your body weight (12-15 pounds) can reduce your risk of diabetes by 58%.
2. Walking strengthens your heart. In one study, mortality rates among men who walked less than one mile per day were nearly twice that among those who walked more than two miles per day. Women in one study who walked three hours or more per week reduced their risk of a heart attack or other coronary event by 35% compared with women who did not walk.
3. Walking is good for your brain. In a study on walking and cognitive function, researchers found that women who walked the equivalent of an easy pace at least 1.5 hours per week had significantly better cognitive function and less cognitive decline than women who walked less than 40 minutes per week. Think about that!
4. Walking is good for your bones. Research shows that postmenopausal women who walk approximately one mile each day have higher whole-body bone density than women who walk shorter distances, and walking is also effective in slowing the rate of bone loss from the legs.
5. Walking helps alleviate symptoms of depression. Walking for 30 minutes, three to five times per week for 12 weeks reduced symptoms of depression as measured with a standard depression questionnaire by 47%.
6. Walking reduces the risk of breast and colon cancer. Women who performed the equivalent of one hour and 15 minutes to two and a half hours per week of brisk walking had an 18% decreased risk of breast cancer compared with inactive women. Many studies have shown that exercise can prevent colon cancer and even if an individual person develops colon cancer, the benefits of exercise appear to continue both by increasing quality of life and reducing mortality.

I don’t know if we’ve convinced you yet, but a walking program is a great way to start the New Year! Write down your fitness goals. Put a sticky note on your bathroom mirror that asks, “Did you exercise today?” or a picture of yourself 20+ pounds lighter. Come visit Janet at Healthy Steps and get a new pair of shoes to start your program. (She gives great advice as well). Make 2009 your year to keep your New Years resolution and become your ideal self!

Walk or Run Happy! Moving in the Right Direction!!