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As a fracture surgery specialist, Ulises Militano, M.D., is a welcome addition to Heekin Orthopedic Specialists’ team. Rahul V. Deshmukh, M.D. Gavan P. Duffy, M.D. Chris R. Goll, M.D. R. David Heekin, M.D., FACS Robert K. Hurford Jr., M.D. Ulises Militano, M.D. Kevin P. Murphy, M.D. Paul Shirley, M.D. Timothy L. Sternberg, DMD, M.D.
Fellowship trained at University of South Florida, Tampa in spend time doing auto and all fracture work including complex intrarticular fractures, foot motorcycle mechanics and and ankle fractures, pelvic and acetabular fractures, Dr. Militano restoration, any type of wood also performs post traumatic reconstruction including nonworking – from antique unions, mal-unions and post traumatic arthroplasties. restoration to guitar building, “I like the level of complexity and diversity in fracture work,” to just general tinkering. If explains Dr. Militano. “Although two fractures may be of the it’s hands-on work, I’m not same bone and same classiﬁcation, generally no two fractures afraid to tackle it.” Swimming are alike and need to be approached differently, based both on competitively for 14 years the repair of the injury and the individual needs of the patient.” helped instill in him disciDr. Militano has auto mechanic experience as well – he grew up learning car and motorcycle “...it’s important to remember that most repair and spent close to eight years as a merunners are out training on our local city chanic. He believes that such knowledge gives streets along with motor vehicles. Keeping him an edge with his patients. “Although paan eye out for trafﬁc, wearing appropriate tients are very different from inanimate objects, I approach fracture repair much like a mechanic reﬂective clothing, and stay away from and that experience allows me to take fracture busy, high trafﬁc roads will help keep a runcare to another level,” he explains. ner safe and hopefully never in need of my Dr. Militano comes from four years at Holmes services.” Regional Medical Center, a Level 2 trauma cen— Ulises Militano, M.D. ter in Melbourne, Florida. Before that he served as the Chief of Orthopaedic Trauma at Kings County Hospital Center, a Level 1 trauma center in Brookpline and a work ethic with lyn. While there he also performed the complex trauma attention to details. cases at Jacobi Medical Center, a Level 1 trauma Now that running and center in the Bronx. race season, particularly the Originally from Bronx, New York, Dr. MiliGate River Run, is here, Dr. tano received his undergraduate degree from Militano offers advice. “I have City College of New York. He earned his seen some severe traumatic medical doctor degree and from SUNY fractures in runners, from Downstate, in Brooklyn, where he basic falls, to the extreme also completed his orthopaedic situation where a runner residency. may be hit by a car,” says He and his family look forward Dr. Militano. “In addition to to getting settled in Jacksonproper training, conditioning, ville. He and his wife Olga, and stretching for an event a pediatric clinical pharmato prevent the soft tissue cist, have been married type injuries, it’s important to for almost seven years. remember that most runners They have two children: are out training on our local Dylan, age ﬁve, and city streets along with motor Madeleine, age two. vehicles. Keeping an eye out When he is not for trafﬁc, wearing appropriworking, he enjoys ate reﬂective clothing, and spending time with stay away from busy, high his family and trafﬁc roads will help keep working on a a runner safe and hopefully variety of handsnever in need of my servicon projects. “I es,” he says.
I love this time of year. The holidays are long gone and the New Year is in full swing. PUBLISHER A.J. Beson BUSINESS DEVELOPMENT DIRECTOR Michael E. Hicks EDITOR Vanessa Wells ART DIRECTOR Christine Tarantino OPERATIONS MANAGER Stacey Cotner MARKETING CONSULTANTS Stephanie Autry Shannon Mayo Lori Robinson MEDIA RELATIONS MANAGER Michelle Jacobs MEDIA RELATIONS SPECIALIST Katie Whiteman GRAPHIC DESIGNER Kyzandrha Zarate SENIOR WRITER Virginia J. Pillsbury CONTRIBUTING WRITERS Laura Capitano Kathy Hagood Cheryl Lock Jon Vredenburg Julie Watson PHOTOGRAPHER Hayes Photography
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The weather will be getting warmer soon and spring is right around the corner. Perhaps one of the reasons why I love this time of year is because race season really gears up. It seems like every weekend, there is a chance to participate in a unique and fun race. From the 26.2 with Donna to the Gate River Run to the Mud Run, there are plenty of opportunities to get out there and have a blast for a good cause. I love getting involved with the broader community. Whether it’s a race, serving on a board or attending an event, there are so many opportunities in Jacksonville to make a difference. It’s something I encourage my staff to do as well. Each of us is invested in serving the community in our own way. Throughout the year, as we celebrate the successes of our individual causes, we talk about them as a group and we get involved as a company. This month, I will participate in the 26.2 with Donna relay for the second year in a row. My team, Monica’s Macho Nacho Men, will once again race to help ﬁnish breast cancer. And on the heels of that race is the Gate River Run. The Gate River Run is more than a race. It’s an annual tradition that really illustrates the spirit of community in this city. It’s a blast running alongside so many people, many of whom live in Jacksonville. With several bands along
the route, tons of volunteers and plenty of people cheering you on, it a great event to be a part of. The 26.2 with Donna race is just as exhilarating as thousands of people rally for a common cause. As we gear up for race season, I hope to see you out there beating the pavement for a cause that inspires you. Until next month…
A.J. Beson email@example.com
BESON4 MEDIA’S GATE RIVER RUN GIVEAWAY Send story ideas to firstname.lastname@example.org or call 904-992-9945.
www.HealthSourceMag.com HealthSource is published by Beson4 Media Group, 13500 Sutton Park Drive South, Suite 105, Jacksonville, FL 32224, 904.992.9945. Content of the contributing advertisers do not reflect the opinions of Beson4 Media Group. Advertisers have proofed respective articles and content is assumed true and correct. HealthSource is not responsible for the care given by its advertisers. HealthSource is for informational purposes only and is not meant as medical advice. HealthSource believes that choosing a medical professional is a serious decision and should not be based solely on an advertisement. © 2011 HealthSource, Inc. All rights reserved. The contents of this publication including articles, may not be reproduced in any form without the written permission from the publisher.
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Beson4 Media is giving one lucky winner
A complete running package valued at over $350. Email email@example.com for a chance to win. *Apparel colors may vary based on availability. Winner will select appropriate shoe and apparel sizes at 1st Place Sports.
You can now follow HealthSource magazine on:
“Thank you for urging me to get screened for my own peace of mind... even though I was only 45. I remember the sheer relief on your face when you said that you had successfully removed a precancerous polyp and if I had waited any longer to get screened — you would have been telling me I had cancer — instead of a clean bill of health.”
The American Cancer Society recommends if you are 50 and older to get screened.
March is Colon Cancer Awareness Month, and the doctors at The Borland-Groover Clinic have teamed up to bring this nationwide effort of the American Cancer Society to the First Coast.
For a FREE informational packet on colon cancer or to schedule a screening colonoscopy call:
In the Jacksonville region 904.398.7205
Including: Fernandina Beach, St. Augustine, Macclenny In Port Orange (386) 788-1242 I In Ormond Beach (386) 677-0531 I In Delray Beach (561) 245-4550
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Welcome to HealthSource, the most informative health magazine in North Florida. Our mission is to help residents like you make knowledgeable health decisions. Inside you will find a number of practitioners located in your neighborhood. Overall, the purpose of HealthSource is to help you become more familiar with the caregivers in your area. Remember, this community service is for you, so tell us what you want to read. Please take a moment to communicate your thoughts; we want to hear from you.
HEART HEALTH Reduce risks and stay heart healthy
Your Heart Health pg 36 Since February is American Heart Month, we’ll discuss risk factors and ways you can stay heart healthy.
The 34th Annual Gate River Run
Minimize the Wear & Tear of Running
Runner Safety Tips
The Right to Bare Feet
Your Heart Health
The Contents of an Index
More than Shelter
PROFILES Runners In the 34th Annual Gate River Run pg 13 Participants in this year’s Gate River Run reveal why the race is so important to them.
Healthy Recipe pg 49 Chicken Pasta Primavera
6—H E A L T H S O U R C E
A round-up of healthy info, tidbits and happenings
If you are a runner in Jacksonville, then you have likely conquered the green monster
Smart steps to keep you on track
Stay safe on the road
What to know before you lose those shoes
Reduce risks and stay heart healthy
Carbohydrates, the glycemic index and you
Changing lives and building futures
If you suffer from migraines, facial or jaw pain, poor posture, or neck or upper spine pain, it may be time to see a dentist. Keith Blankenship, DDS
Most people don’t think of the dentist when they’re dealing with headaches or neck or back pain, but according to Keith Blankenship, DDS, a dentist who specializes in neuromuscular dentistry techniques, most of the upper body and head pain people experience is caused by a poor relationship between their jaw joints, the muscles in their neck, head and face, and their bite. “While dentistry focuses on the teeth and overall health of the mouth, neuromuscular dentistry also takes into consideration your nerves, muscles and the proper position of your jaw,” says Dr. Blankenship, who has two ofﬁces – one in Ponte Vedra and one in the Oakleaf Town Center. “Neuromuscular dentistry recognizes that your teeth, mouth, jaw joints, muscles and nerves all work together to properly align your jaw. If any of these elements are out of alignment, the result will be a misaligned or ‘bad bite,’ which often leads to pain.” Unfortunately, many people who suffer from migraines or facial or neck pain rely on pain medications to alleviate their symptoms simply because the real cause of the pain has not been determined yet and should be addressed. “When we treat patients, our goal is to put everything back in alignment in a relaxed physiologic balance– a relaxed position that helps keep the relationships between the nerves, muscles and joints in good form,” explains Dr. Blankenship.
