Jun
17

Walk with a Doc

National Program Comes to NEPA by way of GCSOM

Special Feature “ Health & Exercise Forum” with Geisinger Commonwealth School of Medicine the 3rd Monday of every month!

Cecelia Strauch, MD2

Cecelia Strauch, MD2 of Factoryville is a member of GCSOM’s MD Class of 2021. She is a member of GCSOM’s Family Medicine Interest Group (FMIG), and served as co-president in 2017-18.  She attended Lackawanna Trail High School in Factoryville, and received her undergraduate education at the University of Scranton from which she graduated with majors in biology and philosophy and a minor in Spanish Language.

Geisinger Commonwealth School of Medicine (GCSOM) is teaming up with The Wright Center for Community Health to encourage Scranton residents to take a step toward better health with Walk with a Future Doc, a health program that brings medical students, doctors and patients together to walk every fourth Saturday monthly at 9 a.m. at one of two partner sites: Lackawanna River Heritage Trail at West Olive Street or Backcourt Hoops at 5 West Olive Plaza.

The initiative is led by GCSOM medical student, Cecelia Strauch of Factoryville, a member of the Class of 2021.

Walk with a Doc is a national nonprofit organization whose mission is to encourage healthy physical activity in people of all ages and reverse the consequences of a sedentary lifestyle in order to improve the health and well-being of the country.

“This program has had tremendous participation and success in hundreds of cities around the country,” said Jennifer Joyce, MD, professor of family medicine at GCSOM. “I’m very pleased to bring this exciting and simple program to Scranton because it has shown such improved health results for countless people around the country.”

The walk is open to the community and each walk will feature a short educational talk about a health topic of interest to participants. Participation is free and pre-registration is not required. Walkers will enjoy a refreshing and rejuvenating walk with medical students and healthcare professionals from GCSOM and The Wright Center for Community Health, who will provide support to participants and answer questions during the walk.

“Walk with a Doc is honored to team up with the Geisinger Commonwealth School of Medicine. By incorporating this program into the practice, GCSOM is demonstrating an exceptional level of care and commitment to their community,” said Dr. David Sabgir, founder of Walk with a Doc.

Scranton joins a growing list of communities nationwide that have started local Walk with a Doc (WWAD) programs. WWAD was created by Dr. David Sabgir, a cardiologist with Mount Carmel Health Systems in Columbus, Ohio.  He has walked with patients and community members every weekend since 2005.

Learn more about Walk with a Doc at www.walkwithadoc.org.

Benefits of Walking

“There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.”

According to the American Heart Association, walking as little as 30 minutes a day can provide the following benefits:

  • Improve blood pressure and blood sugar levels
  • Help maintain a healthy body weight and lower the risk of obesity
  • Enhance mental well-being
  • Reduce the risk of osteoporosis

Use Efficient Technique

Proper walking technique

Like everything, there is a right way of doing something, even walking. For efficiency and safety, walking with proper stride is important. A fitness stride requires good posture and purposeful movements. Ideally, here’s how you’ll look when you’re walking:

  • Head up, look forward – glance at the ground but don’t stare down.
  • Relax your neck, shoulders and back – avoid a rigid upright posture.
  • Swing your arms freely with a slight bend in your elbows.
  • Keep your stomach muscles are slightly tightened (work the core) with a straight back.
  • Walking smoothly – rolling your foot from heel to toe.

Plan Ahead

  • Gear Up – but don’t go overboard. Good running shoes with proper arch support and shock absorption. Wear weather appropriate dry tech clothing with bright, reflective visible colors.
  • Select the Best Path – begin on level surfaces like a “rails to trails.” In inclement weather consider walking in a shopping mall.
  • Warm up. Walk slowly for five to 10 minutes to warm up your muscles and prepare your body for exercise.
  • Cool down. At the end of your walk, walk slowly for five to 10 minutes to help your muscles cool down.
  • Stretch. After you cool down, gently stretch your muscles. If you want to stretch before you walk, remember to warm up first.

Set Realistic Goals

Anything is better than nothing! However, for most healthy adults, the Department of Health and Human Services recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, or an equivalent combination of moderate and vigorous aerobic activity. The guidelines suggest that you spread out this exercise during the course of a week. Also aim to do strength training exercises of all major muscle groups at least two times a week.

As a general goal, aim for at least 30 minutes of physical activity a day. If you can’t set aside that much time, try several short sessions of activity throughout the day. Even small amounts of physical activity are helpful, and accumulated activity throughout the day adds up to provide health benefit.

Remember it’s OK to start slowly — especially if you haven’t been exercising regularly. You might start with five minutes a day the first week, and then increase your time by five minutes each week until you reach at least 30 minutes.

For even more health benefits, aim for at least 60 minutes of physical activity most days of the week.

Track Your Progress

Keeping a record of how many steps you take, the distance you walk and how long it takes can help you see where you started from and serve as a source of inspiration. Record these numbers in a walking journal or log them in a spreadsheet or a physical activity app. Another option is to use an electronic device such as a pedometer or fitness tracker to calculate steps and distance

Source: Mayo Clinic

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Jun
10

Preventing Softball Pitching Injuries

Dr. Mackarey's Health & Exercise Forum

High school softball season is over; however, many young women will continue their sport throughout the summer. Unfortunately, female athletes are often forgotten when it comes to injury prevention. It is the purpose of this column to raise the level of awareness regarding prevention of pitching injuries in softball.

Pitching injuries in softball are very similar to the pitching injuries in baseball.  Bursitis, rotator cuff injury, impingement syndrome, little league shoulder, little league elbow are all common to the softball player/pitcher.  Sherry Werner, Coordinator of the Human Performance Laboratory at the Tulane Institute of Sports Medicine, says that 80 percent of college softball pitchers miss some playing time because of arm pain.  Equally startling is that the same problems exist for players in the 12 – 18 age groups.  The focus of this article is preventing arm injuries in the softball pitches.

Gerald Warner, a Colorado pitching coach, identified 10 injury-causing softball pitching problems:

  1. Overuse – As with baseball pitching, the most common cause of injury in softball pitching is overuse.  While there presently is no sanctioned pitch count in softball, one must be careful that a pitcher does not throw too many pitches and has adequate recovery between games.  It has been suggested that 12 year olds throw no more than 60 pitches, 13-18 year olds no more than 60 pitches and no more than 100 pitches for athletes 15 years old and over. 
  2. Inadequate warm-up – Muscles must be warmed up and stretched prior to demands of pitching.  Jogging for 3-5 minutes followed by a stretching program (never stretch a cold muscle) is essential before the first underhand pitch.
  3. Bending at the waist – Young pitchers have a tendency to bend at the waist during the final portion of their pitching motion.  At the time of release, bending forward causes a slower pitch and often can lead to back injuries. 
  4. “Snapping” the release – Some young players get into the habit of stopping their arm motion as soon as the ball leaves their hand which is known as “snapping the release”  Continued snapping the release rather than a controlled follow through may result in elbow and forearm injuries.  
  5. “Chicken-winging” – “Chicken-winging” is when a pitcher’s elbow flies out during the pitching motion.  This is not a natural part of a pitch release or follow-through which can lead to elbow and shoulder problems.  The pitcher should try to keep the elbow close to their side at the release to avoid undo stress.
  6. Practicing breaking pitches before you are ready – As with baseball, breaking pitches place undue demand on developing skeletons.  Although they may have the knowledge and ability to throw breaking pitches, they do not have the bone structure to weather the stress.  Growth plates are at risk and future pitching in advanced leagues may be compromised due to permanent shoulder injury.
  7. Pitching from the “Open” position –   Some pitchers are taught to “keep your body open (sideways to the catcher) when you release the ball”.  Unfortunately, many who are taught with this method develop a problem of bending at the waist during the final downswing and through the release of the pitch.  This additional torque can put severe pressure on the pitcher’s back. 
  8. Improper landing of the stride foot – Since the majority of female fastpitch pitchers use the “leap and drag” style of pitching, it is important that the stride leg drives out fast and far.  Ideally, the knee will be slightly bent at landing and the stride foot will land at an angle of between 20 and 30 degrees.  If the pitcher’s foot is pointing more directly toward the catcher, it can cause the bent knee to “buckle” and lead to injury.  If the foot lands at more of an angle, more than 45 degrees, it is too far sideways, and the “blocking” or pushback against the landing foot can cause an ankle, calf, and/or knee problem.
  9. “Jerking” the shoulders or head back at the release of the pitch – Although rare, some pitcher can develop a body “jerk” as they whip their arm down through the release point.  Although this “arm whip” is essential for maximizing the speed of the pitch, it should not involve any snapping of the upper back, neck, or head which may result in injury.
  10.  Not pitching like a girl – Many young female athletes are taught fastpitch basics from male instructors.  Unfortunately, there is a tendency by many male instructors to tell girl softball pitchers to “do it the way I do it” regardless of the girl’s age, size, physical and emotional development, athletic ability, etc. All pitches need to be adjusted to the abilities, needs and comfort-level of the pitcher.

CONTRIBUTOR: GARY E. MATTINGLY, PT, PhD, Professor Emeritus, University of Scranton, Dept. of Physical Therapy

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

May
06

Studies Show That Sitting Time in USA Rises and That Sitting is Unhealthy!

Dr. Mackarey's Health & Exercise Forum

Get Off Your Butt!

A recent study published in the Journal of the American Medical Association (JAMA) found that the average daily sitting time in the USA has increased by almost an hour over the past decade. This translates to approximately 8 hours of sitting for teenagers and 6 ½ hours for adults in this country. The study found that more than 50% of kids and adults spend more than one hour of LEISURE time per day on a computer. Surprisingly, the greatest increase in sitting time was found among the “oldest” adults. These findings are particularly concerning when one considers the many other studies that have demonstrated the risks of prolonged sitting.

Research has repeatedly correlated the amount of sitting time per day to health problems. In fact, one study found a relationship between the amount of time an individual watches television to a decrease in their average life expectancy. Seriously, watching television and sitting is literally killing us. The Heart and Diabetes Institute of Australia conducted extensive research on sedentary behavior, including a review of almost one million people. They used actuary science, adjusted for smoking, waist circumference, and diet and exercise habits to assess the specific effects that the hours of sitting in a day impacts a person’s life span.  They found that sitting too long results in a decrease in muscle contraction of the big leg muscles and because these unused muscles need less fuel, more unused glucose (fuel) is stored in the muscle. High glucose levels result in high blood sugar, which leads to adult onset diabetes and other health issues.

How Sitting (TV Viewing) Impacts Life Span – as compared to non-viewers

One Hour Sitting (TV) after age 25 =   Decrease Life Span by 21.8 Minutes

One Cigarette Smoked after age 25 =   Decrease Life Span by 11 Minutes

Six Hours Sitting (TV) over lifetime = Decrease Life Span by 4.8 Years

It is very important to note that exercise alone was NOT the solution. Even people who exercise 30 minutes 3-4 days per week or more, but watch more than six hours of TV, have the same mortality as a non exerciser who does NOT watch TV.

But, if you watch TV AND sit in a chair all day at work in a sedentary occupation, YOUR LONGEVITY IS SHORTENED DRAMATICALLY!

The average adult spends 50 – 70% of their non-sleeping life time sitting. Those with greater sedentary behavior (TV + Sitting Time), have 112% increase risk for adult onset diabetes, 147% increase for cardiovascular disease, 49% increase risk for premature death…even with regular exercise.

Tips to Get Off Your Butt

Exercise

Exercise is still very important, but you still must sit less and be active in between exercise time.

Limit TV Time

Make a conscious effort to watch less than 2 hours of TV per day. Join the lower risk group.

Get Off Your Butt While Watching TV

When you watch TV, get up and move during every commercial…stand, walk, march in place.

Get Off Your Butt At Office

Every 30 minutes get up and stretch, march in place, or walk for 3-5 minutes. Take the stairs instead of the elevator. Stand up during coffee breaks or when you‘re on the phone. Consider having meetings in which you stand up, use a standing desk or a work station which allows you to walk slowly on a treadmill while you’re working such as a TrekDesk.R (www.trekdesk.com).  

In conclusion, don’t kid yourself. Exercise alone will not result in improved longevity if we eat poorly and sit around watching TV the rest of the time. It is about BALANCE…exercise, diet, stress management, and living an active lifestyle with more activity than inactivity. Shut off the TV and get off your butt!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

Paul J. Mackarey, PT, DHSc, OCS is doctor of health science specializing in orthopedic and sports physical therapy. He practices in downtown Scranton and is an associate professor of clinical medicine at GCSOM.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Apr
29

Avoid Spring Baseball Shoulder Pain

Dr. Mackarey's Health & Exercise Forum

It happens every spring. A young pitching ace that started strong is now beginning to lose some speed on his fast ball. A third baseman that had no problems last week can’t throw to first base without pain. Shoulder pain in young baseball players occurs every spring just as the first robin, warmer temperatures, and the emerging sprouts of the spring flowers. And, the well-intended father/coach develops severe shoulder pain from hours of throwing balls at batting practice. The cause of the condition was the usual: not properly preparing the arm for the season.
Spring shoulder pain may be prevented with the proper preparation for the season. Throwing a baseball requires the shoulder to be very strong. In the off season, a shoulder can lose much of its essential strength. This loss will result in a deconditioned shoulder at the start of the first spring practice. Practicing with a deconditioned shoulder commonly results in sprain, strain and pain.
To avoid spring shoulder pain it is necessary to maintain shoulder strength. Strengthening exercises need to concentrate on three groups of muscles: the large power muscles of the shoulder, the muscles which stabilize the shoulder and the all important rotator cuff muscles. Strengthening power muscles of the shoulder is fairly easy. Pushups, lat pulldowns, bench presses, and bicep curls will cover all bases. While these exercises are important in maintaining strength and power of the throwing shoulder, they are not as important as the exercises for shoulder stabilizers and rotator cuff muscles.

The shoulder stabilizer muscles connect the arm to the torso. They serve as the foundation of the arm helping to stabilize the arm to the torso. The many stabilizing muscles include the trapezius and the rhomboid muscles.

Exercise for theses muscles include: shrugs, T’s and Y’s. (See Photos A, B, C)


PHOTO A: SHRUGS: Stand with Dumbbell Weight in Hands, Raise Shoulders, Hold 3 Seconds and Repeat 10 times.
PHOTO B: “T’s”: Lying Face Down with Forehead on Towel Roll and With Light Dumbbell Weight in Hands, Raise Arms up in the shape of a “T.”
PHOTO C: “Y’s”: ”: Lying Face Down with Forehead on Towel Roll and With Light Dumbbell Weight in Hands, Raise Arms up in the shape of a “Y.”

The rotator cuff muscles have many functions. They are essential for the stability and proper function of the shoulder joint and in the throwing athlete they serve as brakes during the follow-through phase of a pitch. Exercises for the rotator cuff muscles include internal and external rotations. (See Photos D, E)

PHOTO D: Shoulder Internal Rotation: Stand with Exercise Band in the Throwing Hand and Elbow at the Side and Bent at 90 degrees, “Turn In – Against the Band.”

PHOTO E: Shoulder External Rotation: Stand with Exercise Band in the Throwing Hand and Elbow at the Side and Bent at 90 degrees, “Turn Out – Against the Band.”

