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.

Sep
03

Have a healthy Labor Day

Dr. Mackarey's Health & Exercise ForumSince 1894 Labor Day has been designated as the national holiday that pays tribute to the contributions and achievements of American workers. Research supports the notion that healthier employees are happier and more productive. When employers encourage healthy behavior and safety at work, they benefit in many ways. For example, in addition to improving job satisfaction and productivity, healthy employees save money by using less sick time, worker’s compensation benefits and health benefits. For example, according to the Centers for Disease Control and Prevention, approximately 75 percent of employers” health care costs are related to chronic medical problems such as obesity, diabetes, high blood pressure, and high cholesterol. Deconditioned, overweight employees are more likely to suffer from these preventable conditions and are at greater risk for injury. Employers, please consider using this holiday as an opportunity to start a health promotion program at your workplace…have a health fair, offer healthy snacks, encourage walking, smoking cessation, exercising at lunch, and offer fitness club stipends.

Lower back pain, one of the most costly illnesses to employers, is one example of a problem which can be prevented with a good health and safety program. It is widely accepted in the medical community that the best treatment for lower back pain (LBP) is prevention. Keeping fit, (flexible and strong), practicing good posture, and using proper body mechanics are essential in the prevention of LBP. At our clinic, significant time and effort is spent emphasizing the importance of these concepts to our patients and employees.

The City of Scranton is a perfect example of the merit and value of LBP safety and prevention. I have served as a rehab consultant for the city, working with human resources and they have saved significant dollars in workers compensation dollars with a safety program. During this time, the city has noticed a significant reduction in LBP injuries through an onsite safety program which promotes education, wellness, body mechanics, lifting techniques, postural and stretching exercises and ergonomics.

Prevention of Lower Back Pain

  • Maintain Fitness Level: As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well, exercise regularly and don’t smoke. Smokers have a much higher incidence of LBP and failure from lower back surgery.
  • Practice Good Posture & Body Mechanics: Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back.

Proper Sitting Technique

Proper Sitting Technique

Perform postural exercises throughout the day. Most of the day we sit, stand, and reaching forward and bend our spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.

  • Chin Tuck: Tuck your chin back to bring your head over shoulders.
  • Shoulder Blade Pinch: Pinch your shoulder blades together.
  • Standing Extension: While standing, put your hands behind back and  extend lower back 10-20 degrees.

Good Body Mechanics and ergonomics are also important in the prevention of LBP. When lifting, think twice. Think about the weight, shape and size of the object. Think about where the object is going and the surface resistance of the floor. Does it require two people to lift? Can I safely lift that high or bend that low?

When bending to lift an object think about safety:

  • Spread Legs Apart Shoulder Width
  • Bend at the Knees and Limit Forward Bending the Spine
  • Arch Lower Back Slightly
  • Get and Maintain a Firm Grip
  • Contract and Hold Abdominal (stomach) Muscles
  • Lift With Legs (not back)
  • Do Not Pivot or Rotate Spine With Load (use feet and step turn)
  • Lift Slowly and Carefully (don’t hurry)
  • Take Time to Perform Back Extension Stretches After the Lift
  • Remember, Pushing is Better Than Pulling a Heavy Load

Proper Lifting Technique

Proper Lifting Technique

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.

Aug
27

Addiction and avoiding opioid dependence with pain medication alternatives: Part 2

Dr. Mackarey's Health & Exercise ForumADDICTION: Avoiding Opioid Dependence and Alternatives to Pain Medications

Part 2 of 2

(read Part 1 of this series at this link)

International Overdose Awareness Day, August 31, 2018

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

Guest Columnist: Anthony Morada, MD2 

Anthony Morada, MD2

Anthony Morada, MD2

Anthony Morada, a second year medical student at Geisinger Commonwealth School of Medicine (GCSOM). Anthony Morada majored in Cell and Developmental Biology and minored in English at the University of California Santa Barbara. As a community advocate, Anthony has hosted a Metastatic Breast Cancer Symposium at GCSOM and will be hosting a free Hepatitis B Screening at GCSOM for the Steamtown Health Fair on September 22, 2018.