David League is one of Dr. Blankenship’s patients who suffered with migraines for over 15 years. He says that his headaches were at times debilitating, requiring an ER visit three to four times per year. “I saw several physicians over the years, including a family practitioner, neurologist and a headache specialist, all to no avail,” says League. Fortunately, League learned of Dr. Blankenship and his experience with neuromuscular dentistry. After consulting with the doctor and conﬁrming that he did indeed have a bite problem, League underwent the treatment. “Since completing the neuromuscular dentistry treatment, I have not had a single migraine, and I have had no need to take pain medication,” says League. “I can conﬁdently say that this procedure actually cured my migraines.” League’s results are common. “The good news is that this type of treatment
works on just about everyone,” says Dr. Blankenship. In addition to neuromuscular dentistry, Dr. Blankenship also offers comprehensive dentistry covering all aspects, including cosmetic, general, and implant dentistry. He has received extensive training from many of the “elite” educators of today, such as the Las Vegas Institute (LVI) for Neuromuscular and Cosmetic Dentistry, Nash Institute of Cosmetic Dentistry, The Pankey Institute, and the prestigious Misch International Implant Institute. He has also earned fellowships from the LVI and International Congress of Oral Implantologists. Dr. Blankenship is a dentist who is completely focused on giving his patients the best results. As League says, “Dr. Blankenship is an incredible dentist who cares deeply about his patients and their outcomes. In my opinion, he’s the best there is.”
“Since completing the neuromuscular dentistry treatment, I have not had a single migraine, and I have had no need to take pain medication.” David League
— David League
The bad thing about dental phobia is that is prevents people from seeking the care they need—when they need it. The good thing is, today, we can treat fear as successfully as we treat tooth decay or crooked teeth. Over six million people experience some degree of anxiety when they visit the dentist. Two million dental patients are just plain scared, so scared they suffer shaking, confusion, heart palpitations and changes in speech and blood pressure just thinking about dental treatment. Thanks to many dedicated researchers, we’ve learned a lot about what causes fear. And we have the antidotes. Finally, a visit to the dentist is just not the same as it used to be. Our practice is pleased to offer Relaxation Dentistry, which is, just that: While you are slightly sedated we perform difﬁcult or extensive procedures in a few hours. For fear patients, or those on the run, Relaxation Dentistry affords the care you need in a single session. After an initial consultation where the entire process is explained in detail, we’ll schedule you for medication
“I am so grateful that I can smile now. I have more conﬁdence and I feel so much better about my outward appearance. My smile is contagious because now when I smile, others smile back.”
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before your visit. It’s good to come with a friend to help you get there safely and not concern yourself with transportation. At your appointment, you’ll be drowsy, but thoroughly responsive. Our Relaxation Dentistry team monitors your every move throughout the procedure. Another big plus: Most patients don’t feel a thing, and we can work uninterrupted. Best of all, with your dentistry done, your appointment will be over and you will feel relaxed and comfortable when you return home. Please contact our ofﬁce if Relaxation Dentistry interests you, or would work for a loved one who’s put off dentistry far too long. We’ll be happy to sit down and talk.
“It was a life-changing experience completely worth every penny.”
“When I ﬁrst came to see Dr. Tannen I had major dental problems and even worse dental phobia. Thanks to Dr. Tannen and her wonderful staff. I no longer fear going to the dentist. But most importantly I have a fantastic smile.”
Millie Tannen, DDS, MAGD Master, Academy of General Dentistry
Dr. Millie Tannen received her Doctor of Dental Surgery degree from Virginia Commonwealth University Medical College of Virginia and has been serving the Jacksonville community since 1982. In 2008, she received the Mastership award from the Academy of General Dentistry, an honor which is only earned by about 1% of U.S. dentists. In her pursuit of excellence, she has studied at the Las Vegas Institute for Advanced Dental Studies and the Misch International Implant Institute. She is also a Fellow of the International Congress of Oral Implantologists and a member of the American Academy of Cosmetic Dentistry.
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1. Main Street Bridge and Acosta Bridge loop including the North Bank Riverwalk (approximately 5 miles) Forsyt h St.
Bay St .
e. Av ide ers Riv Start/Finish
St. Johns River
Duval Co Courtho unty use
Gulf Life Dr.
2. Beauclerc Road, Scott Mill Road and Forest Circle route (10 miles) Start/Finish
St. Johns River
d. Sunbeam Rd.
Au Old St.
9. Pick out a runner up front and catch up to him/her within 10 seconds. 10. Come alongside someone, and ask, “How are you doing?” Chatter helps. 11. Treat parts of the race as intervals. Run hard for 3 minutes, recover 1 minute. 12. Concentrate all the time while running. 13. Treat bridges as a Monday night drill. 14. At the top of the Hart Bridge, take off and pass people. Use that last burst of speed – you can hear and see the ﬁnish line. 15. Smile at the ﬁnish line – you know you did your best.
ge Brid sta Aco
No alcohol the night before. Don’t overdress – it’s not a fashion show. No new shoes! Get to the race start in time to talk to people, enjoy the crowd and relax. Don’t run according to a friend. When the gun goes off, you have no friends. They are competitors. Cut tangents – look up 20 yards or so, easing to the appropriate side. Drink plenty of ﬂuids, especially during the early part of the race. Thank volunteers and police ofﬁcers.
Main St. Bridge
1. 2. 3. 4.
Bob Carr is a member of the River Run Hall of Fame. He has participated in 33 Gate River Runs and more than 20 Boston Marathons. Here’s his insight on running a successful race.
BOB CARR’S RUNNING TIPS:
When asked what the top 5 runs in Jacksonville were, Doug Alred, Owner of 1st Place Sports had this to say, the ﬁve best routes are as follows:
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R E G U L A R FE AT U R E
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ing to bed and then back to normal after waking. Those pesky lights from all of our modern technology can influence our sleep more than we realize. An inexpensive sleep mask can work wonders.
Flo rida Blv Neptune d. Beach
8th N. Ave.
Beach Blvd. Jacksonville Beach
5. Riverside Ave and St. Johns Avenue (approximately 8 miles) Start/Finish
10 Post St. d. Blv elt ev os Ro Avondale
ve. ide A Rivers
Fuller Warren Bridge San Marco
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Lifestyle considerations: Nutrition can impact our rest in several ways. Not only do we want to avoid eating too close to bedtime, we should limit our caffeine and control our dinner portions. Also, including quality protein in your dinner can help keep you full, preventing nighttime snacking.
4. Jacksonville Beach, Neptune Beach and Atlantic Beach on the sand at low tide (approximately 10 miles) May port
Health Designs provides questions and answers for Ask a Health Coach.
Environmental elements: Sleeping in cool, dark and quiet conditions are best for great slumber. Consider adjusting the thermostat up or down about a half hour before go-
Relaxing rituals and routines: Start to relax at least one hour before bedtime. Reading a good book, writing in a journal, a warm bath or shower or even chatting with your family are much better choices at that time than exercising, eating or worse, work! Avoid emails and work-related functions that require thinking or planning and possibly lead to being anxious.
d Blv ntic Atla Start/Finish
er O Riv
Dear Sleepy Susan, Thank you for bringing up an often overlooked area of wellness. While so many of us focus on weight, exercise and nutrition, we tend to forget the relationship sleep has with all of these and other areas of our health. While different ages have different sleep needs, adults should aim for 7-8 hours of quality sleep per night. Consider the following for greater success with your sleep. When trying to get a good night’s rest, it’s important to establish and stick to routines and consider environmental and lifestyle factors. Here a few tips to help you catch some z’s.
St. Johns River
er R Riv
— Sleepy Susan
For more info on this topic or to submit a question for the health coach, visit www.healthsourcemag.com/blog.
San Marco Blvd.
Dear Health Coach, With the holidays over and life in full swing again, my stress seems greater and has really inﬂuenced how well I sleep. I ﬁnd myself some nights lying in bed for 30 or more minutes before falling asleep and other times not staying asleep through the night. How can I get better sleep?