While exercise is essential for conditioning the shoulder in the off-season, a graduated throwing program is also important. In the book The Athlete’s Shoulder, a throwing program is suggested. Training is every other day with a day’s rest in between. A ten minute warmup such as light jogging is suggested before throwing.
Day 1: 45ft – 25 throws – rest – repeat
Day 3: 45ft – 25 throws – rest – repeat – rest – repeat
Day 5: 65ft – 25 throws – rest – repeat
Day 7: 65ft – 25 throws – rest – repeat – rest – repeat
Day 9: 90ft – 25 throws – rest – repeat
Day 11: 90ft – 25 throws – rest – repeat – rest – repeat
Day 13: 120ft – 25 throws – rest – repeat
Day 15: 120ft – 25 throws – rest – repeat – rest – repeat
Day 17: 150ft – 25 throws – rest – repeat
Day 19: 150ft – 25 throws – rest – repeat – rest – repeat
Day 21: 65ft – 25 throws – rest – repeat
Day 23: 65ft – 25 throws – rest – repeat – rest – repeat

With the proper preparation, spring shoulder pain can be avoided in any baseball player.

Contributions: Gary E. Mattingly, PT, PhD is a retired professor at the University of Scranton, Dept of Physical Therapy
Models: Ron Chiavacci,, former professional baseball pitcher; Maggie Reilly, physical therapy student.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Apr
22

Vaccines and Children: What Every Parent Should Know, Part 3

Part 3 of 3

(Read Part 1 or Part 2)

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

Guest Author: Timothy D. Welby, MD – board certified pediatrician at Pediatrics of NEPA and associate professor of pediatrics at GCSOM.

Dr. Timothy Welby
Dr. Timothy Welby

For centuries, millions of adults and children died around the world of illnesses that are now preventable with vaccinations. In fact, just a generation ago, most Americans knew a family who lost a child to measles or pertussis (whooping cough). Those of that era also knew someone who had been paralyzed for life by childhood polio. But, thanks to modern medicine and science, this is no longer a common occurrence or fear. For example, in 2000, measles was eliminated in the United States, according to the Centers for Disease Control (CDC). However, since 2000, outbreaks of these preventable diseases have reoccurred. In 2015, almost 200 cases of measles were reported at an amusement park in California. Last year, 18 cases were reported in New York in the Orthodox Jewish Communities and this year the count rises again. What do all these outbreaks have in common? Unvaccinated children!

The purpose of this column over the next few weeks is to discuss the prevention of common childhood diseases using vaccinations and to review potential side effects, both real and imagined.

Vaccination Side Effects

Despite the overwhelming scientific evidence that childhood immunizations are safe and effective to protect children and adults from serious and potentially fatal diseases, many parents remain skeptical and reluctant to get their children immunized. As with any medication given to millions of patients annually, side effects do occur, however, most are mild and self limiting. Side effects include; redness, swelling or pain at the injection site (usually in the front of the thigh in children and the outer upper arm in adults and children over one). These symptoms are uncomfortable but not dangerous. Mild fever is also common after a vaccine or when multiple vaccines are given together and should be treated with ibuprofen (Motrin, Advil) for children over 6 months old or acetaminophen (Tylenol) for any age child. Fever, especially in a very young child, may not be a side effect to a vaccine but a sign of infection. High fever or lethargy in an infant or child should always prompt a call to the doctor.

Rarely a child can get an infection at the site of a vaccination. It can look similar to a mild reaction but tends to occur a few days after the injection, not immediately following. Also, some children can get a very high fever after vaccination, more likely after the Measles, Mumps, Rubella (MMR) or Measles, Mumps, Rubella, Varicella (MMRV) vaccines which can lead to fever seizures with illness unrelated to the immunization. Measles and chickenpox vaccine can also cause a rash 10 -14 days after immunization, which is harmless but alarming to parents if they are not expecting it.

Measles vaccine may also cause immune thrombocytopenic purpura, a frightening-sounding reaction that occurs when a child’s blood clotting system is affected by the immune system. The condition causes a rash and possible blood clotting problems which can be treated with medication but usually resolves on its own. Rotavirus vaccine, the only oral vaccine routinely given to children, may cause swelling of lymphoid tissue in the intestine called intussusception. It causes a bowel blockage and vomiting and requires urgent medical attention. Fortunately, this reaction is so rare that medical scientists are not sure if it is any more frequent in vaccinated babies as in those unvaccinated. However, what is clear is that prior to routine vaccination against rotavirus, about 60,000 children in the U.S. were hospitalized and 20-60 died each year due to the illness.  The most severe reaction to a vaccine is called anaphylaxis. It is a potentially deadly allergic reaction which occur less than one for every million doses administered. However, due to the life-threatening potential of this reaction, immunizations for children should only be administered in a setting fully equipped to handle this emergency.

Some patients with special needs, such as those with illnesses and immune problems, may not be able to receive certain vaccinations. This is not a complete list of reactions to vaccinations. Always ask your physician any questions you have before your child gets their immunizations.

MMR Vaccine and Autism Controversy

Some parents are hesitant to get their children immunized because they have unfounded fears about vaccine side effects. The biggest recent concerns surround the MMR vaccine and Autism, which arose after a small study linking MMR vaccine and Autism was published in England. The article was discredited and retracted by the journal that printed it. Unfortunately, fear remains despite the fact that there is overwhelming data proving that no connection exists.

Some parents also worry about the effect of multiple vaccines given together might “overwhelm” a young child’s immune system and lead to problems later in life. However, many studies have shown that children with a significant amount of exposures have better immune systems. For example, children who grow up on a farm with a vast number of exposures have better immune systems than their cousins growing up in a city. Ask your family physician or pediatrician … only a phone call away!

In conclusion, the research clearly supports the fact that your child and your community will be far healthier and safer from receiving their vaccinations and the low risk of side-effects and reactions far outweigh the risk of living without vaccination.

For More Information:  Center for Disease Control; The American Academy of Pediatrics; the American Academy of Family Physicians

Source: NEPA Vital Signs – The Journal of the Lackawanna County Medical Society

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Apr
15

Vaccines and Children: What Every Parent Should Know, Part 2

Part 2 of 3

(Read Part 1)

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

Guest Author: Timothy D. Welby, MD – board certified pediatrician at Pediatrics of NEPA and associate professor of pediatrics at GCSOM.

Dr. Timothy Welby
Dr. Timothy Welby

For centuries, millions of adults and children died around the world of illnesses that are now preventable with vaccinations. In fact, just a generation ago, most Americans knew a family who lost a child to measles or pertussis (whooping cough). Those of that era also knew someone who had been paralyzed for life by childhood polio. But, thanks to modern medicine and science, this is no longer a common occurrence or fear. For example, in 2000, measles was eliminated in the United States, according to the Centers for Disease Control (CDC). However, since 2000, outbreaks of these preventable diseases have reoccurred. In 2015, almost 200 cases of measles were reported at an amusement park in California. Last year, 18 cases were reported in New York in the Orthodox Jewish Communities and this year the count rises again. What do all these outbreaks have in common? Unvaccinated children!

The purpose of this column over the next few weeks is to discuss the prevention of common childhood diseases using vaccinations and to review potential side effects, both real and imagined.

Preventable Childhood Diseases

While this column is not intended to present all of the diseases that childhood vaccines can prevent, it is imperative to discuss those which are most prevalent and important.

Measles

Measles virus infection causes high fever (as high as 105 degrees), cough, red eyes and a classic rash. It is highly contagious. One in every thousand people who contract measles will get encephalitis, a dangerous inflammation of the brain, which often causes lifelong damage. One or two in every thousand people with measles will die from respiratory or neurological complications. Prior to the measles vaccination in the United States in the early 1960’s, millions of children got measles annually and about 500 children died every year in this country alone. Even today, in countries too poor to afford vaccines, or with an underdeveloped medical care system, 115,000 children die each year of the measles. While measles has been eradicated in the United States due to vaccination, outbreaks still occur when measles is brought back to the states by travelers coming home or by people who caught measles in their home country and travel to the U.S. These outbreaks can spread quickly and become very deadly in areas where immunization rates are low.

Rubella Virus or German Measles

Rubella Virus, or German Measles, is also highly contagious but usually causes a milder illness with fever, sore throat and a rash. However, its true danger is to infants in the womb. If a pregnant woman gets Rubella, the infant can die in the womb or shortly after birth. The infant is also at risk for congenital rubella syndrome, which can cause deafness, heart and brain defects and glaucoma. There is no cure for congenital rubella syndrome and before routine vaccinations for it in 1969, outbreaks were common. In 1964-1965, for example, an estimated 12 million people got rubella. 11,000 women lost babies in utero, 2,100 died at birth, and 20,000 were born with congenital rubella syndrome. Currently, about 10 people get rubella yearly in the U.S. and all of these cases were contracted outside the country.   

Hepatitis B Virus and Human Papillomavirus (HPV)

Hepatitis B Virus and Human Papillomavirus (HPV) are unique among vaccine-preventable illnesses because they are a major cause of cancer in adults. Every year approximately 17,500 women and 9,300 men in the U.S. get diagnosed with cancers caused by HPV, and the most well known of these is cervical cancer in women and throat cancer in both men and women. It is well established that the current HPV vaccine used in adolescent girls and boys will prevent 90% of these cancers.

Hepatitis B virus causes infection of the liver. Symptoms of acute infection include vomiting, diarrhea and jaundice (yellow coloring of the skin). Some patients, children and adults, who get infected, progress to chronic hepatitis B infection which lasts for years and eventually can cause cirrhosis and liver cancer. 1800 deaths annually are directly related to this condition.

Influenza (Flu Virus)

Influenza or Flu Virus is an annually occurring illness that sweeps across the globe during the midwinter months in each hemisphere. Because the virus mutates (changes) every year and the vaccination only provides immunity for about 6 months, immunity against the flu must be repeated every year. Influenza virus causes fever, cough, headache, muscle aches and fatigue. It sometimes causes vomiting and diarrhea, more often in children than in adults. Unfortunately, antiviral medications used to combat the flu are not very effective, especially in young children, elderly and those at risk of getting seriously ill from the flu. Every year, about 100 children and thousands of adults die from the flu in the U.S.

Source: NEPA Vital Signs – The Journal of the Lackawanna County Medical Society

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Read Part 3 on “Vaccinations”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Apr
08

Vaccines and Children: What Every Parent Should Know, Part 1

Part 1 of 3

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

Guest Author: Timothy D. Welby, MD – board certified pediatrician at Pediatrics of NEPA and associate professor of pediatrics at GCSOM.

Timothy Welby, M.D.

For centuries, millions of adults and children died around the world of illnesses that are now preventable with vaccinations. In fact, just a generation ago, most Americans knew a family who lost a child to measles or pertussis (whooping cough). Those of that era also knew someone who had been paralyzed for life by childhood polio. But, thanks to modern medicine and science, this is no longer a common occurrence or fear. For example, in 2000, measles was eliminated in the United States, according to the Centers for Disease Control (CDC). However, since 2000, outbreaks of these preventable diseases have reoccurred. In 2014, almost 400 cases of measles were reported in an Amish community in Ohio. In 2015, almost 200 cases of measles were reported at an amusement park in California. Last year, 18 cases were reported in New York in the Orthodox Jewish Communities and this year the count rises again. What do all these outbreaks have in common? Unvaccinated children!

The purpose of this column over the next few weeks is to discuss the prevention of common childhood diseases using vaccinations and to review potential side effects, both real and imagined.

What is a Vaccine?

Vaccines are pharmaceutical products developed through a vigorous scientific research process over many years. These products are designed to “trick” a patient’s immune system into producing immunity against a particular serious illness, usually caused by a bacteria or virus. When a child becomes infected with an illness naturally, the child becomes sick and their immune system recognizes the bacteria or virus as a foreign invader and mounts a response comprised of antibodies and white blood cells in their bloodstream. These antibodies hopefully defeat the illness and the child recovers. In the process, the immune system remembers the particular invader and the next time the child is exposed it will resist it more effectively. A child’s immune system is particularly good at developing memory antibodies to fight infection compared to an adult, however, it cannot do so if it does not get an opportunity. Unfortunately, some of the infections are serious and deadly, especially to infants and children whose nervous systems, hearts and lungs may not be developed enough to survive the infection.  

A particular vaccine consists of multiple ingredients. The principle component is the actual “immunizing agent” which can be in one of three forms: a live attenuated (weakened) virus, a killed virus, a portion of a bacteria or virus or a group of proteins from an infecting microorganism. It is this immunizing agent that provokes the patient’s immune system to respond by fooling it to mount a protective response against the fake “foreign invader” without causing the actual illness. Therefore, when exposed, this allows the patient to either fight off the viral or bacterial infection entirely or partially without serious or deadly consequences. Often, vaccines also contain other products such as aluminum salts to improve the immune response to the immunizing agent, preservatives to prevent bacterial or fungal contaminations and stabilizers such as sugars (sucrose), amino acids (glycine), or proteins (gelatin), to ensure that the vaccine maintains its potency. Some patients can have an allergic reaction to these additional vaccine components.

Who Needs to be Vaccinated?

Infants and children are the most obvious people in need of protection from serious illness and death; however, many adults are also at risk. Older and sickly adults with poor immune systems are also at great risk for serious illness and death when exposed to many childhood illnesses that are preventable with vaccines. Children who are ill shed large amounts of the virus or bacteria that they are infected with in various ways; coughing, sneezing, vomiting, and other unpleasant means. Therefore, it is also important to understand that high childhood immunization rates help keep vulnerable children and adults healthy. High childhood immunization also protects vulnerable young children who cannot be immunized for valid reasons such as those resistant to vaccine effectiveness. For example, a child under one year of age who has partial immunization through their mother cannot get effectively vaccinated. Because the antibodies from their mother aren’t very effective, especially in young infants, they are at grave risk if the children around them are not immunized. Others at risk include children born with weak immune systems from birth and those taking strong medications like chemotherapy for cancer which weaken their system. These cases clearly illustrate how critical it is to attain the highest immunization standards possible because the greater the number of healthy children receiving immunization, the more we protect them, the children and adults close to them, and any other vulnerable people their communities.

Source: NEPA Vital Signs – The Journal of the Lackawanna County Medical Society

 Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week Read: Part 2 of 3 on Vaccinations.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Apr
01

HIGH-INTENSITY INTERVAL TRAINING

Dr. Mackarey's Health & Exercise Forum


NEW RESEARCH DEMONSTRATES ONE TYPE OF EXERICSE MAY HAVE SUPERIOR FAT-BURNING AND ANTI-AGING BENEFITS

HIIT is the new hit! If the primary reason you exercise is to burn fat and lose weight than you many want to rethink your training program. High-intensity interval training (HIIT) is the “new buzz” in exercise. Like all new trends, participants are excited and quick to swear to its positive effects. As popular and common as exercise is little is known about the influence and impact it has at the cellular level. Over the past few years, researchers decided to explore the effects of HIIT. Last year, a research team at Mayo Clinic determined that HIIT exercises have anti-aging effects in the muscles at the cellular level. A more recent study published in the January issue of The British Journal of Sports Medicine decided to investigate the impact of HIIT on body fat.  

THE STUDIES

The Mayo team chose 72 men and women and separated them into two groups; 30 and under and older than 64. All subjects were healthy but sedentary. Pre test analysis was performed for blood sugar levels, gene activity, muscle cell mitochondrial health, and aerobic fitness level. Group One: Vigorous weight training 3-5 times per week, Group Two: HIIT aerobic exercise on a stationary bike (pedaling hard and fast for four minutes followed by a recovery at a slow pace for three minutes then repeating the sequence 3 or more times) 3 times per week, Group Three: Moderate aerobic exercise on a stationary bike for 30 minutes 2-3 days per week and light weight lifting on the other 2-3 days, Group Four: Control group who did not exercise. After 12 weeks, lab tests were repeated and data compiled and analyzed.  

The British Journal publication was a retrospective review of 36 studies involving more than 1,000 participants, young and old, male and female. The purpose of the inquiry was to compare body fat changes before and after two different types of exercise: Group One: moderate-exercise routines including walking, running, cycling or swimming for at least 45-60 minutes. Group Two: 30-40 minutes of high-intensity interval training (HIIT), including a warm-up and cool-down.

