What you need to know about your wounds:

ONE THING YOU NEED TO KNOW ABOUT WOUND HEALING:

After we rule out vascular disease or have improved this by proper referrals, and properly offload a wound, there are still factors at play which significantly alter the potential of wound healing. Often this is seen with patients who have low protein counts in their routine blood tests.

When you have a wound, sometimes called a pressure sore, getting in higher amounts of high quality protein is so important. Your protein needs roughly double compared to your normal amount. 

Recent research has shown good results healing wounds with protein consumption of 0.84 grams of protein per pound of body weight per day. Overall, depending partially on the severity of the wound, medical recommendations range from 0.55 to 0.84 grams per pound of body weight per day. 

NOTE: The quality of the protein is important. 

Depending on your overall status, the recommendations above would be: *

• Between 70 and 105 grams of quality protein per day for a 125 pound person
• Between 84 and 126 grams of quality protein per day for a 150 pound person

Please note that if you believe you might have a pressure sore, you definitely should be consulting a physician for advice that is specific to your individual needs. 

HOW TO GET THAT MUCH PROTEIN? 

An ounce of meat (the weight after the shrinkage of cooking) provides about 7 grams of protein. 

An egg contains about 7 grams of protein.
Milk contains 8 grams of protein per 8 ounce cup

Example: To get 90 grams of protein from meat, you would need to eat 13 ounces of cooked meat each day. 


There are protein supplement options and ask FFLC doctors about this today.

-Dr Timm

What you need to know about your health.

It is our commitment to our patients that drives us to become one of the leaders in helping prevent healing complications post operatively, prevent bacterial infections and viruses, and even enhance wellness without any adverse complications. Our way to do this is through an innovative technology as a distributor for MonaVie health products in our offices.

- Dr Timm

You are not allowing your body to optimally function, which can lead to increased risk of heart disease, reduced memory capacity, and even hypertension. Here's how you can change this and allow yourself to increase vigor, health, and vitality.

Scientific Overview

NATURE’S SCIENCE UNLOCKED

Dedicated to unlocking, sharing, and protecting the earth’s most unique, health-giving resources, MonaVie combines science and nature to bring you the highest quality products possible.

• Draw upon millions of dollars in clinical research
• Supported by more than 60 independent scientific studies
• 10 published studies in national peer reviewed journals
• 4 U.S. patents

YOUR HEALTH, OUR COMMITMENT

MonaVie’s dedication to your overall health extends far beyond the first sip. Combining the best of science and nature, we draw on millions of dollars of clinical research and more than 50 scientific studies—including eight published in national peer reviewed journals—to develop our premium health products.

By unlocking, sharing, and protecting the most valuable resources our planet has to offer, we are able to deliver powerful health-giving benefits in every bottle. Our rigorous testing standards ensure the highest possible quality products and demonstrate our commitment to science and—most importantly—your health.

 

SCIENCE ESSENTIALS

While it is essential to life, oxygen can also have a detrimental effect on your health. As your body’s cells use oxygen to create energy, they also create a potentially damaging byproduct called free radicals.

 

WHAT ARE FREE RADICALS?

Free radicals are organic atoms or molecules that have an unpaired electron in their outer cellular ring. Since electrons have a tendency to exist in pairs, free radicals become unstable and latch on to electrons from other atoms and molecules in your body. This cycle creates a biological chain reaction that can damage cell membranes, accelerate the aging process, and contribute to certain ailments. Stress, lack of sleep, a poor diet, UV radiation, exercise, and pollution can all contribute to the formation of free radicals.

These unstable atoms can lead to a physiological imbalance in your body called oxidative stress. When this occurs, your body is unable to counter the damaging effects caused by these rogue molecules. This can be demonstrated by cutting an apple in half. As the fruit is exposed to air, it starts to turn brown. On a cellular level, the oxygen in the air is interacting with the cell wall of the apple’s tissues, creating free radicals.

 

WHAT ARE ANTIOXIDANTS?

Antioxidants are molecules capable of preventing free radicals from damaging healthy, functioning cells. By donating an electron to these unstable molecules, antioxidants help terminate this chain reaction before crucial damage occurs. Though your body inherently creates some antioxidants, these life-protecting phytonutrients are generally found in richly pigmented fruits and vegetables. While thousands of antioxidants are found in nature, polyphenols and flavonoids (a class of polyphenols) are two of the most effective.

 

WHAT ARE POLYPHENOLS?

Polyphenols are natural chemicals responsible for the color, flavor, and scent in fruits and vegetables. Deeply pigmented berries such as açai are especially high in these antioxidant compounds. Found mostly in the outer layer of fruits, polyphenols offer protection from harmful bacteria and ultraviolet light. In humans, polyphenols protect your body from oxidative damage and support cardiovascular health.

 

POWERFUL NUTRIENTS FIGHT AGAINST AGING

The MonaVie premier juice blends contain powerful nutrients that aid your body in the fight against aging and other symptoms of oxidative stress. In fact, just four ounces provide you with the antioxidant capacity of approximately 13 servings of common fruits and vegetables.

