Comprehensive Medical Care for the Athlete Comprehensive Medical Care for the Athlete. From the elite physiology of a Professional Athlete to the Weekend Warrior, Dr Carfagno, the Athlete's Internist, manages the spectrum of your health.
Created in a unique setting of Internal Medicine and Sports Medicine, along with a Metabolic Physiological Lab, SSMI redefines Sports Medicine. At Scottsdale Sports Medicine, it doesn’t matter if you’re a professional or a dedicated amateur--we believe every athlete deserves top of the line care. Dr. David Carfagno and his team are ready to help you take your health and fitness to the next level w
Operating as usual
Lumbar spinal stenosis is a narrowing of spaces within the spine which puts pressure on the nerves along the spine It can occur anywhere along the tracts of the spine, but most commonly occurs along the lumbar spine. The lumbar region of the spine is also referred to as the lower back. The nerve compression travels through the lower back and can radiate to the lower legs This condition mainly affects the older generation through age related disc degeneration. The most common cause of lumbar spinal stenosis is spondylosis or degenerative arthritis affecting the spine. As an individual ages, the disk becomes less spongy and can result in a bulging disc, bony spurs, and enlarged joints near the spinal canal. When these changes occur, there is less space in the spinal canal which leads to a narrowed space. This places pressure on the spinal nerves which can cause inflammation.
Symptoms of spinal stenosis can be caused by nerve compression or inflammation. A hallmark sign of lumbar spinal stenosis is neurogenic claudication. Patients can experience symptoms such as pain, weakness or numbness in the legs, calves or buttocks while walking or during prolonged periods of standing Also, cramping in the calves can occur with walking. Standing or walking can exacerbate symptoms due to pressure and stretching of the irritated nerves. Symptoms are usually relieved by sitting, lying, or flexion at the gait. Symptoms can be bilateral, asymmetric, and can affect the entire leg.
Diagnosis is a combination of typical symptoms and a neuroimaging study showing impressions of structural narrowing of the intraspinal canal Image studies may involve XRAY, CT, MRI, or myelogram of the spine. A good alternative if a MRI is contraindicated for a patient is a CT Myelography. Management of spinal stenosis involves conversative treatment before considering surgical treatment. This includes PT, analgesic and anti-inflammatory medications, and epidural steroid injections. Surgery is last option
Bagley, C., Et al
(2019). Current concepts and recent advances in understanding and managing lumbar spine
Many take vitamins for health. For example, folic acid is used for child-bearing women to prevent neural tube defects. It is an individual’s choice to take a vitamin supplement, but it used to promote health on top of a well-balanced diet. If a patient is deficient in any vitamins, an individual will be more prone to disease. One of the biggest mistakes is not looking at the back of the nutrition label. Lots of supplements have more than recommended daily value for different vitamins. Although there are many benefits for taking vitamins and minerals, it is important to be aware of the toxic effect it can induce from over supplementing.
When a multivitamin has more than the recommended dietary allowance, the body might not be digesting and absorbing it. There is a recommended intake. When vitamins or minerals are taken beyond the recommended levels, toxic effects can occur. For example, magnesium can cause diarrhea if the dose is greater than 400 mg. Typically, the body gets rid of any excess water-soluble vitamins by urinating it out, but it stores the extra-fat-soluble vitamins in the fatty tissues . Another example is excess levels of vitamin D. Vitamin D assists the body to absorb calcium. When there is an excess amount of vitamin D, it can cause a buildup of calcium in the blood to produce a state of hypercalcemia. Hypercalcemia can cause problems such as osteoporosis, kidney stones, kidney failure, arrythmias, or CNS problems.
To prevent over-supplementation, screening should be done for all vitamins and minerals. This will help reduce double doses of one vitamin in various supplements. Some examples of conditions that require supplements are pregnancy, anemia, or menopause. Also, it is important to educate patients that vitamins and minerals can be obtained through diet such as eating an orange for Vitamin C. Having a good diet with lots of whole grain, green vegetables, citrus fruits, and meats provide a well-balanced and eliminate the need for vitamins.
Kamangar, F., & Emadi, A. (2012). Vitamin and mineral supplements: do we really need them?. International journal of preventive medicine
Happy Mother’s Day 💕
I want to thank each and every nurse that I have worked with… Have a fantastic day you are much appreciated!!
Treat and compete… That’s been my motto. All sides of the spectrum….overseeing the medical operations of large scale endurance events, to the one on one in office management of my athletes, to getting to compete with my athletes side by side. Love to practice what I preach but more so, I say, inspiring by perspiring.