Both groups performed their exercise routines for at least 4 weeks and had pre and post body fat analysis.

THE RESULTS

The Mayo study found all three experimental groups improved in fitness level and blood sugar regulation. As expected, the vigorous weight training group, showed the greatest gains in muscle mass and strength. Also, not surprising, the HIIT group, had the greatest gains in endurance. However, the most unexpected results came when retesting the muscle cells by biopsy. Only the HIIT group demonstrated the most significant improvement in the activity levels of their genes in both the young and older groups, when compared to the vigorous weight training and moderate exercise groups.

CONCLUSION

It is well know that loss of muscle mass and strength is common with age. Specifically, older muscles have been found to regenerate slowly and incompletely and the problem runs as deep as the cellular level as the mitochondria diminish in quality and quantity. However, this study suggests that HIIT can actually regenerate and reverse the aging mitochondria. Healthier mitochondria are able to produce energy for muscle cells to function at a higher level.

In addition to anti-aging, HIIT may also address the number one reason people exercise; to burn fat and lose weight. The good news is that all forms of endurance exercise moderate or intense, promote weight loss when compared to controls. However, HIIT allows participants to lose a significantly greater amount of body fat in a shorter amount of time (30 minutes compared to one hour).

TAKE HOME

Interval aerobic exercise can have anti-aging effects. In fact, the older your muscles, the more you will benefit from, not just moderate exercise, but more vigorous interval aerobic exercise. Furthermore, interval training may be applied, not only to aerobic exercise, but to weight training for the upper and lower body. According to the American College of Sports Medicine, high intensity interval training, also called HIIT workouts, involves a repetition of a series of high-intensity exercise (aerobic or weight training) for a specific period of time (3-5 minutes)  followed by a specific period of rest or low-intensity exercise (1-3 minutes). The intensity can be increased by speed or resistance.

Depending on one’s ability to tolerate higher intensity exercises, it may be wise to consider incorporating HIIT into your exercise routine. However, do not attempt to increase the intensity of your exercise program without consulting with your physician first. Once medially approved, consult with a doctor of physical therapy to create a program specifically designed for you.     

Visit your doctor regularly and listen to your body.      

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Mar
11

Top 10 apps Recommended by Physicians to Patients


Dr. Mackarey's Health & Exercise Forum

When computer technology was first applied to medicine, many were concerned that it would negatively impact the quality of patient-physician communication. While some may feel that technology has lead to more distant interaction, others feel that it has contributed to more informed, involved and empowered patients.  

In a recent report released by the Joint Commission, it was determined that poor patient-clinician communication is responsible for approximately 70 percent of serious adverse health outcomes in hospitals. It may be fair to assume that this problem also occurs in outpatient and in home health services. Therefore, any opportunity to improve patient-clinician communications, including mobile apps, must be considered. The most effective apps should allow patients to securely list medical history and medications, as well as, quickly search for and access physicians, hospitals, clinics, first aid, and other health information. Other important features allow patients to be empowered through safe self management with texting, voice mail, and video communications. For those with chronic illnesses, some patient engagement apps will allow for direct communication between patients, health care navigators and other members of the health care team. Many physician groups and hospitals offer mobile apps for patient – physician communications with privacy protections.      

Some tools improve engagement between physician and patient while others focus on research, tracking and logging to improve health and wellness. The suggestions below are considered to be some of the best for patients according to leaders in technological applications in medicine:

1.Apple Health App; GenieMD; CapzulePHP – are highly rated health record apps designed to help uses visualize and store their health records from multiple institutions along with data which can be added manually

2. My Medical App – The Personal Medical Record is a comprehensive medical record-keeping which works as a digital file cabinet. It securely organizes and safes appointments, medical records, lab results, medications and other essential medical data.

3. Epocrates; PEPID; UpToDate; Medscape – top medical reference apps

4.  MySugr App – Blood Sugar Control, Glucose Tracker, Insulin Use and Carb Counter: This app created by people with diabetes to assists patients with diabetes often struggle to monitor their condition at home. This app provides a food database for patients to track their consumption and allows physicians to monitor any fluctuations. A free app is available for trial.

5.  iCookbook Diabetic – Recipes, nutritional information and health articles for people with diabetes: a great app, created by dietary professionals, to provide healthy alternatives for cooking healthy. It provides various tools for meal planning and grocery shopping for the diabetic.

6.  Lose it; Fooducate Nutrition TrackerApps for Weight-loss and nutrition  are invaluable tools to promote weight control by helping to track meals, exercise, calories, and nutrition. It uses a built-in barcode scanner and menus from popular restaurants.

7. Blood Pressure Companion –  A useful app for patients on the go to monitor their blood pressure and weight. It also provides lifetime data visualization and statistics with displays for medication correlations.

8. Apple Watch Series 4 with ECG and Atrial Fibrillation Features – this device, released in December of 2018 may be the most important technological devices for those with a history of  cardiac problems, specifically atrial fibrillation. In fact, for those between the ages of 60 and 64 there is a 76 percent positive prediction value which significantly improves with older users.   

9. Best Fitness Apps –  MyFitnessPal; Headspace – are fitness apps which tract exercise and diet to best meet your goals. Fitness watches and wrist devices such as Apple Watch and Fitbit are also very useful.

10. Pocket First Aid & CPRIn addition to general first aid instructions, this app also shares the American Heart Association’s guidelines on CPR. It offers high-quality videos and illustrations to assist those in need.   

10. iCalcRisk– Cardiac Risk Tracker: Calculates cardiac risk to promote healthier choices. Physicians can use the visualizations to assess the patient’s ability to manage their cholesterol, blood pressure, and lowering their risk of heart attack. 

SOURCES: Modern Medicine Network; American Heart Association

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Mar
04

The Female Runner and Body Mass Index

Dr. Mackarey's Health & Exercise Forum

PIAA Spring Sports (Track & Field) Begins today, March 4Th! To prevent injuries such as shin splints and stress fractures, participants, especially female athletes, must take time to properly prepare for your event.

Have you notice more local running enthusiasts in the past few years? Moreover, have your noticed that most of the runners are women? Scranton Running Company has contributed to NEPA’s participation in a national trend; more women are engaged in running than men! Female runners account for 9.7 million runners (57%) while 7 million males run on a national level.

With this surge, the female runner has been subjected to a host of related injuries, including shin splints, which often lead to stress fractures. New research has found that stress fractures may be related to the loss of weight and body mass associated with the sport.

A recent study from Ohio State University found that female runners with a Body Mass Index (BMI) below 19 may have a higher risk of developing stress fractures than women with a BMI of 19 or above. Furthermore, the study also found that these women took longer to recover from these injuries.

According to Timothy Miller, MD, “When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture,”

The study also found that female runners with a BMI of 19 or higher with severe stress fractures required 13 weeks to recover from their injuries and return to running. Runners with a BMI lower than 19, however, took more than 17 weeks to recover.

They concluded that women should know their BMI and consult with a medical professional to maintain a healthy number. Additionally, women should cross-train and include resistance training to improve the strength and muscle mass of the lower extremities to prevent injury.

The current BMI wisdom, according to the National Institutes of Health, is 19.8 for men and 24 for women, however, strong and competitive women tend to have a BMI of 26. A BMI of 18 is considered malnourished.

What is BMI?

Body mass index (BMI) is a measure of body fat based on height and weight of adult men and women over 20 years of age, according to the National Institutes of Health.

BMI = (weight in pounds / height in inches squared) X 703)

Example 1: a person who weighs150 pounds and is 68 inches (5 feet 8 inches) tall has a BMI of 22.8

Example 2: a person who weighs 110 pounds and is 66 inches (5 feet 5 inches) tall has a BMI of 17.7

Underweight      < 18.5%

Normal weight      18.5 to 24.9%

Overweight      25 to 29.9%

Obesity            30 and over

What is a stress fracture?

A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia (shin bone) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.

Who is at risk for stress fractures?

FEMALE RUNNERS WITH BMI LOWER THAN 19 – is a primary risk factor.

10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are: sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.

The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).

Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.

Other Causes of Stress Fractures

  • Overuse, Overload, Over-training – is the number one cause. Running too many miles with too much intensity with too much frequency is the perfect formula.
  • Inadequate Fitness Level – or activity level prior to the stress fracture. For example, the high school runner takes the summer off and then quickly accelerates his/her program to quickly for cross-country in August/September.
  • Poor Biomechanics – when your feet hit the ground the forces are absorbed and transferred to the rest of the body. If the biomechanics of feet are not perfect, then the forces are not absorbed and another body part bears too much force. For example, flat or pronated feet poorly absorb the shock and pull the tendons of the foot and shin.
  • Recent Change in Training Schedule – sudden increased intensity or speed
  • Recent Change in Running Surface – sudden change to a hard or soft surface
  • Recent Change in Footwear – shoes too hard or too soft, too much control or too little control, too much pronation or too much supination
  • Overweight – running with an extra 10 pounds and attempting to return to running as a method of weight loss
  • Underweight – the underweight female athlete is at high risk for stress fractures. If underweight and have a history of menstral irregularities or and eating disorder, the risk of stress fracture increases significantly
  • History of Stress Fractures – makes the athlete two times as likely to have another

Prevention & Treatment

  • Maintain Ideal BMI – 24 for female runners
  • If Overweight – gradual exercise with diet, not too much too quickly

         Mix run & walk every 10 minutes

  • If Underweight – improve diet maintain healthy body fat%
  • Alternate Training – cross train with non-weight bearing activities: bike, swim, elliptical
  • Perform lower body weight training – to strengthen the muscles of the lower body, thighs, knees, ankles, feet.
  • Gradually Build Up Fitness Level – wean into activity 1-2 miles, then add ½ mile at a time
  • Correct Biomechanics – Orthotics, Running shoes, see a Podiatrist
  • Gradual Change in Training Schedule
  • Gradual Change in Surfaces – ½ run on soft surface, ½ run on hard surface
  • Gradual Change in Foot ware – walk in new shoes first, then run 1-2 miles
  • Consult Family Physician/Orthopedic Physical Therapist/Nutritionist

Source: Ohio State University, Science Daily

Visit your doctor regularly and listen to your body.      

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Feb
25

Research Shows Exercise Keeps Your Heart Young!

Dr. Mackarey's Health & Exercise Forum

New Research

It is a well established fact in the medical literature that the benefits of regular exercise and physical activity are numerous, from reducing blood pressure to lowering the risk of falls. However, a study recently conducted in the Human Performance Lab at Ball State University and published in The Journal of Applied Physiology found that people in their 70s who have been exercising regularly for decades have defied the aging process…maintaining heart, lung and muscle fitness of healthy people at least 30 years younger!

As it turns out, many people who began exercising in the 1970’s running and aerobic boom have continued to do so for 50 years without interruption. Researches felt that this population of lifetime fitness enthusiasts would be interesting to study and compare to their contemporaries and younger people.

Subjects were divided into three groups; Group One: Lifelong Aerobic Exercisers with an average age of 75 years, who engaged in a structured aerobic program of running or cycling, four to six days a week, seven hours per week. Group Two: No Structured Exercise throughout life, with an average age of 75 years, who may have occasionally walked, golfed or participated in leisure activities. Group Three: Lifelong Aerobic Exercisers with an average age of 25 years, who, like their senior counterparts, engaged in a structured aerobic program of running or cycling, four to six days a week, seven hours per week.       

All subjects were assessed for cardiovascular fitness on an indoor bike to determine maximum oxygen uptake (VO2 Max). Muscle biopsies were also performed to assess microcirculation to the muscle and blood work was conducted to examine enzyme levels related to carbohydrate and fat metabolism.

Results showed that those engaging in aerobic exercise consistently throughout their lives had both muscle and cardiovascular benefits similar to those 30 years younger.

Discussion

It is important to note that in this study an aerobic program consisted of running or cycling, four to six days a week, seven hours per week. This level of lifelong commitment is limited to a very select group of individuals. However, many other studies have demonstrated the value of any aerobic exercise program, even if less intense.

In general terms, aerobic exercise is any type of sustained exercise that strengthens the heart and lungs to improve the body’s use of oxygen. This may include running/jogging, brisk walking, cycling, swimming, rowing, and the use of a treadmill, elliptical, stepper or similar device, at light to moderate intensity which requires the use of oxygen to adequately meet the oxygen demands of the body for an extended period of time. The generally accepted time and frequency is at least 30 minute sessions performed three or more times per week.

Moreover, it is important to remember that everyone ages differently. With the onset of age related osteoarthritis and other illnesses, one may not be capable of maintaining regular exercise with the intensity described in this study. Regular exercise, even at a low to moderate level has many benefits. In fact, studies continue to support the fact that a well-balanced and individualized exercise program including aerobic, strengthening, stretching and balance activities contribute to, not only longevity, but quality of life.     

A comprehensive exercise program includes:

  1. Aerobic Exercise: 30-45-60 minutes, 3-5 days per week. Walk, swim, bike, etc.
  2. High Intensity Interval Training: 3 minute high intensity bursts followed by 2 minute slow paced recovery repeats for 15 minutes. For sport specific endurance and strength and prevention of delayed onset muscle soreness
  3. Resistance Weight Training: (bands, free-weights, weight machines) For strength and conditioning
  4. Stretching, Core, Yoga, Pilates, Balance Exercise: For flexibility to prevent injury and muscle/joint tightness, and promote relaxation, body awareness and prevent falls
  5. Plyometric Exercise: For sport specific training  

Some simple suggestions for beginning an exercise program are:

  • Get your physician’s approval
  • Consult with a physical therapist to set up a program for your needs
  • AEROBIC EXERCISE:
    • Buy good running sneakers – not walking shoes
    • Plan to exercise 3-5 times per week for 30-35 minutes
    • Walk for aerobic fitness
    • Begin 5-10 minutes and add 1-2 minutes each session
    • Walk in a mall if it is too hot or too cold
  • WEIGHT TRAINING:
    • Use light dumbbells, sandbag weights and resisted bands
    • Begin with 5-10 repetitions and add 1-2 reps each session
    • Alternate weight training days with walking days

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Feb
11

Exercise & Diet for Brain Health – It’s not too late!

Dr. Mackarey's Health & Exercise Forum


New Research

It is a well established fact in the medical literature that the benefits of a healthy diet, regular exercise and physical activity are numerous, from reducing blood pressure to lowering the risk of falls. (SEE BOX A Below) However, a study recently published in journal Neurology, reported that a healthy diet along with regular aerobic exercise may also improve brain health and improve cognitive tests, even in those already showing signs of an aging brain. Prior to these new findings, it was unclear if this healthy behavior initiated later in life would reverse signs of an already aging brain when compared to those following a poor diet and sedentary lifestyle.  

Researchers observed 160 subjects over the age of 55 who began showing signs of a slowing brain similar to people in their 90s, which was an average of 28 years older than their actual age. All subjects were sedentary at the time of the study, had at least one risk factor for heart-disease and showed signs of cognitive decline, without any signs of dementia.  

The subjects were divided into one of four groups; Group one participated in aerobic exercise; Group two followed a healthy diet; Group three followed a healthy diet and participated in aerobic exercise; Group four only participated in education sessions about improving brain health but did not alter their diet or engage in exercise.

Aerobic exercise in this study was defined as three months of supervised physical activity at a research facility in which subjects attained 70% of their peak heart rates on a treadmill or stationary bike three times a week. Diet in this study was defined as the Dietary Approaches to Stop Hypertension (DASH) which emphasizes reducing salt and increasing fiber to control blood pressure and improve heart health.

The results found improvement only in group three, the healthy diet and aerobic exercise group, who improved their scores by nine years. The control group continued to decline in brain function while the exercise only and diet only groups did not show signs of improvement.

