When feet need a fat grafting

Q: I am young, 5 feet 6 inches tall, weigh 129 pounds, and don’t have diabetes. But because of unlucky genes, I have severe atrophy of the plantar fat pads on my feet. You can see the bones of my feet pressing against my skin. Podiatrists tell me there’s no treatment other than custom orthotics and shoes. They’re not working. I have read about injecting fat and using “GraftJackets.” Do they work?

— Grace, San Diego

A: There’s a lot of interest in fat grafting these days because the aging population is facing a serious fat-vanishing act. Not from our waists (if only!). From our faces and, oddly, the balls of our feet, where fat acts as a shock absorber.

Fat grafting sounds like a neat solution to your problem: Your doc takes fat from elsewhere on your body and grafts it onto your feet. With a little help from a kind of biologic scaffolding called GraftJacket, your body builds new tissue to replace the missing fat. GraftJacket helps heal diabetic foot ulcers and injured tendons, but it hasn’t been widely used for your problem.

Some docs are trying a less-complicated procedure: injecting silicone, collagen or other “fillers” into feet — yes, the same stuff that’s used to plump up wrinkles in faces. It’s expensive and must be repeated often. Still, combined with custom orthotics, it might ease your pain and get you back on your feet. Meanwhile, swim to get your cardio up, and do resistance exercises to build your strength. You can stay fit without being on your feet.
Q: A 67-year-old friend has allergies, asthma and COPD. Should he take N-acetyl cysteine, and if so, how much?

— Michael, via email

A: Dr. Mike prescribes about 1,200 mg a day of N-acetyl cysteine to many of his patients with chronic obstructive pulmonary disease, a lung condition that steals your breath. It’s made up of chronic bronchitis, emphysema or both — usually given a nasty nudge from smoking.

Your body uses NAC to make glutathione, a major antioxidant that helps prevent lung damage and gives your immune system a healthy goose. While the evidence on NAC isn’t clear-cut, several studies show that taking 400 to 1,200 mg daily for three to six months reduces bronchitis attacks in people with COPD. We YOU Docs also think that NAC reduces inflammation.

Even though NAC appears to have no side effects, your friend should talk to his doctor before taking it, and should get his levels of inflammation-quelling vitamin D-3 tested, too. If it’s low, D-3 supplements are also in order.

Q: I get knots just above my left shoulder blade. Massage helps, but now my left arm tingles 80 percent of the time. Often my hand does, too. What’s going on?

— Marliss, Waukesha, Wis.

A: We can’t tell for sure from here, but tingling suggests nerve involvement, and that could stem from just about anything — a neck injury, back trouble, a pinched nerve, an injured muscle pushing against a nerve, lousy posture, even a tumor (don’t panic; odds are, that’s not it).

You also could have something called thoracic outlet syndrome, which occurs when tight muscles, fibrous tissue or bone abnormalities press on the nerves and blood vessels that pass through your collarbone or upper ribs to your arms. TOS often is seen in people who stock shelves or work at keyboards or on assembly lines.

With TOS, there’s pain and tingling in your neck and shoulder and numbness down your arm. Your grip may be weak.

While we heartily endorse massage, the next appointment you need is with a doctor who will do diagnostic tests and recommend treatment. If it is TOS, your doc probably will send you for physical therapy; if that doesn’t work, surgery may be needed.

The YOU Docs, Mehmet Oz and Mike Roizen, are authors of “YOU: On a Diet.” Want more? See “The Dr. Oz Show” on TV. To submit questions, go to www.RealAge.com.

SF Examiner
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