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MUSC Health Blog

Date: Oct 2014

MUSC held a press conference on Thursday, October 16 to announce that the hospital is ready and able to treat any Ebola patients that might need care in the state of South Carolina. Situations such as this cause anxiety and fear, and SCDHEC and MUSC staff have been prepared for numerous other, related situations, and stand ready to evolve along with the current situation.

isolation gurney
Isolation chamber used to transport infectious patients.
MUSC Medical Center CEO/Executive Director Patrick Cawley, M.D. stated “Our goal today is to make sure those we serve know that we are doing what we can to remain vigilant, measured and compassionate in how we respond to this evolving health crisis. It’s important that our community, our state, and our nation know we are prepared and ready to help, and will continue to seek out evolving best practices here at MUSC to care for a person afflicted with this disease.”

MUSC Chief Quality Officer Danielle Scheurer, M.D., offered practical advice for people seeking ways to prevent the spread of the virus, strongly encouraging seemingly simple measures such as practicing good hygiene and remaining calm as changes in the crisis occur. She encouraged the community to continue to monitor the latest CDC and WHO recommendations regarding prevention and controlling the spread of the virus.

What is MUSC doing to prepare?

  • Our infection control, disaster preparedness, and education leaders are educating and training all MUSC Health staff on how to SCREEN – ISOLATE – COMMUNICATE – KEEP CALM (eg “SICK”).
  • A smaller repertoire of clinical volunteers are being trained and educated on the clinical care of the patient, with particular emphasis on the “donning and doffing” of personal protective equipment.
  • Our infection control, disaster preparedness, and facility leaders are continuously refining the safest place to admit any patients suspected of the Ebola virus.
  • Our laboratory leaders are prepared to quickly send a specimen to a qualified lab for confirmatory Ebola testing.

Guest Post by:
Lindsey Clarke, MS, ATC, CMT
Athletic Trainer
MUSC Sports Medicine

Favorite singlet? Check.
Shoes? Check.
Race number? Check.
Pre-race nutrition plan? Ummmmm.

Running a race takes preparation, strength, and energy, and how you approach your pre-race eating plan can affect all three. In the weeks leading up to the race and immediately before the event, a correctly balanced pre-race nutrition plan will contribute towards your best performance. Throughout training, your diet plays a significant role in helping you perform and recover. Whether you are a novice running your first race, or an experienced runner with countless races under your hydration belt, here are a few tips on giving yourself everything your body needs to have a successful and enjoyable race.

WEEK PRIOR: Moderate quantities of carbohydrate-rich foods will fill your glycogen stores throughout the week leading up to the race. Depending on the length of your race, shoot for about 3-5 grams of carbohydrates per pound of body weight per day, with foods like oatmeal, potatoes, carrots, and other vegetables. For example, a 150-pound adult would need at least 450 grams of carbohydrates per day. Many runners focus so much on getting enough carbohydrates that they don't pay enough attention to their protein consumption. Protein is used for some energy, but mostly in repair of tissue damaged during training. Again, depending on your training/length of race, you should consume .5 to .75 grams of protein per pound of body weight. Good sources of protein are fish, lean meat, poultry, beans, nuts, whole grains, egg whites, low-fat milk, low-fat cheese and some vegetables. This is the time to experiment with discovering what foods work best for you, and which foods you want to avoid…experimenting on race day is never a good idea!

DAY BEFORE: Many beginning runners hear that “carbo-loading” before a race is a good idea and mistakenly overindulge on enormous portions of carbohydrate-rich foods. Gone are the days of indulging in stacks of pancakes or sitting down to an all-you-can-eat pasta bowl. Instead, continue eating as you have in the week leading up to the race, increasing your intake of up to 5.5 grams of carbohydrates per pound of body weight; a 150-pound adult would need up to 825 grams of carbohydrates. Foods with a moderate to high glycemic index are your best choices before a race. Eat foods like whole-wheat pastas, which contain 40 to 50 grams of carbohydrates per dry cup serving, and vegetables.