St .J oh n
3. San Marco portion of the Gate River Run course River Road, River Oaks (approximately 4 miles)
St. Johns River
Wearing sunscreen, eating well and exercising, and not smoking will give you a head start in preventing cancer. Also, talk to your doctor about cancer screenings. The earlier we diagnose cancer the easier it is to treat and the better chance for a cure.
www.ďŹ rstcoastoncology.com 10881 San Jose Boulevard I Jacksonville, FL 32223
Last year more than 19,000 runners and walkers participated in one of the most fun and dynamic events Jacksonville has to offer. This year proves to be more of the same at the 34th Annual Gate River Run.
t By Virginia J. Pillsbury
his event is the largest 15K in the U.S. and is once again the USA 15K Championship with the nation’s top Olympic athletes competing for $80,000 in prize money. Runners begin at EverBank Field, wind their way through downtown Jacksonville, across the Main Street Bridge, through historic San Marco and St. Nicolas, over the Hart Bridge (affectionately known as the Green Monster) and then finish back at EverBank Field. It’s a festive event with live bands at 10 locations, a water station at every mile and medical stations along the way. The following Gate River Run profiles are unique and versatile runners who have marked March 12 on their calendars for several different reasons. Read their stories and share their journey. You may even be inspired to join them on race day.
W W W .H E A L T H S O U R C E M A G . C O M —13
Nick Rogers When Nick Rogers, 31, went for a run last summer after work, he never expected that it would lead to knee surgery. “I was less than a quarter of a mile down the road when I felt something funny in my knee,” remembers Rogers. “I waited for it to go away after a few weeks and it never did; I couldn’t do any activity.” A former Bolles athlete, and star centerfielder for the Florida State University baseball team, Rogers also played professional baseball for the Oakland A’s for four years and has always been involved in sports. “I started playing t-ball when I was four or five,” he remembers. “Baseball was always my favorite; I enjoyed practicing, playing and being part of the team.” When he received his first recruiting letter from Florida State University during his sophomore year of high school, he knew that baseball was a big part of his future. For someone whose life has revolved around sports, his injured knee worried him. “My first thought was ‘I’m getting older and I can’t just do what I want any more.’ I was also scared about the possibility of facing life-long knee problems.” He also says that he waited about two months before seeing a doctor and urges others not to do that. “I was out the entire summer because I waited,” he says. “I really wish that I had gone ahead and seen the doctor right away.” After many suggestions from friends and family, Rogers made an appointment with Heekin Orthopedic Specialists. Once meeting with the doctors, they came to realize that the diagnosis was torn cartilage. There his physician, Dr. Kevin P. Murphy, who specializes in sports medicine, reassured Rogers about his concerns over having arthroscopic surgery. “I really loved everything about Heekin
Orthopedic Specialists,” says Rogers. “Even though this was my first major surgery, Dr. Murphy made it sound easy to handle, and he even joked about the surgery taking 22 minutes and 30 seconds to do,” says Rogers. “This is a fairly routine surgery and common to life-long athletes,” says Dr. Murphy. “Nick did the right thing by having his knee taken care of and by doing the necessary rehab,” he adds. “Dr. Murphy told me that if I wanted to get back into sports then I had to get it done. He also assured me that I’d be back on my feet and good to go in a few short weeks,” he remembers. The surgery went well and Rogers spent eight weeks doing rehabilitation therapy. “I feel back to normal now and am just starting to train,” he says. “I am taking it slow with the running and working my way into the pounding on the pavement,” says Rogers who also plays golf, volleyball and football. “I am also taking my time to stretch and warm up and do the things that we have been told to do when we work out or exercise.” He plans to run in the Gate River Run which will be his first race since his surgery. “I’ve done the Gate River Run about four times. It’s fun because there are so many people who run it and that excitement carries you throughout the race,” he says. His wife Taylor runs with him. “We’re not avid runners but we have fun with it,” says Rogers, who enjoys the time they spend running together.
“I was out the entire summer because I waited,” he says. “I really wish that I had gone ahead and seen the doctor right away.” — Nick Rogers
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the 34th annual
} GATE RIVER RUN
Jacksonville Symphony Concertmaster Philip Pan at the ﬁrst annual Jacksonville Symphony River Classic Run.
Viola, Jacksonville Symphony Orchestra Susan Pardue started playing the viola and running when she was in high school; she enjoys and excels at both.
Philip Pan Principal First Violin, Jacksonville Symphony Orchestra Jacksonville Symphony Orchestra concertmaster Philip Pan started running in March of 2010 thanks to last April’s inaugural Jacksonville Symphony River Classic run, sponsored by Beaches Residents Actively Supporting the Symphony. “I decided to start running for that race. At first I could do nothing – I was panting after a block, but little by little I kept building up my endurance. At first I found it difficult and exhausting, but I enjoy running now,” says Pan who is training for his first Gate River Run. He tries to run about three times a week and his training course is also the course of the Jacksonville Symphony River Classic which he plans to participate in again. “I enjoy the second wind phenomenon when you start feeling refreshed and get a rhythm going. I am competitive with myself and enjoy improving my times. I like knowing that I have the ability to run a long distance,” he says. The book, “Born to Run” has been a great influence too. “It gives every runner the confidence to run because our bodies are made for it,” he says. “Running increases my overall
feeling of well-being,” says Pan who has been with the Jacksonville Symphony Orchestra since 1984. “I love what I do and am very proud to be a part of the symphony. It has grown enormously in size, budget and quality, and I love the challenges and variety of music,” he says. Pan enjoys being in touch with his environment so he doesn’t listen to music while he runs. He also runs barefoot. “I started by wearing the Vibram Five Fingers shoes and ran the symphony race in those. After that, I tried my old Nikes again and found them to be really heavy and slow. That’s when I decided to run barefoot,” he remembers. “I love to go barefoot as often as possible anyway, and when my wife and I go hiking, I am barefoot.” While he plans to run the Gate River Run without shoes, he’ll carry a pair just in case.
“I knew people who had back and shoulder injuries from playing the viola and I thought running would help build strength and stamina,” says Pardue, whose high school diploma and bachelor of music are from the North Carolina School of the Arts. Her master of music is from The Julliard School of Music. “I think that running helps me in everything that I do – it helps me to relax and I come up with good ideas when I run,” Pardue says. She tries to run every other day, and since she is in training for the 26.2 with Donna and the Gate River Run, she also does a long 20 mile run each week. She doesn’t listen to music while running. “I think about music when I run and use it as a transition between having a rehearsal and playing in the concert.” A viola player with the JSO since the 1991-1992 season, Pardue loves being in an orchestra with musicians who excel in their job. “The violas sit in the middle of the orchestra and we
are surrounded by music making on all sides,” she says. “That is a wonderful spot to be.” She started running the Gate River Run in 1999 and has run each year except last when an injury kept her out. “It is the only chance that I have to run with Olympic level runners because it is the national championship 15K,” says Pardue. “It’s both fun and frustrating because it is so huge and crowded but that is also part of its charm.” She will also participate in the Jacksonville Symphony Orchestra River Classic run in April. “It is a fun four-mile run and there are musicians playing all along the course.”
“It’s both fun and frustrating because it is so huge and crowded but that is also part of its charm.” — Susan Pardue
Susan Pardue, with another avidrunning Symphony musician John Wieland, principal bassist.
W W W .H E A L T H S O U R C E M A G . C O M —15
Kellie Howard A “social runner” since high school, Kellie Howard, president of the Florida Striders used to enjoy running alone. “When I moved to Jacksonville I started running with groups and now that is all that I do,” she explains.
Timothy L. Sternberg, DMD, M.D. While he has been a runner for years, Timothy L. Sternberg, DMD, M.D., doesn’t consider himself a running enthusiast. “I run to stay in shape and I always feel better after the run than I do during the run,” he says. “It’s a straightforward exercise – it can start and end at your front door and you can do it at any time.” Nor does he make a big deal about training for races. “If you are in condition then you just go out and do it.” He works out at the gym daily, runs on the weekends and uses his bicycle as his main mode of transportation. “I do what I do every day and then when it comes time I run the race.” He runs in the Marine Corps half marathon, the Outback Classic half marathon and the Gate River Run. Originally a Jacksonville native, Dr. Sternberg returned to Jacksonville and started participating in the Gate River Run in 2003. “It’s a great way to have fun in the community and you get energy from running in the crowd. I don’t think I’d be motivated to run that distance otherwise,” he says.
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On weekends Dr. Sternberg enjoys doing his long run alone. “I’ll run by the river for an hour or so and that is always therapeutic.” His wife also runs, but they don’t run together. “The beauty of running and biking is that you can do it by yourself,” he says. As a pain management specialist with Heekin Orthopedic Specialists, Dr. Sternberg recommends a regular exercise routine. “Use your body the way it is supposed to be used,” he explains. “Regular exercise is a key to taking care of pain.” He also reminds runners to stretch before and after running. “Stretching both times is equally important.”