In 2017, Pennsylvania recorded the second highest increase in deaths from opioid overdose in the country.1 While this alarming measure included illegal opioids such as heroin, prescription painkillers consisted of more than 40% of all US opioid overdose deaths – calculating to more than 46 victims per day.2 Prescription painkillers like Methadone, Oxycodone, and Hydrocodone, are part of the opioid drug class because of the way they affect the pain receptors in the body. These pills are commonly prescribed by physicians to treat severe or persistent pain. While most patients appropriately use opioids to manage their pain, minimizing opioid use and seeing alternative forms of pain relief can help reduce the risk of opioid dependence and overdose.

Know The Risk Factors – Who is Most Vulnerable?       

Eliminating the need for opioids completely or using the lowest needed dose will reduce the chance of developing opioid addiction disorders. Research found that among patients prescribed opioids for chronic pain, approximately 10% of them will be diagnosed with an opioid use disorder.3 As the name describes, patients with an opioid use disorder rely on or are addicted to opioids, including prescription drugs and heroin. While not all patients will experience reliance on these drugs, researchers identified factors that may be associated with an increased risk of developing an opioid use disorder: the presence of another substance use disorders (including tobacco use disorders), a family history of substance use disorder, other mental health disorders (such as depression or posttraumatic stress disorders), a history of legal problems or incarceration, and individuals using opioids younger than 40 years of age.4,5 Therefore, patients meeting any of the previous criteria should be aware of the increased risk for developing opioid use disorder. Consequently, opioid addiction parallels the increased risk of death primarily due to the elevated rates of overdose and trauma.

 

Limit Exposure and Opportunity

Eliminating prescription opioids in the household can minimize the chance of family or friends from getting possession of opioids. Investigators found that prescription opioids were more often obtained from friends or relatives than from a clinician.6 Therefore, by removing unnecessary opioids, patients can reduce the amount of drugs in the community. Fortunately Pennsylvania’s Department of Drug and Alcohol Programs has a Drug Take-Back Box Program that allows individuals to safely dispose of their unused opioids at their local hospitals and pharmacies. While complete elimination may not be entirely reasonable, taking the minimum dose needed or alternative non-opioid pain relief can yield similar outcomes while decreasing the chance of adverse events.

In response to the epidemic, the Centers for Disease Control and Prevention (CDC) released prescription guidelines that recognize specific situations where a low dosage of opioids are appropriate such as: cancer treatment, palliative care, end-of-life care, and certain acute care situations. For long term pain management, the CDC recommends physical therapy for symptoms that are related to low back pain, osteoarthritis, fibromyalgia, or other chronic pain lasting longer than 90 days.7 Research has found that, treatment with opioids was not superior to nonopioid treatment for improving pain-related function over 12 months. The American Physical Therapy Association’s (APTA) launched a national public awareness campaign to encourage patients to #ChoosePT as a safer alternatives for long term pain relief.

 

Find Safer Alternatives for Pain Management

As a more permanent solution, physical therapy breaks the cycle of chronic pain while opioids temporarily masks symptoms and actually delays recovery. A physical therapist will partner with their patient to create a customized plan of care that addresses their painful movement faults. Physical therapists can treat symptoms through therapeutic exercise, hands-on techniques, and patient education on chronic pain management.8 Exercise therapy can be modified to include aerobic, aquatic, and resistance exercises that addresses musculoskeletal imbalances or poor conditioning causing pain. Impairment-specific exercise programs combined with patient education on pain mechanisms can help address fear associated with chronic pain symptoms. Physical therapists can also address proper posture, ergonomics, sleep positioning, and body mechanics to decrease overall daily stress on the body and improve functional capacity.9 Patients can be referred to other experts on behavioral and stress management techniques that promote overall health and wellness. The education process includes building a multidisciplinary team and setting patient-centered goals that are realistic for recovery without opioid use.

 

Use Resources

Victims of an opioid use disorder have a number of resources to help them manage their disease, and reduce the risk of recurrence and overdose. While self-diagnosing an opioid use disorder may prove difficult, there are a number of signs that may suggest a misuse of prescription drugs – these indications include: using more drugs than planned or for a longer period of time, unable to cut down the need for drugs, having a craving or strong desire to use, neglecting work or family, or any other symptoms that prevent the individual from previously normal activities.10 Individuals who are worried that they may have a problem with drugs are highly encouraged to talk to their primary care physician, or a mental health counselor. This way consultation and treatment programs can begin before the drug abuse gets out of hand. Normally, treatment of opioid use disorders involves 3 components: medicine, counseling, and support groups. Physicians can prescribe medicines that help patients reduce drug cravings and eliminate the high that comes from opioids. Addiction counseling helps patients come to terms with their addiction and helps them develop a life that does not involve drugs.