One of my favorite of all time national championship weekends with USAT Triathlon Multisport. An organization that really harbors exercise is medicine mentality within each athlete who adopts that credo and being active at whatever ability or age you are. Its my credo in my medical practice as I preach Daily to all of my patients and athletes. This weekend I competed in three events aquathon 1000 m swim 3 mile run, aqua bike 1500 m swim 24 mile bike 3 mile run and a duathlon 3 mile run 12 mile bike 1.5 mile run. Finish them all excel and wait For the final tally on making team USA again to go to Spain.
Start your your week off right and get a little bit of exercise whether it’s a walk down the block a simple modified push-up, couch dip, arm curl with your water bottles or mini squat on your walker. Todays a day to start and build your routine and regimen.
US Triathlon MultiSport National Championships Race Day 1 in books Aquathon. 1000 meter swim 3.1 mile run. Good Friends, Times and Good Food. Had to get a picture of one of my favorite water concoctions with cucumber water… Got that from watching the Other Guys with Will Ferrell and Mark Wahlberg. No we didn’t have tickets to Jersey Boys or court-side txt to the Knicks lol.
Sleep and the Athlete
Sleep is essential part of health. It is plays a role in cognition, emotional balance, reduces disease, and regulates stress . Sleep may vary and can change based on stress and illness. Adults should have seven to nine hours of sleep. Over sleep duration, sleep quality is an important part of health and well-being. Sleep is crucial because it allows for recovery and healing. Majority of athletes sleep less than eight hours due to anxiety before a competition. Along with brain health, sleep is associated with athletes having better performance and faster recovery illness or injury.
Barriers to sleep in athletes are due to training volume and schedule. When there is an excessive training, it decreases sleep duration and quality. Also, traveling to games alters time zone and changes regular sleep schedule. In a study with 576 elite male athletes, an independent predictor came up as a lack of sleep being the cause for lost competitions. there is also poor reaction time. Proper sleep fosters concentration, which are essential for cognitive performance.
Interventions to promote sleep involve medical screening for conditions such as insomnia, sleep apnea, depression, or anxiety. Adolecer athletes, assess how well the child manages academics and sports. Also, conducing a healthy sleep environment and schedule is crucial for healthy sleep. Sleep environment should be clear of exposure of blue UV screens such as phones. Also, the environment should be cool, dark, and have minimal noise. Also, athletes have training schedules. Therefore, sleep and wake time should be consistent and include relaxation time of thirty to sixty minutes prior to sleep to help initiate the start of sleep. Another factor is to avoid stimulants such as energy drinks or coffee before bedtime so individuals can have a sensation to sleep. Medical professionals should endorse the importance of proper scheduling, travel requirements, time management, and stress control to maintain sleep hygiene..
Watson, A. M. (2017). Sleep and Athletic Performance. Current Sports Medicine Reports, 16(6)
Tell my athletes to monitor the Air Quality and Pollen Counts, especially this time of year. Humbling data on Air Quality and outdoor workouts. Move em indoors when at their worst...
Heart Attacks Follow Dirty Air Like Clockwork Vehicle and industrial emissions may be the worst pollutants for the heart
What is the risk of Achilles Tendon rupture in patients taking Quinolone antibiotics?
Fluoroquinolones are antibiotics used to treat a variety of infections from UTIs, respiratory infections, and skin infections. They have excellent absorption, tissue penetration, and broad-spectrum coverage but the risks need to be considered. Based upon epidemiologic studies, patients taking quinolones are at a higher risk for Achilles tendon injuries. The exact cause of cellular injury isn’t well understood, but it is thought that quinolones cause injury. Because of this, the FDA placed a black box warning for this drug class.
Clinical presentation of quinolone induced tendinopathy is abrupt, sharp pain that occurs spontaneously with activity and weakness with walking and weight-bearing exercises. If Achilles tendinopathy occurs, the quinolone antibiotic should be discontinued, patient should rest, NSAIDs, and, when appropriate, begin strengthening exercises. A complete tendon rupture may require surgery. Athletes should not be prescribed this class of antibiotics unless absolutely necessary.
A study by Jupiter et al., (2018) reviews the relative risk of tendon injury when taking quinolones when compared to other antibiotics. Nearly 1 million patients taking quinolones were compared to patients taking antibiotics from other drugs and rates of tendon injury were compared. The results showed less than 0.5% incidence of Achilles tendon injury among both the quinolone users and other antibiotic users. This information concludes that the absolute risk if minimal, especially among healthy populations. The risk of tendon injury is slightly higher among patients older than 60 years, males, patients taking corticosteroids, or with comorbid diseases. In conclusion, the risk is small but these medications used cautiously.
Godoy-Santos, A. L. et al (2018). Fluoroquinolones and the risk of achilles tendon disorders: update on a neglected complication. Urology
Jupiter, D. C., et al (2018). The relative risk of Achilles tendon injury in patients taking quinolones. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
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