“There are so many different groups that I can run any day of the week with one. Running in a group gets me motivated because I don’t want to be the wimp of the group. And you are not alone in being crazy and going out and running in the cold weather,” she explains. “Running makes you strong and tough and you feel like you have accomplished something for the day,” she adds. The Florida Striders currently boasts about 680 members and they sponsor four runs each year. “At the Gate River Run we have a pre and post race get together and we have space blocked off at the fairground,” says Howard. “It’s a gathering place for our runners where we have tents, extra restroom facilities and food,” she says. For more information, go to www.floridastriders.com. For Howard the Gate River Run is more of a holiday than a qualifying run. “There is so much going on with parties and events the week of the run that on
race day I just have fun and enjoy myself,” she says. “I find a race within the next month to run fast and qualify for a seeded number,” she says. “I love my running friends and I love that all you need is a good pair of shoes,” says Howard. “You can have a flexible running schedule and it’s a great way to stay in shape.” Howard serves as director of medical staff services at Shands Jacksonville. “We have a running club at Shands and we are the official medical provider for the Gate River Run,” says Howard. For new runners, Howard suggests a good pair of running shoes. “Enjoy your run, it’s not supposed to hurt,” she says.
“Running makes you strong and tough and you feel like you have accomplished something for the day.” — Kellie Howard
the 34th annual
} GATE RIVER RUN
Steve Lucie, M.D., and Sharon Lucie When Sharon Lucie runs a race, her self-made inspiration bracelets help her to move on down the road. “I know people who have overcome a lot in their lives and I’ve made bracelets with their names on them,” explains Sharon. “I assign each person on my bracelet a mile and during that mile I will think about them and what they have overcome – it inspires me to keep going,” she says. Dr. Steve Lucie, an orthopedic surgeon with Jacksonville Orthopaedic Institute, runs mostly because his wife runs. They are training for their tenth marathon which they will run in April in London. “Sharon is the real runner,” explains Dr. Lucie. “She realized in about 2000 that she was a pretty good runner and she got me involved at that time.” The Jaguars head athletic trainer also worked with Dr. Lucie with exercise, nutrition and running. The Lucies ran their first marathon in San Diego in 2001. “Her bucket list is ten marathons,” he says, and boasts of his wife, “She has won ‘Most Outstanding Senior Runner’ award in Jacksonville in her age group and I only beat her when she is hurt or hasn’t trained.” Sharon first started running back in the 1970s when the running craze started. “I wanted to do a marathon by the time I was fifty,” she remembers. “Then I turned fifty and had added some extra weight along the way – it was put up or shut up,” says Sharon who started running to shed weight. After running several Gate River Runs, she wanted to do a marathon; she ran the Jacksonville Bank Marathon to qualify for Boston and qualified. They’ve completed two San Diego Rock ‘n Roll marathon, two New York Marathons, two Boston Marathons, two Disney Marathons, and Sharon has run the Jacksonville Bank Marathon with her best time ever. Dr. Lucie ran the Flying Pig Marathon in Cincinnati, and last summer Sharon and her husband ran Grandma’s Marathon in Duluth, Minnesota. “I think that running or any form of exercise keeps you healthier, gives you more energy and keeps you physically fit,” says Dr. Lucie. “My job is physically demanding so the better shape I am in,
the better I feel.” His workout schedule includes running and cycling several times a week. “As you get older you have to take it a little easier, take days off and not run every single day,” says Dr. Lucie. “Listen to your body – it is never harmful to take a break.” Before any of the local race events, including the Gate River Run, Dr. Lucie sees patients who have injured themselves. This always brings the question about whether running is bad for the knees. “Running isn’t bad but running on bad knees is bad,” says Dr. Lucie. “That is where running might not be the best exercise – swimming or cycling might be better. If you start running and have pain, then listen to your body,” says Dr. Lucie who says he sees more overweight people with bad knees than runners. Sharon has torn her meniscus and had surgery. “I still had two marathons lurking in my brain after my surgery,” she says of her quest to do ten. “I’m almost sixty and wanted to have ten marathons by sixty even if we have to walk them.” She loves the friendly competition she and her husband have with running. “While I might run faster than he does, he is the inspiring force for me,” she explains. “He makes me get out there and run and I make him faster.” Time alone is one of the many things Sharon loves about running. “No one can get to you. When I run I come back with a lot of ideas and issues settled. It’s my passion. I’m not very coordinated so it is one of the few things that I can do well,” she says. She cautions others to take it slow when training. “If you are in training, don’t be a weekend warrior. Build up or you will get hurt. At the first sign of pain, rest, and if it doesn’t get better, get help or it will get worse and shut you down.” HS
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Ivis Alvarez, D.M.D., P.A. 7807 Baymeadows Rd. East Suite 305 Jacksonville, FL 32256
904.641.7455 Office Hours: Monday - Thursday 8:00 a.m. to 5:00 p.m.
“It’s a jungle out there” is more than just a saying at Safari of Smiles. It’s a jungle inside, too – the kind that kids love to visit. By design, the office of pediatric dentist Ivis Alvarez is family-friendly. That extends beyond the safari-themed décor to the welcoming, accessible Dr. Alvarez and her staff.
The setting at Dr. Ivis Alvarez’s Pediatric Dental Practice is specially designed to make a child’s trip to the dentist more like a trip to a theme park. The Safari of Smiles theme includes three-dimensional animals on the walls, live parrots, jungle sounds and colorful murals.
Also New since the office opened in its new Baymeadows location are technology advances including fully digital radiographs and Web site enhancements, says Dr. Alvarez. “We now offer patients the option of receiving appointment reminders by email. We also save them time by providing online patient questionnaires and update forms they can complete before their child’s visit. The best thing about those tools is that it gives parents more one-on-one time with me and the office manager when they arrive at the office, because they don’t have to sit and fill out paperwork.” One-on-one attention is a luxury in many health care environments, yet it is the main focus of Dr. Alvarez and her staff. “We are set up to provide the highest quality of individual care and communication that is not possible in some practices,” she notes. “We take time to play with the children, so they are comfortable with us before we bring them into the treatment rooms. We use gentle, carefully-chosen behavior management techniques to address children’s fears and encourage them to be good patients. That puts parents at ease as well.” Parents also appreciate the way Dr. Alvarez continually seeks out new and better dental products and procedures that can successfully be used on young patients’ teeth. “Updating
our skills and product knowledge is an important part of our commitment to our patients,” she says. “In addition to frequently attending continuing education courses about the latest techniques, we work with the best and most suitable products and materials. For example, we are now offering parents the option of using tooth-colored crowns for posterior teeth. In the past, those crowns had to be silver. This product offers results that are both predictable and aesthetic.” “The Academy of Pediatric Dentistry recommends that parents schedule their child’s first visit to a dentist between six months and one year, thus establishing a dental home early on for the child.” says Dr. Alvarez. When we see children that young, we can teach good oral hygiene and dietary habits that can prevent tooth decay. Those early visits can establish a child’s attitudes about their dentist for life. So we work to make the situation warm, friendly and fun. A positive experience at a young age makes patients less fearful, and can have lasting benefits for their oral health.” To learn more about the family-friendly environment and quality of care at Dr. Ivis Alvarez’s Pediatric Dental Practice, visit www. safariofsmiles.com. The site also offers a schedule of free playtime events to familiarize young children with the office setting and staff.
20â€”H E A L T H S O U R C E
H E A LT H Y B O D Y
Running on a consistent basis improves one’s cardiovascular and bone health as well as coordination and mood. It also conditions joints, helping keep them healthy. That may come as a surprise to those who believe running goes hand in hand with joint problems.
Smart steps to keep you on track
By Kathy Hagood
“Cartilage is designed to protect our joints. While the outer layers are smooth and promote gliding, the inner layers are filled with fluid. When a load is put on the bones, it squeezes the fluid out lubricating the joints and keeping them limber,” said Kevin Kaplan, M.D., an orthopedic surgeon with Jacksonville Orthopaedic Institute. So why does running get a bad rap when it comes to joint wear and tear? It’s a high-impact exercise that when approached improperly can easily damage cartilage, ligaments and tendons. Such injuries often lead to joint problems, including bursitis and arthritis. Common running injuries and conditions include miniscus and anterior cruciate ligament (ACL) tears, runner’s knee, plantar fasciitis, tendonitis and even stress fractures. “Running obviously is a great form of aerobic exercise, but it does put stress on the joints, bones, etcetera, making them more vulnerable to damage. The thing we can do is mitigate the stress of running, lessening the chance of injury,” said Ross Osborn, M.D., of the Center for Health and Sports Medicine. Dr. Osborn is board certified both in family practice and primary care sports medicine. Smart Shoes It’s critical to wear proper footwear while running, Dr. Osborn and other physicians agree. Getting a professional fitting for running shoes at a store specializing in running is recommended. Ask for a salesperson who’s experienced in fitting running shoes. Those with flat feet and/or who pronate or supinate when running should take care to purchase running shoes, and in some cases insoles, that best address those conditions. Otherwise cumulative micro-injuries could lead to joint dam-
age and pain over time. Pronation and supination can be determined through a foot-strike and running gait analysis. Such analyses may be provided by sports medicine clinics, podiatrists and, in some cases, running shops. “Running shoes are designed to cushion and stabilize your foot while you’re pounding the pavement. The shoe that’s best for someone else might not be best for you,” said Michael Patney, D.O., an orthopedic surgeon with First “Running obviously is a Coast Orthopedics. great form of aerobic exerTo avoid cumulative cise, but it does put stress on damage it’s also important not to run in shoes with the joints, bones, etcetera, soles that have lost their making them more vulnerresilience. Although the shoe’s upper part may able to damage. The thing be in great condition, we can do is mitigate the the shoe may actually be stress of running, lessening worn out when it comes to its ability to support and the chance of injury.” cushion the foot. A good — Ross Osborn, M.D. rule of thumb is to replace running shoes every six months. That’s based on running about 500 miles, or three to five miles five days a week for six months. “Of course if you run 13 or 14 miles a day you’re going to have to replace your shoes more frequently,” Dr. Patney said. Typically you’ll wear a larger size in a running shoe – a half to a full size larger - to allow for your feet to expand as you run. Wearing running shoes that are too short can lead to the development of bunions. The midsole area should feel com-
W W W .H E A L T H S O U R C E M A G . C O M —21
Kevin Kaplan, M.D.
