Red Shirts Vs. Klingons OR Calor,Rubor, Dolor & Tumor

Yes, Here I go with the doctor speak again.

Inflammation.

It's a buzzword lately, but it's been discussed since the Greeks started thinking scientifically.

One of the very first things they taught us in medical school were the following terms:
Rubor--redness
Dolor--pain
Calor--heat
Tumor--swelling

These are the cardinal signs of inflammation.
You can also add:

functio laesa--loss of function.

Little did I know that this was my first Latin medical language lesson.
I spent a large amount of time with my medical dictionary at my side during my first year of medical school. Most definitions also had the Greek word, in Greek, next to the word. I was very glad I took ancient Greek in college for a semester. It gave me an instant leg up on medical language-- but I digress.

Inflammation is caused by not only infections, but by foreign bodies; injuries to an area like a cut,  broken bone, or crush injury; by cancer; by allergies; and by autoimmune states (attack of self by mistake); by toxins; and by radiation.

It gets pretty complicated. I want to keep it simple.
We may get more complicated if you want, down the road, but let's lay the foundation.

So let's say you get a cut. First it gets red and warm, and painful, and swells and you stop moving it because it hurts. Why does that happen? 

The cut activates a whole cascade of inflammation.

 First, cells at the site of injury recognize a problem and send out a chemical signal that causes the blood vessels around it to open up and get wider. That increases the size of the surrounding highways (blood vessels) for the blood cells and fluid and special chemicals and proteins to get to the site of the injury to wall off invaders, and close up a bleeding wound.

All of the extra blood flow and leakage of proteins and cells causes the wound to ooze, and to get red and to feel warm, and the area to get puffy.

Foreign Invader or "Klingon"

 Also, all of this extra swelling causes some of the bacteria and fluid to get swept up into the lymph blood vessels (lymphatic vessels) which travel to lymph nodes and make them swell up also.  Hence, swollen "glands" when you have a pharyngitis or sore throat.

In the lymph nodes, other immune responses start up. There are special white cells there that get activated when they recognize a foreign invader. (Let's call the foreign invaders the Klingons, and the white cells the "Red shirts"). I think of the lymph nodes as battle stations for the white cells to gather to help with inflammation. (For non Trekkies-In Star Trek, the good guys in red shirts always die. Klingons are one of the bad guys).

Anyhoo, the white blood cells are directed by chemicals released at the site of the injury to the affected area.

Activated WBC or "Red Shirt"

There they line the blood vessel walls. Then they squooge (a scientific term) through the blood vessel walls into the tissues around the wound. Once there, they kind of help direct the show, releasing more chemicals to attract other white cells to the area.  
They recognize the Klingons, and put up tractor beams to pull them in and suck them into the USS Enterprise where Captain Kirk makes out with a pretty girl, Oh, never mind. 




 Okay, where were we?  Oh yeah.

The white cells eat the bad guys, or release chemicals that cause the Klingon to blow up. 

There are also chemicals that cause fibrin to be released. Fibrin is kind of like a fishing net thrown over the wound, and platelets then get caught in the net and cause the wound to stop bleeding by closing up the wound with a clogged up fishing net. 

Some of the white blood cells, the neutrophils, are the real "red shirts" of the process because they often die at the end of the inflammatory process and form pus. So when you have a pus pocket, or a boil, or abscess, you have the remnants of a colossal battle between the Klingons and Red shirts.

The Red shirts will win if the pus is drained and the inflammation goes away.

Anyway, there's a lot more to it, but I decided to keep it simple today.
Maybe, later on, we'll get more specific about all the different types of white cells, their jobs, the chemicals they release, and the immune and clotting systems.

Live Long and Prosper. 

Doctor Diva

Fun with Doctor Language.

Use a Word and Make it Yours 

or

Fart Jokes ALWAYS Help You Retain New Words.

Today, we are going to use common "doctor dialect" and translate it and use our new words in our every day speech. To "own" a new word, you need to use it in a sentence.


 I tried dictating this post but my word recognition software made quite a mess of it. I suspect that the garbled language my dictation software misunderstood, is what my patients hear too.


Let's begin:

The suffix for inflammation is "-itis."
rhino means nose. I always liked that one because it was pretty obvious. A rhinocerous has a big
nose.
W.C. Fields had "Rhinophyma"--a bulbous red & enlarged nose.People used to equate it with alcoholism, but really it's just part of a disease called "rosacea."