Discussion

In this study, people who followed the DASH diet and performed aerobic exercise for no less than 30 minutes, three times per week at a 70% peak heart rate for three months improved their performance on cognitive tests. Moreover, in those with evidence of cognitive impairment, it is not too late to derive benefits from a healthy diet and aerobic exercise. These results reinforce previous research that supports the fact that heart health promotes good circulation throughout the body and brain, which is important for maintaining oxygen-rich blood to fuel its activities, including cognition.

Aerobic Exercise

Aerobic exercise was strictly defined in this study but should not intimidate those interested in exercise. In a broader sense, aerobic exercise is any type of sustained exercise that strengthens the heart and lungs to improve the body’s use of oxygen. This may include running/jogging, brisk walking, cycling, swimming, rowing, and the use of a treadmill, elliptical, stepper or similar device, at light to moderate intensity which requires the use of oxygen to adequately meet the oxygen demands of the body for an extended period of time. The generally accepted time and frequency is at least 30 minute sessions performed three or more times per week. For those with back, hip, knee and other lower body pain, consider low-impact or partial weight-bearing activities such as a recumbent bike or stepper or upright bike instead of a treadmill.  

For More Information: Dietary Approaches to Stop Hypertension (DASH) – National Heart, Lung, and Blood Institute at National Institutes of Health.

BOX A:
Some of the more important benefits of exercise are:

Loss or Maintained Body Weight

Reduces LDL /Raises HDL Cholesterol

Reduces risk of type II diabetes

Improves Circulation and Blood Pressure

Reduces Risk of Heart Disease

Prevents Bone Loss

Reduces Stress/Muscle Tension

Lowers Risk of Depression

Improves Sleep Pattern

Improves Strength and Flexibility

Improves Balance/Reduces Risk of Falls

Improves Immune System

Improves Pain Threshold

Stimulation of Neurogenesis (formation of new brain cells)

Visit your doctor regularly and listen to your body.      

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.

Jan
14

AVOIDING CARBS…LOTS OF OPTIONS

Dr. Mackarey's Health & Exercise Forum

We are two weeks into the New Year and many of you are working hard to hold onto the number one resolution…to lose weight! Today, this column will offer some sage and practical advice on satisfying hunger with healthy snacks. You have probably noticed a lot of attention being paid to sugar lately. In fact, some people have decided to avoid all refined sugars with the goal of improving their health and wellness. Terms like simple sugars and simple carbs, which are purported to be bad, and complex carbs, suggested to be good, are being used ad nauseam. While medical research does not support the value of a short term “sugar cleanse,” it may have value for another reason. For example, it would be very beneficial if one engages in a “sugar cleanse” for the purpose of changing their palate with the hope of developing long term healthy eating habits.

While I am an advocate of moderation, I decided to provide my readers with some answers to some simple questions about the fuss over sugar. What is a simple sugar? What is a complex sugar? Which sugars are good for you? What are some good low-carb snacks?

WHAT IS A SIMPLE SUGAR (CARBOHYDRATE)?

Sugars, along with starches and fibers, are one of three types of carbohydrates (also referred to as a carb). A carb is “simple” or “complex,” based on its chemical composition and how it is processed in the body. It gets a little complicated because some foods have both simple and complex carbs.  Typically, simple carbs are chemically more “simple” and basic, and therefore they are broken down more easily and serve as a quick source of energy. Some of these carbs are naturally simple (like fruit and milk) while others are processed or refined sugars such as those used in candy, soda and baked goods. To determine if a food product has good or bad simple sugar, you must also know how much fiber, vitamins and minerals are in the food. A food with a higher sugar content combined with a low fiber, vitamin or mineral content will be worse than  a food with the same sugar content but high fiber and vitamins or minerals. For example: a candy bar, which is high in sugar without fiber or vitamins or minerals, is not as healthy as a fresh orange, which contains fiber, vitamins and minerals along with its simple sugar (fructose).

Examples of simple carbs:

Most candy products, non-diet soft drinks, cookies and cakes, iced tea and lemonade with sugar, energy drinks, and ice cream.

WHAT IS A COMPLEX SUGAR (CARBOHYDRATE)?

Complex carbs have a more complicated chemical makeup and take more time for the body to break down for use as energy. Therefore, these are considered “good” carbs because they provide a more even distribution of energy for the body to use during activity. They cause a more consistent and gradual release of sugar into the blood stream (as opposed to peaks and valleys caused by simple carbs) and provide energy to function throughout the day. Additionally, “good” carbs have the added benefit of providing vitamins, fiber, and minerals that are missing from simple carbs.

Examples of complex (carbs):

Whole grains: buckwheat, brown rice, corn, wheat, barley, oats, sorghum, quinoa, breads and pastas made with whole grains

Dairy: low fat yogurt, skim milk

Nuts, Seeds, Legumes: lentils, kidney beans, chick peas, split peas, soy beans, pinto beans, soymilk

Fruits and Vegetables: potatoes, tomatoes, onions, okra, dill pickles, carrots, yams, strawberries, peas, radishes, beans, broccoli, spinach, green beans, zucchini, apples, pears, cucumbers, asparagus, grapefruit, prunes  

WHY EAT COMPLEX CARBS INSTEAD OF SIMPLE CARBS?

Remember that carbohydrates fuel the body and are an important source of energy, especially for active and athletic people. However, carefully selecting the type of carb you eat is critical to peak function and performance.

Simple carbs taste great (according to our modern brain raised on simple sugars) and are easy to breakdown into a quick source of energy. However, the sensation of hunger is quick to return because the sugar is released and used up in the body quickly, giving the sensation of needing more.

Simple carbs are often “refined” and therefore stripped of their fiber, vitamins and minerals, which is why they are often referred to “empty” calories.

Simple carbs lead to rapid spikes in blood sugar and insulin levels after meals. When these levels are not controlled over time, it can lead to obesity, which is ultimately related to adult-onset diabetes and high blood pressure.  

Complex carbs make you feel full faster and longer and therefore, are an important component to weight loss.

Complex carbs keep the body fueled for an extended time.

Complex carbs are easier to digest and the fiber content allows for smoother digestion with less bloating and gas, and improved toxin removal.

Complex carbs from vegetables have been found to lower LDL cholesterol, blood pressure and heart disease.

10 Healthy Low-Carb Snacks

  1. Fruit and Cheese

Sliced apples or pears are a great compliment to a variety of cheeses. With only 10 grams of carbs, the combination of protein, fat and fiber is, not only tasty, but will sustain you for hours.

2. Avocado Spread on a Low-Fat Cracker

Mash a ripe avocado and spread on a low-fat cracker or crisp. This delicious high-fiber snack has 17 grams of carbs.

3. Yogurt and Cucumbers

Greek and Middle-Eastern cultures have long known the value of yogurt. By adding cucumber (slices or spears) for dipping or diced, the snack becomes high in protein (21 grams) while low in carbs (10 grams)

4. Chicken, Turkey, Porketta Lettuce Roll-Up

Use healthy, white deli meat but avoid the bread. Instead, use a lettuce to wrap the meat and maybe add spicy mustard. 1 ounce of sliced turkey has only 3.7 grams of carbs.

5. Cottage Cheese and Fruit

Add you favorite fruit, (blueberries, strawberries, raspberries, pineapple, peaches, etc) to low-fat cottage cheese and you get a tasty, healthy low carb (17 grams), low-fat with the additional benefit of fiber and protein.  

6. Celery and Peanut Butter

2 stalks of celery filled with 2 tablespoons of natural peanut butter creates a simple, yet healthy snack loaded with fiber and protein and only10 grams of carbs.

7. Nuts

Mixed nuts, in moderate quantities, are a good snack because they offer a crunchy, salty, high protein option with 6 grams of carbs per ounce. However, some nuts are better for you than others: macadamias have more heart-healthy monounsaturated fats, cashews are high in iron and zinc and almonds are very high in fiber and vitamin E.

8. Edamame

Edamame are high-fiber, high-protein soybeans have only 6 grams of carbs in a half-cup. A frozen bag pops into the microwave to become a quick easy healthy snack.

9. Hummus

Hummus is a very popular and healthy chick pea dip. And, if not eaten with copius amounts of pita bread, it can also be low carb. Instead, dip carrots, celery, red bell pepper wedges, and zuchinni (16 grams of carbs).

10. Tuna-Stuffed Tomato

3 ounces of tuna stuffed into a fresh tomato half offers a healthy snack with only 3.5 grams of carbs.

Sources: webMD

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Jan
07

NALOXONE – A LIFE SAVER!

Especially in light of a recent spike (nine in one week) in overdose deaths in Lackawanna County

Guest Columnist: Dr. Gretchen Welby, PharmD, MHA

Dr. Welby received undergraduate degrees from Keystone College and Philadelphia College of Pharmacy and Science. She received a Master’s Degree in Health Administration from the University of Scranton and a Doctor of Pharmacy degree from Temple University. She currently teaches at Marywood University as an Assistant Clinical Professor for the physician assistant program.

The Crisis

We are all aware of the opioid crisis facing our community, state, and nation today. In fact, nine people in Lackawanna County died in one week in December of 2018. According to the Center for Disease control (CDC), drug overdose deaths in the US for the year 2017 exceeded 72,000. Pennsylvania has one of the highest overdose rates in the country at 37.9 per 100,000. The percentage change in drug overdose deaths in Pennsylvania from 2015-2016 was a staggering 44.1%. The issue of drug overdose continues to be one that plagues our state.
One bright spot in this horrific crisis is Naloxone because of its potential to save lives. Also known by the brand name, Narcan,R it is a opioid antagonist (antidote) used to counteract the effects of an opioid overdose. In some states, like Pennsylvania and Connecticut, State Troopers report saving hundreds of lives, from ages 14 to 83.

Opioids are a category of drugs that are indicated for pain management. Prescription opioids are designated by the federal government through the Food and Drug Administration (FDA) according to their level of addiction potential. Drugs such as heroin are Schedule I agents indicating an extremely high level of abuse potential and no valuable medical purpose. Opioids such as oxycodone, fentanyl, and hydromorphone are Schedule II agents with a very high potential for abuse but with a recognized place in therapy to manage pain.

All opioid agents interact with opioid receptors in multiple locations throughout the body to produce effect. Opioid receptors are particularly concentrated in the brain where they influence pain relief. Other responses to opioids that are mitigated via brain opioid receptors include euphoria, sedation, nausea, and decreased respiratory rate.

Fatal overdose situations arise when an excessive amount of opioid is used which significantly interacts with the opioid receptors. The leading cause of opioid overdose death is respiratory arrest. The CDC lists these four risk factors for prescription opioid overdose; 1. Obtaining overlapping prescriptions from multiple providers and pharmacies. 2. Having mental illness or a history of alcohol or other substance abuse. 3. Taking high daily dosages of prescription opioid pain relievers. 4. Living in rural areas and having low income. Risk factors associated with illicit (obtained through illegal means, diverted, or heroin) opioid overdose include; coexisting drug use (in combination with amphetamines, alcohol, cocaine), prior abstinence or reduced use, and smoking.

Naloxone

Federal, state, and local governments have increased awareness of the opioid epidemic. Legislation has focused on altering opioid prescribing practices and increasing funding for education and addiction treatment. Another tool used in the efforts to prevent death from opioid overdose is naloxone. Naloxone is a drug that acts to block opioid receptors and prevent opioids from interacting with them to produce their characteristic effects. It is a drug free from side effects. It is safe to use for anyone. It is given in overdose situations to reverse the effects of opioids. The state of Pennsylvania has a provision to allow anyone to obtain naloxone from the pharmacy. Standing Order DOH -002-2018 is known as the “Naloxone Prescription for Overdose Prevention” act. This legislation was implemented in 2015 by Governor Tom Wolfe. The prescription order is signed by the current Physician General of Pennsylvania, Dr. Rachel Levine. This standing order may be used by as a prescription to obtain naloxone from a pharmacy if a person is unable to obtain a naloxone prescription from their provider.

Naloxone can be used for all types of opioid overdose. It can be administered via injection or through a nasal spray. It must be administered immediately upon recognition of an overdose situation. It is a short-acting agent. The effects of the opioid may outlast the effect of naloxone therefore it is vital that the patient receives medical attention after the dose of naloxone. It is recommended that all who obtain naloxone go through a training session to know how to use it effectively. Getnaloxonenow.org is a free site for naloxone training.

The opioid epidemic continues to afflict our communities. Work is being done to combat the issue and provide help to those addicted. Despite these efforts, deaths from opioid overdose continue to increase. Naloxone is a drug that can save lives. Through the PA Standing Order for Naloxone, access to this drug is available throughout the state. Ask your pharmacist or provider about obtaining naloxone.

FOR MORE INFO ABOUT NALOXONE ADDICTION SERVICES:
www.getnaloxonenow.org
www.drugabuse.gov
www.ddap.pa.gov/overdose/pages/Naloxone_Reversal.aspx
www.pa.gov/guides/opioid-epidemic/

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Dec
24

This Holiday Season, Be Religious and Spiritual–It’s Good for Your Health

Dr. Mackarey's Health & Exercise Forum

Holiday Spirit Requires a Healthy Mind, Body, Spirit!

Happy Holidays! It is at this time of year that we celebrate life with great hope and faith. People of many faiths take time to reflect, respect, and resolve. Christians celebrate Christmas, the miraculous birth of Christ, the Son of God, and the Messiah. Jews celebrate Chanukah, the miraculous festival of lights, when one night’s oil provided enough light and safety for 8 nights. Both major faiths promote healthy lifestyles for the mind, body and spirit. These faiths are grounded in hope, faith, love and peace. It is no surprise that studies repeatedly demonstrate that people of faith outlive those without!

With this in mind, I purport, that to be truly healthy, one must have faith because complete health is multidimensional. Socrates preached this message to his students thousands of years before Christ. One must have a healthy mind, which requires intellectual stimulation with attainable goals related to education and intellect. One must have a healthy body by eating well, engaging in physical activity and have attainable goals related to his/her body. Likewise, one must have a healthy spirit with faith, hope, prayer and meditation, comrades and counsel, and set attainable spiritual goals.

5 Health Benefits of Religion and Spirituality….(health.com)

How being religious or spiritual has been shown to benefit your mind, body and spirit…

Healthy Blood Pressure

High blood pressure (hypertension) can lead to heart disease and stroke, which are the leading causes of death in the United States, according to the Centers of Disease Control (CDC). It affects 1 in every 3 adults and only half of these people have their blood pressure under control. Well, religion and spiritually may help …

The health benefits of religion or spirituality are well documented.  One study conducted at Duke University Medical Center on 4,000 subjects, older adults who described themselves as religiously active were 40% less likely to have high blood pressure when compared to those less active. Moreover, they were surprised to find that those who described themselves as spiritual rather than religious also were less likely to develop high blood pressure.

Greater Sense of Satisfaction

Research also indicates that religious people are more satisfied with their lives than those without faith. A sociology study determined that high satisfaction among church goers may be due to the strong social bonds that are developed within a religious congregation. Regular church attendees see the same people weekly and often more often, when participating in rewarding and gratifying church-related volunteer work.

Greater Tolerance for Adversity

In an impressive study published in the Journal of the American Medical Association, researchers interviewed 345 late-stage cancer patients to assess their spirituality as it related to their illness. 88% stated that they were religious as it related to their coping mechanisms. It was determined that those using religion for coping demonstrated a 7.4% rate of resuscitation as compared to 1.8% for those not using religion as a coping mechanism.   

Stronger Immune System

According to a Duke University study of 1,718 older adult participants, those described as “highly spiritual” were 50% less likely to have high levels of anti-inflammatory proteins that weaken the immune system and have been linked to some cancers, viral infections and autoimmune diseases. The outcome was similar for those who attend religious services at least once a week.  

