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Flip Flop Foot: Muscle Cramps From Wearing Flip Flops

Have you ever had a strange cramp in your foot (between your big toe and the next one or in the ball of your foot) after wearing flip flops all day?  Do you get sore calves or pain in the bottom of your feet?

Flip flops seem comfortable and easy to wear (I like them because they don’t pinch wide feet) but they actually create more work for your foot and leg muscles than regular shoes.  You may not realize it, but when you wear flip flops your toes must grip them extra firmly to keep them from sliding off or sideways.  So you actually contract many extra toe muscles (like the adductor hallucis and the flexor hallucis brevis) with each step you take.  Wearing flip flops for long hours can give you actual cramps in these muscles and others.

In addition to muscle cramps, flip flops have no arch support so your calf muscles and Achilles tendon have to work extra hard and can become sore.  And finally, the lack of support can strain your plantar fascia (a thin rubbery band on the bottom of your foot), causing pain at its point of origin on the heel bone.

So if you’re having foot pain or muscle cramps – it may be caused by too much flip flopping.  Of course, the cure is simple: wear comfortable shoes with good arch support and sturdy straps.  Luckily for you, summer is almost over and your feet may recover naturally as you pack up the flip flops and pull out the work shoes.This post originally appeared on Dr. Val’s blog at

What Does Labor Day Have To Do With Doctors?

Labor Day was founded in the late 1800’s as a way to thank
American workers (as Peter J. McGuire, a cofounder of the American Federation
of Labor put it): “who from rude nature have delved and carved all the grandeur
we behold.”  There is some debate
about who originated the concept of the holiday, but one truth remains:

“All other
holidays are in a more or less degree connected with conflicts and battles of
man’s prowess over man, of strife and discord for greed and power, of glories
achieved by one nation over another. Labor Day…is devoted to no man, living
or dead, to no sect, race, or nation…  It
constitutes a yearly national tribute to the contributions workers have made to
the strength, prosperity, and well-being of our country.”

Resident physicians are on my mind with Labor Day
approaching. I know that they are toiling away in hospitals across the nation,
and many of them do not get to take Labor Day off for vacation.  Physicians work for 3-7 years after
graduating from medical school, and are paid (on average) about the equivalent
of a home health aide or a medical secretary but work about twice the hours
during residency.  In fact, if you calculate
out the salary by the hours they work, resident physicians are paid about $9
-$10/hour which is roughly $1.50 more than minimum wage.

Not surprisingly, resident physicians have joined unions to
lobby for more reasonable wages and caps on the number of hours they must work
per week.  The national cap is now at 80
hours per week – about 20 hours more than a truck driver is allowed to work
(for “safety reasons”).  Research from Harvard
suggests that errors made by overworked residents increase by 700% when they
have worked more than 24 hours in a row.

Residents from the University of New Mexico, for example, received wages in the lowest 1% for resident physicians in their region, and
were denied a salary increase until they recently joined forces with CIR (the Committee of Interns and Residents) to
negotiate more reasonable salaries and working conditions.  The New
Mexico contract adds one more CIR chapter to the more
than 70 hospitals — each with multiple residency programs — that are part of

Founded in 1957 to improve patient care and resident working
conditions, CIR has remained true to those two goals throughout the decades. In
1975, CIR won an end to every other night on-call in New
York City, and created the first-ever Patient Care Fund in Los Angeles, where
residents could purchase equipment or create innovative programs to help
patients. Campaigns to prevent needle stick accidents by moving to safer needles,
or needle-less equipment, have also improved working conditions for residents.

CIR has been on the forefront of safe and humane work hours
for residents, helping to win the 80 hour regulations in New York State
in 1989, which became the foundation for the 2003 national guidelines. But
evidence shows that this is still too many hours, and so the advocacy around
hours continues unabated.