While support groups, like Narcotics Anonymous, provides a forum for those with the same conditions to share their experiences and advice with each other. In Scranton, there a few local resources aimed to help those with opioid and other substance use disorders. Some of the example organizations are the Greater Scranton Steamtown Area of Narcotics Anonymous and the Drug and Alcohol Treatment Service, Inc. in Scranton. The Pennsylvania Department of Drug and Alcohol Programs also supports a 24 hour hotline with a purpose to assist patients in finding treatment providers or funding for addiction treatments; this number can be reached at 1-800-662-HELP (4357). Alternatively, you can find this information on their website entitled PA Get Help Now at “apps.ddap.pa.gov/gethelpnow/” that will also help you find local care providers and pill take-back locations based on a zip code.

Other Multimedia Resources

Contributor: Kay Kovitprakornkul, BS, SPT

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 inquiries 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.

 

Aug
20

Addiction Awareness: Part 1 of 2

Dr. Mackarey's Health & Exercise ForumADDICTION: Part 1 of 2. 

International Overdose Awareness Day, August 31, 2018

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

Sana Chughtai, MD2

Sana Chughtai, MD2

Guest Columnist: Sana Chughtai, MD2 

Sana Chughtai is a second year medical student at Geisinger Commonwealth School of Medicine from Pittsburgh, PA. She received a Bachelor of Science in Biological Engineering from Purdue University in 2017. Her current interests in medicine include preventative medicine and health education. 

“I’m addicted!” It’s a phrase many of us use loosely, whether we’re referring to our favorite snack or our newfound love for a TV show. For some though, the addiction is real. Here in northeastern Pennsylvania the opioid crisis has only gone from bad to worse. Before we can understand the scope of the crisis, we must understand how addiction works. What changes within our bodies and our brains that sparks the start (and continuation of) an addiction?

Whether or not addiction is truly considered a disease is still debated amongst experts in the field, but what is mutually agreed upon is that there are changes in the brain. The first time may have been a choice, but subsequent engagement involves the alteration of normal processes of the brain.

The basal ganglia is often referred to as the brain’s reward circuit. The continuous use of certain drugs, including opiates, over-activates this center, producing what most addicts refer to as a drug high. With repeated exposure of this circuit by the same substance, tolerance is developed. This means that the basal ganglia’s sensitivity is reduced, making it difficult for drug users to feel pleasure from healthy activities that used to bring pleasure before the initiation of drug use. This is one of the factors that leads to dependence, since addicts struggle to feel pleasure from anything other than the drugs they use.

The extended amygdala is involved in handling stressful emotions and is primarily responsible for the feelings of withdrawal. Unlike the basal ganglia, the sensitivity of this area is increased with repeated drug use. This leads to drug-seeking behavior to reduce the unwanted discomfort of withdrawal symptoms.

The prefrontal cortex of the brain is involved in impulse control. Extended drug use can impact the ability of the prefrontal cortex to function properly, leading to impulsive drug-seeking behavior.

It is also important to understand the role of dopamine in drug addiction. Dopamine is a neurotransmitter, meaning it is a substance released from one neuron (a cell in the nervous system) to act on another. When a person engages in a pleasurable activity, neurons release bursts of dopamine, signaling the brain to associate that particular activity with positive feelings. The purpose of doing so is to form habits and reflexes that increase the frequency of the activity that produces pleasure. Drugs produce larger bursts of dopamine than other, normal routine activities, leading to the formation of the habit.

There are generations of people that continue to believe that addiction is the result of immorality and weakness and that a strong sense of willpower is all that is needed to overcome it. So many of us are quick to blame addicts for their situations, hindering our ability to truly see it as an affliction that requires legitimate treatment.