MORNING OF: The length of your race will determine what and when you’ll eat. For shorter, higher speed races, you’ll want to take in a lighter meal approximately 90 minutes prior to the start. This will provide you the energy to get you through the race, but will also aid in preventing any gastro-intestinal distress. For longer races, your body will require more fuel, so a more substantial meal is warranted approximately 2 hours prior to start in addition to a light snack 1 hour prior to.

In making food choices, it’s always best to stick with what you know works. A well-rounded diet of lean meats, legumes, dairy, fruits, and vegetables is a great way to set your self up for success come race day. Some foods to include in race preparation are:

*Whole grain pastas, brown rice
*Lean proteins; salmon, chicken
*Fresh fruit
*Fruit/Vegetable juice
*Oatmeal
*Bagels
*Yoghurt drizzled with honey
*Toast with nut butter

Some foods to avoid in race preparation are:

*Cruciferous vegetables; broccoli, cauliflower
*Sugar-free items/artificial sweeteners
*Bran; cereals, muffins
*Caffeine(unless you regularly consume)
*Fried foods
*Fatty meats/high fat cheeses
*Alcohol

Another extremely important and often forgotten about component of pre-race preparation is proper hydration practices. Many runners underestimate how much fluid they actually lose during their runs and don't drink enough while they're running as well as post workout/race. The result? Dehydration. This is detrimental to performance and dangerous for your health. In the days leading up to your race, you’ll know you’re properly hydrated if you void a fairly large volume of pale urine at least six times a day. On the day of, drink 8-16oz. of water one to two hours before the race, and then another 4-8oz just before. Consumption will vary depending on the length of your race.

LENGTH OF RACE:

ONE HOUR OR LESS
Three to six ounces every 15 to 20 minutes. Water is usually fine. For a tougher runs over 30 minutes, consider a sports drink to replace electrolytes and glycogen.

ONE TO FOUR HOURS
Three to six ounces every 15 to 20 minutes. A sports drink with carbohydrates and electrolytes will replenish sodium.

OVER FOUR HOURS
Three to six ounces of sports drink every 15 minutes, after which use thirst as your main guide (drinking more if you're thirsty and less if you're not).

POSTRUN
Replace fluids, drinking enough so you have to use the bathroom within 60 to 90 minutes after your run(approximately 8-24oz).

Whether you dragged yourself over or kicked it out with your arms raised high, you’ve made it across the finish line. So what comes next? Post race practices are very important in regards to recovery. Replacing fluids lost and replenishing glycogen stores are crucial and the window of opportunity is small. It is best to consume a recovery ‘meal’ within the first 30 minutes after completion of the run. The optimum ratio is 3:1 carbohydrates to protein. Depending on your preference, this meal can take the form of nutrition bars, recovery sports drinks, or even chocolate milk. For longer runs, you should also take in a full meal within 2 hours of completing your race that contains lean proteins, carbohydrates, and maybe even a post-race treat…you deserve it! This attention to detail in your meals leading up to your race will definitely take a bit of planning, but getting the proper nutrition for pre and post race will not only help your performance and recovery, but will make the experience over all much more enjoyable and successful!

Guest Post by:
Stephanie Davey, ATC
Certified Athletic Trainer
MUSC Sports Medicine

bridge river run image
Runners Ready for the Cooper River Bridge Run

So you’ve decided to run a 5K or 10K race. There are a few things to consider before you start your training. First, select a quality running shoe. Find a reputable running store to have your foot properly fitted. Many shops have treadmills and will let you run in them prior to purchasing them. The shoe should fit you and your specific foot needs.

 

Second, you need to decide when and how long you need to train. If you’re new to running, you should start you’re training program eight weeks prior to the 5K race. There are many training plans available online to help guide your training. Every good running program should include running, strength training, stretching, and rest. Depending on your fitness level, you can start with a run/walk program. These programs slowly increase running while decreasing the walking until you’re running the entire time. Strength training should be balanced between lower extremity, upper extremity and core exercises. A proper strength training program will not only make you stronger and faster, but it will also aid in injury prevention.