So please have safe travels on your Labor Day weekend – we
wouldn’t want you to wind up at a hospital where the residents work more than
24 hours in a row for ~$9/hour.  Resident
physicians are one group of laborers who don’t have much to celebrate yet this
Labor Day.  But with CIR’s help, next
year might be a little brighter.This post originally appeared on Dr. Val’s blog at

The State of Statins (Cholesterol Lowering Drugs)

We’ve known for quite a while that lowering your cholesterol can reduce your risk of heart disease, heart attack, and stroke.   Low fat diets, weight loss, and exercise can help people to control their cholesterol levels – but for those who do not succeed with these methods, a class of medications have been developed (known as “statins”) to reduce cholesterol.  These drugs have been so successful at reducing cholesterol that some doctors have joked about putting statins in the water supply.  In fact, 36 million Americans take a statin every day, generating annual sales of
$15.5 billion for the manufacturers, and making two statins – Lipitor and
Zocor – the top two best-selling drugs in the USA.

Four new studies were published in the past week about these drugs.  I thought I’d summarize the findings for you to keep you up to speed with the very latest statin information.

Statins May Reduce Mortality After Having A Stroke

Spanish researchers followed the progress of 89 stroke patients who were already taking statins.  For the first three days after the stroke, 46 patients received no statins, and 43 got their normal dose.  After three months, 27 people – 60 % of the “no statins”
group – had either died or were disabled to the point that they needed
help to live a normal life, compared with 16 people from the group
allowed to keep taking statins.
This small study suggests that stroke patients should not stop taking their statins.  More research is needed to clarify the role of statins in stroke.

Statins May Reduce The Brain Plaques Associated With Alzheimer’s Disease

Researchers at the University of Washington examined the brain tissue of 110 people who had donated their brains to research upon their death.  They found there were
significantly fewer plaques and tangles (the hallmarks of Alzheimer’s disease) in the brains of people who had taken statins compared with those who had not.  This is good news, but will require further research to determine whether or not statins could be used (or should be used) specifically for the treatment or prevention of Alzheimer’s Disease.

Statins Don’t Seem To Reduce The Risk of Colon Cancer

A group of Greek researchers conducted a review of the scientific literature to see if there may be a reduction in colon cancer rates among people who take statins.  They found no evidence that statins reduce the risk of colon cancer.

Statin Side Effects Appear To Be Ignored By Some Physicians

The journal Drug Safety surveyed 650 patients about their experience with statins.  Eighty-seven percent of patients reportedly spoke to their physician
about the possible connection between statin use and a symptom.
Physicians were  more
likely to deny than affirm the possibility of a connection. Rejection
of a possible connection was reported to occur even for symptoms with
strong literature support for a drug connection.  This report is concerning since it seems to suggest that physicians don’t take patient complaints as seriously as they should.

I asked Dr. Frank Smart what he thought about the side effects of statins and whether or not physicians should be more aware of them.

“The statin side effects exist
but in my opinion are overplayed. In my practice about 5% of people on statins
have some muscle issues. Most improve with dose reduction or change to a more
hydrophyllic compound.

Physicians should be better educated about side effects and the one who
should do the educating is pharma, and websites like Revolution Health.  Most docs are as
familiar with statin side effects as they are with other drug classes, so good
but not great. We would all love to raise the bar but it is tough as you

As many as 30% of patients reportedly experience a side effect from statins (including: headache, nausea,
vomiting, constipation, diarrhea, rash, weakness, and muscle pain) though severe muscle damage is very rare (for example, one article reported 24 cases in 252,460 patients.)  Overall, statins have many health benefits and are well tolerated by the majority of patients.This post originally appeared on Dr. Val’s blog at

Slow Down, Dr. Val

I was a bit tired today, thinking about how nice the long weekend will be.  A colleague wrote me an email reminder to slow down… he said, “go home and have a nice glass of wine and relax.”  I guess research supports drinking in moderation – it’s good for the heart, right?