Take a lifelong smoker who develops lung cancer for example. The way family, friends, and community members react to this news differs greatly from how many would react if that same individual was acknowledged to suffer from addiction instead. With a cancer diagnosis typically comes feelings of empathy and focus on treatment, while learning of someone’s addiction tends to bring feelings of blame and shame.

But why? People don’t tend to blame the cancer patient for developing his or her cancer, even if their decision to smoke contributed to its development. People do however tend to scrutinize an individual’s addiction and the choice (or series of choices) that led to their dependence.

It’s not always that simple though. Although the term addiction tends to elicit the stereotypical profile of who an addict is, addiction is an affliction that transcends the boundaries of age, sex, skin color, and household income. While many drug addicts’ addictions are a result of illicit drug use, addiction for many others begins with a prescription medication in the absence of any initial illicit activity.

Addiction is a complex issue that requires a complex solution. A simple first step we can all take is to put aside our preconceived notions and cookie-cutter mental images of who addicts are and what addiction entails. We must first change the way we see those who are affected so that we can properly help them in the hopes of improving not only their lives but the lives of family, friends and all those in the communities that have been affected by this plague.

For More Information:

  • Drugs and the Brain. (2018). Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain
  • https://www.rd.usda.gov/files/PA_Opioids_Maps_Database_2018_Opt.pdf
  • https://www.overdosefreepa.pitt.edu/know-the-facts/view-overdose-death-data/
  • https://www.cdc.gov/drugoverdose/epidemic/index.html

NEXT WEEK: Part 2 of 2, Addiction and Pain Management Alternatives

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 inquiries 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.

Aug
13

Preventing heatstroke in football, soccer, and fall sports

Dr. Mackarey's Health & Exercise ForumPREVENTION OF HEATSTROKE: For Football, Soccer and Fall Sports

Summer football training camps and practice sessions are in full swing in Northeastern Pennsylvania. A few years ago, the Pennsylvania Interscholastic Athletic Association (PIAA) implemented “Preseason Heat-Acclimatization Guidelines” This policy is slightly updated for starting dates each year (www.piaa.org).

At this time each year, I receive several emails from concerned parents regarding heat stroke in football players and hopefully this column will serve to educate coaches, players and parents about the importance of heatstroke prevention.

Most medical professionals agree that the amount of protective equipment worn by football players makes them more susceptible to heat stroke than athletes in other sports. It is also well-accepted that prevention is the best treatment for heat stroke. They feel that overweight and poorly conditioned players should be monitored closely by weighing in before and after practice. A player who loses more than 3% body weight is at risk for heat stroke. These players should be required to take more breaks, with more fluid intake before, during and after practice. Heat stroke one of the most serious heat-related illnesses. Heat stroke is caused by long term exposure to the sun to the point which a person cannot sweat enough to lower the body temperature. The elderly and infants are most susceptible as are athletes wearing full gear and protective equipment. It can be fatal if not managed properly and immediately. Believe it or not, the exact cause of heatstroke is unclear. Prevention is the best treatment because it can strike suddenly and without warning. It can also occur in non athletes at outdoor concerts, outdoor carnivals, or back yard activities. The American Academy of Pediatrics and The American College of Sports Medicine has the following recommendations:

Signs of Heatstroke:

  • Heat Exhaustion – can be a precursor to heat stroke.
    • Signs: cramps, weakness, fatigue, nausea
    • Treatment: rest in shade, cool down with cool (not cold) towels, and drink plenty of fluids.
  • Core Body Temperature above 105 degrees Fahrenheit
    • Hot, dry skin – flushed but not sweaty
    • Lack of sweating
    • **NOTE: athletes often have external heatstroke and they can sweat even with an increase core temperature
  • Very rapid pulse
  • Mental confusion, disorientation or hallucinations
  • Physical clumsiness, sluggishness or fatigue
  • Seizure
  • Dizziness

Treatment of Heatstroke:

  • CALL 911 – Remember this may be life-threatening
  • Relocate Athlete – to a cool shady place or air-conditioned indoors and lie down with slight elevation of feet
  • Undress – Remove outer garments and roll onto side to expose as much skin as possible to the air
  • Cool Down – spray or sponge with cool water (not cold) and fan athlete
  • Ice – place ice packs to the groin, neck and armpits to cool down large blood vessels. No ice bath.
  • Core Temperature – is the only accurate measurement so medical personnel may take rectal temp if necessary. Must get core temp to 102 degrees Fahrenheit ASAP.
  • Begin CPR – if breathing stops
  • No Aspirin or Acetaminophen – to decrease temp
  • Administer Fluids – if person is alert enough to swallow give 32 to 64 oz over 1-2 hours

