Excercise vs. Diet

This may be controversial but after a certain age, excercise and activity will not make you thin.  This is important for me as a surgeon because after injury, so many patients make a renewed commitment to lead healthier and more active lifestyles.  This often begins with weight loss.  So a frustrating cycle begins with more activity to try to burn more calories and it leads to more injuries.

If a person runs a full 26 mile marathon, they will only burn 2600 calories.  That will easily be made up by the celebration Big Mac and French fries.  In fact, the Powerbar that’s consumed to prepare for a workout will have more calories than the workout will consume.

Running burns only 100 calories per mile

There has been much written about this.  The purpose of excercise it seems is to maintain a habit of activity which in the end will lead to a more active lifestyle which in the end will lead to great health.  None of this will however make you thin.

Only maintaining healthy eating habits will make you thin.

I have a few suggestions:

Don’t eat food that is white.  No pasta, no rice, no bread, no flour, no sugar.

Never skip breakfast.

Eat at least 5 small meals a day.  Always.

Eat at least 100 grams of protein a day! Always. (one chicken breast is 30 grams of protein)

Drink 2 gallons of water every day.  Check to make sure your urine is always clear.

All of these suggestions will minimize highly refined sugars which inappropriately stimulate insulin.  These sugars give you a false metabolic high and promote fat production.  Only protein provides the correct stimulus to build muscle, decrease fat, and tells the brain to stop desiring food. Protein may be the single most important substance in promoting weight loss. Breakfast and small regular meals prevent sensations of hunger and will help avoid binge eating.  It is hard to control eating if you are always hungry.  Finally, water will flush away all the by-products of fat breakdown and is an effective appetite suppressor.

These suggestions are not a diet but a reasonable approach to permanently changing our eating habits which will lead to a healthy lifestyle and weight control.

Never expect to lose more than 1 pound of weight per week.  To lose more than that will be at the cost of bone strength, muscle atrophy, and a large increase in the risk of injury and disease.

In two months, our annual Orthopedic Foot and Ankle Weight loss competition will begin.  Stay tuned for details and join our progress through this blog and our Facebook fan site at www.facebook.com/ofaccolumbus.

Candy, candy, and candy.  Halloween is one of my childrens favorite holiday. And in just a couple of weeks, your kids will be tugging on your arm to take them trick or treating the moment they get home from school.

My children are crazy for Halloween

So, before you slip on your witches hat, please keep these 10 tips in mind for a safe and fun Halloween night.

1.) Select a safe and bright costume. Make sure your child’s costume (including beards, masks and wigs) is clearly marked as flame resistant or look for flame resistant fabrics such as nylon or polyester. If the costume does not have any reflective fabric, add your own reflective tape on the back and front. Avoid billowing or long trailing features, especially those made of lightweight fabrics or materials. Your child should wear well-fitting shoes to prevent trips and falls. Costume accessories, including swords and knives, should be soft and flexible.

2.) Masks can obstruct children’s vision and restrict breathing. Consider make-up instead, checking all labels to ensure that it is non-toxic. If children do wear a mask, make sure they can see and breathe easily.

3.) Do not let children under age 12 go trick-or-treating or cross the street without the supervision of an adult on Halloween night. For guidance and safety’s sake, accompany younger children to the door of every house they visit.

4). Make sure your child has his or her own flashlight or glow stick to illuminate pathways and curbs.

5). Trick or treat with your smaller children during daylight hours.

6.) Teens should always go trick-or-treating in a group. Advise them to only stop at familiar homes with an illuminated outdoor light. Remind teens that they should never enter a stranger’s home, car or walk in unpopulated areas. At least one child in their group should have a fully charged cell phone.

7). Make sure you know where and when your teen will be trick or treating and with whom. It’s also a good idea to have the phone number of their friends’ parents in the event of an emergency.

8). Illuminate jack-o-lanterns with flashlights or glow sticks. Avoid candles as they can pose a danger for trick-or-treaters who may come in contact with the open flames and ignite their costumes.

9). Advise your child not to eat any of the candy until you have inspected it first. This is especially important if your child has any food allergies.

10). Monitor their candy intake too. You’d be surprised at how much sugar, fat and calories a single, snack size candy bar has.