Greater Longevity

Those who attend religious services more than once per week are found to live and additional 7 years when compared to those who never attend services. Again, researchers feel that the social benefits of a belonging to a strong religious community may be a large part of the associated longevity. Additionally, the lifestyle of religious people is often healthier: members of these communities rarely engage in risky and unhealthy behaviors such as smoking, excessive drinking, indiscriminate sex, etc. 

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Dec
17

Merry Fitness! Top 10 Fitness Gifts for Christmas!

Every December, as we finish the last of the leftover turkey, patients begin to talk about the holiday season and gift shopping. This conversation invariably leads to suggestions for gift ideas related to health, exercise and fitness. The suggestions below offer a wide variety of fitness related gifts, some expensive and frivolous and others reasonably priced and practical. I hope it makes your shopping a little easier. 

Dry Tech Exercise Clothing

Dry Tech is the best thing that has happened to exercise apparel since “jogging suit” was donned by all the “cool dudes” in the 70’s and 80’s . It is has great style and even better function. The specially made material is light weight and breathable and wicks moisture from the skin to the outer layers. Therefore, it will not get heavy with sweat which can weigh you down and cause friction with your skin which can lead to chaffing and blisters. The following exercise apparel is now available in Dry Tech:

  1. Short sleeve tee with a matching long sleeve shirt
    1. Shorts and compression under shorts
    1. Colorful socks

NOTE: Shoes are a very important aspect to safe and comfortable exercise but are unique for running and other specific sports (tennis, basketball). Therefore, sneakers are too difficult to buy for someone else.

Exercise Mat

An exercise mat is helpful if you decide to exercise at home. Also, if you participate in yoga or Pilates classes, a mat is required equipment.

Hand Held Dumbbells and Sandbag Leg Weights

These are essential for those interested in home exercise. For the average beginner, 3-5-8-10 pound (two of each) weights will be adequate.  Dumbbells are good for shrugs, biceps, and triceps, bent over rows and lats, and lunges. Sandbags, which can be purchased as graduated weights from 1 to 5 pounds, are good for leg extensions, hamstring curls, hip hikes and hip abduction.  

Resistance Bands

These cheap and versatile bands are also essential for a home program. The bands come in different colors to represent the amount of resistance with yellow being the easiest and black the most difficult. They can be used for upper and lower body. For specific band exercises visit a previous column in “Health & Exercise Forum” at The Times Tribune or www.mackareyphysicaltherapy.com

Aerobic Equipment

  1. Bike – Plus: upright or recumbent bikes are an effective and affordable method of aerobic exercise. It is very useful for those suffering from lower back, hip, knee or ankle/foot pain because it can be performed with partial weight bearing. Minus: must be able to bend your knees at least 110/115 degrees.  
  2. Elliptical – Plus: a good alternative to the pounding of running. Minus: expensive, large, a nd require full weight bearing. 
  3. Treadmill – Plus: great for those who love to walk or run and need and indoor alternative in inclimate weather. Minus: large and expensive

Fitness Club Membership

Location is important for convenience. The type of gym, such as, cross fit, exercise machines vs. traditional free weights, must be considered. Equipment and other services such as personal trainers, swimming pool, sauna, hot tubs, Pilates, and yoga classes are also important to some.

If the person you want to gift already belongs to a gym, consider purchasing a gift certificate for massage, Pilates, yoga, spin class or aquatic exercises at their gym (which usually costs extra) or another studio.

Personal Trainer Gift Certificate

This can be an opportunity for someone to either get the proper advice from a professional to begin a fitness program or to revamp and tune up an old stale program. Word of mouth is a good way to find a reputable certified trainer.

Electronic Fitness Monitors or Wearable Tech Monitor

These devices use GPS technology to help the user track their activity to get more out of their exercise routines. They monitor activity, heart rate, distance, location, calories, and more. Some examples are:

Pedometers – clips on a belt – best for tracking steps – tracks steps taken by walkers and runners and translates it to miles. Some also translate calories expended. Suggestions: “Perfect Fitness” or Timex” $5-$25.

Activity Trackers – worn as wrist band – best for tracking general fitness, calories and sleep patterns 24/7. It can be connected wireless to your cell phone. Suggestions: “Fitbit” $119 to $149. Garmin vivofit 2 $100.

Running Watches – are worn as a wrist watch – best for timing workouts and counting laps – a rugged, waterproof watch to be worn while running to track laps, splits, countdown, intervals and training logs. However, it does not track distance, speed or heart rate. Suggestions: Timex Ironman $38.97. Garmin Forerunner220 $149.

GPS Watches – worn as wrist watch – best for tracking speed, distance and altitude. Suggestions: Garmin Forerunner15 $119.99.  Garmin Forerunner230 $249.  

Heart Rate Monitors – worn as a chest-strap or wrist strap – monitors your heart rate in real time.  Suggestions: Garmin Vivofit 49.99. Polar 90051339vM400  $179.95

Weight Loss and Activity Monitoring Apps

Basic Apps are free and more advanced versions are under $10.

Weight Loss – Suggestions: “Lose It” ; “My Diet Coach” – helps you keep a journal, calculates calories. The App gives calorie credits if you exercise and provides ongoing feedback to help you stay on track to attain your optimal weight.

Activity Monitor – Suggestions: “Endomodo”; “Human” – uses GPS to track your every step when you go for a hike, run, fitness walk, touring walk at Disney, or bike ride on trails, ski cross country or downhill. It will calculate distance, speed, location, total time and total calories.

Nutritional Counselor Gift Certificate

Sometimes you need professional help to get started and stay focused. Just as with a personal trainer, a qualified and licensed nutritional counselor will assist you in establishing a safe and effective program to meet your nutritional and dietary goals. Again, ask around to see who has a good reputation or who may be a good fit for the recipient of your gift.

These gifts can be purchased at most local sporting goods stores or on-line.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Dec
10

Use good judgement when buying holiday toys

Dr. Mackarey's Health & Exercise ForumLast Monday, the American Academy of Pediatrics (AAP) received overwhelming national attention in the media regarding a recent report about electronic devices and child development. National Public Radio and Time Magazine were among the many media outlets reporting on the AAP document which cited studies suggesting that heavy use of electronic media may interfere with children’s speech and language development, replace important playtime with parents and lead to obesity.

Studies also have found that more than 90 percent of U.S. kids have used mobile devices and most started using them before age 1. The pediatricians’ group recommends no screen time for children up to age 2. Moreover, they recommend total screen time, including TV and computer, use should be less than one hour daily for ages 2 and older. Pediatricians don’t want parents to overreact and understand that a little screen time on occasion is not likely to harm a child, especially if they are typically active and creative most of the day.

The academy’s website offers suggestions on ideal toys for young children, including balls, puzzles, coloring books and card games. Visit: AAP.org or HealthyChildren.org, the official parenting website of the AAP.

American Academy of Pediatricians Toy Recommendations:

Giving gifts to children is a favorite part of the holidays, whether they’re wrapped under a tree or exchanged with the lighting of a candle. When choosing a toy for a child, the American Academy of Pediatrics recommends the toy be appropriate for the child’s age and stage of development. This makes it more likely the toy will engage the child – and reduces the risk it could cause injury. Below are some additional tips from the AAP on toy selection and safety:

  • Appropriate: Select toys to suit the age, abilities, skills and interest level of the intended child. Toys that are too advanced will frustrate your child and may pose safety hazards for younger children.
  • Developmental: When choosing gifts for babies and toddlers, consider toys that will build developmental skills. Toys that can be manipulated, such as shape sorters, stacking blocks, and baby-safe puzzles, are great for developing fine motor, cognitive, and perceptual skills. For more tips on choosing toys for babies, visit HealthyChildren.org “toy selection.”
  • Purpose: If you are considering a digital device for a child or teen, such as a tablet, smart phone or game system, think about the purpose of the device and the rules you want to set around its use. For more information, see these tips on HealthyChildren.org “mindful technology use” and “digital media use for young children.”
  • Batteries/Magnets: Be cautious about toys containing button batteries or magnets. Children can have serious stomach, throat and intestinal problems – including death – after swallowing button batteries or magnets. In addition to toys, button batteries may be in musical greeting cards, remote controls, hearing aids, and other small electronics. Small, powerful magnets may be part of building toy sets. Keep button batteries and magnets away from young children and call your health care provider immediately if your child swallows one.
  • Electrical: To prevent burns and electrical shocks, do not give children under age 10 a toy that must be plugged into an electrical outlet. Instead, buy toys that are battery-operated.
  • Small Pieces: If you are buying a gift for a young child, look for toys without small pieces. Young children can choke on small parts contained in toys or games. Government regulations specify that toys for children under age 3 cannot have parts less than 1 1/4 inches in diameter and 2 1/4 inches long. For more: HealthyChildren.org “how to buy safe toys.”
  • Balloons: Children can choke or suffocate on broken or uninflated balloons. Do not allow children under age 8 to play with them.
  • Ribbons/Strings: Remove tags, strings, and ribbons from toys before giving them to young children. Watch for pull toys with strings that are more than 12 inches long, because they could be a strangulation hazard for babies. When your child receives a gift, be sure to read the label and instructions. Warning labels give important information about how to use a toy and what ages it is for. Be sure to show your child how to use the toy.
  • Storage: Parents should store toys in a designated location, such as on an open shelf or in a bin, and keep older kids’ toys away from young children. If you use a toy box, choose one with no lid or a lightweight, non-locking lid and ventilation holes. Visit: HealthyChildren.org “toy box safety.”

SOURCE: American Academy of Pediatrics

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Dec
03

Preventing ski injuries

Dr. Mackarey's Health & Exercise ForumPREVENTION OF SKI INJURIES!

Pre-Thanksgiving Snowfall Gets Skiers Pumped up!!!

Winter arrived early this November and, like many in NEPA, I love winter in great part due to my love for downhill and cross-country skiing. However, with age and wisdom, I have become much more aware of the need for safety through the use of proper equipment, good technique and preseason conditioning. While I have discussed this topic before, a local ski enthusiast asked me if I would offer some tips on preseason conditioning for skiing.

The following exercises will target the essential stability, agility, and eccentric training requirements for the prevention of skiing injuries. A BosuR Ball is a useful tool to challenge your balance and strength for skiing and other sports. It is flat on the bottom and round on the top. (www.bosu.com $110 – $125.)

PRESEASON SKI EXERCISES:

Traditional exercise such as weight training for quads, hams, gluts etc are valuable. Also, elliptical and stepper equipment and exercise bikes are important. However, the following exercises are specific to the needs of the downhill and cross-country skier.

  1. Nordic Hamstring Exercise (PHOTO 1):
    1. While kneeling, have a partner stabilize your ankles. Attempt a forward-falling motion using your hamstrings to resist the fall. Keep your hips/trunk rigid and in line with your legs.
  2. Ski BosuR Squat (PHOTO 2):
    1. Stand in ski position on the Bosu Ball with ski poles in hands.
    2. Squat and lower yourself 45 degrees (advanced skiers can lower body until your thigh is horizontal).
    3. Raise yourself back up to the starting position but do not lock knees – perform slowly and feel the quads burn.
    4. Repeat for 30 – 60 seconds
    5. Advance to 5 minutes
    6. Advance to simulation of pole plant and turning while on ball performing squats
  3. Ski BosuR Step Down (PHOTO 3):
    1. Stand in ski position on the BosuR Ball with ski poles in hands
    2. Step down on one leg to the floor while one leg remains on the ball.
    3. Raise yourself back up to the starting position but do not lock knees – perform slowly and feel the quad burn on the leg which remains on the ball.
    4. Repeat Same Leg for 30 – 60 seconds
    5. Advance to 5 minutes. Advance to alternate legs
    6. Advance to simulation of pole plant and turning.
  4. Ski Pole Lunge (PHOTO 4):
    1. Hold ski poles in front of trunk
    2. Perform lunges slowly and hold for 5-10 seconds each repetition
    3. Repeat and advance 10-15-20 times
    4. Advance by performing more slowly and lower to floor
  5. Monster Walk (PHOTO 5)
    1. Walk side to side while keeping your legs apart and maintaining pressure against the resistance band
    2. Advance by increasing band resistance (yellow to red)

 

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is an associate professor of clinical medicine at GCSOM.

Nov
26

Health and safety tips for hunters

Dr. Mackarey's Health & Exercise ForumToday is an unofficial holiday in the state of Pennsylvania…the first day of firearms deer season! Approximately, 750,000 hunters from age 12 to seniors will hike through the woods in search of a whitetail.

While I am not a hunter, I am an avid outdoors person with great passion for mountain biking, kayaking, whitewater rafting, hiking and mountain climbing in our state and national parks. With this in mind, I offer hunter safety tips based on the knowledge of experts in the field and offer health safety associated with outdoor activity based on my expertise as a health care provider. Good luck and be safe!

Common Health Problems for Hunters:

  • Chest Pain/Shortness of Breath – overweight and deconditioned people must be very careful when overexerting themselves in the woods while hunting. This is even truer for those with a history of heart disease. Make sure you take your medication and drink plenty of fluids while hunting. Eat a good breakfast with a balance of protein and carbohydrates. A bagel with peanut butter is a good quick start. Pack healthy snacks and water to sustain you.
  • Knee Pain– in the front of the knee or knee cap is common with hunting. This can happen from excessive hiking on uneven or hilly terrain in the woods, especially if there is weakness in the leg muscles.
  • Neck, Lower or Middle Back Pain– can be caused prolonged hiking with a heavy load or prolonged sitting in a tree stand in slouched positions, especially if one has tight hamstrings. Field dressing and carrying the deer out of the woods is also very stressful on the back. Take multiple breaks and stretch backwards, (the opposite direction of bending over to drag the deer)
  • Shoulder Pain– can occur from recoil of a shotgun.
  • Hamstring Pain– can occur if the muscle is tight or weak. Prolonged walking, and bending over can contribute to this problem.
  • Ilio-Tibial Band Pain– when walking on the side of a hill there is a difference in the length of the legs. Overtime, this can lead to pain on the outside of the hip and leg.
  • Foot Numbness or Pain– can occur from prolonged squatting or poorly fitted shoes/boots. However, lower back pain can also be associated with these symptoms.
  • Hand Numbness or Pain– can be caused by repeated recoil of the gun on the shoulder. Also, this may be associated with prolonged pressure of a shoulder strap or leaning on something under the arm.

Preparing Your Body for Hunting

  • Prevention is the best management of most musculoskeletal and safety problems associated with hunting. First, one can prevent many of the above problems through proper fitting of equipment, clothing and shoes/boots.
  • Be sure to maintain a fairly good fitness level in order to hunt safely. Begin an exercise and walking program 2-3 months before hunting season. If you are a beginner, start slowly. Warm up and slowly walk for 10 to 15 minutes and build up over time. Slowly add hills to your walking program.
  • Wear your hunting clothing, such as boots to break them in while walking for exercise. Drytech clothing instead of cotton can keep you warm and wick moisture away from the body.
  • Work on good strength and flexibility of the quadriceps, calf and gluteal muscles. Instead of using the elevator, climb stairs throughout the day to work these muscles.
  • Be careful not to progress too quickly because a drastic change from inactivity to over activity in a short period of time can create problems.
  • Remember, hunting should be fun! Pain from poorly fitted and improperly maintained equipment and clothing can be avoided with good planning. Moreover, injury and death from inactivity and poor fitness is also preventable.

Sources: www.pgc.state.pa.us

Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Nov
19

Advanced Care Planning

ADVANCED CARE PLANNING FOR NATIONAL HOSPICE AND PALLIATIVE CARE MONTH

Special Feature Health & Exercise Forum with Geisinger Commonwealth School of Medicine the 3rd Monday of every month!

Dr. Glen Digwood, D.O.

Dr. Glen Digwood, D.O.