"Rhinitis" equals inflammation of the nose.

 "Allergic rhinitis" is an allergy that make your nose swell up or itch.

 
A "Diverticulum" is a finger like outpouching of the colon.  Diverticulitis is an inflammation or infection of a diverticulum.

 The Abdomen is the entire belly area.

But, we don't say "abdominitis". Instead, we use the name of the organ that is inflamed. For example,  the lining of the abdominal cavity is called the Peritoneum, so:

 peritonitis=inflammation of the lining of the abdomen
AND:
 appendicitis=inflammation of the appendix
 hepatitis=inflammation of the liver

Okay. So this is pretty dry, right?
Let's spice it up a little.

 When you get a scab we call it an "eschar". What's underneath it, the little divet in the skin is called an "ulcer" or "ulceration".

If we follow through on this we could call potholes "asphalt ulcers."

(Doesn't that sound scientific?)

 In the large intestine,  if you get a lot of ulcerations we call it  "colitis".

 Here in Chicago when the roads are very potholed and there are hubcaps flying all over, we call it 

 "winter". 

 BUT we COULD call the potholed nightmares that pass for roadways in Chicago "diseased".  

They have 

ULCERATIVE ASPHALTITIS.

Tailgating annoys me no end because it's rude, annoying, and extremely dangerous.  I think we should rename it: "RECTUM RIDING."

 Some people have poo for brains. How did it get there, you might ask?
Well, those people must have a conduit to get poo from their colon to their brain (cerebral cortex). I say that those people have a colo-cerebral shunt.

Okay, here's a fun one for those of us who are still amused by farts. (And really, who isn't deep down?)

The technical term for passing gas  is "flatus" or "flatulence".

Urinating is "micturating".

Having a bowel movement or pooping is "defecating".

(Most people know that one.)

SO,  someone who is a gasbag or talks too much has flatulence breath.

Logos means "words". And we all know "diarrhea" is running at the bowels. Put the two together and you get logorrhea--Someone verbose or who is very talkative.

Belching or burping in "doctor" is "ERUCTION"
.

I like using the word "ERUCTION" in public because it always gets confused with other words-- you know, like "ELECTION".

(What? Seriously? Are your minds in the gutter AGAIN?)

So, Let's use our new words in a sentence or two. Here's a little scenario/story using many of our new words.

That guy driving behind us has a colo-cerebral shunt! Did you see how he was rectum riding me? Then we hit that patch of asphalt ulcers and one of his tires blew out. 

He pulled over, got out of his car, and lit up a cigarette.  He walked around his car checking his tires, but when he bent over, there was a simultaneously huge eruction and loud passing of flatus.

 (I almost micturated in my pants laughing.)

Well, who knows what he was eating earlier. It must have been something good because those bodily vapors went shooting up in flames towards the heavens, lit by a spark from his cigarette. 

He started swearing like a sailor as the police pulled over. They took one look at his rhinophyma and figured that he was an alcoholic (although that's not really true). 

They made him do the breathalyzer test.

Suddenly he doubled over in pain, holding his abdomen. The police called for an ambulance and we later found out he'd had emergency surgery for appendicitis. 

So, the moral of the story is:

Don't tail gate, don't smoke, and don't drink or you'll end up with a big nose, horrible gas and a flat tire.

The End

SEE HOW MUCH YOU LEARNED?

Treating a Scald Burn OR Why Buying Preserves is Cheaper (and Safer) Than Making Them

Any one who knows me, knows that I like to make homemade preserves. I love the fresh flavor of jams made without preservatives. My favorite, is BLUEBERRY preserves because:

1.) They're BLUEBERRY (DUH!)

AND

 2.) Have you ever priced out blueberry preserves? (You will soon see the irony in this comment).

Now, I am a trained professional and am very serious about Sterile Technique when I make my own jams.

I also prefer, if possible, to make it without pectin.

 Blueberry preserves take a  little LOT more time to cook without pectin, but they taste AMAZING without pectin.

SO, yesterday I got my 4 pints of blueberries, washed and sorted through them removing the stems and leaves and the yucky couple of blueberries in there.  I mashed them up and had about 5 cups of mashed blueberries.