You must know this about your flexible flatfoot problems

Everyone has or knows someone with pain in their knees, or what some call "flat foot" problems which have been attempted to be treated with orthotics or bracing. If yours or your family or friend's foot problems meet very specific criteria, we will soon be able to offer a minimally invasive flatfoot correction technique to improve symptoms associated from talotarsal displacement in patients with flexible deformity. A company called HyProCure is training the doctors of FFLC to perform this cutting edge procedure in select patients who are candidates for such a correction.

- Dr Timm

Excerpt from their website:

HyProCure^® is a lifetime solution to the devastating effects of partial talotarsal dislocation, a foot imbalance that throws both the foot and the entire body out of alignment. It affects people of all ages, and it is the direct cause of many symptoms and secondary conditions, including: flat feet,overpronation/hyperpronation, bunions, plantar fasciitis, knee pain, hip pain, back pain, and even problems in the neck and shoulders.HyProCure^® is a permanent, minimally invasive solution that corrects talotarsal displacement at its root, realigning both the foot and the entire body. Discover how this unique medical breakthrough can stop and even reverse your symptoms, and how it can help you take back your quality of life.

In principle, anyone older than 3 years of age suffering from the effects of partial talotarsal dislocation can and should be considered for the HyProCure^® procedure. The primary requirement is that the individual has a flexible deformity versus a rigid one. This can be determined by moving the foot and artificially forcing back the ankle bone back to its normal position on the hind-foot bones. If you are able to do so, then the HyProCure^®procedure is a possible solution. If the ankle bone can be repositioned back to its normal alignment on the hind-foot bones, then HyProCure^® can be inserted to maintain that alignment. Fortunately, the vast majority of people suffering from talotarsal displacement do indeed have a flexible deformity. However, the longer this deformity goes untreated, the more likely it is to become a rigid, non-reducible deformity.

The HyProCure^® procedure has been performed on patients of all ages, from age 3 to 90 and above, and activities level, including distance runners, basketball players, ballerina’s and more. Check out ourTestimonials page to hear their stories.

Additional Considerations

It is often possible that other deformities, such as deviated metatarsal bones, ligamentous or tendon laxity or contractures, can be present which may or may not need to be addressed along with the HyProCure^®procedure. Your foot and ankle specialist will be able to determine this during your examination.

Who Isn’t a Candidate?

Some people may have a partially flexible or rigid deformity. Unfortunately, these patients are not good candidates to benefit from HyProCure^® because their feet lack the necessary flexibility to adapt to the corrected shape. These patients will need other types of treatment in order to improve their condition.

Check Yourself

The majority of people affected with partial talotarsal dislocation are candidates for the HyProCure^® procedure. In order to confirm if you may be a candidate, first check and make sure that your foot is flexible.

The 3 things you must know about neuromas

1) You do not NEED surgery.

At FFLC we are always finding new and improved ways to treat this painful lesion in your foot by nonsurgical measures, which are equally as effective as removing the neuroma, and without any of the side effects or risks of surgery. The best part is these modalities can be performed several times without negative consequences, and in most cases even with previous surgery performed, the treatments can be highly effective to reduce pain and improve your day to day walks.

2) After injection therapy (Sclerosing agents) you will need orthotics.

Most patients are under the assumption that once the pain is gone, orthotics are no longer necessary. This is untrue. IN fact, the need for orthotics increases, because your foot will resume previous function after the neuroma pain is gone, and this could predispose you to later recurring pain. In the proper hands, a custom molded device, or an accomodative device off the shelf can improve function in shoegear which will help the metatarsal bones stay apart so that a future nerve impingement can be much less likely to recur.

3) Radiofrequency ablation works. (NeuroTherm)

Many of our patients are presenting to our office with previous treatments attempted, such as numerous cortisone injections, previously fashioned orthosis, and even surgery. This is of no concern to us, as we have been using NeuroTherm for these very difficult cases with excellent results. We use the latest and least invasive technologies to better serve our patients, and I believe we are in the forefront of technology in this area for most foot and ankle pathology in Southwest Florida.


Dr Timm

Ankle issues for those who cannot have surgery

Not everyone is healthy enough for ankle reconstructive surgery. In fact, in Naples the average age of our patients is 65, and that can infer more often than not that some form of co morbidity exists in the summation of medical concerns which may complicate  the option to electively undergo any type of surgery. Some patients are fresh off of a myocardial infarction, others are too weak with congestive heart failure and kidney disease. The rest are very poor surgery candidates secondary to leg circulation which cannot be improved by vascular intervention. Yet this category of patient is still able to be treated for ankle and foot pains, because we can make a mold of your ankle and foot, and create a custom molded ankle/foot orthosis. This is the most common nonsurgical treatment to manage chronic pain from abnormal motion and deformity in patients who are just not candidates for any reconstructive surgery, and this allows their relatively limited mobility to be achieved with less pain and allows some patients to avoid needing a wheelchair as a primary modality of transportation. Often times, this brace will take 3-6 weeks to be available, so we offer many off the shelf intermediate bracing options for this cornerstone of patient population, as well as PRP injections and physical therapy options as well. We are not only foot and ankle surgeons at FFLC, we are also very naturalistic and have had good success with nonsurgical management of most of our patient's chief complaints regarding pain in the ankle and foot.

