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Readers Follow Up With Questions Regarding Past Columns

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 7th, 2018

Hello, dear readers, and happy summer! We hope you're getting a chance to enjoy the longer days and warmer weather. Here at Ask the Doctors headquarters, our mailboxes continue to overflow. Let's dive in.

-- Regarding the column we wrote in response to a reader who has frequent bouts of strep throat, we heard from Martha, a reader whose family had an unexpected experience with the bacterium:

"One of our children got repeated and frequent strep infections," she wrote. "Finally, the pediatrician suggested we test the whole family, and we found we had a carrier -- our then-toddler, who had no symptoms at all." Once the toddler was treated with a course of antibiotics, the incidents of strep within the family stopped.

The toddler is an example of what is known as an asymptomatic carrier. That is, although the individual is a host for a bacterium or a virus, they are not adversely affected. However, as Martha and her family learned, people who come into contact with the carrier can become infected and fall ill. Strep, typhus, C-difficile, norovirus, Epstein-Barr and even HIV are just a few examples of infectious agents that have been found in individuals with no outward symptoms.

-- After reading our column about genital herpes, a reader asked for help in dealing with the pain and itching that often accompany an outbreak. Although there is no cure for herpes, there are several antiviral medications that can curtail the length of an outbreak by several days, if taken at the first sign of symptoms. The antivirals acyclovir, famciclovir and valacyclovir are prescription-only. People living with herpes who have frequent outbreaks sometimes opt for suppressive therapy. That is, they take an antiviral every day.

For localized symptoms like pain, over-the-counter pain relievers can be helpful. As for itching, an intriguing study found that ointments and creams containing propolis, a resin-like substance made by honeybees, was more effective than both a placebo ointment and a topical treatment containing the antiviral acyclovir. Dosing depends on a user's age and general health, so if you decide to give this alternative treatment a try, please check with your family doctor for user guidelines.

-- We heard from a reader regarding the claims that coconut oil is useful as an agent to either prevent or treat Alzheimer's disease. One of the theories behind the idea is that the brains of Alzheimer's patients can't break down glucose and that certain properties of coconut oil provide an alternative energy source.

Although the use of coconut oil has indeed shown promise in several small clinical trials, the benefits at this time remain largely anecdotal. The good news is that there is now increasing interest in this area of study, and the larger studies that are needed to corroborate and expand on the existing research are quite likely on the horizon.

In the meantime, for those of you following through with the use of coconut oil, please remember that it is a saturated fat. Depending on your daily diet, its use may require you to make corresponding adjustments.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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Stretching Can Help Alleviate Pain of Plantar Fasciitis

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 6th, 2018

Dear Doctor: I recently began running again after a six-year hiatus. My only problem is that my heels hurt after I run -- so much so that I limp for a few minutes the next morning until my body adjusts. As the day progresses, I stop noticing the pain. Any suggestions?

Dear Reader: Running is supposed to be good for you, so it can seem perplexing and frustrating when, instead, it causes pain. In your case, I suspect the cause is plantar fasciitis.

The plantar fascia is a band of thick tissue that attaches to your heel bone (the calcaneus) and extends from there all the way to the base of your toes, providing support for the arch of your foot. Because the plantar fascia is prone to inflammation, it's a common cause of foot pain in adults. This inflammation, known as plantar fasciitis, is most common in adults ages 40 to 60 and accounts for nearly 1 million doctor visits each year in the United States.

One-third of the time, as in your case, the symptoms are on both sides. Runners and dancers are more likely to develop plantar fasciitis than people in the general population because of repetitive trauma. In runners, the pain can be related to poor-fitting running shoes; tightness within the calf, Achilles tendon and hamstrings; flat feet; or running on hard surfaces.

The typical symptom, which you described, is pain in the heel that is noted with the first step out of bed. The pain is sharp and may subside with walking, but may reoccur by the end of the day if an affected person is on his or her feet all day.

Your doctor can usually diagnose plantar fasciitis simply by examination, although he or she may recommend X-rays to rule out other causes for heel pain.

As for what you can do, I would recommend stretching. Tight calf muscles and Achilles tendons can cause the heel to lift so that the contact point with the ground when walking and running is at the area of the plantar fascia. Stretching the calf and even the hamstring can help change that contact point. A foam roller can massage and stretch the calf and hamstring, as can a nighttime splint that keeps the calf stretched and the foot flexed upward. Also, just as stretching the back of the leg is helpful, so is strengthening the muscles at the front of the leg. A physical therapist can recommend specific exercises.

Other pain-reducing tips include buying shoes with good arch and heel support, and using heel inserts to cushion the heel while walking or running. NSAIDs such as ibuprofen and naproxen can decrease inflammation and pain, as can icing your heels after a run.

Finally, you should curtail the running until the pain in your heels subsides. Don't resume it until you've improved your biomechanics through stretching and strengthening exercises.

If the pain persists, a doctor may recommend a steroid injection into the heel, but this should be reserved for people who have not been helped by physical therapy and courses of oral anti-inflammatories.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Cannabinoids' Effect on Glucose Control Still Not Yet Understood

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 4th, 2018

Dear Doctor: I have Type 1 diabetes and have used marijuana for years to control my blood sugar. I've seen my blood sugar drop 100 points in five minutes with marijuana, a lot faster than my Humalog insulin can manage. Why is that? Will medical marijuana ever go mainstream?

Dear Reader: Marijuana, or cannabis, contains more than 100 active chemical compounds. Known as cannabinoids, each of them behaves differently in the body. As the number of states that allow the use of cannabis for medical purposes continues to grow, so does the body of evidence that many of the compounds found within the plant have therapeutic potential. The most common use of cannabis in the United States right now is for pain control. It's also widely used for anxiety, to manage nausea and has been shown to be effective in reducing inflammation. It also shows promise in managing symptoms of neurological conditions like Parkinson's disease and multiple sclerosis.

The challenge to investigating medical claims regarding cannabis is the fact that, despite what's happening in individual states, it remains illegal at the federal level. Cannabis is a Schedule l drug, in the same category as heroin, which means research is subject to numerous restrictions. Even so, various studies and clinical trials are moving forward, and in time we will learn more about what cannabis can -- and can't -- do.

In researching your question regarding cannabis and diabetes, we found that you're not alone in noticing its effect on blood sugar. However, much of what we found is anecdotal evidence, which lacks scientific rigor. At this time, the study of cannabis and its potential effects on diabetes is in the early stages, with much of the work done in mice and on donated tissue samples. Until researchers are able to work extensively with human populations, the how and why of the effects of cannabis on the complex physiologic processes encompassed by diabetes will remain educated guesses.

Preliminary research suggests that certain cannabinoids may help with glucose control. Some studies have found that cannabis can have a positive effect on insulin resistance. A study published in 2016 in a journal of the American Diabetes Association found that THCV, one of the cannabinoids that are not psychoactive, improved glycemic control in some individuals with Type 2 diabetes. Another study that same year drew a link between cannabidiol, a compound in cannabis, and a decrease in inflammation of the pancreas. In an observational study using data from the federal Centers for Disease Control and Prevention, researchers found the incidence of diabetes among regular cannabis users to be measurably lower than that of the population at large. At the same time, the results of several other recent studies contradict a number of these pro-cannabis findings. So, basically, the jury is still out.

Although cannabis shows promise in the area of diabetes, science has yet to catch up with the claims being made. In the research that has been done, the reason for the effects of cannabis are not yet fully understood. Interest in the subject is strong, though, and continues to grow. We'll keep an eye on the topic for you and report back as we learn of new advances.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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