Glen Digwood, DO, Assistant Professor of Medicine at Geisinger Commonwealth School of Medicine

Dr. Digwood was born and raised in Taylor, PA., attended Riverside High School, Ursinus College and Lake Erie College of Osteopathic Medicine. He completed Internal Medicine Residency at Scranton-Temple Residency Program and subsequently completed clinical fellowship in Hospice and Palliative Medicine at North Shore University Hospital in Manhasset, NY. Currently he serves as the director of Palliative Medicine for Geisinger’s Northeast region and is a assistant professor of Medicine at the Geisinger Commonwealth School of Medicine.

November is National Hospice Month! Each November, the community of hospice and palliative care professionals celebrates National Hospice Month. Although, at first glance, spotlighting the concept of death and dying may seem a bit gloomy, it’s actually the concept of quality of life and the focus on living that is truly being celebrated.
It is true that hospice serves those patients and their families who are on the journey of a serious or terminal illness. But as any hospice professional from the nurse to the social worker to the volunteer to the pastoral counselor will attest——the focus is ALWAYS on the value of life being maintained and the quality of living for each and every patient.
This column, written by guest author Dr. Glen Digwood, hopes to raise the level of awareness regarding the importance of advanced care planning.

What is Advance Care Planning?

Have you ever wondered what choices would be made for you if you could not make them yourself? Whether you are young, old, sick or healthy, it is important to discuss and clarify your goals, values, and preferences, as they relate to healthcare, in advance. Advance Care Planning (ACP), as defined by the National Hospice and Palliative Care Organization, is “making decisions about the care you would want to receive if you become unable to speak for yourself”. An additional consensus definition of ACP has been presented to clarify the process. ACP is intended to support adults in understanding and sharing personal values, life goals, and preferences regarding future medical care so that care is consistent with their values.

What Does ACP Entail?

There are two major components of creating an Advance Directive. First, the naming of a surrogate decision maker. This could be done by declaring a Healthcare Proxy or Power of Attorney (POA) for Healthcare. This is the person who will be acting on your behalf should you lose capacity to do so yourself. After choosing this person it is crucial to discuss your wishes about medical care and quality of life with them. Secondly, the piece that this article speaks more to, is the documenting of preferences. This is most commonly done through completing a Living Will. This document specifies what type of medical treatments you would or would not want in differing circumstances.

It would seem to make sense that we should want our wishes known, right? Surprisingly, the rates of completion are quite low. Only about one in three U.S. adults have any type of advance directive completed. The result is that when you get sick your healthcare team is often left to figure out your goals and preferences in the most heightened emotional time. Even more surprising should be that those who are the sickest in our population have even lower rates of completion compared to the healthier parts of our society. The importance of ACP has been specifically demonstrated in studies of elderly populations. Those who engage in ACP are “approximately three times as likely to have the end of life wishes known and followed, and their family members suffer significantly less stress, anxiety, and guilt after their loved one’s death.

How to Overcome the ACP Stigma?

Why have ACP completions rates been so low historically? How do we change our views on ACP and improve completion rates, or at minimum, promote conversation about “what matters most”? The first step likely lies in changing how our society views ACP. Upon hearing the term, people often picture mounds of legal paperwork loaded with “I do want, or I do not want” checkboxes. This legalization of healthcare preferences, although vitally important, is a major hurdle to those of limited means and access to legal professionals. Additionally, this formal paperwork completion also connotes a certain level of finality to these decisions. In contrast, ACP should be thought of as a longitudinal and dynamic conversation that can change over time as aging occurs and new medical conditions arise. These conversations should happen regularly both with an individual’s healthcare provider and loved ones. The best time to develop your advance directive is before you’re sick. This allows for time to develop a clear understanding about your options. It also provides time for you to communicate your wishes to your loved ones and your doctor.

How Can I Start the Process?

If you are confused and overwhelmed by the alphabet soup of all of this (ACP, POA, POLST, etc.) innovative tools exist to promote conversation around goals, values, and preferences. Initiatives like the The Conversation Project, documents such as Five Wishes and conversation games such as Hello (Common Practice LLC) aim to enhance conversation and limit the taboo nature of this issue. These are not meant to replace the legal documents to which we are accustomed. Instead, they serve to enhance conversation by, hopefully, removing some of the stigma and taboo nature to these conversations. To this point, advance directives are only as good as the discussions which precede their execution and use. Remember, it is never too early to start the conversation.

For more information:

https://www.geisinger.org/patient-care/patients-and-visitors/advance-care-planning

https://theconversationproject.org

https://www.nhpco.org/.advance-care-planning

NEXT WEEK: Read Dr. Mackarey’s Health & Exercise Forum – every Monday.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com.

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Nov
12

Ankle Sprains: Part 2 of 2

Alexa Rzucidlo, SPT3 is a third year doctor of physical therapy student at Temple University (2019) and intern at Mackarey Physical Therapy. She grew up locally in Factoryville, PA. She graduated from Lackawanna Trail High School and Temple University for her undergraduate degree in Kinesiology. Alexa plans to continue her clinical experience at Grand Junction VA in Colorado.

Zach Brandt is native of Dalton and a 2014 graduate of Scranton Preparatory School. Zach is currently a senior at Penn State University majoring in Kinesiology and intern at Mackarey Physical Therapy with plans to graduate in December. He plans to attend graduate school to attain his doctorate in physical therapy.

Ankle Sprains: Part 2 of 2

What is one of the most common injuries in high school sports? Ankle sprains. In basketball alone, 40% of all injuries are ankle sprains. The most common ankle sprain occurs when the foot or ankle rolls in (inversion), often when landing on the foot of another player after getting a rebound. This excessive motion stretches the ankle ligaments beyond their limits. Because the ligaments hold the ankle bones together and provides ankle stability, even a mild ankle sprain may cause chronic ankle instability and may lead to early arthritis.
Ian Cowder is a basketball player at Dunmore High School with a history of recurrent ankle sprains. He reinjured his ankle last season and spent 8 weeks this summer working diligently on a strength, conditioning, agility, and proprioception program to prevent ankle sprains. This column will share his ankle injury prevention program to educate others with similar ankle problems.

Sprains are typically accompanied by swelling and bruising, but you should be able to walk on the ankle, though it will be painful, immediately following a sprain. If you cannot take four steps immediately following the injury you may have a more serious injury to the ligaments or bones and should seek medical attention.
Once the pain and swelling have gone away you can begin walking normally, but should not immediately return to sport. Returning to sport without additional training puts a person at risk for more ankle sprains. In addition to the strength exercises discussed last week, agility and proprioception exercises are necessary to prevent reoccurrence.

Exercise 1: Single Leg Stance (Photo 1): With two chairs sitting beside you for a safety precaution, lift one leg up in the air and stand on one leg. Without placing your hands on the chairs, stand on a single leg for 15 seconds to begin. When that becomes easy add another 15 seconds. Once a single leg stance can be held for a minute with ease and no pain, progress to exercise 2

Exercise 2: Single Leg Stance on Pillow/Foam: A variation of the exercise described above, place a pillow or a foam pad underneath the foot you are standing on. Once again hold the stance for 15 seconds to begin with, increasing by 15 seconds every time the exercise is completed easily. Once a single leg stance on a pillow/foam can be held for a minute with ease and no pain, progress to exercise 3.

Exercise 3: Single Leg Stance on Stability Disc (Photo 2): The next variation of the single leg stance exercise involves a rubber disc that is inflated with air. These exercise balance stability discs can be found on Amazon for as little as $12. Like the pillow/foam exercise, the disc is placed under the foot but this time the goal is to stand on the disc for five seconds at a time, repeating it five times. Once a single leg stance on a stability disc can be held for up to 15 seconds 5 times in a row with ease and no pain, progress to exercise 4.

Exercise 4: Single Leg Stance on Stability Disc w resistance Sportscord (Photo 3): The final variation of this exercise involves a sportscord, which is an elastic band that is anchored on one side of the cord and strapped around the waist at the other. As the patient stands in a single leg stance on the stability disc, the elastic sportscord provides a pull on the body forcing core muscles to activate and creating a dynamic exercise. Begin with holding the stance for 5 seconds 5 times and progress to holding the exercise for 15 seconds 5 times.

Exercise 5: Agility Ladder: (PHOTO 4): Once the exercises listed above become easy, you can progress to more advanced exercises such as the agility ladder.
The exercise progression above aims to increase strength, balance, and proprioception, but how do you know when it is safe to return to play? One way to self test is with a single leg squat. If you can perform a single leg squat to 90 degrees without the knee collapsing or pain in the ankle, it may be time to return to play.
Another way to gauge your ankle stability/function is to fill out an assessment such as the Ankle Joint Functional Assessment Tool, which provides a numerical representation of your ankle instability. A score of >26 indicates that you may have a functionally unstable ankle and you may benefit from an aggressive program designed for your needs. For more comprehensive exercise programs, consultation with an athletic trainer or sports physical therapist would be required.

It is important to note, that if you have a history of ankle sprains, the best way to prevent another injury is to participate in an aggressive preseason strength, agility and proprioception program for 6-8 weeks.

Link to the assessment is found at https://meetinstrumentenzorg.blob.core.windows.net/test-documents/Instrument4149/AJFAT meetinstr.pdf

Model: Ian Cowder, a junior at Dunmore High School where he plays varsity basketball.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).

Nov
07

Ankle Sprains: Part 1 of 2

Guest Coauthors: Alexa Rzucidlo, SPT3 and Zach Brandt

Alexa Rzucidlo, SPT3 is a third year doctor of physical therapy student at Temple University (2019) and intern at Mackarey Physical Therapy. She grew up locally in Factoryville, PA. She graduated from Lackawanna Trail High School and Temple University for her undergraduate degree in Kinesiology. Alexa plans to continue her clinical experience at Grand Junction VA in Colorado.

Zach Brandt is native of Dalton and a 2014 graduate of Scranton Preparatory School. Zach is currently a senior at Penn State University majoring in Kinesiology and intern at Mackarey Physical Therapy with plans to graduate in December. He plans to attend graduate school to attain his doctorate in physical therapy.

Ankle Sprains: Part 1 of 2

What is one of the most common injuries in high school sports? Ankle sprains. In basketball alone, 40% of all injuries are ankle sprains. The most common ankle sprain occurs when the foot or ankle rolls in (inversion), often when landing on the foot of another player after getting a rebound. This excessive motion stretches the ankle ligaments beyond their limits. Because the ligaments hold the ankle bones together and provides ankle stability, even a mild ankle sprain may cause chronic ankle instability and may lead to early arthritis.

Ian Cowder is a basketball player at Dunmore High School with a history of recurrent ankle sprains. He reinjured his ankle last season and spent 8 weeks this summer working diligently on a strength, conditioning, agility, and proprioception program to prevent ankle sprains. This column will share his ankle injury prevention program to educate others with similar ankle problems.

Sprains are typically accompanied by swelling and bruising, but you should be able to walk on the ankle, though it will be painful, immediately following a sprain. If you cannot take four steps immediately following the injury you may have a more serious injury to the ligaments or bones and should seek medical attention.

If the sprain is mild, symptoms usually resolve within a couple of days. Symptoms of moderate ankle sprains include swelling, bruising, and loss of ankle motion, and may persist for several weeks. Severe ankle sprains typically require a period of immobilization (i.e. cast or brace) and limited weight bearing (i.e. use of crutches).

Regardless of the severity of the sprain, immediately following an ankle sprain the priority is to minimize swelling and allow damaged ligaments to heal. If you are unable to walk without a limp, rest may include an immobilization shoe and/or the use of crutches to allow ambulation without any weight or limited weight on the injured ankle. The best way to do this is with the RICE method: rest, ice, compression and elevation. Rest meaning you should stay off the injured ankle as much as possible in order to allow the ankle to heal. Ice should be applied to the ankle for up to twenty minutes every few hours to help reduce pain and swelling. Compression of the ankle can be done by using medical bandage wrap, this aids in reducing swelling and internal bleeding. Elevation is also used to reduce swelling and is simply done by placing a few pillows underneath the ankle in order to raise it above the level of the heart.

Immediately after a sprain resting is beneficial, but for how long? Even though it may be uncomfortable to walk, movement is important. Movement helps to pump swelling out of the joint and to prevent the ankle from stiffening up. Movement, however, should be limited and controlled so as not to reproduce pain. It is usually performed in a non-weight bearing position during elevation. The amount of time you should rest will vary on how severe the sprain is and your pain level, but even partially weight bearing or performing ankle pumps (gas pedals) will help prevent ankle stiffness and weakness down the road.

Once the pain and swelling have gone away you can begin walking normally, but should not immediately return to sport. Returning to sport without additional training puts a person at risk for more ankle sprains. Some strength exercises that are easy to do in your home include heel walks for strength and side step over drills for agility.

  1. Heel Walk: While wearing sneakers, walk on your heels. Perform as a timed activity, beginning with 15 seconds and advancing as tolerated to 1 minute. Repeat 3 times and perform 2 sessions daily.
  2. Exercise Band Strength Exercises: See 4 Photos
    1. Photo 1. Ankle Pump Down- push down against band
    2. Photo 2. Ankle Pump Up – pull up against band
    3. Photo 3. Ankle Turn In – turn in against band
    4. Photo 4. Ankle Turn Out – turn out against band
  3. Side Step Overs: Place several cones on the ground greater than shoulder width apart. While standing with your feet shoulder width apart, tie an elastic band between your ankles. As quickly as you can, step over the cones moving left to right and then right to left. Perform as a timed activity beginning with 15 seconds and advancing as tolerated to 1 minute. Repeat 3 times and perform 2 sessions daily.

An important aspect that is often overlooked when it comes to ankle sprains is the ankle’s proprioception. In short proprioception is the body’s ability to sense stimuli regarding position, motion and equilibrium. When a sprain occurs, this proprioception is damaged and the brain is not able to receive these signals. In order to regain this proprioception, a person must work simple exercises that target these stimuli. One simple progression of exercises that is very helpful for the prevention of ankle sprains is a set of exercises that build off of a simple single leg stance.

Model: Ian Cowder, a junior at Dunmore High School where he plays varsity basketball.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Prevention of Ankle Sprains: Part 2 of 2

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).

Oct
29

Tips for Running in the Rain

Dr. Mackarey's Health & Exercise ForumRegardless of your source, it is fair to say that this summer has been one of the wettest in recent memory. According to The Weather Channel, NEPA has received 36.85 inches of rain as of August 15th exceeding the previous record set in 1945. Runners, walkers, cyclists, hikers and other outdoor enthusiasts have learned to adapt to a changing environment or bust! While there are other options such as exercising indoors, (not exercising is not an option) and while this may suffice on occasion, nothing compares to being outdoors…even in the RAIN! The purpose of this column is to provide some tips for running in the rain with the hope of making it slightly less awful.

For many, running is a not fun. For others, running in the rain is even less fun, unless you enjoy heavy, wet, clingy clothes and spongy, smelly shoes, blisters on your feet and skin rashes on your armpits, thighs and breasts. However, living in regions of the world where the sun shines less than 50% of the time and rain moistens the earth like a rainforest (especially NEPA this summer), one must reach deep to “embrace the experience” and “find joy in the moment” of running in the rain. Moreover, with a little preparedness and investment in proper clothing and equipment, running in the rain can prove to be less like form of self-inflicted torcher and more like a “rite of passage.”

Some elite runners feel running in the rain is an opportunity to “mix it up” and have a new experience. Others feel it cools you off and lowers your heart rate in the summer heat. Also, there is a “badge of honor” associated with running in the rain as it gives you a little toughness and preparedness because it feels hardcore.