I added 3 1/2 cups of sugar and 1/4 cup of fresh lemon juice and the rind of a lemon to the mix.

I got a nice, rocking, foaming boil going and the handy dandy candy thermometer said it was around 205 to 210 degrees F.  I cooked the preserves to a nice thick consistency (about 30 minutes) and tested for gelling on frozen plate (I put a drop on the plate, ran my finger through it and the preserves didn't run together through the trough).  I also taste tested them and YUM!

 I washed my hands for the five thousandth time in the process after that, too. (I'm serious about sterile technique).

Meanwhile, I had my jars a-boilin' away in the canner, the lids and rings in another pot, all of my towels out, my jar tongs, my little magnetic rod (to pick my rings and lids out of the boiling water), all ready to go.

I started taking the jars out of the boiling water, one by one, with my special handy-dandy jar tongs and one slipped and poured scalding hot water all over my abdomen, left leg, and the top of my foot.

Now, I was never trained in the art of stripping, but you would never have known that if you had been in the kitchen with me.  I tore off my shirt, and suddenly the foot burn registered, as I tore off my sneakers, socks and pants, and was left standing in the kitchen in my underwear, swearing.

Just so you know, it is not possible to run your abdomen and your foot under cold water for twenty minutes without suffering from hypothermia. 

 I grabbed some ice and made a cold pack with a wet washrag, put it inside my bathrobe and tightened the belt to hold it in, put ice on my foot inside a sock, and went outside to tell my husband that I had scalded myself.

HOWEVER, before I went outside to let my husband know that I was possibly mortally wounded, I poured all of the jam using excellent sterile technique into the sterile jars with a sterile funnel and a sterile ladle, left a 1/4 inch of head room, and wiped off the tops of the jars without touching the preserves or the inside of the jar. I again, with excellent sterile technique, placed the lids and  the rings on the jars, and put them in the boiling water bath with 2 inches of water on top of the jars and processed them for 15 minutes.

Why waste perfectly good blueberry preserves?

Just so you know, the cost of the preserves was about Fifty dollars, after my husband ran to the pharmacy to get me nonstick bandages, wrapping bandages, burn gel, tape, etc.

Below is a link to some AWESOME instructions on how to make your own Blueberry Preserves. 

Even though in my case, they cost about fifty zillion dollars, they are so incredibly worth it. Just stand FAR AWAY FROM THE BOILING WATER WHEN YOU TAKE OUT YOUR JARS.

http://www.tasteofsouthern.com/blueberry-jam-recipe/

URINARY INCONTINENCE PART DEUX.

First off:  This is informational only. Please, please, PLEASE, use this to talk to YOUR DOCTOR. Don't treat yourself. Don't stop medications unilaterally. Use this to add to your knowledge base as you talk to your Doc.This information is not meant to be medical advice.

Stress incontinence. This is the run, jump, cough, laugh, sneeze  incontinence.

Urge incontinence-is the "got to go right now or I'm going to have an accident" incontinence. Or the "Key in the doorknob" incontinence.

Mixed incontinence-it's a combination of urge and stress incontinence. Your bladder is very full and you've got to go, NOW, and then you cough and then leak.

Overflow incontinence-"Oh my, my bladder is so full that I had better get to the bathroom right now or.... oh bummer!"---type of incontinence. Often there is frequent or constant dribbling or inability to empty the bladder, and the stream is weak. This can be caused by bladder injury, a blocked urethra, MS, diabetes or prostate gland problems(in men).


Functional incontinence occurs because people are mentally or physically unable to make it to the toilet. Think, nursing home patient with dementia, or immobilization from physical illness.


When you have incontinence, you and your doctor need to look at your diet, overall health, and your medications.  

For example, coffee, tea, soda and alcohol can increase incontinence. (I know, right?! Always the good stuff) They are all mild diuretics and/or stimulants of the bladder.
  
Drinking large volumes of fluids, quickly, increases the amount of urine in the bladder.

Diuretics, also known as "water pills" can increase your urine output and make it virtually impossible to get to the bathroom in time, especially if you already have difficulty moving quickly.