Stretching should happen both before and after your workout. Start your workout with gentle dynamic stretching to warm up your body. These stretches should not only warm your muscle, but should also start to slowly raise your heart rate. After your workout, plan on at least ten minutes of gentle cool down stretching. Give special attention to your calves, hamstrings, quadriceps, hip flexors, and gluteus muscles. These muscles do most of the running work and are the most prone to injury.

The last part of your training program is rest. Depending on your mindset, it could be the most important part. You should have one to two non-running days built into your program. If you do two days, one of these days can be easy cross training such as cycling, the elliptical trainer, yoga, or Pilates. The second day could include some gentle stretching. Rest helps keep your body fresh and injury free.

Unfortunately, injuries are part of running. While not all are preventable, most injuries can be prevented with a proper training program. If you start to have pain, listen to your body. You can modify any program by adding cross-training or rest days. If an injury lingers, consider seeing an orthopedic doctor for a diagnosis and specific plan to rehabilitate.

Hopefully, you enjoy your training. If you don’t, find a way to modify it. That could mean finding a training partner, or finding a new location. If you normally run on a treadmill, try running outside. Running groups are popping up all over the place. These groups usually have varied interests and have runners at all levels. A group can not only make running more fun but will help hold you accountable!

Guest Post by:
Robert A. Glass, M.D.
Internal Medicine
MUSC Health

Raise your hand if you have ever tried the latest fad diet or extreme workout plan to lose a few pounds quickly. Almost everyone has. With the obesity problem in America reaching epidemic proportions, the airwaves and bookshelves are filled with people purporting to have the latest and greatest method for shedding those unwanted pounds.

The unfortunate part of most folk’s approach to weight loss is that it focuses on the short term and not on the facts that we know about the physiology of weight gain and loss. Despite what the specialty weight loss clinics and infomercials may tell you, sustained weight loss is only a product of consistent effort and lifestyle change. Fortunately, your local MUSC Physicians Primary Care clinic has access to all the tools you need to start making the scale go the right way.

Personalized Nutrition Plans

The basic physiology of weight loss dictates that the number of calories put in must be less than the number of calories used. From portion size to number of vegetable servings per day, it is vital to have a comprehensive nutrition plan that ensures you are taking in both the proper type and amount of calories each day. Meeting with a certified MUSC nutritionist is a wonderful experience for most patients that shows them exactly what their grocery list and dinner plate should look like, and many find that it jump-starts their weight loss and lifestyle change efforts.

Get Up

While diet control is the lynchpin to losing weight, consistent exercise is the key to keeping that weight off. Many folks can use a fad diet for three to four weeks and lose weight, but almost none can sustain that diet for a lifetime and keep weight off over the long term. Exercising for at least one hundred and fifty minutes per week is a great start to establishing a healthy pattern that will allow you to lose weight and then keep it off for years to come. Many people seek assistance from professionals to help structure their exercise plan. The MUSC Wellness Center has a multitude of programs for people of all ages and skill levels to get you moving in a fun and non-judgmental atmosphere. You can even meet with personal trainers to develop completely personalized exercise plans.

Medication

Though medications are not a long-term solution for weight loss, they can be used to jump-start your weight loss program. There are multiple FDA-approved medications that your MUSC Physicians Primary Care provider can discuss with you. Certain conditions, such as high blood pressure, may limit which medications can be used, but one can usually be found if a patient is interested.

Surgery

Though it may seem like an extreme measure to some, weight loss surgery in the right patient can be very effective. Many people with large amounts of weight to lose can experience excellent benefits with weight loss surgery. Quite often, successful bariatric surgery can also lead to improvement or even resolution of such diseases as diabetes, high blood pressure, and high cholesterol. Your MUSC Physicians Primary Care physician can tell you if you meet basic qualifications to schedule an appointment with an MUSC weight loss surgeon.