TIPS FOR RUNNING IN THE RAIN

1. BEGIN WITH A POSITIVE ATTITUDE ABOUT THE RAIN …ENJOY THE SENSATION OF GETTING WET!
The sound of the rain taping off your head can be viewed as a waterfall massage to your scalp. The smell of a fresh rain on a hot humid day or crisp autumn afternoon can open up your nasal passages and “clear your head” if you think about it the right way. Run in a long-sleeve, lightweight shirt, shorts, and shoes that drain well.” Sometimes you need to skip the rain jacket on your run. While a rain jacket will keep you dry, you might overheat, so, layer correctly to ensure you are warm enough but not trapping in heat.

2. CLOTHING MATERIAL MATTERS!
Avoid cotton in the rain because it absorbs water and gets soggy and heavy which will lead to skin irritation. Instead, wear “drytech” materials that wick away water and moister. In cooler temperatures, look for “Smartwool” which keeps you warm but does not hold water.

3. WEAR A HAT WITH A BRIM!
If you wear glasses or contact lenses, a brim keeps the rain off your glasses and out of your eyes to improve your visibility.

4. WATER RESISTANT SOCKS – A MUST!
Again, avoid cotton. Waterproof or water resistant socks are highly recommended for running in the rain. Dexshell Ultralite Bamboo, Randy Sun and Rocky Gore-Tex are a few highly rated products.

5. CONSIDER WATERPROOF/RESISTANT SHOES
While a completely waterproof shoe may not be necessary, some runners find that tighter mesh products handles mud and water really well. For a more waterproof/resistant shoe consider; Under Armour Fat Tire GTX; Altra Lone Peak NeoShell; The North Face Ultra MT GTX or Brooks Adrenaline ASR 12 GTX.

6. USE THE LUBE!
Skin irritation and chafing is awful! Think of burning flesh! It is very common when running in the rain and the best treatment is prevention. While many “skin lube” or “bodyglide” products are available, good old Vaseline works like a charm on your armpits, groin, breasts, and especially your feet.
7. PLAN TO FINISH AT A WARM SHELTER WITH A HOT SHOWER!
Plan your run so you can access a shelter with a warm drink and hot shower and change your wet clothes ASAP!

8. USE REFLECTORS AND HEAD LIGHTS
If it is a dark cloudy day, be sure to wear reflective material and use flashers and headlights.
Sources: Greatist.com ; Allie Flinn, beauty, fitness, and wellness writer.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Oct
22

Stay Limber and Stay Healthy

Dr. Mackarey's Health & Exercise ForumOctober is National Physical Therapy Month! The American Physical Therapy Association (APTA) would like to recognize the thousands of physical therapists as dedicated health care providers. Moreover, physical therapists would like to thank the public for allowing us to participate in your health and wellness. While PT’s may not save lives…we do save LIFESTYLES!

This column will address a question that is frequently asked by people of all ages and activity levels…stretching. First, it is important to keep in mind that stretching should NEVER be performed without warming up your body and muscles first. This can be done by running slowly in place or around the block for 5-10 minutes. Second, stretching should NEVER be painful. Third, a good stretch should be performed slowly and feel like slight tension in the muscle. NEVER bounce or jerk. First, perform the stretches by actively moving your muscles slowly and deliberately 5-10 times. Then, hold the stretch for 5-10 seconds, repeat 5-10 times, 2-4 times per week.

Remember, flexibility is only one aspect of complete health and wellness. Strength training, cardiovascular fitness, meditation and stress management and proper nutrition are also necessary for a healthy lifestyle. Also, be careful not to overstretch before competition as it may weaken the muscle.

10 MOST COMMON STRETCHES:

1. CALF STRETCH

  • Stand with your feet facing a wall shoulder width apart.
  • Step your right foot back keeping it facing forward.
  • Bend your left knee and keep the right knee straight
  • Lean forward and push against a wall for the best stretch, keeping heels on the floor.
  • Feel the stretch at the back of your right leg below the knee
  • Repeat on the left

2. QUAD STRETCH – (PHOTO A)

  • Stand with your left arm holding on to a stable object for balance.
  • Bend your right knee and bring the heel up toward your butt by pulling up/back with your right hand.
  • Feel the stretch at the front of your right thigh.
  • Repeat on the left

3. HAMSTRING STRETCH – (PHOTO B)

  • Lying on your back, clasp the back of your right knee
  • Straighten out your right knee slowly up toward the sky
  • Feel the stretch at the back of your right thigh.
  • Repeat with your left leg straight.

4. GROIN STRETCH

  • Sit with your legs bent with heels together. (Indian Sit)
  • Hold your ankles or feet with both hands.
  • Keep your back straight and stomach in.
  • Push your knees toward the floor.
  • Feel the stretch on the inside of your thighs.

5. LOW BACK FLEXION STRETCH – (PHOTO C)

  • Lie on your back and raise your knees to your chest.
  • Hold the knees with both your hands.
  • Feel the stretch at the bottom of your back.

6. LOW BACK EXTENSION STRETCH – (PHOTO D)

  • Lie on your belly and prop up on your forearms
  • Hold this position and inhale and exhale
  • Feel the stretch in the small of your back

7. TRUNK SIDE STRETCH

  • Stand with your left hand on your left hip and your right arm above your head.
  • Bend to the left by sliding your left hand toward your left knee without leaning forward or back.
  • Feel the stretch on your right side.
  • Repeat with your left arm.

8. TRUNK ROTATION STRETCH

  • Stand upright with feet shoulder width apart
  • Cross arms over chest and turn to the right with your upper trunk
  • Keep lower body facing straight
  • Feel the stretch on the left lower back and trunk
  • Repeat turning to the left

9. SHOULDER STRETCH – (PHOTO E)

  • Take your right arm across your chest.
  • Use your left hand to pull your right elbow across your chest.
  • Keep your body facing forward.
  • Feel the stretch on the back of your right shoulder.
  • Repeat with your left arm.

10. CHEST STRETCH

  • Stand facing a corner with feet 12 inches away and put both arms up in a “T” position
  • Lean into wall with chest and keep feet away from wall
  • Feel the stretch in your biceps and chest.

MODEL: Sarah Singer, PTA; Mackarey Physical Therapy

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Oct
15

Breast Cancer Awareness

Daniel Savaria, GCSOM, MD4

Daniel Savaria, GCSOM, MD4

October is Breast Cancer Awareness Month

GCSOM “Health & Exercise Forum” – 3rd Monday of the Month…

Guest Columnist: Daniel Savaria, GCSOM, MD4

Daniel Savaria of Collegeville is a 4th year medical student at Gesinger Commonwealth School of Medicine (GCSOM). He is a 2012 graduate of Muhlenberg College and received a master of biomedical science degree from TCMC in 2014.

It is fair to say that most of you have heard the phrase, “diet and exercise are the “magic pills.” One very good variation on the analogy says, “Exercise is a magic pill that takes just 30 minutes per day to swallow.” Despite the ubiquity of the sentiment, in the case of breast cancer, current medical research, including a project being conducted at GCSOM, leads me to believe that the public can’t hear the advice often enough.

Before we explore why maintaining a healthy weight is so important to breast cancer prevention, let’s begin with some background. This Breast Cancer Awareness month, there are several things women – and men – should know about this common and feared disease. First of all, breast cancer is not a single disease and is much more complicated than what can be disseminated in the general news media. There are several kinds of breast cancer, including its most common form, estrogen- or progesterone-receptive.

Estrogen-receptive cancer has some very good, targeted treatments, including drugs like tamoxifen and anastrozole, which block estrogen effects. Another type of breast cancer, which is less common, is HER2-receptive breast cancer. As the Mayo Clinic explains, “HER2-positive breast cancer . . . tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells.” As in the case of estrogen-receptive cancer, HER2-positive cancer has a very effective, targeted treatment: trastuzumab. This drug is an antibody that interferes with the HER2/neu receptor.

A third and more aggressive type of breast cancer is Triple–negative breast cancer (TNBC). It is frequently diagnosed in younger and premenopausal women. Since TNBC tests negative for estrogen and progesterone receptors, as well as HER2/neu, it is unlikely to respond to hormone-and/or HRE2-based therapies. Due to its aggression and the lack of a targeted treatment, TNBC can difficult to treat. According to the National Breast Cancer Foundation, TNBC “occurs in about 10-20 percent of diagnosed breast cancers and is more likely to affect younger people, African Americans, Hispanics, and/or those with a BRCA1 gene mutation.” Also, this cancer is more likely to spread and recur. Therefore, finding a way to block growth and proliferation of TNBC cells would be an important tool for treating this fast-moving cancer.

I have had the privilege of assisting in the lab of GCSOM scientist, Dr. Raj Kumar, where he is exploring the overarching goal of identifying what drives TNBC growth and determining how to stop it. Stress hormones, like cortisol, and obesity/metabolic syndrome appear to play a role in TNBC. Discovering a way to block stress-hormone cell receptors could lead to a targeted treatment, something not available today. Dr. Kumar’s lab is currently pursuing a way to target this pathway for drug development. However, if obesity is unequivocally linked to cancer cell proliferation, as we believe it may be, perhaps we already have something infinitely better than treatment – prevention.

That’s where the magic pill comes in. It has been shown that lifestyle changes decrease breast cancer risk even in high-risk women. We should also make abundantly clear that, in rare instances, men can get breast cancer and so should also be concerned with prevention. According to the Mayo Clinic and the American Cancer Society, here’s what men and women can do:

  • Control your weight. The National Cancer Institute (NCI) says there is an increased risk of postmenopausal breast cancer in obese women. NCI explains, “After menopause, when the ovaries stop producing hormones, fat tissue becomes the most important source of estrogen. Because obese women have more fat tissue, their estrogen levels are higher.” NCI further notes that the relationship between obesity and breast cancer risk may also vary by race and ethnicity. There is limited evidence that the risk associated with overweight and obesity may be less among African American and Hispanic women.
  • Be physically active. Physical activity can help you maintain a healthy weight, which, in turn, helps prevent breast cancer. For most healthy adults, the Department of Health and Human Services recommends at least 150 minutes a week of moderate aerobic activity or 75 minutes of vigorous aerobic activity weekly, plus strength training at least twice a week.
  • Limit alcohol. In addition to being linked to cancers of the mouth, throat, larynx and esophagus, excessive alcohol use has also been implicated in cancers of the pancreas, liver, colon and breast.
  • Don’t smoke. The American Cancer Society notes that the 2014 U.S. Surgeon General’s report on smoking concluded that there is “suggestive but not sufficient” evidence that smoking increases the risk of breast cancer. Nevertheless, not smoking is one of the best things you can do for your overall health and certainly lowers your risk for other types of cancers.

This October, while supporting every good observation aimed at raising awareness and raising funds to defeat breast cancer, take time out to review how often you take the exercise pill. Swallowing it for a little over 20 minutes every day will have protective effects on your body that are almost magical.

Medical Reviewer: Raj Kumar, PhD is Director of Research and Professor of Biochemistry in the Basic Sciences Department at GCSOM.

Sources: Centers for Disease Control, Journal of Infectious Diseases, National Cancer Institute.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com.Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Oct
08

Steamtown Marathon Recovery

Dr. Mackarey's Health & Exercise ForumCongratulations to the close to more than 2,000 runners who finished the 23rd Annual Steamtown Marathon yesterday. Most, if not all of you, are waking up this morning with a little less jump in your step than you had yesterday.

Runners, by nature, are very active (often hyperactive) people who may have difficulty sitting and resting, even the day after a marathon. However, today should be a day of rest…you earned it! It is not wise to ignore the pain and stiffness in your muscles and joints. Therefore, I would like to offer some words of wisdom, based on science, to encourage you to adequately rest and allow your body to recover.

REST AND RECOVERY…RESPECT THE DAMAGE TO YOUR BODY:

The Effects of Running 26.2 Miles on the Body:
(RunNow.com – Jim Peskett)

Muscle-Skeletal System:

One of the most obvious effects of running a marathon is significant muscle and joint pain and stiffness. It will set in after you sit for a while and attempt to get up and move around. For most, it will be more pronounced the day after the marathon, as you get out of bed and limp to the bathroom. Studies show that the leg muscles, (especially the calf muscles) display significant inflammation and necrosis (dead tissue) in the fibers of the muscle. In other words, the trauma to the muscles is so severe that tissue damage causes muscle cells to die. Consequently, studies found that muscle strength, power and endurance is compromised and required significant time to recover… sometimes as long as 4-6 weeks!

Additionally, many runners report severe bone and joint pain following the race. Some studies report findings of microfractures or bone bruising from the repeated and prolonged pounding of the marathon. It is purported that the stress on the joints may be related to: weight and body type, running shoes, running style and mechanics. While not dangerous, again, it is important to respect the stress placed on the body and allow adequate healing…LISTEN TO YOUR BODY!

Cellular Damage:

Creatine kinase is an enzyme found in the brain, skeletal muscles and heart. It is found in elevated levels in the presence of cellular damage to these tissues, for example, following a heart attack. Similarly, significantly elevated creatine kinase levels are found in the blood of runners up to 4 days post marathon, demonstrating extensive tissue damage at the cellular level. It is important to note, that these enzyme markers are present, even if a runner does not experience muscle soreness. So, adequate rest for healing and recovery is required, regardless of soreness.

Immune System:

It is not a coincidence that the runners are more likely to contract colds and flu after intensive training or running 26.2 miles. The immune system is severely compromised after a marathon and without adequate recovery; a runner can become ill and ultimately lose more training time or will underperform.

TEN TIPS TO SPEED UP YOUR RECOVERY

(www.runnersworld.com)

1. WALK
Once you cross the finish line, keep walking…for 10-15 minutes after the race to gradually lower your heart rate and prevent a buildup of lactic acid in your traumatized muscles.

2. EAT AND DRINK
Eat small snacks in the first hour after the race and avoid a big meal for later in the day and drink 24 oz. of water for every 2 pounds of weight loss after the race.

3. RELAX
If there was ever a time to enjoy a good movie or television show, it is after the marathon. Just get up and walk around every 20- 30 minutes.

4. ELEVATE YOUR LEGS
While relaxing, elevating your legs is a good idea to improve circulation. If your traveling by car or plane for longer than one hour, wear compression socks while you elevate.

5. ROLL AND MASSAGE
Wait approximately three hours after the race before you roll out and massage your muscles. Make sure you hydrate first.

6. STRETCH
Also wait 3 hours to gently stretch your tight muscles. Be gentle because the muscles are already traumatized.

7. DO NOT RUN
The research clearly states that running too soon will slow down full recovery. Many elite runners like Paula Radcliffe take one month off after the marathon and do yoga and cross-train.

8. WEEK ONE POST-RACE
No running. Do yoga, swim, walk, etc.

9. WEEK TWO POST-RACE
If you no longer have pain, continue cross-training and gradually introduce light, soft running for 30 to 60 minutes.

10. WEEK THREE POST-RACE
Gradually increase the time, distance and speed if you are pain free.

3 MYTHS THAT PREVENT REST AND RECOVERY IN RUNNERS:

1. If I don’t have pain, then I did not damage my body and I can run again soon after the marathon.

FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.

2. Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.

FALSE: In addition to rest, drink, drink, drink – 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.

3. If I don’t run, I will lose all of my conditioning in one week.

FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Oct
01

What you need to know about OTC drugs: Part 2 of 2

Dr. Mackarey's Health & Exercise ForumOVER THE COUNTER DRUGS…What You Need to Know

PART 2 of 2

(Read Part 1 here)

 This is the second of two columns dedicated to the proper use of over-the-counter drugs used, especially  during the “cold and flu” season. First and foremost, consumers must read and comprehend the information provided on the labels of all over-the-counter (OTC) medications before taking the drug themselves and before giving the drug to a loved one, especially a child.

