Real Problems + Real Answers
Bad knees, a little extra tummy, uneven skin tone—we all face our fair share of challenges that require some guidance, whether they are medical or cosmetic. We asked local health care professionals for their advice on some real issues.
Q: Unfortunately, I am genetically predisposed to bunions, and I already can see them starting to form. I hear it’s unhealthy to not have the surgery—is that true? I know it’s unsightly, but I don’t want to risk complications and be off my feet for six weeks (that’s what I hear, at least). And I love wearing high heels. Would I be able to wear normal shoes afterward? When is the ideal time to have surgery, considering age and severity?
— Off on the Wrong Foot
A: There are many different types of bunions, and they don’t all need to be surgically treated. The best advice is to see a podiatrist who can evaluate your unique situation and give you a realistic picture of what you’re in for. Ignoring a bunion that is causing an ulcer on the foot is not good. Padding the area and wearing special shoes is one nonsurgical option.
The ideal time for bunion surgery varies. It’s smart to consult a podiatrist for a realistic framework to make a decision that is good for your lifestyle and schedule. Many schoolteachers do it during the summer, and people who have trouble with swelling like to do it in the winter because the cold temperatures help.
Recovery time depends on the type of bunion. Weight-bearing activity is not an issue after surgery. It is common for patients to drive three days after the procedure. The general idea is to wear a protective shoe or boot for three to four weeks and then switch to tennis shoes. The goal is to get patients back into footwear they like to wear, but to accomplish this, there are times when minor follow-up surgeries are necessary, especially for those who wear tight footwear. These procedures are often minimally invasive and just require a few days of convalescence, but it’s important that patients be aware this may be necessary.
— Dr. Michael Horwitz, podiatrist, Feet for Life
Q: I’ve always felt like I look better when I have some color, which is now showing itself on my skin. When I was younger, I didn’t always wear sunscreen, and I even frequented tanning booths in college. Now I know better, but my face has numerous sun spots from my earlier mistakes. What can be done to get rid of them, and is there anything I should be doing to even out my skin tone or protect it (besides wearing sunscreen)?
— Not-So-Sunny Complexion
A: There are a few ways you can get rid of sun spots, depending on what they look like and how aggressive you want to be. The easiest and least expensive option is to use a topical cream that has a prescription-strength fading ingredient. It takes about three to six months to see results. You’ll also want to have a chemical peel or microderm-abrasion once a month. This will help deeply exfoliate and get rid of dull, dry, damaged skin so the medication can work better.
Laser treatment is another option if the spots are medium or dark brown. There are laser treatments that just target the brown spots, and they will get dark and flaky after about a week. A different type of laser treats the whole face and provides some skin rejuvenation along with treating brown spots. It’s more intense and has a recovery period of about a week.
There are several over-the-counter options that can be used to even out skin tone. These take longer to work and have a subtler result than prescription treatments. Products with retinoids (vitamin A derivatives with beneficial impacts on the skin) and antioxidants are good to use. Make sure you are using a really good sunscreen with at least 4 percent zinc oxide to block UVA rays that cause discoloration. These rays can come through windows, so always wear sunscreen regardless of how much time you’re spending outside.
— Dr. Natalie Semchyshyn, dermatologist, SLUCare Physician Group
Q: I’ve been told by a couple of different doctors that, due to my arthritis, knee replacement surgery is imminent—in both knees. The everyday pain is getting worse, and the swelling has increased as well. It’s all affecting my mobility. Will surgery really fix the problem and get me back to running and moving around normally, or should I not expect those results? And part of me wants to do both knees at the same time so I only have one recovery, but I’m learning that might not be the best option. If I have separate surgeries, how long should I wait in between?
— Weak in the Knees
A: A knee replacement can be very helpful for the symptoms of arthritis, but it’s not a guarantee. It can help with pain during daily activities, but up to 20 percent of patients still have residual pain after surgery. It is important to discuss your specific case with your surgeon and get a better understanding of his or her expectations of your outcome. Knee replacements are designed for activities of daily living—walking, stairs, etc. It is possible to be moderately active, with activities like swimming, hiking and biking, but knee replacements are not designed for high levels of activity like running.
Having both knees done at once is possible, but it comes with higher rates of complication. I recommend discussing your risk factors with your surgeon. The typical recovery following a knee replacement is three to 12 months, but it may vary if the surgery is complex or has any complications. Research and literature suggest that waiting at least three months between surgeries decreases the risk for complications.