But then, I noticed this poem in Paul Levy’s blog – and I realized that we docs could all use a little slowing down…

By Warner V. Slack, MD

Next to Children’s Hospital, in a hurry
Down the stairs, two at a time
Slowed down by a family, moving slowly
Blocking the stairway, I’m in a hurry
I stop, annoyed, I’m in a hurry
Seeing me, they move to the side
A woman says softly, “sorry” in Spanish
I look down in passing, there’s a little boy
Unsteady in gait, holding onto an arm
Head shaved, stitches in scalp
Patch over eye, thin and pale
He catches my eye and gives me a smile
My walk is slower for the rest of the day
This post originally appeared on Dr. Val’s blog at

Facing Our Own Mortality: Richard Dawkins and Alternative Medicine

On the recommendation of several members of the blogosphere, I’ve been watching a new British TV Series called “The Enemies of Reason” hosted by Richard Dawkins, a noted atheist and evolutionary biologist at Oxford.  The series offers a skeptical review of the claims of alternative medicine practitioners, strung together with Michael Moore-like skill, and designed to showcase the fringiest believers as they concoct wild, pseudoscientific explanations for the mechanism of action of their therapies.  It is entertaining and whimsical – though Dawkins himself appears dogmatic and cold as he ultimately builds a case for science as a religion.

Although I agree with Dawkins on many points, I think his approach is somewhat superficial and unnecessarily adversarial.  Instead of unmasking kookiness and labeling people as “enemies of reason,” I think it would be more interesting to ask: why are people seeking out pseudoscience?  What is the deeper need that scientific medicine is not satisfying?  Why are billions spent on alternative therapies?  (Please note that the “alternative therapies” that Dawkins evaluates include things like quantum homeopathy, magnetic healing, angelic guidance, and other treatments that don’t have evidence-based underpinnings.)

I think that at the very heart of the matter is that we humans want to feel in control.  For millennia we’ve been conjuring up bizarre theories in order to believe that we can influence our destinies and our health.  Just take for example the elaborate Egyptian religious myths (health was controlled by one’s ka which required regular food and drink offerings – not to mention all the elaborate embalming rituals to influence a good afterlife).  All of these rituals provided the Egyptians with a sense of control over their lives, deaths, and reincarnations.  I’m not entirely sure that we humans today are much different in our desire to control our lives.  We just manifest it in other ways.

Ironically, science feeds pseudoscience – the more we know, the more definitive we can be about a disease or its prognosis – and the greater the desire to buck against that.  And so as we advance in medical understanding, it is not surprising that there is renewed interest in magic as a means of influencing our clinical course as the inalterable progression becomes clearer and clearer.  Add to that the fact that the physician-patient relationship has been undermined by a series of unfortunate historical circumstances (the rise of health insurance middle men, decreasing reimbursements, administrative red tape, etc.) and you have a group of dissatisfied patients with chronic diseases that have predictable complications – all seeking alternative outcomes at the hands of any compassionate person who promises to give them some control back.  Of course, our “quick fix” culture also gives rise to a preference for simple solutions, rather than complex (though effective) ones.  Is there any wonder that snake oil has emerged as a major player in this climate?

Dawkins makes the convincing argument that certain alternative medicine practices rely entirely upon the placebo effect.  If this is the case, practitioners of these therapies cannot admit that their remedies are placebos – in so doing they would undermine their potential effects.  Therefore, one cannot expect a rational response from them when confronted with evidence that their strategies do not work or are implausible.  For the remedies to have a perceived effect, they only need to be believed in by the recipient.  The millions of dollars spent by the National Health Service and National Institutes of Health attempting to uncover the mechanism of action of implausible therapies (such as homeopathy) will not influence the millions of faithful believers who turn to such practices for their health.  I suppose that once the placebo effect has been scientifically proven, only the skeptics will be convinced by the data.

In the end however, Dawkins’ “war” is not between the evidence based medicine camp and the placebo based medicine group, it’s really an internal battle that each of us faces about our own mortality.  The process of coming to terms with health and disease is uniquely personal – some want to be (as Dawkins puts it) coddled, others want the cold hard facts.  As for me, all I want is for patients to be able to make informed decisions, not to be misled about therapeutic safety or efficacy, and not to be guided away from known effective treatments and towards known ineffective treatments.  I suspect that this is what most people want as well.

This post originally appeared on Dr. Val’s blog at

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