Children and Medications

According to the Centers for Disease Control, approximately 200,000 children (17 years old and younger), visit emergency departments each year due to adverse drug events, including OTC drugs, and children less than 5 years old are more vulnerable than older children. Dosing recommendations for this age group have not been established by the Food and Drug Administration. Many OTC remedies contain numerous ingredients which can increase the risk of an accidental overdose when using multiple products or when used in conjunction with prescription medication. Most product labels are vague about the hazardous consequences resulting when these drugs are given to infants and toddlers. There is no cure for the common cold and there is no evidence that OTC cold remedies are more effective than placebo in children under 2 years of age. The American Academy of Pediatrics recommends alternative solutions to alleviate the symptoms of a child’s cold: (1) To loosen mucous in the nose, use saline nose drops or a cold-air humidifier, (2) To clear nasal congestion, use a rubber suction bulb. If parents have patience and allow several days, the child’s symptoms usually subside. If your child frequently experiences a runny nose, earache, or sinus infection, food intolerances can be the culprit. Avoiding provoking foods such as dairy, wheat, corn, and tree nuts often affords relief to the child with food allergies.

 TIPS TO REDUCE THE RISK OF ADVERSE DRUG EVENTS IN CHILDREN:

  • Use prescription and OTC medications only as directed
  • Carefully give medicines as directed on the label or as instructed by a physician or pharmacist
  • Make sure that safety caps are locked
  • Keep medications in a safe place where young children cannot see or reach
  • Never leave children alone with medications…take the meds with you if you have to answer the phone or do something else
  • Never tell you children that medicine is candy, even if you trying to encourage them to take it
  • Remind grandparents, babysitters and other houseguests to keep purses or bags with medications in it, out of reach
  • Post the Poison Help number in a visible place and store it in your cell phone: 1-800-222-1222

Teenagers and Medications

“Pharming” is when teenager’s use prescription and OTC medications to get “high.” OTC cold remedies containing Dextromethorphan (DXM) are popular recreational drugs for children between the ages of 13 and 16 to induce the sensation of intoxication and even hallucinations. A survey conducted by the Partnership for a Drug-Free America concluded that 1 out of 11 teens has used OTC cold remedies for a recreational “high”.  DXM is readily available (probably in your medicine cabinet), inexpensive, and not illegal.  DXM is considered a “drug of concern” by the Drug Enforcement Agency but there are no legal restrictions except that OTC medications containing DXM are now stored behind the counters of retail stores .

DXM is an ingredient in more than 120 OTC cold remedies including: Robitussin, Nyquil, and Vicks Formula 44. Chemically similar to morphine, DXM has been added to cough syrups and cold medications since the 1970’s. Coricidin HBP Cough and Cold Tablets contain a significantly higher dose of DXM providing an easy and convenient “high” after the ingestion of only a few pills.

In addition to DXM, OTC diet pills, sleep aids (Tylenol PM, Excedrin PM, Sominex), and motion sickness medication (Dramamine) are also abused by teenagers. Diet pills have the potential to produce a “high” and Dramamine causes hallucinations when recommended dosages are exceeded. The abuse of sleep aids can result in narcolepsy. As the frequency of usage increases, teens are at risk of developing physical and psychological dependence to these drugs.

Today’s teens are more likely to abuse OTC medications because of the plethora of information available. Advertisements in magazines, newspapers and on the television have portrayed OTC drugs as safe or harmless. The internet provides an abundant supply of information to the computer savvy teen. Children have access to knowledge about what kinds of OTC remedies to buy for a “high” and exactly how much of the drug should produce the desired effect. The effects of OTC medications can be enhanced and potentially fatal when combined with other OTC drugs, alcohol, or prescription medications. Fortunately, many of these medications are now only available “behind-the-counter” and some states limit how much a person can purchase each month.

Children abuse drugs to gain social acceptance or to alleviate stress from school, friends, and family. Be alert for a child that may be abusing OTC drugs if drugs are missing, grades decline, behavior changes, or eating/sleeping is disrupted. Potential OTC drug abuse can be prevented by: conducting regular drug inventories, communicating with and listening to your children, and establishing well-defined family rules to provide your teen with the information necessary to give the appropriate responses when confronted with recreational OTC drug abuse. Contact your physician if you suspect a potential OTC abuse problem in your child or loved one.

CONTRIBUTIONS: Janet Caputo, PT, DPT, OCS

Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune. Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. Dr. Mackarey is an associate professor of clinical medicine at GCSOM.

Sep
24

What you need to know about OTC drugs: Part 1 of 2

Dr. Mackarey's Health & Exercise ForumOVER THE COUNTER DRUGS…What You Need to Know

PART 1 of 2

According to the Consumer Healthcare Products Association, approximately 3 billion trips to the pharmacy are made each year to purchase over-the-counter (OTC) drugs in the United States. The average household spends about $338. per year on these products and seven out of 10 parents have given their child an OTC in the middle of the night for various symptoms. Consumers purchase OTC remedies for a variety of ailments; to reduce fevers, ease body aches, soothe sore throats, and alleviate nausea and diarrhea. OTC medications are considered safe if they are used according to the directions printed on the label. However, there is much more to be considered when using these products.

OTC medications are readily available, are often less expensive than prescriptions and can be purchased without a visit to the physician’s office. The FDA considers these drugs to be safe for healthy consumers to use if the instructions printed on the label are followed. These medications have few side effects, low toxicity, and a low potential for abuse. Nonetheless, there is the possibility of serious and unpredictable interactions with other drugs that the consumer may be taking. Therefore, if the consumer is taking other prescription or OTC medications, a consultation with a doctor or pharmacist before selecting an OTC remedy may be a wise decision. Furthermore, the consumer must “self-diagnose” when using OTC medications which may result in mistaking a minor ailment for a more serious illness. For example, “headache” may indicate a brain tumor or “heartburn” may be a sign of a heart attack! Moreover, older individuals are at greater risk of developing adverse effects and drug interactions from OTC medications because increasing age affects the absorption, distribution, metabolism, and excretion of many drugs. Finally, some OTC drugs such as cold remedies, cough syrups, and pain killers contain substances that can produce drowsiness, impair judgment, and slow reaction times. Individuals experiencing these side effects are at risk of injury or even death while operating equipment or motor vehicles.

There are several other problems that can occur when using OTC medications. Even though the side effects of OTC drugs are few, they can be dangerous. Heart attacks and strokes can be side effects of Advil, Aleve, and Motrin which are classified as non-steroidal anti-inflammatory drugs (NSAIDs). An OTC remedy may worsen a pre-existing condition. NSAIDs can aggravate peptic ulcers and some decongestants can elevate blood pressure. Because OTC medications are mistaken as “harmless”, they are often taken more frequently and in higher dosages than recommended which can cause organ damage and toxicity. An accidental overdose can occur since some of the actions of OTC medications are similar to prescription drugs. For example, OTC aspirin taken with prescription Coumadin, Heparin, or Plavix can result in excessive thinning of the blood and increase the risk of bleeding. Rare and unpredictable allergic reactions can be produced by some OTC drugs. Anaphylaxis, a life-threatening allergic reaction, is a possibility after taking Aspirin or Advil. The consequences of the prolonged or excessive use of some OTC remedies can require years or decades to develop: liver and kidney damage or osteoporosis.

The consumer has the ability to alleviate the annoying symptoms associated with many common conditions through the use of OTC medications. However, the right to purchase OTC medications does not come without responsibility. In order for these drugs to be used safely, the consumer is advised to follow these guidelines: (1) Read the label for the active ingredient, correct dose, precautions, and which conditions would make the drug a poor choice. (2) Consult a pharmacist or physician when in doubt about which active ingredient would most appropriately address a particular symptom or to identify drug interactions and side effects. (3) Select an OTC drug that treats your exact symptoms. If you only have a cough, avoid the multi-symptom remedies. (4) OTC medications are intended for short-term use. Do not exceed the recommended treatment duration. If symptoms persist, consult a physician. (5) Consult a physician before taking any OTC remedy if you have health problems or are taking prescription medications. (6) Use reliable internet resources for more information such as WebMD or Epocrates Rx on iTunes App Store.

CONTRIBUTIONS: Janet Caputo, PT, DPT, OCS

Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune. Next week read, Part II of II OTC Drug Safety. Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. Dr. Mackarey is an associate professor of clinical medicine at GCSOM.

 

Sep
17

How to prepare for your visit to the doctor

Patrick Connors, M.D.

Patrick Connors, M.D.

Guest Author: Patrick Connors, MD, 2014 Graduate TCMC (GCSOM)

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

In 2009 65 young men and women became part of TCMC’s (now GCSOM) charter class and less than ten years later, after completing residencies in various medical specialties, 14 have return to NEPA to serve our community. Dr. Patrick Connors, class of 2014, is among those eager to contribute to the health and wellness of the people in his hometown. Dr. Connors, son of Pat and Ann Biglin Connors, graduated from Dunmore High School and Temple University before attending TCMC (GCSOM) school. He completed his residency in internal medicine at Thomas Jefferson University Hospitals in Philadelphia and is practicing at the Prime Med office on Pittston Avenue.

“It is nice to practice in an area with people who have meant so much to you,” says Dr. Patrick Connors, Dunmore native who has recently returned to NEPA to practice medicine with Prime Med in South Scranton. He is eager to give back to the community he feels gave him so much. In this column, Dr. Connors and his staff have compiled a list of suggestions that will make your visit to the doctor more effective and efficient.

The majority of visits with your doctor are scheduled to last about 15 minutes. Making the most out of such a short encounter is a challenge, but a little bit of preparation can go a long way.  With many people only seeing their doctor once or twice per year, the importance of being prepared is enormous.  The following is a list of tips to help you make the most out your 15 minutes.

  1. Write down questions.
    1. An easy way to make sure all of your questions are answered is to make a list. At the beginning of your visit, let your physician know that you brought a list of questions.  This helps to ensure you have enough time to discuss all of your concerns.  It may also be helpful to ask family or friends if they can think of anything you need to ask or always forget to ask.
  2. Ask family members what conditions run in the family.
    1. Many conditions have a genetic predisposition. Testing for some of these conditions is not always routinely done in the general population but may be performed if a patient has a strong family history. Certain screening tests like colonoscopies are often performed at an earlier age in patients with a family history of colon cancer.
  3. Bring your medication list.
    1. Medication errors are a major problem in healthcare. With many patients obtaining prescriptions from multiple specialists, medication lists can be a helpful way of keeping track. It is important that the patient, physician and pharmacist are all on the same page about what medicines someone is taking.  If you aren’t sure of your medications, bring in your pill bottles.  Dosages and frequencies are important also.
  4. Try to anticipate questions your doctor will ask.
    1. How long have you had a particular symptom or what were you doing when it started? Has it ever happened to you in the past?
  5. Dress in comfortable clothing that also allows for an exam.
  6. Bring in a log of home readings.
    1. If you check your blood pressure or blood sugar at home, make a log and bring it in for review. Relying on your memory for these isn’t as accurate as a written log.  Often times a log helps to demonstrate a pattern that can be useful.
  7. Bring copies of results of tests with you.
    1. Unfortunately, it is not always easy to get access to prior MRI or lab test results. It could be helpful to bring a copy of these to your visit – especially if it involves something you want to discuss that day.
  8. Bring the names of all physicians that you see.
    1. This helps if we need to contact another provider to discuss a result or plan of care.
  9. Try to arrive early – especially if it is your first time at a new office.
    1. The first visit often involves a lot of paperwork and forms to be signed. It is best to get this out of the way prior to your visit.
  10. Bring your insurance information and contact information.
    1. It is best to have the most up to date information on your record. An up to date emergency contact and an active phone number will make sure you are contacted as quickly as possible if it ever becomes necessary.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commowealth School of Medicine.

Sep
10

Compression socks for runners

 Dr. Mackarey's Health & Exercise ForumHEALTH AND EXERCISE FORUM, By: Dr. Paul J. Mackarey

 Compression Socks for Runners – Wear After The Race! Jury Out on Value for Running Performance –

But New Research Suggests Socks May Prevent Post Race Bloot Clots —One month to go until the Steamtown Marathon!

The 23rd Annual Steamtown Marathon will be held on Sunday October 7, 2018. Approximately 2,500 runners will attempt to conquer 26.2 miles from Forest City to downtown Scranton. While I have not participated in the event in several years, I would like to share some of my past running mistakes with the hope that you might have a better and healthier race and recovery…consider using compression socks AFTER you train/race if the run is longer than an hour and the drive/fight home is longer than 1 ½ hours.

Completing the long and arduous 26.2 mile journey is not an easy task. In fact, the mechanical and physiological toll on your body is tremendous; from painful joints, muscles, tendons, to black and blue toes. Not so obvious, however, is the damage to your deep veins and tissues of the circulatory system. New research indicates that strenuous endurance exercise, such as marathon running, stimulates the clotting mechanisms in your body in response to the multiple micro traumas sustained over 2 or more hours. While most healthy athletes will naturally heal from post exercise clot formation, others may be at risk…those traveling more than 1 hour (by car, bus, train or plane). The risk increases substantially for those with a longer period of travel/sitting post-race, history of previous trauma, blood clots or have the genetic predisposition for clot formation.

What Are Compression Socks? How Do They Work?

Compression socks are familiar to most people as the tight knee-high support stockings worn after a surgical procedure such as a knee or hip replacement to prevent blood clots. They are made with a special fabric and weave design to provide graduated compression (stronger compression at foot and ankle and less at the top of the sock) to promote better circulation and movement of fluids from the foot, ankle and calf back to the upper leg and ultimately the heart. Compression socks work similarly in runners. As the stagnant fluid with lactic acid and other byproducts of exercise is removed from the space, fresh blood, nutrients and oxygen is replaced to foster healing of micro damage to tissue and promote more efficient use of the muscles.

Is There Any Research?

The Journal of Strength and Conditioning Research published a study that found wearing compression socks improved running performance. However, similar studies have failed to support this claim. One finding that has been repeatedly supported in the literature, including The British Journal of Sports Medicine, found that compression socks worn in soccer players and runners improved the rate and magnitude of recovery. Moreover, recent studies, including a study with the Boston Marathon, have demonstrated the reduction in clotting mechanisms in those wearing compression socks AFTER the marathon, as compared with those wearing “sham” socks. Benefits seem to be less obvious for short duration activities or when running 10km or less.

Conclusion

In conclusion, only time will tell if compression socks will improve performance in runners will or be merely a fad based on placebo or true fact supported by scientific research. Based on current wisdom, these socks may offer value and benefit AFTER activities of long duration (more than 1 hour) or long distance running (more than 10km) to expedite the recovery from exercise-induced blood clot formation, muscle soreness from the accumulation of lactic acid and other muscle damage byproducts.

It is this author’s opinion that this product is worth a try. However, whenever you try something new for your sport, trials should occur during practice and if successful used during competition. Consider trying a lower compression to begin (the socks come in different degrees of compression). Even if one is hesitant to use the product while running, it appears the greatest value of the sock is after a prolonged training session or competition to reduce exercise-induced muscle soreness and prevent blood clots, especially in athletes at risk for clotting and those traveling for an hour or more after the race. Additionally, in view of the fact that some studies which showed only minimal to moderate improvement in well-trained athletes, it may be that those in greater need, such as deconditioned individuals attempting to begin a fitness program and novice weekend athletes, may benefit more from compression socks than elite athletes.

TAKE HOME: Runners, cyclists, triathletes, soccer players and others participating in endurance sports should consider compression socks, if not during the activity, certainly following the activity for 24 to 48 hours…especially those at risk for blood clots and those traveling for more than one hour after the race.

With one month to go before the Steamtown, it is not too late to try compression socks and see if they work for you during and more importantly, after your long training runs.

Where to find compression socks:

2XU Compression Racing Sock – www.2XU.com

Scranton Running Company – Olive Street – Scranton

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.

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