Prevention of Heatstroke:

Gradual Acclimatization to Heat – REFER TO PIAA HEAT-ACCLIMATIZATION Source: www.piaa.org

  • Get used to the heat gradually. Begin short conditioning sessions in early summer. Have shorter and less intense practices for the first 7-10 days. If athlete recently had the flu or an illness with a temperature, keep them home for a while and gradually introduce the heat and humidity with short periods of exercise. They are at increased risk for heat stroke.
  • Humidity Index (RI) – Be very aware of the temperature (T) and the relative humidity (RH). RI = T + RH. If the sum of the temperature and relative humidity are greater than or equal to 160, take serious precautions (short sessions in early morning or evening, shorts and half pads, plenty of water and sports drinks etc). If the sum of T and RH are greater than 180, practice and/or games should be canceled.
  • Take Frequent Breaks – 15 minutes after each hour if T & RH is equal to or greater than 160. Rest in shaded areas, helmets off, jerseys loosened or off.
  • Unlimited Cold Water – should be available at all times. Mandatory scheduled water breaks every 15-20 minutes. Break in a shaded area and water down your head, neck etc to cool down. Guidelines: 16 oz 2 hours prior to activity, ½ water bottle every break, after practice continue drinking 1 cup per hour for 4-5 hours, avoid caffeine drinks (can dehydrate), avoid carbonated drinks (bloating will limit water intake) and avoid alcohol.
  • Electrolyte Sports Drinks – are very helpful to replace electrolyte loss. DO NOT USE SALT TABLETS. Generously season food and use sports drinks instead.
  • Dress For Heat – use drytec type material under your pads to wick sweat away from body and change shirts at break. Wear light colors. Use fishnet jerseys over your pads to keep cool. Remove helmets often in hot weather.
  • Medical Files – keep an index of individual athletes with medical problems or history for problems, especially those at risk for heat related problems. Certain medications may put an athlete at risk for heat stroke. Pay special attention to those players.
  • Keep Alert – coaches, parents, players must be on the lookout for signs of a problem in themselves and their teammates such as fatigue, lethargy, inattention, stupor, and loss of coordination. Remove the athlete from the field, cool down in shade with cool (not cold) damp towel/blanket, seek medical attention.
  • DO NOT IGNORE SIGNS OF PLAYER DISTRESS OR POOR PRACTICE MANAGEMENT – YOU MAY SAVE A LIFE! – If you witness signs of a player in distress or signs of poor practice management that may jeopardize the health of an athlete, diplomatically speak up. Use references to educate those in charge to recognize their mistakes and improve conditions. Problems occur not because of malice, but usually because of ignorance.

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.

Aug
06

Headaches can be a pain in the neck

Guest Coauthor: Alexa Rzucidlo, SPT2

Alexa is a second year doctor of physical therapy student at Temple University (2019). 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.

According to the World Health Organization about half of the world’s adult population has had a headache at least once in the past year. For many people, these headaches are infrequent and do not often affect daily life. But what about when your headache occurs frequently or is so severe it prevents you from going about your day to day activities? Some types of headaches are more easily treated and managed than others.
There are two types of headaches: primary and secondary. Primary headaches occur without an underlying disease and include migraines and tension-type headaches. Secondary headaches can be associated with serious disease, requiring emergency care, or can be referred from other structures of the body such as the cervical spine (neck).

Headaches symptoms that may constitute a medical emergency are: vomiting, seizures, fever, muscle pain, night sweat, weight loss, and neurologic symptoms such as blurred vision. If you are experiencing any of these symptoms, if your headache worsens, or your symptoms change it is recommended that you seek medical attention. Any headache that is unusual for you and does not resolve itself in a reasonable time, should be brought to your primary care physician’s attention.