Ross Osborn, M.D.
Michael Patney, D.O.
Rahul Deshmukh, M.D.
fortable (try loosening the laces if it’s too tight and tightening if too loose), and there should be little or no slipping at the heel. Runners who exercise on a daily basis will want to buy two pairs of shoes to let the shoes dry out between each use. Stretching Tips Warming up before running and then cooling down and stretching afterwards is also essential to help avoid injuries, said Rahul Deshmukh, M.D., an orthopedic surgeon with Heekin Orthopedic Specialists.
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If you also stretch before you run, don’t do it with cold muscles, or you could damage the tendons and ligaments you’re trying to protect. Warm up first. Suggested stretches for runners include hip flexor, quad, hamstring, Achilles tendon and foot stretches. To avoid injury, don’t bounce when stretching, but gently extend and hold the stretch. Those who suffer knee problems will want to avoid deep lunges and other stretches that put excess strain on the knees. “Ease into your run so you don’t strain or tear your muscles, tendons and ligaments,” Dr. Deshmukh said. “And then because your muscles tighten up as you run, you want to gently stretch them out afterwards. Many runners skip this step, and it often causes them problems over time.” Avoid Injury and Reduce Stress The type of surfaces you run on can contribute to the potential for injury. Semisoft surfaces like grass or dirt are better than macadam pavement or concrete sidewalks. Even if you can’t always run on semisoft surfaces, opt for them when possible. Mushy surfaces like soft sand and uneven surfaces can lead to twisted ankles and other injuries and should be avoided. “Even running on hard-packed sand can be a problem because of the incline of the beach,” Dr. Deshmukh said.
The steep inclines of bridges also put stress on the knees and should be avoided by those who have knee problems. Setting the incline too steep on the treadmill at the gym can also cause knee damage. Another way to lessen the stress of running on joints and bones is to not drive yourself too hard and overdo it, Dr. Osborn said. Those who are just starting a running program, for example, should (assuming they have a health clearance from their physician) start by alternating walking and running a relatively short distance. The newbie can then gradually build up running time, distance and intensity. “Don’t try adding an hour to your run in one day, add 15 minutes instead,” Dr. Patney said. “If you rush building up your endurance, you can easily injure yourself, especially the older you get because tendons and ligaments become less resilient.” Experienced runners who want to build their endurance also should take an incremental approach, increasing their workout by no more than 10 percent per day. For example, transitioning from periodically running in 5K races to taking on a marathon best isn’t hurried. Runners should begin training in enough time in advance to safely increase their endurance levels. Long distance running increases the chances for a stress fracture, especially
when the runner is greatly increasing his or her distance over several weeks or months. The extra distance combined with a biomechanical flaw or calcium shortage may lead to tiny cracks in a bone such as the metatarsal, tibia, femur or sacrum. Symptoms include muscle stiffness, soreness and pinpointed pain in the affected area of the bone. See a specialist if you suspect you may have a stress fracture. “A stress fracture will just get worse unless it’s addressed,” Dr. Osborn said. Cross training can help runners avoid injury because cross training helps build up leg and other muscles not commonly used while running. Swimming, bicycling or using a stair stepper or elliptical training machine are all good complements to running. Strength training is also recommended. “Strength training builds the muscles around your joints so that the cartilage and ligaments don’t have to do as much work,” Dr. Patney said. “My patients with joint pain are always surprised when physical therapy (including strength training) reduces their pain, which they could have avoided in the first place with strength training.” Cross training is often recommended for arthritis sufferers who run to give their joints a rest between running bouts. “I don’t ever want to tell someone who wants to run not to run, if at all possible,” Dr. Osborn said. Even with proper precautions running may periodically lead to twinges, aches and pains. Self-help remedies such as icing the affected area, elevating and resting it can help ease discomfort as can the use of over-the-counter anti-inflammatory medicines. “Forget what you’ve been told about pushing yourself through the pain. Pain is always a signal. Reduce the intensity of your workout, and see if the pain abates. If not, rest and try self-help remedies,” Dr. Kaplan said. Not listening and responding to the body’s signals increases the likelihood of injuries that will require medical treatment. When pain is severe or chronic, the runner should visit an orthopedic or sports medicine specialist. Physical therapy and other treatments may be needed. “It’s best to address the problem early on when conservative treatments can remedy it,” Dr. Deshmukh said. “We try to help the patient avoid surgery if at all possible, but in some cases it is necessary. Fortunately we often are able to use arthroscopy, which is minimally invasive.” HS
W W W .H E A L T H S O U R C E M A G . C O M —23
HELPING YOU WIN
H E A LT H Y A D V I C E
RUNNER SAFETY TIPS HealthSource talked with experts at Brooks Center for Sports Therapy to discover tips on runner safety. These experts walk the walk and talk the talk. Not only do they consult runners on a daily basis, they all run and compete in triathlons. Rob Coltman, PT, MPT, OCS, MTC; Mark Baughman, PT, MPT, OCS, ATC; Dennis Conlon, PT, MPT; and David Segars, PT, MPT; and Libby Bergman, PT, DPT, provide insight into runner safety. Injury Prevention: “Be careful with increasing training volume/ mileage too fast,” says Center Manager Rob Coltman, PT, MPT, OCS, MTC. “Do not increase the variables of volume and intensity at the same time.” Dennis Conlon, PT, MPT, also recommends, “Be careful who you listen to. For example, it is always advisable to consult with a physical therapist if you are having a painful condition related to your running program. A licensed physical therapist will be able to fully assess your condition and make proper recommendations.” Other tips that will help avoid injury include: s Stick with the rule of not increasing mileage any more than 10%. s Listen to your body. If you feel overly fatigued, or have pain that is more than typical muscle soreness, this is probably a sign that you need an easy day or day off. s Have your running gait evaluated by a physical therapist that uses video running gait analysis to see if you have any impairments or deficits in strength, flexibility, neuromuscular control or running form that could lead to an injury. s Have your footwear evaluated by your PT or at a reputable running store.
Protecting Your Knees: “Pick the right parents,” jokes Mark Baughman, PT, MPT, OCS, ATC. While good genetics play a role, Baughman says you can maximize what your parents gave you by incorporating low impact crossing training. Other ways you can protect your knees: s Don’t over train s Maintain a good running form s Listen to your body s Wear proper footwear s Perform strength and functional training for the entire lower kinetic chain s Improve flexibility and balance s Strengthen core, hips and ankles s Seek early intervention at the onset of symptoms
Most Common Injuries: “Every runner is different and even every injury is different within each individual,” says Libby Bergman, PT, DPT, of Brooks Ponte Vedra. “The key to successful
treatment and rehabilitation is finding the cause of the injury.” Common injuries include: s Plantar fasciitis s “Shin Splints” or MTSS - medial tibial stress syndrome s ITB friction syndrome s Achilles or patellar tendonopathy s Patellofemoral pain s Trochanteric (hip) Bursitis
Injuries That Sideline Runners For Good: “There are very few injuries which would permanently sideline a runner,” says Bergman. “For the most part with patience and modification of a training program, a runner can continue to enjoy a healthy program throughout the lifespan. The key is patience and the ability to adapt running mileage by supplementing aqua jogging or cross training in a runner who may have a chronic degenerative condition such as osteoarthritis.” Two of the injuries that can sideline a runner are discussed below. s “A traumatic injury like a motor vehicle accident can sideline a runner for good,” says David Segars, PT, MPT. “Watch out for cars and be aware of your surroundings.” s “It’s not recommended that someone with a joint replacement at the hip or knee return to running due to the wear and tear on the prosthesis,” says Conlon, “But non-impactful activities such as cycling or swimming can usually still be performed.”
Physical Safety: “Always carry identification like a driver’s license or a road ID,” says Coltman “A road ID is an identification tag that includes ID, medical info and an emergency contact.” s Remain aware of your surroundings even if you listen to music. Keep the volume low enough to hear what’s happening around you. s When running at dawn or dusk, wear reflective material. s Wear a headlamp when running on uneven surfaces in dark conditions. HS February 2011
W W W .H E A L T H S O U R C E M A G . C O M —25
If you are training for Jacksonville’s 34th annual Gate River Run, it is important to be aware of painful injuries that could have you sidelined.
