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Posted by on in SSMI News
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In his 11th year as Ironman AZ Medical Director, Dr Carfagno had the distinct pleasure of teaching new race medical directors from Ironman Woodlands and Hermann, Texas as well as Ironman Muskoka, Canada the ropes on Ironman AZ Medical....
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First off lets start off the discussion with describing what the transverse process of the spine is and what is the mechanism that causes us to fracture it, in the first place. The transverse process are the lateral projections off the right and left of our cervical, thoracic, and lumbar vertebrae, and in general are considered a stable structure. If the transverse process is considered a stable structure why have we seen both Neymar the famous soccer player, and Tony Romo recently experience these injuries? The answer to that question lies in the mechanism of action that causes the injury. The most common mechanisms of injury for this type of injury is through blunt trauma (motor vehicle), avulsion of the psoas and by trauma that causes a sudden extreme lateral flexion/extension (getting hit in the back). All of these mechanism of actions require and extreme force and require further work up...
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Posted by on in SSMI News
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Concussions in sports such as football, boxing or in military training and combat used to be thought of as a part of the "game", something to work through and past for those who worked or competed in rigorous fields. These days, concussions are no longer seen as innocuous events. Multiple research studies have highlighted the damage done to one's brain over time. Striking observances have become more commonplace as physicians and researcher have identified sequelae of neurodegenerative diseases such as Parkinson's or depression, headaches, sleep disturbances and other illness as a result of years of repetitive brain trauma. No longer is a concussion seen as the last diagnosis upon failure to identify brain injury. With the advent of newer scanning techniques, we now realize that physical neurometabolic dysfunction takes place in concussive events and that damage can be cumulative over time. Each year, more than 1.74 million Americans suffer brain injury....
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Posted by on in SSMI News
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Gout, or monosodium urate crystal deposition, is characterized by extracellular saturation. All patients with gout have hyperuricemia in their lifetime, but some may never experience the clinical manifestations of gout. The clinical manifestations of gouts vary and range from acute inflammatory gouty arthritis to tophaceous deposits and uric acid nephrolithiasis. Gout occurs in three to eight million Americans, with an increasing incidence in the United States. Gout is classically found in a population ranging from 30-60 years old, obese, hypertensive and those that frequently imbibes alcohol. Gout typically appears with severe pain, swelling and redness that occur in 80% of individuals in the great toe. This pain may appear in multiple joints, such as the ankle, wrist, elbow, fingers and shoulders. These attacks will reach maximal pain in 12-24 hours and can last from days to weeks. Factors that provoke or are associated with Gouty arthritis attacks are trauma, surgery, starvation,...
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Posted by on in SSMI News
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What do increased neurotransmitters, rats, brains, health and you have in common? Exercise! More and more research points to the positive effects of exercise on increasing health, memory enhancement, skill-retention on aging athletes. The studies, while in the recent past have shown the positive effects in rats, have moved beyond the realm of Rattatoui's talking chef rats and into a higher reality and relevance zone showing the positive effects in human studies. There are four neuropeptides that have been in discussion increasing in exercise and we will review the basics of each. The first three are actually chemical cousins of each other and are grouped under the parent chemical compound of monoamines. Classical monoamines are further divided into histamines, catecholamines and tryptamines. In the catecholamine category, two brain neurotransmitters are released in response to exercise. The first, a "no-brainer" to many readers, is Norepinephrine (nor-adrenaline, or NE). While norepinephrine is largely...
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Posted by on in Health News
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I have had chronic low back pain for years, and my doctor told me I have degenerative disc disease at L5-S1. I have no history of trauma to my spine. Why does this happen? According to our understanding of the evolution of mammals, our earliest mode of ambulation was on four limbs. As human species assumed an upright, two-limbed (bipedal) stance, the change in posture resulted in compensatory curves in the shape of the spine, which brought about a mainly posteriorly directed wedge-shaped L5 vertebral body. The wedged shape results in a curve in the lower back, known as the lumbosacral kyphotic curve in medical terminology. This curve marks the boundary between the junction of the lumbar spine and the sacrum. So why does the lumbosacral junction degenerate over time? Because the spine is curved at this junction, there is an uneven loading and transfer of forces. Long term stresses caused...
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Posted by on in Sports News
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The lower leg consists of 2 bones, the Tibia and Fibula, that are bordered by the knee joint superiorly and the ankle joint inferiorly.  The tibia, located more medially of the two, is also known as the shinbone. The tibia is the major weight bearing bone of the lower extremity. The Tibia and Fibula are attached via an interosseous membrane to further provide stability. Surrounding these 2 bones, are fibrous fascial structures that divide the lower extremity into four separate compartments. Anterior, posterior and deep posterior that surrounds the tibia, and a lateral compartment that envelops the fibula. Inside these compartments lie multiple layers of muscle and vascular components that assist the foot in moving upwards and downwards during walking and exercise.   Lower leg injuries are very common in athletes, and individuals that participate in physical activity. The most common of these injuries is Medial Tibial Stress Syndrome (MTSS), or...