And here are the dates for Beggars Night in Central Ohio 2009

Ashville

October 25

4-5:30 p.m.

Ashley

October 31

6-8 p.m.

Baltimore October 31
5-6:30 p.m.

Bexley October 29
5:30-7:30 p.m.

Blendon Township October 31
6-8 p.m.

Canal Winchester October 29
5:30-7:30 p.m.

Carroll October 29
6-7:30 p.m.

Clintonville October 29
6-8 p.m.

Columbus October 29
6-8 p.m.

Commercial Point October 29
6-7:30 p.m.

Concord Township October 29
6-8 p.m.

Delaware October 31
6-8 p.m.

Dublin October 29
6-8 p.m.

Gahanna October 29
6-8 p.m.

Galena October 31
6-7:15 p.m.
Costume party at Ruffner Park will follow at 7:30 p.m.

Genoa Township October 31
6-8 p.m.

Grandview Heights October 31
6-8 p.m.

Granville October 31
5:30-7 p.m.

Grove City October 29
6-8 p.m.

Groveport October 29
5:30-7 p.m.

Hamilton Township October 31
6-8 p.m.

Heath October 29
5:30-7 p.m.
Mall-O-Ween, Indian Mound Mall October 30, 6-8 p.m.

Hebron October 29
5:30-7 p.m.

Hilliard October 29
6-8 p.m.

Jefferson Township October 29
6-8 p.m.

Johnstown October 29
6:30-8 p.m.

Lancaster October 29
6-7:30 p.m.

Lewis Center October 31
6-8 p.m.

Lithopolis October 29
6-8 p.m.

Lockbourne October 29
6-7:30 p.m.

Madison Township October 29
5-7:30 p.m.

Marble Cliff October 31
6-8 p.m.

Mifflin Township October 29
6-8 p.m.

Milford Center October 31
6-8 p.m.

Minerva Park October 29
6-8 p.m.

New Albany October 29
6-8 p.m.

New Concord October 31
6-7 p.m.

Newark October 29
5:30-7 p.m.

Norwich Township October 29
6-8 p.m.

Obetz October 31
6-8 p.m.

Orange Township October 31
6-8 p.m.

Pataskala October 29
6-8 p.m.

Pickerington October 29
6-8 p.m.

Plain City October 31
6-8 p.m.

Powell October 31
6-8 p.m.

Prairie Township October 29
6-8 p.m.

Reynoldsburg October 29
6-8 p.m.

Shawnee Hills October 29
6-8 p.m.

Sunbury October 31
6-8 p.m.

Upper Arlington October 29
6-8 p.m.

Utica October 29
6-7:30 p.m.

Westerville October 31
6-8 p.m.

West Jefferson October 29
6-7:30 p.m.

Whitehall October 29
6-8 p.m.

Worthington October 29
6-8 p.m.

  One of the many challenging and complex problems our diabetic patients face is Charcot foot or neuroarthropathy. This condition creates destruction and collapse of the bones in the foot and can lead to amputations.

"Normal" foot on xray

“Charcot Foot” with joint dislocations

The physicians at OFAC  are skilled at this complex reconstructive surgery and are constantly developing and using new techniques to improve patient outcomes. Recently, Dr. Hyer is one of the first physicians in the world to utilize this innovative, new intramedullary compression device within the bones of the foot as part of this reconstruction. This new implant (called TarsX) provides a much stronger form of fixation compared to typical screws and plates that are used and should allow for better bone healing. 

Here is a video of technique on cadaver specimen (you’re warned!)

Case Presentation

This case has a typical pattern of midfoot joint destruction with severe foot deformity as a result.

Severe Charcot Midfoot deformity with planned correction

Reconstruction in process. Half of implants in.

Reconstruction and realignment finished. Complete implants in.

Implants in. Realigned foot and arch achieved.

  Please check back often for updates and new techniques such as this for these challenging cases.

Dr. Hyer

The physicians of OFAC recently had their research published in the peer-reviewed journal, Foot and Ankle Specialist. The article demonstrates a new method to correcting severe bunion deformities while safely allowing patients to ambulate much sooner. The procedure, called a Lapidus arthrodesis or fusion, typically required patients to be in a non-weight-bearing cast for at least 6 -8 weeks. New techniques and evidence documented in this study by OFAC has shown a higher healing rate than other published studies and with patients weight-bearing at 2 weeks after the surgery!