Rahul V. Deshmukh, M.D. Gavan P. Duffy, M.D.
Two fellowship-trained, sport medicine experts provide critical information to help you prevent ﬁve of the most common running injuries.
Chris R. Goll, M.D. R. David Heekin, M.D., FACS Robert K. Hurford Jr., M.D. Ulises Militano, M.D. Kevin P. Murphy, M.D. Paul Shirley, M.D. Timothy L. Sternberg, DMD, M.D.
MUSCLE PULL A muscle “pull” is actually a series of small muscle tears that strike runners in the hamstrings or quads. Rahul Deshmukh, M.D., of Heekin Orthopedic Specialists recommends stretching before and after a run. As muscles build strength, they become stiffer and tighter. As a runner increases his distance, he should proportionally increase his stretching. Stretch the hamstrings by placing one leg on a chair and bending with the extended knee straight. Hold for 15 to 20 seconds and repeat. “Flexibility and not overexerting oneself is the best prevention,” advises Dr. Deshmukh. SHIN SPLINTS “Shin splints” refer to pain that can develop along the shinbone and the front of the lower leg. The pain is caused by stress on the shinbone and connective tissues that attach the muscles to bone. Dr. Deshmukh adds that shin splints are a sign a runner is training too intensely. It could also be a sign of old or ill-ﬁtting shoes. “A shoe is like a tire,” says. Kevin Murphy M.D., also of Heekin Orthopedic Specialists. “They can wear out over time.” Dr. Murphy notes that brand new shoes can be a problem too. Runners may be inclined to buy a new pair of shoes before a big race. That can be a mistake, unless it is the same type and brand of shoe in which the runner has been training in. Proper warm-up including stretching is also important. Flexibility plays a part too. Dr. Murphy recommends increasing one’s running regimen by only 10 percent per week before a big event. STRESS FRACTURE A stress fracture is a tiny crack, usually in the weightbearing bones of the foot or leg. When muscles grow tired, they can no longer absorb the shock of pounding feet. The stress is transferred to the bones and cracks can occur. Stress fractures might develop gradually at ﬁrst, but pain
becomes more severe with daily routines. Rest is the usual remedy, but in some cases surgery may be required. A calcium-healthy diet that promotes bone strength helps prevent stress fractures along with strength training and rest between runs. Dr. Deshmukh recommends cross training with other activities like weightlifting or cycling in order to help increase strength and aerobic endurance. PLANTAR FASCIITIS Tight calf muscles or the wrong shoe can cause inﬂammation of the heel. When the tissue connecting your heel on the bottom of your foot gets overworked, plantar fasciitis can result. Dr. Deshmukh suggests a good round of calf stretching before and after each run to prevent this painful jog-stopper. An orthotic shoe insert might also help. LABRAL TEAR Dr. Murphy has treated many runners who have encountered hip-related injuries. A hip labral tear presents itself with pain in the groin and a “clicking” or “catching” in the hip. Dr. Murphy advises runners to stop running at the ﬁrst sign of a clicking of the hip and seek professional advice. “We know about running,” says Dr. Murphy, who once ran alongside former President George W. Bush in a 10K race, “and our goal is to get runners back into the race as soon as possible.”
BASIC STRETCHES FOR RUNNERS:
Proper stretching, active warm-up sessions cross training and the right shoes can help you avoid injury when training and preparing to participate in the Gate River Run.
Gastrocnemius (Calf) Stretch: s /NE WAY TO COMPLETE THIS STRETCH IS TO stand facing the wall, with your hands on the wall, step forward with one foot, leaning hips toward the wall and keep the other leg straight with the heel on the floor. s 9OU CAN ALSO PLACE A SMALL FREE WEIGHT on the floor. Rest the balls of your feet on top of the free weight with your heels firmly GROUNDED 9OU CAN STRETCH BOTH FEET AT THE same time or one at a time. s 9OU CAN ALSO PERFORM THIS STRETCH WHILE out running. Simply find a curb and rest the ball of your foot on the edge of the curb with your heel firmly grounded.
SHIN SPLINTS Stress on the shinbone and connective tissues that attach the muscles to bone can develop along the shinbone and the front of the lower leg.
MUSCLE PULL A series of small muscle tears that strike runners in the hamstrings or quads.
Hamstring Stretch s /NE WAY TO COMPLETE THIS STRETCH IS TO sit on a firm surface with one leg out in front and slowly lean forward, trying to touch your toes. s !NOTHER WAY TO PERFORM THIS STRETCH IS to prop one leg up on a stable structure and bring your chest to your knee. Quadricep Stretch s 3TAND ON ONE LEG USING A STABLE STRUCTURE for balance, bend the knee of the other leg and grasp with your hand and gently pull up towards the glutes.
STRESS FRACTURE A stress fracture is a tiny crack, usually in the weight-bearing bones of the foot or leg.
Iliotibial (IT) Band Stretch s /NE WAY TO COMPLETE THIS STRETCH IS TO stand next to a wall, about a foot away, with one leg toward the wall, cross over the other leg in front and lean your hip into the wall. s !NOTHER WAY TO COMPLETE THIS STRETCH is to find a stable structure to help balance yourself, cross the ankle of one leg just above the top of the opposite knee and slowly bend into a squat. Hip Flexor Stretch s +NEEL ON ONE KNEE CUSHIONING KNEECAP with a folded towel if needed, place the other leg forward, using a stable structure for balance. Lean forward, shifting bodyweight on front leg until stretch is felt through hip and thigh. Perform three repetitions of each stretch. Hold each repetition for 30 to 60 seconds
PLANTAR FASCITIS When the tissue connecting your heel on the bottom of your foot gets overworked, plantar fasciitis can result.
LABRAL TEAR A hip labral tear presents itself with pain in the groin and a â€œclickingâ€? or â€œcatchingâ€? in the hip.
BROUGHT TO YOU BY HEEKIN ORTHOPEDIC SPECIALISTS
The Right to Bare Feet
By Laura Capitano
What to know before you lose those shoes Many athletes turn to running for its simplicity. All you need to play is one man, one path and one finish line. Very little equipment is required to complete the goal. However, some runners find even the one piece of athletic equipment most depend on – the shoes- to be too confining, and prefer to feel the Earth beneath the soles of their feet.
t Jeff Galloway
“About every ten years the [barefoot running] fad comes in. Initially they will feel good running on the beach or on the golf course, and then they try to do more and get injured. Enough people eventually tell their friends that they got injured running barefoot, and the fad goes away.” — Jeff Galloway
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he practice of running barefoot or in barelythere minimalist shoes, including the Vibram FiveFingers and New Balance Minimus collection, can pique the curiosity of more traditionally shoed runners, but it’s important that novices don’t just jump on the trend with both feet. While running without shoes can have certain strengthening benefits, making the switch can be a shock to the system if not managed responsibly. Runner and running coach Jeff Galloway began his athletic career in 1958 when he joined his school’s winter cross country team. He made the 1972 U.S. Olympic team and has coached more than 300,000 runners in his lifetime, so he has been around long enough that he said he has seen the barefoot running fad come and go from the sport five times. “About every ten years the fad comes in,” Galloway said. “What happens is that someone or some publicity piece will be in the news about barefoot running, most currently it’s from the “Born to Run” book [Christopher McDougall], and people go out and try it. Initially they will feel good running on the beach or on the golf course, and then they try to do more and get injured. Enough
people eventually tell their friends that they got injured running barefoot, and the fad goes away.” Gil Hayag, Director of Physical Therapy at Heekin Orthopedic Specialists said that, “Contrary to popular belief, barefoot running has been around for some time. Most in the medical community believe it to be harmful for most since valid studies are lacking, but others argue that barefoot running can strengthen the foot, decrease strain on the lower leg and can relieve pain caused by the use of running shoes.” Proceed With Caution The injuries common to novice barefoot runners, stress fractures, tendon and bone problems and calf strain, tend to be the result of a misunderstanding of running mechanics. Chris Roman, M.D., an ultramarathoner who prefers minimalist shoes, explained that while barefoot running forces athletes to run and strike the ground with the forefoot, the vast majority of people who run are heel strikers. This means heel strikers may make that switch to barefoot running, but their midfoot is not used to it and not strong enough to compensate. The strain can cause calf or Achilles tendon injuries.
“If you are a heel striker and just totally switch to barefoot running, you will get injured,” Dr. Roman attested. Instead, he suggested runners curious to try the barefoot or minimal style should start on a small scale, maybe once or twice a week for 2 to 3 miles at a time.
Chris Roman. M.D.
“If you are a heel striker and just totally switch to barefoot running, you will get injured.” — Chris Roman, M.D. Dr. Roman added that he’s finished a 100-mile race in his New Balance MT101 minimalist shoes, and that one of the best ultramarathon runners in the world, Jason Robillard, does the majority of his running barefoot, so it can be done safely. “There’s just a lot of misconception, and most of it comes from a general lack or understanding,” Dr.