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Posted by on in Health News
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Herpes simplex virus (HSV) is the most widely spread virus in the herpes virus family. About one billion perople worldwide have been infected with herpes viruses. Orofacial herpes most commonly results from primary infection with HSV-1 during childhood. Approximately 20% to 40% of people have experienced orofacial herpes at some time. In the United States, approximately 130 million individuals over the age of 12 are infected with HSV-1 and the prevelance is more than 70% of those over the age of 80 in Europe. At SSMI, we can evaluate you and prescribe an effective treatment that was recently evaluated. You can read about the clinical test here. Sitavig-Clinical.pdf...
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Posted by on in SSMI News
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A trigger point is a muscle that has spasmed, or knotted up, and won't release on its own. Common therapies include massage, stretching, and moist heat packs. Trigger points can last for months or even years if the cause of the trigger point is not addressed (poor posture, bony alignment issues, etc.) In these cases, a more aggressive approach may be needed to break the cycle of pain and spasm in the muscle. Trigger point injections are commonly done in doctors' offices, usually injecting a local anesthetic and saline or corticosteroid into the spasmed muscle with a small needle. Several trigger point sites may be injected in a single visit. At Scottsdale Sports Medicine, we use ultrasound guidance to direct the needle to properly place the medication into the affected area. Benefits of using ultrasound guidance are: Increased accuracy of getting medication in the muscle and not in surrounding tissue. Reduced...
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Posted by on in Health News
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I've been hearing a lot about testosterone therapy in men with low libido. Would testosterone therapy help women for the same condition? Androgens are a group of chemically similar hormones that play a prominent role in male development and function. Although they are commonly thought of as "male" hormones, androgens are also produced in women. In both men and women, the adrenal glands, the triangular organs situated next to the kidneys, are the primary producers of androgens. The outer layer of the adrenal gland, called the adrenal cortex, is the major site of steroid hormone production. Other major sites of androgen production are the testis in males, and the ovary in females. The major androgens are hydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione, testosterone, and dihydrotestosterone (DHT). In men, androgens are responsible for the development of secondary sexual characteristics at puberty, including muscle building, hair growth, and deepening of the voice. In women, androgens are precursors for estrogen synthesis, but the...
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Posted by on in Health News
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Diabetes can be a debilitating disease with many long term consequences. Some types of diabetes are forced onto us by genetics, predispositions, and other types are partially more our own doing but all types can be dramatically benefitted by strict glucose control and regular physical exercise. Many folks think that once they have diabetes, they are restricted from being active or they must be severely limited in the activity in which they participate. While there are a few limitations, active exercise (doing more) can:  prolong and enhance your quality of life, keep you from being overtaken by the pharmaceutical pill monster, prolong acquisition of, and lessen, any long term consequences of diabetes. What is diabetes? It is a failure of the pancreas to secrete enough insulin.  Type I diabetics generally have it forced onto them earlier in life, are thinner and have a complete failure of the pancreatic β cells to...
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Posted by on in Health News
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"Why does this have to happen now when I have so much to do?" You may be asking this question as you are raking the leaves, shoveling snow, cleaning the garage or even beginning your renewed exercise routine. Or "There goes that arm pain I have been having again-what a nuisance!" or maybe even, "That's probably just my indigestion kicking in..." These are commonly felt ideas and pains that one can experience as we age. Though sometimes we would like to push through pain and finish our work, these are warning signs of heart attacks or angina and are signs that you should see a physician immediately. Once any immediate danger has been ruled out by your physician, you may be asked to complete one of a series of tests. One of these tests is a cardiac stress test. Cardiac Stress Tests are beneficial for the diagnosis of coronary artery disease...
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Posted by on in Fitness
VO2 Max Uptake Norms by Scottsdale Sports Medicine
Maximal oxygen uptake norms for men (ml/kg/min)   Age (years)           rating 18-25 26-35 36-45 46-55 56-65 65+ excellent > 60 > 56 > 51 > 45 > 41 > 37 good 52-60 49-56 43-51 39-45 36-41 33-37 above average 47-51 43-48 39-42 36-38 32-35 29-32 average 42-46 40-42 35-38 32-35 30-31 26-28 below average 37-41 35-39 31-34 29-31 26-29 22-25 poor 30-36 30-34 26-30 25-28 22-25 20-21 very poor < 30 < 30 < 26 < 25 < 22 < 20 Maximal oxygen uptake norms for women (ml/kg/min)   Age (years)           rating 18-25 26-35 36-45 46-55 56-65 65+ excellent > 56 > 52 > 45 > 40 > 37 > 32 good 47-56 45-52 38-45 34-40 32-37 28-32 above average 42-46 39-44 34-37 31-33 28-31 25-27 average 38-41 35-38 31-33 28-30 25-27 22-24 below average 33-37 31-34 27-30 25-27 22-24 19-21...