Muscle relaxants, blood pressure and heart medicines can sometimes affect the muscles, or the amount of urine your body makes. (Don't stop them. Talk to your Doc)

• Uncontrolled Diabetes increases the amount of urine the kidneys make.
• Obesity increases the pressure on the pelvic floor and increases leakage. 
• Constipation increases incontinence by interfering with emptying of the bladder, or by pushing on and irritating the sacral nerves. 
•  Pregnancy hormones and the stress of vaginal delivery affect supportive tissues and cause the pelvic floor to prolapse. 
• Hysterectomy can increase the likelihood of incontinence. 
• Bladder infections can cause incontinence. 
• Kidney stones, bladder stones and bladder tumors can cause incontinence.
• Aging can decrease the bladder's storage capacity
• Menopause decreases estrogen which causes the tissues around the urethra to shrink back/atrophy.
• Prostatitis -an infection in the prostate in men, sometimes causes incontinence. 
• Benign prostatic hypertrophy or Prostate cancer, both, can cause the bladder to get blocked off and also the treatment of that can cause leakage. 
• Neurologic diseases like Stroke, Multiple Sclerosis, Dementia, Parkinson's, Spinal cord tumors, Spinal cord damage, Brain tumors, all can affect bladder function

SO...What the heck do I tell my doctor? Isn't it normal to have urinary leaking? I mean, Look at that list! Seriously? What DOESN'T cause incontinence?



1.) Keep a Urinary and Fluid Intake Diary. Yes, I know that sounds weird and OCD, but believe it or not, I've had people drink 3 gallons of water a day and wonder why they had urinary frequency. 

2.) Bring a list of medications to every single appointment. 

3.) Write down your specific symptoms.

4.) Write down recent life changes, for example, longer commute to work? Increased stress at home? New medications? New herbal supplements or vitamins?

Testing you might have: 
1. Urinalysis and culture to check for abnormal blood cells, infections, etc.

2. Blood tests to check for diabetes, thyroid, etc.

3. Pelvic Ultrasound to check for abnormalities in the pelvic organs.

4. Post Void Residual or Bladder Scan. Here, a gyne or urologist or urogynecologist, has you urinate, then checks how much urine is left in your bladder with a special scan or with a catheter.

5. Urodynamic Scanning-usually done by the urologist or urogynecologist. It measures how much
 pressure is in your bladder at rest and as it fills. This can help with whether the sphincter is healthy
 or the muscles of the bladder are over or under active.

6. Cystoscopy-a fiberoptic scope is inserted through the urethra into the bladder to look around for
  tumors, stones, blockages in the lower urinary tract.

Treatment:  It Depends on the TYPE of incontinence and your other medical conditions.

Timed Voiding-going every 1-2 hours on schedule

Bladder Training-delaying urination by increasing lengths of time after you get the urge to go.

Double voiding -go, then wait and go again, to help you completely empty your bladder.

Fluid/Diet Management-lose weight, limit alcohol, caffeine, soda, acidic foods and fluid volume.

Physical Therapy- Pelvic floor exercises-done by a specially trained physical therapist to teach you the correct muscles to tighten and relax. They also use special biofeedback devices and gentle TENS units (electrical stimulation). You learn how to do the exercises at home and it takes months.

Medications:  
Anticholinergic medications-used for overactive bladder/urge incontinence. Lots of side effects but often very helpful

Topical estrogen-creams, rings, patch-improves the thinning out of the tissues and improves tone. Bonus:  It may Also help with pain with intercourse seen post menopausally. Again, side effects/adverse effects like blood clots. stroke, uterine lining cancer, etc. but very helpful in the right circumstances.

Duloxetine-an antidepressant sometimes used for stress incontinence

Imipramine-an old fashioned tricyclic antidepressant sometimes used for mixed incontinence but again-tons of side effects. Cardiac arrhythmias, dry mouth/eyes, feeling faint/lightheaded,
     constipation.  I have seen it used, mostly by urogynecologists.

Non-Surgical Treatments-
Pessary- is a rubbery knobby ring like device that is placed into the vagina to press on the urethra  to prevent leakage. It has to be cleaned regularly, and often, vaginal estrogen is used with it to  prevent irritation of the vaginal mucous membranes.

Photo credit:
 http://www.huntingtonwomenshealth.com/vaginal-pessary/


Collagen or other bulking injections-again done by urogynecologist, around the urethra, to bulk up the tissues and keep the urethra closed and leakage reduced. Generally has to be repeated, however.



Nerve stimulators- I've seen one, once. It's like a pacemaker for your bladder. It is attached to the sacral nerves which go to the bladder. It helps prevent overactive bladder.