Primary Headaches:

Migraines: Migraines are a primary form of headache that typically lasts from four to seventy two hours, can range from moderate to severe pain, and typically are located on only one side of the head. Often they can be accompanied by an aura, nausea or vomiting, sensitivity to sound, or light sensitivity. Migraines can be aggravated by routine physical activity such as going up stairs. This type of headache is thought to occur in the central nervous system and is related to blood vessels.

Tension-type: Tension-type headaches are the most common primary headache disorder and can last anywhere from thirty minutes to seven days. These headaches can often have a pressing or tightening quality that occurs on both sides of the head. Usually there is no nausea, vomiting, light sensitivity, or aggravation with physical activity. This type of headache is thought to occur in the central nervous system but can have a hereditary component and is usually associated with muscle tender points. Tension – type headaches can be treated with relaxation techniques such as Progressive Muscle Relaxation (PMR), medications, and physical therapy.

Secondary Headaches:

The most common secondary headache that is not related to a serious medical condition is a cervicogenic headache (originating from the neck).

Cervicogenic Headache: The length of time a cervicogenic headache can last varies. Usually, the pain is on one side and usually starts in the neck. This type of headache is aggravated or preceded by head postures or movements of the neck. Due to the nerves of the neck and face sharing common connections, pain signals sent from one region can lead to discomfort in the other. Physical therapy can be an effective treatment to help relieve symptoms. For example: posture, exercise, ergonomics, massage, manual techniques, traction, trigger point, and acupressure.

A cervicogenic headache can be caused by an accident or trauma or can stem from neck movement or sustained postures. Sustained postures could mean sitting in front of a computer at work or looking down at your phone. Changing these postures throughout the day could help reduce symptoms. Changing postures could mean bringing your phone closer to you using pillows or another supportive surface when checking social media. If you are someone who works at a desk, it could involve taking breaks or getting a standing desk. However your life requires you to move, there are some simple and effective exercises you can perform throughout the day to help cervicogenic headache symptoms.

5 TIPS FOR TENSION HEADACHES

  • Progressive Muscle Relaxation: PMR is an effective method for reducing tension throughout the body. With this method you first tense a muscle group, such as at the neck or shoulder, then relax the muscles noting the difference between the two. This helps reduce both stress and tension. For more information or to learn how to do PMR, refer to podcast at: https://www.psychologies.co.uk/try-progressive-muscle-relaxation
  • Manage your stress level: While stressors vary from person to person, one method for managing stress is with exercise. Any form of exercise can help reduce stress, but a cost free method is aerobic exercise such as walking or running. A less time consuming method could be to perform deep breathing exercises throughout the day.
  • Heat or cold: When feeling sore or stiff, applying a hot or cold pack or taking a hot shower can help ease a tension headache.
  • Posture: Some tips for posture are to make sure your head is over your shoulders rather than sitting forward and making sure you are sitting or standing up straight with your shoulders back. See photo A: “Upright Desk Posture”
  • Over the counter medications: Talk to your doctor or pharmacist for additional information.

5 TIPS FOR CERVICAL HEADACHES

  • Posture: See tips listed under tension headaches.
  • Ergonomics: If your job or hobbies require you to sit for extended periods it may be beneficial to change positions throughout the day or consider getting a standing desk. When sitting make sure the monitor is at eye level, your legs are able to fit under your desk, and you are close to the keyboard and monitor. If you are working with a laptop avoid putting it in your lap, bring your laptop closer to you by putting pillows on your lap. See photo A: “Upright Desk Posture”
  • Exercise: Some exercises to help relieve symptoms are chin tucks, shoulder blade pinches, and back extension. These exercises can be performed multiple times throughout the day in sitting or standing.
  • Physical Therapy: Physical therapy may include massage, manual techniques, stretching, traction/ decompression and exercise. A physical therapist can assess your posture and provide strategies specific to you. See Photo B: “Manual Traction”
  • Over the counter medications: While medication may not cure cervicogenic headaches, they may help relieve pain. Talk to your doctor or pharmacist for additional information.

Models: Danielle Higgins and Zach Brandt

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).