Severe Bunion Deformity

Severe Bunion Corrected with Modified Lapidus Technique

With this new technique, patients often can begin protected weight-bearing in a bunion boot walker around 10-12 days. This is an important advance as early weight bearing minimizes time lost from work, eases burdens onto family and friends and is overall much healthier for our patients. 

'Bunion Boot'- protects foot during early weight-bearing.

Not all bunions need to be fixed, but when they do, the physicians of OFAC have the expertise and experience to insure the solution is the right one for you.  I encourage everyone to ask questions, discuss with your doctor and understand what is being recommended and why.

One of our main tenets in practice is to continually educate and strive to improve. I am proud of the research and education efforts our team provides and am confident it is unmatched anywhere. Our new website allows us to quickly broadcast this new information as it becomes available, often before it is even in print.

Check back often as more and more of our work moves toward publication in leading medical journals.

Christopher F. Hyer, DPM, FACFAS

Co-Director, Foot and Ankle Fellowship, Orthopedic Foot & Ankle Center, Westerville, Ohio

Trauma Section Editor, The Journal of Foot and Ankle Surgery

Editorial Board, Foot and Ankle Specialist

I have never encountered such a stark difference between two cities in any one country as I have seen between Beijing and Shanghai.  Whereas Beijing instills the weight of history with Tiananmen Square, the Forbidden City, and the Great Wall of China, Shanghai is modern, organized, and expansive.  People here will say that if you want to see China the way it was in the past, go to Beijing but if you want to see where China will go in the future, go to Shanghai.

Even the public bathrooms at the hospital demonstrate this difference.

A typical traditional bathroom in Beijing

The typical Shanghai hotel bathroom with heated seats and power bidet

The hospital I visited had 1100 beds with almost 2 million patient visits every year.  They perform 27,000 surgeries a year.  The orthopedic service has formal rounds with a full team of attendings, residents, all nurses, and all therapists twice a day.  Yet, to keep costs controlled, they employ traditional interventions.

A bamboo splint for a low cost option

Their medical experience is different from ours.  Neither is better but without question, China’s experience is vast.  Both their medical teams and their patients demonstrate stoicism, perseverance, and discipline.

This applied discipline appears to begin early and continues in nearly everyone I have met.

2nd grade recess in the school yard

For complicated reasons, I found myself at a street side noodle shop at 2:30 in the morning with an equally hungry 30 year old man.  I am in my business suit and he is in his hip torn jeans with an equally hip polo shirt.  He tells me he makes socks.  I wonder if he works in one of the many narrow alleys I’ve seen around the city.  Rather, he makes socks for the US.  He makes all the socks for the US, including those for Walmart, JC Penny, Target, and Nike.  He owns a large factory outside of town and employs 300 people to make socks.  Armed with 2 cell phones and a laptop, he constantly monitors the price of cotton in Turkey and Yemen to remain competitive and worries over the timeliness of his container ships crossing the Pacific.

I leave wondering if he is typical of every 30 year old man in Shanghai.

I just returned from the annual American Osteopathic Academy of Orthopedics meeting in Boston. The lectures and exhibits offered a great forum for education, it was also exciting to catch up with old friends. Boston is a fascinating and historic city. However, the highlight of the weekend was getting to spend time with some of OFAC’s previous fellows. Seeing how these fellows have become successful leaders is truly one of the most rewarding things about running our fellowship program.

Dr. Deol, Dr. Saar and Dr. Smith.

Training 120 Chinese Orthopedic Surgeons who do not speak English posed more than a few challenges.  Many of my lectures rely on humor and subtitles.  Explaining complex ankle deformities become almost impossible.  However, amazingly, through body language and intonations and I think their desire to understand, the day ended with a successful grasp of techniques of ankle replacement and arthritis, tendon reconstruction, and bunion surgery.

120 Orthopedic Surgeons from every province in China

Beijing itself has over 20 million people.  Over 150 cities in China are larger than Columbus Ohio.  Although the surgeons and hospitals are equivalent to ours, there are very few Orthopedic Surgeons who specialize in Foot and Ankle. The surgeons here recognize this need and I’m sure this is why the meeting this weekend was so well attended and so enthusiastic.