Surgical Treatments:
 Sling procedure-a bit of synthetic tissue/mesh or your own body's tissue is used to make a sling to pull up the bladder neck and urethra if it's fallen down/prolapsed. This really helps most with
stress incontinence.

There are others, but a urogynecolgist or urologist are the best judges of which of these will work

Skin Care: 
Pads/Diapers/Undergarments-there are all different types out there now. Most important, realize that  menstrual pads are not designed to absorb urine. They may be cheaper, but they are not designed to absorb urine.
 There are smaller volume pads, larger volume pads, night time garments, etc. MOST important is to change them when they get wet to protect your skin. 
Use zinc oxide ointments/creams (Desitin, Boudreaux's Butt Paste, etc) to protect your delicate skin and prevent sores and ulcers from the urine. Keep your skin clean but be very gentle.

Don't get dehydrated to prevent urine leakage. It's tempting to just stop drinking fluids, so you don't leak.

Especially if you are on blood pressure medications, or are older, this is a bad idea and can cause dehydration and kidney failure. Talk to your doctor about how much fluid YOU should be taking in a day, as it's different depending on your medical conditions. 
    

I DON'T WANT ANYTHING THAT DIES OR WILTS OR REQUIRES DUSTING FOR MOTHER'S DAY

(I know this isn't medically oriented, but it sort of is, given Mother's Mental Health is involved.)




On the days leading up to Mother's Day, there is a lot of hype about what Mother needs and wants.

Don't drink the Kool-Aid of commercialism.

Most mothers do not want flowers, stuffed animals, figurines, or any other stuff that dies, wilts, drops leaves or requires dusting, maintenance or paying of the bill in the long run (cell phones).

Jewelry is fabulous if you like it, which I don't. 
I can't wear big flashy rings because I use gloves at work.

Necklaces just whack people in the face when I bend over and listen to their hearts.
 I have a nickel dermatitis so I can't wear most Earrings.
Bracelets are pain in the butt, literally. They get in the way when I write. They make noise. They're hard to wear when you're doing a breast or rectal exam. They get in the way when you're washing your hands. So for me, personally, jewelry is out.

Also, I do not want ice cream, cookies, cake, candy, teddy bears, flowers, or anything else that will make me fat, will die, or will require finding a place for. Or ballons. I saw about 5 mylar ballons floating up in the sky, away into heaven, today.


Perfume. Don't even go there. Doctors can't wear perfume. Why? Because we take care of people who could die from strong odors. Think asthma, emphysema, other terrible lung diseases. People who have allergies. People who would have sneezing fits and then pee in their pants. (See previous post. Yeah I know I still have to finish it.)
 I  have perfume that is from the late 1980s. Seriously. I never wear the stuff. Don't buy me perfume.

Now, I may be a little jaded here. I know, children are a gift from God and I'll miss them when they're gone but right now they're driving me bat shit crazy.

So here's what I want, and I'm going to go out on a limb here and guess that a whole bunch of other moms, want for Mother's Day.
(I even highlighed it so you don't have to take notes)


1.)  Pick up all your crap off the floor. Daily. And flush the toilet and wipe off the poop!

2.)   Change a light bulb now and then. I don't like living in a Bat Cave and I'm the only one that changes the damned lightbulbs

3.) I know this is impossible but I'd really love to have a girl Friday. Somebody to go through the mail, line up all my bills for me to pay, throw away the thousands of pounds of junk mail we get a week. To take my cleaning to the cleaners. To run all of my errands. To drop the kids off here and there.

4.)  Okay I know I'm going out on a REALLY long limb here, but how about a personal chef. Somebody to cook dinner. Every night. Right now we cook on the weekends and if we're lucky sometimes we cook during the week. I would love to have a personal chef make me lots and lots of nutritious meals with lots of vegetables that are complicated and time-consuming and taste just amazingly excellent and are perfectly portioned-a la Oprah.

5.) Massive de-crapification of my house.

There is stuff on every single surface of my house. When my children are done with something, instead of putting it away, they just leave it. I would like to go through the house and pretend that we are moving and get rid of stuff. Worse yet, I inherited some stuff from my parents who were hoarders. It was a lot of stuff that is kind of important and they never did anything with, photos and such. So far I have continued the tradition, leaving it in boxes and not doing anything with it.
Mostly because I know that it is going to require an enormous amount of effort to organize and put things away in a nice way. I don't want to get started if I am only going to leave it half done, which is my usual modus operandi when I start a project.