Jul
30

Prevent dehydration in elderly: Part 2 of 2

Dr. Mackarey's Health & Exercise ForumPREVENTION OF DEHYDRATION IN THE ELDERLY  (Part 2 of 2)

Last week in Health & Exercise Forum, we discussed dehydration as a potentially life-threatening problem, especially in those over 60.Summer heat and humidity are here and the risk of heat related illnesses are greater than normal. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year round. Furthermore, age related changes in 50-60 year olds can also make one vulnerable to dehydration, especially if they are active and exercise in the heat.

It is widely accepted that the best treatment for dehydration is prevention. One must take a proactive approach to ensure and/or encourage adequate fluid intake, especially with age and in high temperatures. Consider some of the following practical tips to promote optimal hydration.

  • Medications: Review your medications and note if any have the potential to reduce your body fluid levels or alter your electrolyte balance. Diuretics, hypnotics, and laxatives are some examples of medications that have the potential to contribute to dehydration.
  • Fluids that can dehydrate: Avoid beverages that contain caffeine or alcohol since both have dehydrating properties.
  • Check on your urine: As a general guide to hydration, urine should be plentiful, pale in color, and odorless. Dark, scanty, and strong-smelling urine may be the signal of dehydration.
  • Early morning or late day exercise or activities: Avoid the hottest part of the day. Remember that simply breathing in and out uses more than a pint of water a day. Drink slowly and frequently when exercising. On an average day, try to drink about two liters of water and with activity you can double or triple that amount and consider sports drinks with electrolytes if you are engaging in activities longer than 45 minutes.
  • Extra caution to hydrate if you are ill: You will need to hydrate more of you are experiencing vomiting, diarrhea, or an infection that causes fever.
  • Make a hydration plan: Some elderly individuals fear frequent nightly urination. To prevent this occurrence, begin your fluid consumption early and not later then 6 o’clock at night. Eliminate the need to “think” about drinking more fluids. Carry a water bottle around with you or at least keep a glass filled with your favorite, healthy beverage within your reach or at least within your view! Having fluids nearby and easily accessible will help to remind you to drink!
  • Be creative: Plan and provide “opportunities to drink”. to schedule a happy hour before your evening meal and serve liquid appetizers (e.g. tomato juice, orange juice, V-8 juice) or non-alcoholic drinks such as a virgin Bloody Mary.Fluids with appealing colors (e.g. pink lemonade) served in attractive bottles, glasses, or stemware are more alluring to the senses and more likely to be sampled. Use a blender to mix cocktail combinations: kiwi-strawberry, vanilla and root beer soda, ginger ale and cranberry juice, and orange and pineapple juice. Garnishing a simple glass of water with a wedge of lemon or a frozen strawberry may be the stimulus that some people need to take their first taste. Adding sprigs of fresh mint or lemon verbena can make a fresh-tasting drink with an appetizing aroma. If texture is an important factor, create frozen liquids such as lemon ice, popsicles, gelatin desserts, Italian ices, and snow cones. Consider fresh fruit such as watermelon and pineapple. Fruits and vegetables are great examples because they contain 80% to 90% water.

Remember, knowledge and awareness of the symptoms of and the prevention of dehydration can reduce unnecessary hospitalizations and maximize health and well-being for the elderly and not-so-elderly individual.

Visit your doctor regularly and listen to your body.

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

Contributor: Janet M. Caputo, DPT, OCS

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.

Jul
23

Dehydration risk and increase with age: Part 1 of 2

Dr. Mackarey's Health & Exercise ForumDEHYDRATION …increased risk associated with age! Part 1 of 1

Summer heat and humidity are here and the risk of heat related illnesses are particularly high for those over 65, especially dehydration. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year round. Furthermore, age related changes in 50-60 year olds can also make one vulnerable to dehydration if they are active and exercise in the heat. Recently, a local medical professional and good friend of mine was hospitalized for several days due to dehydration and associated illness. He is an active, fit, healthy 59 year old who continued his daily running for exercise during the July heat wave.

It is often forgotten that, next to oxygen, water is the nutrient most needed for life. A person can live without food for a month, but most can survive only three to four days without water. Even though proper hydration is essential for health, water gets overlooked as one of the six basic nutrients. Dehydration occurs when the amount of water taken into the body is less than the amount that is being lost. Dehydration can happen very rapidly (i.e. in less than eight hours); the consequences can be life threatening and the symptoms can be alarmingly swift.