Training new techniques on artificial foot bones

Meeting and conversing with a wide variety of Chinese surgeons was rewarding.  The Chinese are not allowed more than one child per family.  Therefore, everyone is an only child.  No one has brothers and sisters.  Unless someone is ill or handicapped, almost all Chinese people work.  So all these only children were raised not by their mothers but by grandparents or relatives. Families are strong.  People do not eat alone.  Meals, even in business meetings, are always eaten family style.  Food is placed in the center of the table and people will reach and double dip one serving at a time. People rarely move from the province of their families and if they do, it’s only for educational opportunities.

There are not enough university positions for the 1 billion people who would like to enter.  Therefore, education is highly competitive.  Those who do not score well on their entrance exam will never receive further education.  Conversely, those who succeed into medicine are truly the best and brightest that China has to offer.

With a few hours of free time and a quick visit to the Great Wall of China, it was easy to see how this cultural discipline could create a mind boggling 2000 mile wall through precipitous mountain ridges.

The meandering Great Wall of China cutting through the mountainside

China Day #1

As many of you may have know from my frequent twitter and facebook posts, I had an upcoming trip to China.  I thought this would be a good way to launch our social media efforts.

With a new Blackberry phone, equipped with all the latest Twitter and Facebook add-ons, I was prepared to Tweet and Facebook my way through China and Taiwan.

The surprise of course was to discover that neither Facebook nor Twitter is available in China.  It is available almost everywhere in the world but not here.  For many reasons, most of which are outlined in every weekly copy of Newsweek and Time magazine.  As progressive and modern as China is, there are certain freedoms and liberties that do not exist here that we enjoy daily in the US.

My last twitter post summarized the difference between a coach seat and a business class seat.  Hope everyone caught that.

It was a long flight.  For anyone who may not have braved a transpacific flight, unless you have a great backlog of fiction books, a full iPod of songs, and 2 powerpoint presentations to produce, do not attempt this alone.

The flight map of a long trip

Once you land in a foreign country, it’s disorienting.  In addition to being sleep deprived, a queasy sense of nausea, and a constant mild headache, none of the signs make any sense.  Exiting the airport, you want to find baggage claim and a taxi but they’re no where to be found.

Even the signs out don't make sense

Wisked away to a business dinner surrounded by well meaning Chinese orthopedic surgeons, we dig into dinner. Smells great, looks great but no one can tell you what it is.  The most common comment was ”it not chicken”.

Really good food if you knew what it was

Given that I’ve been here for only 5 hours, I have a few thoughts.

Traveling is an adventure.  It is tiring and should be enjoyed when young and not old.  The subtle differences are thrilling but thank god that there are a few things that are constant……or is this a good thing?

The KFC by Tianemen Square

A typical dessert stop for the average Chinese

Just steps for Chairman Mao's tomb. I think he would be proud.

Every year as we get deeper into football season, I see more and more reports of turf toe. While the name sounds fairly innocent, this injury associated with playing sports on rigid surface can be debilitating to athletes at all levels. Turf toe occurs when the toe is hyperextended causing varying degrees of tearing to the capsule and ligaments surrounding the joint. SEE BELOW

NOTRE DAME’S JIMMY CLAUSEN SUSTAINED THIS KIND OF INJURY EARLIER THIS FALL.

Turf toe injuries are graded based on the amount tearing (partial or complete) to the joint lining and ligaments as well as the degree of associated bone injury. Afflicted athletes may have difficulty with acceleration, change of direction, and jumping. Most players will recover in one to three months with rest, taping, anti-inflammatory medication, physical therapy and custom inserts. Fortunately, only the most severe turf toe injuries require surgery.

If you experience a turf toe injury that results in difficulty walking, pain with motion of the joint, and doesn’t improve with rest, schedule an exam with your local foot and ankle expert. An MRI will help determine the severity of your injury and the required treatment.

Take a look at this video featuring a local athlete and his turf toe injury experience.

For more in-depth information, you can check out the Turf Toe chapter we contributed to the new book, Foot and Ankle Surgery Operative Techniques.