6.) I would love to have a personal trainer. Someone to kick my butt into action

7.)  While were at it, I'd also like to have a personal shopper. Yeah, it would be nice to get a makeover and the clothes, but really, I want someone else to shop for my kids clothes, and for groceries. 
And Don't talk to me about Peapod. They cost a bazillion dollars for itty bitty portions of stuff.

 In summary, all I really want for Mother's Day is order to be restored in my house, the dog not to smell like a kennel, the furniture fabreezed of dog odor, the crap picked up around my house and straightened, and the light bulbs to be changed. Is that too much to ask for? Happy Mother's Day

Rights of Passage and Peeing in Your Pants, Part I

Your "First" of stuff is important.


Your first steps.
Eating solid food.
Getting your period.
Your first kiss.
Your first baby.
Menopause.
Peeing in your pants when you run across the street to catch the bus.

Most of these are rights of passage, like winter turning into Spring (finally).

 Peeing in your pants...is NOT.
 
Run, squirt. 
Jump, squirt. 
Cough, squirt. 
Sneeze, squirt. 
Key in the doorknob urgency to go. Stopping every hour on a car trip to go. Carrying extra underwear and pants with you at all times, just "in case."



Women of a certain age know what I'm talking about. It's a shock when it happens to you that first time. When it becomes a more regular event you consider wearing pads and you go to THAT aisle at the grocery store.

I don't know about you, but I was shocked when I perused the aisles and realized how many different products there are now for incontinence of urine. I shouldn't be surprised. We do have a ballooning population of baby boomers.

In the past, women hid in shame and expected it was normal. Doctors didn't ask, and women didn't volunteer the information.

There are many causes of incontinence.
There is something that can be done for most causes of urinary incontinence.
You don't have to be like this Buddha, hiding away.

So why do women develop incontinence and men don't until they have prostate problems? Well it's not all that straightforward but to start with, the urethra, a little tube that leads from your bladder to the outside is very short in women. If you think about it, the urethra in men is very long. It goes from the bladder all the way through the penis to the outside of the body. Lots of room to prevent incontinence. But  men DO develop incontinence.


Wouldn't it be nice, ladies, to just be able to drop trou and pee anywhere, like guys, and dogs?






The muscles in the pelvic floor have to hold up against the gravity and weight of all of the abdominal and pelvic organs pressing down through the hole in the bottom of the pelvic bone. (see below-there is a big hole in the bottom of the pelvis and "stuff" can fall out)

Carrying babies, pushing out babies, getting fat and getting older stretches the muscles out and the organs push down through the hole. Sometimes, they prolapse or evert (the vagina or the rectum can start turning inside out and push out).

Women have three holes, if you will, in the pelvic floor. The Urethra, the vagina, and the rectum. Three places where things can fall down through. Vaginal and bladder prolapse are often associated with incontinence. Prolapse is just a fancy word for things kind of turning inside out and falling out. Also another cause is the ligaments that hold the bladder up tearing or stretching out of place.

Credit:  http://www.myhealthypelvis.com/pelvic-prolapse/


I blame my children. It's all their fault.

Next Blog Post, More about Incontinence. Types, Treatment, and (gasp) physical therapy for the pelvic floor.

Have you Dyed Your Easter Feet Yet?

Feet.



Feet are like poop. 


Some people are completely disgusted by feet (and poop), and others are fascinated by them. There seems to be no in-between.

Why am I writing about feet, you ask?

First, I've already written about poop. (Still one of my favorite columns, if I do say so myself).

Second, a fellow Wood Badge participant (Boy Scouts) was lamenting not having worn arch supports or of taking good care of her feet during her mis-spent youth (not really mis-spent. I just like how literary that sounded. Actually, she's an upright citizen and a great person)



Third, I recently purchased sneakers for my kids and it was almost impossible to find shoes to fit either kid properly, and it WAS impossible to find shoes for myself.


Whether you call them Tennis shoes, Tennies, Runners, Running shoes, Sneakers, Athletic shoes, gym shoes, it depends upon what part of the country you're from.  No matter what you call them, they need to be supportive and prevent injury from the ways we torture our feet.

