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Posts for: January, 2014

                 Fungi have long held a very important role in the ecosystem and even in our recipes. Although they grow in the ground and appear to be plants they are actually eukaryotic organisms and either eat dead material or live as parasites on others. You may be shocked to hear that a relatively common malady is essentially just a fungus making your skin its home!

                Tinea Pedis, or more commonly known as Athlete’s Foot, is an itchy, red, flaky rash that grows in areas of our bodies that are mostly kept warm and moist. Our feet, armpits and groins are essentially the perfect breeding ground for these fungal infections.

**** Many of the fungi that cause these rashes are of the same family and often cause skin diseases in animals! ****

(Picture of Epidermophyton floccosum from Wikipedia. This fungus specifically prefers humans!)

                  The way in which most people acquire this infection is through contact of their skin with a surface that other infected people have come into contact with. Showers, saunas and even the areas around swimming pools have been found to harbor the spores of these pesky creatures. After these spores establish themselves on your skin they lay in wait for your socks, shoes and clothes to cover them and create the environment that they love.

                 Prevention is the best solution to this problem, but if you find yourself with Athlete’s Foot you have a few options to get rid of it.

-       Do nothing. In some cases, if you bathe and change your socks often enough, the natural antifungal properties of your skin will snub out the invading fungus.

-       Topical antifungals, in creams or sprays, will take care of the problem. They are found at most drug stores and supermarkets.

-       Using foot powders will help keep your feet dry inside of yours shoes and socks, therefore leading to less fungus!

-       Don’t forget to wash and/or disinfect your shoes. If it’s on your feet and your feet have been in your shoes…It’s in your shoes too.

-       In some of the worst cases of tinea pedis, bacterial infections can also appear in the areas irritated by the fungi. If you are noticing that your condition is worsening or has persisted for too long you should see a doctor! 

(Picture from

**** Wearing sandals or just plain going barefoot once in a while is healthy for your feet and will help prevent the dreaded foot fungus!****

            In addition to an unsightly rash or stinky scent these foot fungi can make their way under your nails and establish themselves there for the long haul. Discoloration, thickening, becoming gnarly and misshapen are all consequences of prolonged nail fungus infection on your toenails!

            So be sure to keep your feet clean and dry, wash those old shoes that you have probably never washed, and remember to wear some flip-flops the next time you brave the showers at the gym!



    Peripheral Artery Disease (PAD) is a health problem involving the arteries that lead away from the core of your body, towards the periphery. (Legs, Arms and Head.) As a person ages the inside of their arteries become narrower as plaque deposits there. Due to decreased amount of blood, the tissues that the arteries supply get less oxygen and nutrients. This can cause cramps in muscles and even poor healing of cuts and bruises. 

(Picture of PAD from

     The risk factors associated with this disease are diabetes, smoking, uncontrolled levels of cholesterol in your blood and high blood pressure. Together these problems are the perfect storm in which PAD may develop over time.

**** Even if an artery in your leg becomes completely blocked by plaque, the lower part of your leg may still be receiving blood from other arteries that take over its workload! This is called collateral circulation. ****

    One of the best ways to protect against PAD is to have your doctor monitor you for health problems that put you at risk and remove other risk factors within your control. With that being said, an Ankle-brachial Index (ABI) is a simple and painless test that your doctor can perform to diagnose PAD.

(Picture of an ABI being performed from

            Your brachial blood pressure, taken from both arms, is measured against the blood pressure taken from arteries on the top of your foot and the back of your leg. These measurements are then used in a formula to determine if the disease is present, and if so, at what level. In addition to arterial tests, many machines used to calculate ABI also measure the venous return in a patient to evaluate them for venous insufficiency simultaneously.

            If you are diagnosed with PAD there are several treatment options depending on the severity of the disease. Medications for Blood Pressure, High Cholesterol, Unregulated Blood Sugar levels and medicine to prevent blood clots form forming may all be prescribed to help treat Peripheral Artery Disease. In the worst cases, where clots have completely occluded an artery, surgery may be deemed necessary to re-establish the blood flow.

            PAD screenings should be a valuable tool in assessing your vascular health, especially in the lower extremity. PAD testing is performed in the office and is covered by most insurance plans. It is a mandatory test for diabetics, those with a family history of PAD and other vascular disorders. Dr. Garibaldi and Dr. Harper both utilize these methods to provide the best care they can for you and your family.

Keep Your Footing in This Cold Front!

    With the holidays finished and a new year underway, we are facing a huge cold front with extreme fluctuations of temperatures across the nation. One day it’s a balmy 54 the next it’s 13. And although this gives us license to a snug fireplace and warm cups of cider, it could also mean snow on the ground or even worse…Ice. [1]

(Picture from

    Every year in the winter months our Emergency Departments are bombarded with fall injuries related to ice and snow. While sometimes these are minor scrapes and bruises, these falls can also result in sprains, strains and fractures!

**** The most common injury that results from a slippery mishap is a fractured ankle!****

            Since lack of friction is the root cause for slipping on ice, efforts should be made to wear a good quality shoe or boot with adequate tread. Leather, slick bottom boots and high heels should also be avoided. Patients with Diabetes and poor circulation (Raynaud’s) should avoid prolonged exposure to the cold and be sure to wear warm insulated foot gear and socks. Avoiding excessive caffeine and smoking also helps poor circulation! Finally, diabetics should be extra wary of the cold and injuries from heavy snow boots as well as any bumps or abrasions to the lower extremity.

***Diabetics should NOT soak their feet in hot water to warm them!!!****

    Another common mistake is not wearing socks at all. A patient may think that their “Uggs” that are lined with faux fur will keep them warm, but when their feet begin to sweat…that wetness can, and most likely will, lead to frostbite!!!

Tips for Avoiding Falls

-    Walk with your weight in the center of your body. This will avoid a staggering gait and help provide a more solid footstep and thus more traction.

-    Be careful when exiting vehicles!

-    Always use handrails when provided.

-    Inside buildings can be just as treacherous due to melting snow and ice.

-    Don’t spend too long out in the cold if you can avoid it. Numb feet are more likely to be banged around and abused without noticing!

(Picture from

    There are plenty of ways to reduce your risk for a fall but one of the most important is ICE AND SNOW, TAKE IT SLOW. This “mantra” will help you think deliberately about your footsteps and provide you with a soundness of mind when trekking across your slippery sidewalks and driveways.


[2] Fractures and other injuries from falls after an ice storm.

Smith RW, Nelson DR. Am J Emerg Med. 1998 Jan;16(1):52-5.