Roman explained. “Even the New Balance Minimus shoes come with a disclaimer that you shouldn’t just convert to a minimalist style.” Hayag added that, “I would caution against beginning barefoot running without proper research and discussing it with healthcare practitioners. Certain conditions like diabetes, peripheral vascular disease and persons with suppressed immune systems would be discouraged among runners considering barefoot running. I would also recommend ‘minimal’ shoes, like the ‘finger’ shoes to help cushion the beginner and also to begin smartly like running 20 to 30 yards then up to 200 to 300 yards, instead of thinking in miles.” Ben Baeker, a marketing specialist for St. Vincent’s HealthCare started running in 2009 and fell in love with the sport. After reading “Born to Run” he got hooked on the idea of barefoot running and thought he would be a good candidate for it since he was a new runner who hadn’t yet had the chance to develop any poor running form habits, like the heel striking to which Dr. Roman referred. Baeker went out and started running around his neighborhood with no shoes and later with Vibram FiveFingers.
“If I had a nice system of trails I would more than likely be wearing Vibrams all the time, but we’re in a concrete jungle and just can’t do that.” — Ben Baeker Ben Baeker
“Anything less than 7 miles I would wear my FiveFingers,” Baeker said. These days he has found a comfortable ratio of wearing his minimalist shoes 40 percent of the time and lightweight Kinvara shoes the remainder of the time. He admitted that if he had the right circumstances, his ratio might be different. “If I had a nice system of trails I would more than likely be wearing Vibrams all the time, but we’re in a concrete jungle and just can’t do that,” Baeker explained. Galloway, who has published more than 20 running-related books and
heads up runners’ resource JeffGalloway.com, is not convinced that the benefits of running without traditional protective shoes is worth the risk of injury. “I got some benefit from it in high school and college, strengthening of tendons and ligaments and speeding up the function of the foot while running, but the benefit was very minimal,” Galloway said. “I only saw 12 to 15 seconds of benefit, and it came at such a risk I don’t recommend it.” Galloway noted that runners who are considering using minimal or no shoes need to consider their terrain.
H E A LT H Y B O D Y
The lesser the shoe, the more forgiving the ground must be. He suggested runners seek out beaches and trails to test their bare feet. He warned, “Even if you’re vacationing at the beach, there just aren’t any safe surfaces around. There are sharp shells, glass, washed up sea life with stingers in them, hidden rocks and bits of metal. I caution the runners, particularly those over age 40, that there is just so little benefit to barefoot running compared with the risk.” Focus On Form Galloway sees himself as a problem solver who finds ways for people to keep from getting injured while enjoying the pursuit of whatever they want to do, including marathons. He advised that athletes concentrate on shoe choice, and that this has been his consistent recommendation throughout his 35 years
“I would caution against beginning barefoot running without proper research and discussing it with healthcare practitioners. Certain conditions like diabetes, peripheral vascular disease and persons with suppressed immune systems would be discouraged among runners considering barefoot running.” — Gil Hayag Gil Hayag
W W W .H E A L T H S O U R C E M A G . C O M —29
The Right to Bare Feet of coaching. “Get advice from someone who knows about shoes and foot formation. By going to an expert you can get the best fitting and match up with a shoe that can reduce your risk of injury,” Galloway offered. He also recommended having two pairs of running shoes that runners should alternate. Doing so extends the life of the shoes, and allows you to better assess and compare the condition of the shoes, so you know when it is time to replace them. Doug Alred, a runner for more than 35 years and owner of 1st Place Sports since 1978 considers himself an expert on running shoes and training programs. He suggested that those runners who try barefoot or minimalist shoe approaches make up only about 5% of the running market. “At races I stand and see how many try to run barefoot and see only 1 or 2 out of 1000,” Alred said. He explained that while a lot of runners who walk through the doors of his store are certainly curious about barefoot running, most that walk in are there to get shoes that protect their feet. Alred said the barefoot movement has been so small that he doesn’t
“At races I stand and see how many people try to run barefoot and see only 1 or 2 out of 1000.” — Doug Alred 30—H E A L T H S O U R C E
even carry the Vibram shoe line at his store. He does carry some Nike and New Balance minimalist shoes that average around $100. “The thing about barefoot running that people don’t realize is that running without much cushion is designed for off-pavement,” Alred said. “But, there aren’t many places here where people can run off the road. The roots on the trails at the University of North Florida will kill you without good shoes on. When you land with 3 to 4 times more force than your body weight, running shoes absorb the shock and being barefoot doesn’t address that. Something has to dissipate that shock. Your body uses energy to absorb shock otherwise.” Alred noted that one of the best things to come from the hype surrounding barefoot running is that it stimulates conversation about running habits. These discussions allow people to stop and take a look at their running form and why they run the way they run. It makes people think about forefoot striking and the dangers of over striding. “We used to fit the shoe to the running need, and now we’re more proactive and say maybe people don’t run the best way they could run.” To help runners with their form, 1st Place Sports offers New Balance’s Good Form running classes Wednesday nights at the San Marco location. During the free, one hour class (register online at 1stPlaceSports.com), staff takes video of the 15 class attendees running and critiques the posture, lean, cadence and foot-strike rate. Runners can then practice new techniques to increase their efficiency. According to Alred, “People pick up on the improvements very quickly.” Overall, Alred sees barefoot running as merely a tool at an athlete’s disposal, one that can be used to strengthen certain areas and build the foot and calves, but should be used by younger runners and on a very limited basis. HS
RUNNING CALENDAR FEBRUARY s Pirates on the Run 5K/10K, Feb. 5 s John TenBroeck Memorial Winter Beach Run, Feb. 6 s 26.2 with Donna 5K and Family Fun Run, Feb. 12 s Saint Mary’s Elementary School Relay for Life Fun Run/Walk, Feb. 12 s 26.2 with Donna Marathon and 1/2 Marathon, Feb. 13 s Olustee Festival 5K, Feb. 19 s Swoop the Loop, Feb. 20 s Daily’s Ortega River Run, Feb. 26 MARCH s Nocatee Run, March 5 s Gate River Run, March 12 s St Patty’s Day Run, March 20 s Sulzbacher Center 8K, March 26 s Gockle Run, March 26 APRIL s Run for Cover 5K, April 2 s Navy Run 10K and 5K, April 2 s Don’s Run, St. Augustine, April 9 s Fleming Island Rotary Run, April 9 s Orange Park Medical Center Run to the Sun, April 16 s Beaches Chapel 5K, April 16 s The Katie Ride/Walk for Life, April 16 s Jacksonville Symphony River Classic, April 17 s Corporate Run, April 21 s Somer’s Sunshine Run, April 23 s The Spartan Run 5K, April 30 s Shannon Miller Lifestyle Women’s 5K & Children’s 1 Mile Fun Run, April 30 s Shrimp Festival 5K, April 30 MAY s The Human Race, May 7 s Marty’s Run 5K, May 14 s Never Quit Beach Fest Events, May 21
s Florida Striders Memorial Day 5K, May 30 JUNE s Run for the Pies, June 11 s USGBCNF Green Run 5k, June 18 JULY s Celebration Run 5k, July 4 AUGUST s Tour de Pain, Aug. 5 and 6 s JTC Running Summer Beach Run, Aug. 20 s Fight for Air 5K, Aug. 27 SEPTEMBER s Turtle Trot 5K/10K, Sept. 3 s Beaches Labor Day Run 5K, Sept. 5 s Financial Fitness 5K, Sept. 10 s Avondale 5K Classic, Sept. 17 s Children’s Way 5K, Sept. 24 OCTOBER s Jacksonville Marine Corps 1/2 Marathon, Oct. 1 s The Human Race at the St. John’s Town Center, Oct. 9 s Fetal Hope 5K, Oct. 15 s Race for the Cure, Oct. 22 s Evergreen Pumpkin Run, Oct. 30 NOVEMBER s DSAJ 2nd Annual All Star Beach 5K, Nov. 5 s Native Sun Mandarin Run, Nov. 12 s McKenzie’s Run, Nov. 19 s Outback Steakhouse Distance Classic, Nov. 24 DECEMBER s The Reindeer Run 5K, Dec. 3 s Vystar Gator Bowl 5K, Dec. 31
Source: 1st Place Sports Running Calendar. For more information on each race, visit www.1stplacesports.com/ calendar.html
W W W .H E A L T H S O U R C E M A G . C O M —31
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My sister and I shared a room growing up, clothes in high school, a dorm when we went away to college and most of the same hobbies in between. She told me how relaxing yoga was for her and I wanted to give it a try. During my first class I realized I would never learn this practice with my incontinence problems. My sister told me not to be discouraged. She told me about her urogynecologist and how they specialize in the treatment of women’s
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You might be surprised to know how often a second opinion revealed that surgery wasn’t necessary after all or the tumor wasn’t malignant. When it comes to dealing with breast cancer, there is an expert who is world-renown for her ability to provide accurate, reliable cancer diagnosis, and she’s right here in Jacksonville. Dr. Shahla Masood believes strongly that all cancers are not created equally and neither should they be treated equally. And sometimes—more times than you might suspect—it isn’t cancer at all. Call Dr. Masood today at 904-244-4387, and get a second opinion from the physician that physicians all over the world come to for answers. Shahla Masood, M.D. Professor and Chair of the Department of Pathology at the University of Florida College of Medicine – Jacksonville Chief of Pathology and Laboratory Medicine at Shands Jacksonville Medical Director of Shands Jacksonville Breast Health Center Editor-in-Chief of The Breast Journal President of the World Society of Breast Health
It’s your health, your peace of mind. Your call.