I USED to have AAA feet-super narrow, size 10 feet. 
Then, I had kids.
Now I have high arches, bunions, and wide toe box type of feet.

My daughter has Peruvian feet. Wide, flat, but in a larger size than most woman of Peruvian descent. Women's sneakers do not fit her.

My son has In-toeing, narrower feet and wears out the inside of the heels of his shoes as a result. 

We all need good shoes.

I need men's sneakers because they are wider in the toe box to contain the destruction wrought by carrying two children and the subsequent weight gain.

I never wore heels. Not because I'm tall, (I am, but that is not why). I never wore them because they HURT. 

Heels are a form of torture brought about by a male centric society that values people of height, and women in heels. Both. 

(I'd better stop now or I'll go on and on in some long-winded rant about how society needs to be changed one heel at a time, in order to equalize the world for women all over. )


So, here's the thing. I spend more money on my kid's foot gear than I do on clothes. Or food. Or hair styling products.

 I shop at Tar-jay or goodwill for bargains on clothes that they will outgrow in 3 months. 

It may be a throwback to my grandmother's depression era rant about how her feet were ruined by having to wear hand-me-down shoes, but mostly I think it's because I look at the ravages of time on feet ALL DAY LONG.  I would rather spend money to prevent curled up hammertoes and bunioned feet than to have my kids in stylish but useless foot gear.

I do NOT get grossed out by anything anymore. 

People apologize ALL THE TIME for not having gotten a pedicure before their appointment.

GUESS WHAT? I DON'T CARE!! In fact, I'd rather you didn't. I need to look at the nails, the cuticles, the nailbeds, the fungus between your toes, your calluses and bunions. It's what I do. 

BUT--I beg of you, please buy good fitting foot gear for yourself and your kids. I WILL look at that. I might even comment--For example:

 "Those shoes are shot. You need wider shoes with better arch supports, less flexibility and better cushioning. And if you wear them every day, you need to replace them every six months." 

I know of what I ask.

It is nigh to impossible these days to find sneakers that actually are supportive. I was at an unnamed athletic shoe store and it's sister store in a nearby mall recently. Most of the sneakers had no cushioning in them. They had a few that were supportive with excellent insoles and arches. It was maddening trying to find a pair that were in my or my kids sizes.

After I shelled out a small fortune to get my two kids some decent sneakers, they both commented on how much better the ones I chose felt than the ones they had chosen.

They were, however, lacking that "cool" factor. They weren't fluorescent orange and green, with undulating springing soles that had built in music systems and disco balls. 

But their feet won't be gross in forty years. I hope. 

Okay, go get a piece of brown paper, like a paper bag, and put it on the floor. Wet the bottoms of your feet, and stand on the paper. What do you see?  Do you see a practically full footprint with minimal or no curve where the arch should be? Then you have flat feet, and possibly pronation-or in-rolling  of your ankle joint. THAT causes all kinds of problems, like ankle pain, plantar fasciitis, knee, hip and low back pain. When your ankles roll in or pronate because of flat feet, it causes malalignment of your whole leg, hip and back, wear and tear of the joints and arthritis. Ugh.

Do you have a narrow imprint of the outside of your foot and nothing on the inside of the arch? You have HIGH arches.

Walking shoes are stiffer, running shoes are more flexible, but dress shoes also need to be stiff. Pick up your shoe and hold the heel and the toe box and twist them in opposite directions. Do they twist easily? Then they are flexible. Not great for American feet. Is it challenging to twist them? They are better.

There should be a thumb's width of room between the end of your shoe and your great toe. The shoes should not pinch anywhere, and the heel should not slip off. The old rule of breaking in shoes is defunct. They should fit right out of the box.

Go get fitted in a store where a knowledgeable shoe salesperson works. Remember that the shoe size may not be the same between brands, or even shoes of the same brand. Make sure they're comfortable and they fit properly, no matter the number on the box.

Here is my contribution to EASTER FEET!
Feet:  Dipped in water and food coloring for that special FESTIVE EASTER feet Look.
Decorated by:  Daughter and her Bestie, and Moi.
I especially would like you to take notice of the Easter Walrus. Daughter says that the Easter Bunny is retiring and The Easter Walrus is taking over.

And here is my Long Suffering Esther in her Easter Ears.