Different ankle concerns will require different bracing options, but we are well equipped to use whichever means are necessary to keep you walking.

New Neuropathy Treatments Available!

The Micro-Z™ and The Micro-Z MINI™ is a small, lightweight stimulator that allows patients to receive electrotherapeutic treatment in comfort. It is programmed for two treatment protocols, the first is a 30-minute daytime treatment and the second is an eight-hour nighttime treatment that is administered while the patient sleeps. The Micro-Z™ and The Micro-Z MINI™ can be used to treat acute and chronic injuries, to treat sources of pain, to increase circulation while improving range of motion, and to minimize soft tissue atrophy and injury. Its compact size and ease of use increases patient compliance and when used with Prizm's Electro-Mesh, Silver-Thera, and Stim-Support garment electrodes, they offer opportunity for rapid patient recovery.

It is estimated that nearly 75% of all amputations caused by neuropathy and poor circulation could be prevented with proper care. The National Institute of Diabetes and Digestive and Kidney Diseases recommends control of blood sugar, relief of pain (typically achieved through use of medications and or electrotherapy), and special care of the hands and feet as treatment for diabetic neuropathy. Recommended care for the feet includes frequent visual inspection, good hygiene, use of protective lubricants and wearing of special shoes. There are no commonly recommended courses of therapy that aim to both reduce pain and increase circulation in order to treat the pain associated with neuropathy and, at the same time, help reduce the risk of developing foot ulcers. PRIZM has established a clinical research program with leading specialists in the fields of endocrinology, diabetology, and podiatry at major medical universities. A pilot clinical study demonstrated benefits of the Silver-Thera™ Stocking coupled with the Micro-Z™ pulsed direct current neuromuscular stimulator in treating diabetic foot neuropathy, tissue perfusion and wound healing which resulted in a clinical publication (see research). The convenient, easy to use Micro-Z™ can be worn to bed for easy nighttime use, a factor suggested by studies as effective in alleviating subjective, burning diabetic neuropathic pain as well as dramatically increasing circulation which leads to increased tissue perfusion.

Ask one of our providers today about this new treatment, and it IS COVERED by insurance. We DO OFFER this treatment through an outside company who can get this to your home directly without more than a 7 day delay. We are always looking for improved ways to treat our patients, and this is another treatment modality which can be undertaken without any side effects.

Dr Timm

Big Toe Joint Aches and Pains - What you need to know:

Often times patients will present with what they consider to be a "Bunion" in their big toe joint, and they attribute this to their pain. Many times, this is false. A bunion is an actual deviation or dislocation of the big toe joint, whereas the painful prominence which are often gradually increasing in size after many years removed from an injury can be related or directly attributed to progressive "bump" production which has the general buzzword "Arthritis".

Arthritis is actually a misnomer, because many times the inflammation of the joint is only noted initially in the disease process and over time the cartilage wears away forming spurs and bone prominence which leads to the pain and inability to move the joint fluidly. This is actually an "arthrosis" which is the end result of the condition. Arthritis is not usually visualized directly on a radiograph but arthrosis is easily visualized.

A clinician will find effusions whenever arthritis is active. This is the "Swelling" that patients often note is painful and warrants medical attention. This is often including joint space widening in the case of inflammatory arthritis but narrowing over time with osteoarthritis, and reduction of ability to move the joint without pain and with eventual grinding.

Patients will often times not recall the traumatic event which sparks the progressive wear down of this area on their foot, but many times this is not necessary. Patients will also note that the "bunion" is growing and is usually located on top and side of the joint. This is not a bunion, as these tend to only be located on the side of the joint and not at all on top.

What do you need to know to determine what to do next??

1) If the pain is at the end of the day you should see a foot and ankle specialist.

2) If the motion of the joint is limited or not similar to your other foot, you need to see the specialist.

3) If you have been given 2 or more cortisone injections in the same joint, you need to see a specialist.


There is a common theme here. A foot and ankle specialist is paramount to help a patient achieve a good result in treating first toe joint arthrosis. Often times, this is progressive and may limit treatment options depending on the stage of the pathology. There is no actual cure for any form of arthritis, but there are means to treat and accommodate the condition in order to reduce pain and limitation with walking.  We are adept in treating all forms of arthritis, from the initial swelling stage, to the end stage limited motion in the toe joint.  There are many times several good options depending on the stage of the disease process, and we will be able to give you a definitive solution in many cases.

Dr TIMM.