— Dr. Muyibat Adelani, orthopedic surgeon, Washington University School of Medicine
Q: I am about to turn 40, and I’ve always been in really good Special Section shape. I run almost every day and have a committed strength training routine. When I was in my early to mid-30s, though, I had an evident six-pack, and I want that back! My extra weight is only in my stomach area, and I can’t seem to get rid of it. I’ve maintained my normal fitness regimen, and I’ve even cut out heavy carbs and beer. I eat a super healthy diet focusing on greens, vegetables, chicken and fish. What am I doing wrong?
— Battle of the Bulge
A: Surgical options for abdominal fat depend on the condition of the skin and how much excess fat you have. It’s important to know that it’s not always possible to recapture a six-pack. It’s harder to maintain as you get older, and a consultation will determine if it is a realistic goal. It’s definitely possible to lose some unwanted excess fat, and with proper exercise, you may see the return of abdominal definition.
‘Be consistent’ is my No. 1 tip for everyone. Be aware of what is going in your mouth. We often forget about drinkable calories or snacks we may pick up without thinking. Track everything. We tend to overestimate exercise and underestimate calories. The more you keep track of both, the easier it is to find that flaw that may be going unnoticed.
>> Drink plenty of water.
>> Switch up your workout. If you keep doing the same routine, you’ll eventually stall in physical progress because your body adapts.
>> Train smarter and not always harder. It’s key to have a work-to-rest ratio of 1:2. That means you work really hard for one minute, then rest or go slow for 2 minutes. Reaching peak heart rate and letting it come back down increases the effects on metabolism.
>> Work out frequently. Train most days of the week, hit every muscle group twice a week, and do at least 30 minutes of cardio each day.
>> Be aware of your stress level. Overstressing can cause your body to store fat in the abdominal area. There may be more factors at play than what you’re eating and what you’re doing at the gym. It may be helpful to consult your doctor about hormone changes and other effects of aging.
>> Don’t change too many things at once. If you alter too much in a short span of time, you won’t know which variable is working. It also can decrease your adherence to the program because you aren’t establishing consistency.
— Jason Davis, certified personal trainer, The J
A: Vanquish ME Now is the least invasive option. It uses radio frequency energy to heat up fat cells and program their death. An average of 30 percent of the cells are killed, and it has a large treatment area, allowing it to target 10 times more fat cells than other options. Four to six treatments are done once a week, and there is no recovery time. You can go to the gym immediately afterward.
The next option is Tickle Liposuction, which causes 80 to 90 percent less trauma than regular lipo. It’s done under local anesthesia with oral sedation and laughing gas, and there is less downtime. You can be back to work in two to five days and be back at the gym and doing all activities in two to four weeks. With Tickle Lipo, we can accentuate and define the musculature and tighten tissues.
The last option is J-Plasma, which can be added to Tickle Lipo. It uses cold plasma energy beneath the skin to shrink and tighten the connective tissue underneath. This creates an almost immediate effect and generates new collagen under the surface of the skin, so tightening and firming continue to improve.
— Dr. Richard Moore, medical director, The Lifestyle Center
gyrotonics & gyrokinesis
Gyrotonics and Gyrokinesis were developed by Juliu Horvath, a professional dancer who suffered a series of injuries during his career, to help him regain strength and agility.
>> Works with the spine and teaches you to engage your core
>> Lengthens musculature and strengthens small muscles around the joints
>> Gives you greater freedom of movement and increased agility and strength
>> Can be started immediately after completing physical therapy
>> Often used after procedures like hip, knee and shoulder replacements and spinal surgery
Cryotherapy exposes the body to subzero temperatures for one to three minutes to invoke physiological reactions to the cold. These reactions cause the body to constrict blood vessels and push blood to the core where it is enriched with oxygen, according to Dr. Lauren Munsch Dal Farra, CEO of PALM Health. Potential benefits include:
>> Improved mood
>> Deep relaxation
>> Improved sleep
>> Muscle and joint pain relief
>> Improved physical and occupational therapy sessions
>> Healing of several inflammatory mediated skin conditions like psoriasis
>> Increased collagen production
Traditional Chinese medicine uses acupuncture for pain relief. It’s thought to offer many post-surgery benefits:
>> Decreased post-surgical pain
>> Decreased nausea and vomiting
>> Reduced scarring and swelling
>> Strengthened immune system
>> Increased strength, range of motion and flexibility
>> Less need for opioids and other painkillers
Additional sources: 5pointacupuncture.com, myaculife.com, healthcmi.com