Flu vs. a cold

Flu season is officially upon us! I mentioned the flu shot a few weeks ago. Has anyone had theirs yet?

The patients I work with are typically from Mexico, Central, and South America. There are a few Africans, Asians, and Eastern Europeans in the mix too, but I have a heavy Hispanic population. In my experience, these countries practice medicine differently than we do in the US. I'm not saying we're better, simply that we do things differently. One of the biggest differences is that when my patients are sick for a day or two, they come to me expecting I will give them an antibiotic. This could be standard practice in their home country or it could be due to providers who would rather have a happy and satisfied patient rather than spend a few extra minutes educating them on the proper use of antibiotics.

In a previous post about patient satisfaction, I discuss the proper use of antibiotics. I'll let you go back for a refresher!

So, what is the difference between the flu and a cold? When should you go see your provider? Good questions! This graphic is excellent! I especially like the suggestions on the bottom of when to see your provider. A cold will usually resolve on it's own in 5-7 days. You may have a residual cough, but as long as you're improving every day, you're ok! You do not need to come in to see us! However, you should stay home from work/church/school!

If you have the flu and come in to see us, we may do a nasal swab (slightly uncomfortable q-tip up the nose farther than any finger can reach!) to check for a flu virus. If the swab comes back positive, then your provider may offer you an ANTIVIRAL medication to shorten the duration of the flu. Meaning, without the medication, you may be sick for 7 days, with the medication 4-5 days.

Other than the antiviral medication, symptom management is the same for both; rest, fluids, handwashing, warm showers, steam, vapo-rub, zinc, etc.

Please give your body time to heal and rest. The best piece of advice to keep you and your family cold and flu-free: wash your hands!

Foot pain

There are few issues that bring patients into my office quite as quickly as foot pain. Think about it! If you have foot pain, every single step you take is a reminder of the pain. You can't escape it!

Not all foot pain is the same, but one of the most common issues I see is Plantar Fasciitis. The plantar fascia is the white band you see in the picture. It inserts into the heel bone, right in the middle, and extends to the base of the toes where it fans out and attaches to each toe. It's pretty cool and crucial to our ability to ambulate! The most common complaint I receive is pain in the foot when getting out of bed or after sitting for a long time. The pain is so intense patients have had to crawl because the pain of weight bearing is simply too much.

The best way to describe it is as a reverse rubber band. Instead of the plantar fascia stretching out, it is actually contracting and causing the pain. The causes are varied; over use due to running, excessive stretching, weak supporting muscles (hamstring, gastrocnemius, soleus, and even the Achilles tendon), improper foot wear, and even leg length discrepancy.

How is it treated? Like most musculoskeletal problems, we treat with RICE (rest, ice, compression, elevation), anti-inflammatory medications (ibuprofen, naproxen, Advil, Aleve), activity modification, change shoes, orthotic inserts, steroid injections, splinting, and stretching. I have heard old wives tales of patients have bilateral plantar fasciitis and attempting to have steroid injections completed. They have one foot injected but the pain of the injection is so intense that they forgo the second injection. I'm not sure the validity of this, but if you have ever suffered from plantar fasciitis, you know the pain is intense without an injection!

In my experience as a provider and as a sufferer, stretching the foot out over a ball or round object has the best benefit. By using a baseball or frozen 16 oz water bottle and rolling it under your foot, it helps to stretch the fascia back out. Does it hurt? Absolutely. But, it's a pain that hurts so good. Anything round with a diameter around 2" will do the best job at stretching. Other exercises include writing out the ABCs with your foot, scrunching up a towel with your toes, picking up marbles with your toes, bending your toes over a ledge or step, stretching out your calf by pushing against a wall and putting one foot behind the other, toe taps, fascia massage, and Achilles tendon and calf stretches. This study found that by just stretching, 83% of patients felt relief! Even using a foam roller for the foot and calf would help.

Like many other issues, it takes time and consistency. If you believe you have plantar fasciitis, I would try the above suggestions for up to 2 weeks. If you don't see any relief, then schedule an appointment with your PCP.