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By Will Boggs MD   July 14, 2014   Information from Industry NEW YORK (Reuters Health) - Ultrasonography diagnoses hand bony fractures in pediatric patients with greater than 90% accuracy, researchers from Italy report.   "Ultrasonography is a useful addition to physical examination for the diagnosis of hand fracture," Dr. Ingrid Rabach from IRCCS "Burio Garofoldo," Trieste, Italy told Reuters Health. "It allows a rapid evaluation, using x-ray only with positive ultrasonography examination."   Ultrasonography offers high-resolution evaluation of the bone cortex without exposure to ionizing radiation, and several studies have shown that emergency department physicians with adequate training can rapidly diagnose fractures in children using ultrasonography.   Dr. Rabach and colleagues evaluated the diagnostic accuracy of ultrasonography performed by an expert radiologist in comparison to x-ray for the diagnosis of bony hand fractures (metacarpals and phalanges) in a cross-sectional study of 204 pediatric patients admitted for hand trauma.   Standard radiography (an...
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Tendonitis in the front of the knee Most people who have done any sort of sports, especially those that require a good amount of running, have experienced knee pain at some point.  One of the most common areas to experience pain is in the front of the knee around the kneecap (or patella). This is because the design of the knee uses the patella to increase leverage of the working muscles.  The downside is that repeated stress can accumulate around the patella and cause injury pain and swelling. Runners, people who constantly squat or lunge, and those who jump a lot (basketball, volleyball) are at risk of developing overuse injuries in their knees.  Often, people in the explosive, jumping sports will get knee pain starting either at the south pole of the patella or at the tibial tubercle, where the patellar tendon attaches to the lower leg.  The dynamics of jumping,...
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What is Shoulder Bursitis by Scottsdale Sports Medicine
A bursa is a fluid filled sac that lies between moving muscles/tendons and bony surfaces/other tendons and muscle. These sacs act as friction reducing pads that allow the moving parts to easily glide over each other. When there is too much friction for the pads to take, they can break down and get inflamed. Inflammation is the body's natural response to tissue damage and when a bursa gets inflamed, it's called bursitis. If it happens to a tendon, it's called tendonitis. Shoulder bursa The most commonly affected bursa in the shoulder is the subacromial bursa, which sits between the acromion and the supraspinatus tendon of the rotator cuff. This bursa often gets pinched between these two structures during overhead activities and can get irritated in the process (this is called shoulder impingement). When the bursa gets inflamed badly enough, motions such as crossing your arm in front of your chest and...
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Posted by on in Health News
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Endurance athletes have long known that training at specific intensities and durations yields the quickest results for their efforts. Instead of running or biking at a random pace that just "feels good", you should think about setting up training zones that target specific training goals. For instance, aerobic exercise at a low intensity, commonly referred to as long, slow, distance (LSD), will burn mostly fat as a fuel source. This is fantastic if you're trying to lose fat or are training for a long distance event, however, the downside is that you're burning fewer calories per hour overall. This means that you need to make the "slow" workouts also "long" workouts so you burn an appreciable number of calories. On the other hand, there is an alternative. High intensity Interval training (HIIT) is excellent for extending your body's ability to handle faster and harder efforts while at the same time increasing...
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Loren M Describes how she deals with POTS and wants to run a marathon!
Meet SSMI patient, Loren M. She's a real inspiration and represents what it means to be determined. I'm so happy to have met her! "My successes with SSMI have been happening a lot longer than just the one month Metabolic Program. In early 2010, I was diagnosed with POTS [postural orthostatic tachycardia syndrome]. Some people are bed ridden from POTS, and at my worst I was only able to stand for 20 minutes at a time before fainting or extreme dizziness. I did some research and found that cardiovascular exercise can be very helpful. I prayed specifically for a Doc that could really understand I was in a bad place, but was a dynamic enough thinker to believe I didn't have to stay in that bad place. By the time I increased my running time from 4 minutes to 20 very hard minutes at a time, God brought me to Dr. Carfagno....
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SSMI Patient Story Scottsdale Sports Medicine Dr. Carafgno
Jen is just the latest to join our Top Tens list -- check out her numbers! I'm so impressed with what she achieved. Here's what she had to say: "I'm so happy that I took the first step and started Dr. Carfagno's weight loss and workout program. I'm very pleased with my results so far and will be keeping up with everything I've learned, that is keep active and watch what you put in your body. Thank you to Dr. C, and Dan for being very encouraging!  ...
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Originally from the Midwest, Don graduated from the University of Michigan and attended Cleveland State University for his Masters degree in Exercise Science.  At Michigan, he was a Student Athletic Trainer and worked full competitive seasons with the football team (1993) and women's gymnastics (1994). Because of his dedication to his work with the football team, he received a scholarship to work training camp for the NFL Detroit Lions in 1994 after graduation, allowing him the privilege to work with NFL legends Barry Sanders and Chris Spielman.  While attending graduate school, he was a Graduate Assistant at the Cleveland Clinic Foundation and eventually became a full staff Certified Athletic Trainer and Exercise Physiologist.  Don worked with athletes of all levels as the Coordinator for the Center for Athletic Performance at the Cleveland Clinic, designing sports-specific training programs and performing exercise testing for endurance athletes.  As a part of the Cleveland Clinic...
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