Advancement is a fabulous thing in the medical community, especially for those people who benefit from new studies, new technologies and new findings. Despite round-the-clock efforts by doctors and physicians, heart disease still claims far too many lives in the United States every year.
By Cheryl Lock
here is a light at the end of the tunnel, though, for those who suffer from heart issues, and the past year has brought great hope by way of new, innovative information. We know so much more now about how to help slow the advancement of heart disease—or how to help stop it before it even happens.
Brian Shapiro, M.D.
“Age is one of the most potent risk factors when it comes to heart health, but unfortunately that is unable to be modiﬁed.” — Brian Shapiro, M.D.
36—H E A L T H S O U R C E
A Look at the Numbers: Age and Cholesterol “Age is one of the most potent risk factors when it comes to heart health, but unfortunately that is unable to be modified,” said Brian Shapiro, M.D., Mayo Clinic cardiologist. “But other traditional risk factors such as tobacco use, hypertension, hyperlipidemia and diabetes pose significant risk for atherosclerotic disease, and some of those can be helped. While there are a number of pathologic explanations, these risk factors may lead to shear stress, endothelial dysfunction and ultimately plaque formation. While these traditional risk factors are well established based on Framingham studies, other risk factors still exist, as well.” Factors like gender differences have been underrepresented in the literature, says Dr. Shapiro. There is, however, new data that reflects the fact that women are exposed to the risks of atherosclerotic heart disease at an accelerated rate (and even more particularly post-menopausal women) and present with cardiovascular disease in an atypical manner, which may ultimately lead to misdiagnosis and under-recognition of the disease in women. And then, of course, there’s cholesterol. “Current recommendations from the cholesterol organizations for years have been that young adults in their 20s should have their cholesterol checked, and I guarantee that 90 percent of kids that age don’t do it,” said Pamela Rama, M.D., FACC, cardiologist with Jacksonville Heart Center and current Chief of Staff for Baptist Medical Center Beaches. “There was a recent study, though, that looked at two groups of patients and found that if you follow patients
“Sometimes patients think that if their good cholesterol is really high, that it will outweigh or negate the bad cholesterol they have, but that’s just not the case.” — Mona J. Shah, M.D.
from their 20s to their 40s, the patients who had elevated cholesterol in their 20s were then found to have coronary disease in their 40s. This shows that the earlier testing really can help catch things early on.” The differences between good and bad cholesterol can get confusing, advises Mona J. Shah, M.D., cardiologist with First Coast Cardiovascular Institute. “Sometimes patients think that if their good cholesterol is really high, that it will outweigh or negate the bad cholesterol they have, but that’s just not the case,” she said. “And there are so many medications out there that help lower bad cholesterol, but probably only one good medication has been shown to raise good cholesterol. But exercise and a good diet can help with that, as well.” Diet and Exercise If the typical advice of diet and exercise isn’t quite cutting it, either, Dr. Rama offers some more specific advice—look to the Mediterranean diet.
“The Mediterranean diet is high in olive oil, nuts and grains, and it limits meat intake to once a month in favor of healthier options like fish and seafood,” she said. “There was even a study conducted in France many years ago that looked at the highest risk patients, patients who had had heart attacks, and half the patients had a Mediterranean diet and the other half had regular, Western diets. What they found was that after following the patients for five years, those with the Mediterranean diet had a 70 percent reduction in cardiac events. That’s even better than any of the medications we have out there.” “Obesity has become an American epidemic in recent years, with the last two decades seeing a dramatic increase in the percentage of the population that is considered to be obese,” said Suzanne E. Zentko, M.D., a doctor at Baptist. “In 2009, only two states— Colorado and the District of Columbia— had a prevalence of obesity of less than 20 percent. The American Heart
Pamela Rama, M.D., FACC
Mona J. Shah, M.D.
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W W W .H E A L T H S O U R C E M A G . C O M —37
“We urge patients to go to the American Heart Association website and enter their personal data into a risk factor calculator to help determine their potential for developing heart disease.” — Nathan R. Bates, M.D., FACS
Suzanne E. Zentko, M.D.
Nathan R. Bates, M.D., FACS
Association reports that obesity is the number one indicator of potential cardiovascular disease, which makes sense when you consider that excess fat can cause high blood pressure, increased cholesterol and diabetes.” If exercising isn’t quite your schtick, though, it doesn’t take a marathon-training schedule to make a difference. “Our recommendation from the American Heart Association is 30 to 60 minutes of moderate exercise six days a week,” says Dr. Rama. “That could mean swimming, Pilates, yoga, a lot of different things. And if you can’t find 30 minutes in the day to do it all together, even just 20-minute increments add up. Also, another large study recently showed that leisure-time physical activity, like walking, helps lower the risk of stroke, so it really doesn’t take much, and just a little activity is better than nothing.” Gender’s Impact on Heart Disease When it comes to heart health and genetics and lifestyle factors, the way that Nathan R. Bates, M.D., FACS, medical director Cardiothoracic and Vascular Surgery, Orange Park Medical Center, describes it is as two main groups: controllable and uncontrollable. “You can control risk factors like smoking, hypertension, high LDL cholesterol, diabetes mellitus, obesity, inactivity and stress,” he said. “These are the factors that patients can directly control to lower their risk of having a heart attack. The uncontrollable factors include positive family history, gender, old age, postmenopausal women and certain races— African-American, American Indians and
“As women grow older, their risk of heart disease and stroke begins to rise and continues to rise with age. Coronary heart disease, which causes heart attack, is the single leading cause of death for American women.” — Suzanne E. Zentko, M.D.
38—H E A L T H S O U R C E
Mexican Americans. We urge patients to go to the American Heart Association website and enter their personal data into a risk factor calculator to help determine their potential for developing heart disease.” When it comes to gender, women are at risk with increasing age, said Dr. Zentko. “As women grow older, their risk of heart disease and stroke begins to rise and continues to rise with age. Coronary heart disease, which causes heart attack, is the single leading cause of death for American women. Nearly twice as many women in the United States die of cardiovascular diseases as from all forms of cancer, including breast cancer. Men have a greater risk of heart attack than women, and they suffer attacks earlier in life. A higher percentage of men than women have high blood pressure until age 45. From the ages of 45-64, the percentages of men and women with hypertension are similar. After that, a much higher percentage of women suffer from hypertension.” Stress Less and Take Action Also important for any heart health patients to keep in mind—stress less about what you can do to keep yourself healthy! Stress is bad, and the improvements and advances we’ve made are good. “Treatment targets have evolved, and many of the targets that are now used are more aggressive than even five to ten years ago,” said Dr. Shapiro. “For example, goal blood pressure and lipids are much lower now, and thus working with your physician to use the correct medications to lower risk factors is critical for patients. Lastly, if one is so unfortunate to have symptoms of a heart attack or stroke, it is imperative to seek medical attention early and immediately, as waiting may lead to worse outcomes.” Dr. Shah agrees. “For 80 percent of women out there, their only symptom is fatigue,” she said. “I always tell people that they know their bodies better than anybody else. If you feel something is
different, you don’t want to be thinking what you could have done differently three or six months ago. If someone has been having fatigue problems for years, it’s unlikely that a heart attack has been waiting to happen for that long, so I try to pinpoint with patients when the last time was that they felt good. If they say six months ago, and now they feel different, that’s a red flag to me.” Supplements and Medications When it comes to supplements and self-medicating, Dr. Shah is on the fence about that. “Some supplements, like vitamin D, especially for patients who live in the north or areas where they don’t get a lot of sun, could be helpful. But as far as aspirin goes, unless my patients are over 65, I don’t really recommend taking a daily one unless we talk for a while about the risk to benefit ratio. Someone who has already had a heart attack or stroke, that’s a different story, but with a female below the age of 65, more and more studies are showing that the benefits are pretty minimal for patients who fit that bill.” Another piece of advice from Dr. Shah—invest in a home blood pressure cuff. “It doesn’t matter if the machine is digital, but you want to stick with one that measures around your upper arm, which is closest to your heart,” she said. “Just getting your blood pressure taken every three or six months, at a time when maybe your cholesterol is higher because you’re nervous from being at the doctor’s office or any other factors, isn’t enough. It’s always a good idea to have a sense of what’s normal for your own heart.” Also, men and women alike should establish themselves with a primary care provider or internal medicine physician to have all their risk factors evaluated, says Dr. Zentko. “Primary care doctors are experts at a wide variety of medical conditions and can determine if a patient needs to see a cardiologist for evaluation or treatment.” HS
W W W .H E A L T H S O U R C E M A G . C O M —39
40â€”H E A L T H S O U R C E
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