These four avenues just brush the surface of what is available through MUSC for those looking to lose weight. Obesity has never been a greater problem than now, and MUSC Physicians Primary Care is ready to help you in every way possible to make that morning trip to the scale a much better experience. Once the pounds start coming off, you will be able to live the life you wanted and truly get up every morning to get down.

Guest post by:
William K. McKibbin, MD
Assistant Professor of Orthopaedics
Division of Foot & Ankle Surgery

“Plantar Fasciitis” is the diagnostic term we use for what represents the most common cause of heel pain, localized to generally the bottom, or “plantar” aspect of the heel. Quite literally, the term can be taken to mean “inflammation of the plantar fascia”. This is probably over-simplistic, but works for the discussion of this very insidious and sometimes long-lasting problem in athletes, particularly middle aged “weekend warriors”. The plantar fascia is actually a thick, long ligament that originates at the base of the heel and attaches to the bases of the toes in rather complex fashion. Among other functions, it importantly assists in the maintenance of the foot’s arch structure.

Courtesy American Orthopaedic Foot and Ankle Society

Usually, this type of heel pain occurs without any real inciting event, such as an injury. “Overuse” is most often blamed. We just happen to notice it when we try to step down on the heel, particularly in the morning getting out of bed, or after sitting for a while. This “start-up” pain often causes us to walk on our toes, or up on the ball of the foot, until it calms down enough to walk more normally. The discomfort though can become worse during the day, particularly on concrete floors. It can be quite severe, almost feeling like a “stone bruise”, or even “knife-like”.

plantar fasciitis
Courtesy American Orthopaedic Foot and Ankle Society

Many different types of healthcare providers see patients who present with plantar fasciitis. There are several treatments out there as you might guess, and many of you will essentially on your own try things like stretching, icing, shoe inserts (orthotics), massage, OTC anti-inflammatory medicine, or even the “tincture of time” in order get this problem to go away. The internet is full of free advice, no question (a reasonable discussion can be found at the American Orthopaedic Foot and Ankle Society page). No one really knows what treatment(s) for any one particular individual with plantar fasciitis is(are) going to be ultimately effective in obtaining long term resolution – that is, the state of being pain free, without recurrence. That all stated, there are biases of opinion that I’ve formed over time, in the evaluation and treatment of plantar fasciitis.

The first bias that comes to mind is one of diagnostic “mistaken identity” – that is, the idea that the “heel spur” is the actual culprit. I disagree with that notion entirely, and am of the opinion that the spur that’s commonly found on x-rays is a manifestation of the ongoing inflammation, and not the cause of it. For that reason, I never recommend surgical removal of the spur. In point of fact, many patients with plantar fasciitis will not have a spur at all; and patients who come in for other reasons with no heel pain at all will have a spur show up on their x-rays! Finally, it is probably instructive to know that the spur, when present, “points” forward to the toes, and not down towards the floor into the heel pad tissue.

The most important bias that I hold with this diagnosis relates to what I really believe to be the most common cause for plantar fasciitis – that is, calf muscles that are too tight, too contracted. There is an emerging body of scientific literature in orthopaedics which supports this notion, but does not come right out and prove it. The idea is that calf muscles which are too tight, not stretched out enough, will result in “overpull” of the Achilles tendon at the back of the heel. This chronic and repetitive pull translates immediately downstream to the contiguous plantar fascia, which may set up a chronic inflammatory process. This bias has led me to essentially abandon many common “textbook” treatments (such as cortisone shots, frozen bottle massage, etc.), in favor of those which work on the attainment of a more supple set of calf muscles. Examples would include stretching, physical therapy, night splinting, and even casting. To be clear, there are no quick fixes as this can take some time. Patience usually wins out; I have come to realize that surgery is rarely necessary for the successful resolution of this very common, and sometimes stubborn foot problem.

Having trouble with resolving your plantar fasciitis? Schedule an appointment with Dr. McKibbin by calling 843-876-0111.

 

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