In the body, water is needed to regulate body temperature, carry nutrients, remove toxins and waste materials, and provide the medium in which all cellular chemical reactions take place. Fluid balance is vital for body functions. A significant decrease in the total amount of body fluids leads to dehydration. Fluids can be lost through the urine, skin, or lungs. Along with fluids, essential electrolytes, such as sodium and potassium, are also perilously depleted in a dehydrated individual.

Dehydration is the most common fluid and electrolyte disorder of frail elders, both in long term care facilities and in the community! Elders aged 85 to 99 years are six times more likely to be hospitalized for dehydration than those aged 65 to 69 years. More than 18% of those hospitalized for dehydration will die within 30 days, and associated mortality increases with age. Men appear to dehydrate more often than women and dehydration is often masked by other conditions.

Elderly individuals are at heightened risk for dehydration for several reasons. Compared to younger individuals, their regulatory system (i.e. kidneys and hormones) does not work as well and their bodies have lower water contents. The elderly often have a depressed thirst drive due to a decrease in a particular hormone. They do not feel thirsty when they are dehydrated. This is especially true in hot, humid weather, when they have a fever, are taking medications, or have vomiting or diarrhea. They have decreased taste, smell, and appetite which contribute to the muted perception of thirst. Because of dementia, depression, visual deficits, or motor impairments, elderly persons may have difficulty getting fluids for themselves. Many elderly individuals limit their fluid intake in the belief that they will prevent incontinence and decrease the number of trips to the bathroom. The medications that they are taking (e.g. diuretics, laxatives, hypnotics) contribute to dehydration.

Elders may suffer headaches, fainting, disorientation, nausea, a seizure, a stroke, or a heart attack as a result of dehydration. The minimum daily requirement to avoid dehydration is between 1,500 (6.34 cups) and 2,000 ml of fluid intake per day. Six to eight good-sized glasses of water a day should provide this amount. Better hydration improves well-being and medications work more effectively when an individual is properly hydrated.

Those who care for the elderly whether at home or in a health care facility need to be alert to the following symptoms:

  • CHANGE IN MENTAL STATUS (CONFUSION)
  • WARM,MOIST SKIN WITH POOR SKIN ELASTICITY: gently pull the skin on the forehead and over the breastbone by pinching and releasing a skin fold; if the skin remains elevated for 3 seconds or more, dehydration is suspected
  • DRY, STICKY MOUTH WITH CRACKED LIPS AND DRY FURROWED TONGUE
  • DRYNESS IN NOSE
  • DECREASED BLOOD PRESSURE
  • INCREASED HEART RATE (RACING HEART; HEART BEATING TOO QUICKLY)
  • CONSTIPATION
  • CONCENTRATED URINE WITH SCANTY OUTPUT: as the urine becomes more concentrated and dark, it irritates the bladder and may increase the urge to void resulting in frequent, small voiding (urine output)
  • WEIGHT LOSS
  • SUNKEN, TEARLESS EYES
  • FAINTING WHEN STANDING UP (FEELING LIGHT-HEADED AND DIZZY WHEN STANDING AFTER SITTING OR LYING DOWN)

Plain old tap water is a good way to replenish fluid loss. Some energy drinks not only have excess and unneeded calories but also contain sugar that slows down the rate at which water can be absorbed form the stomach. Consuming alcoholic and caffeinated beverages actually has an opposite, diuretic effect!

Visit your doctor regularly and listen to your body.

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

Contibutor: Janet M. Caputo, DPT, OCS

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next week: Part 2 – Dehydration Prevention”

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.

Jul
16

Protect your skin for your health and looks

Guest Columnist: Eduardo Ortiz, MD4

This week’s article was written by Eduardo Ortiz, a fourth year medical student at Geisinger Commonwealth School of Medicine (GCSOM). Eduardo majored in Biology and minored in Art History at Florida International University in Miami, Florida. As president of the Dermatology Interest group, he helped organize a free skin cancer screening with local dermatologists earlier this year.

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

Skin Cancer

Despite the fact that we have limited exposure to sunny days in NEPA (50%), skin cancer still exists in large numbers. Skin cancer is the most common cause of cancer in the United States. While there are several types of skin cancer and not necessarily all are deadly, procedures to remove these skin cancers are both costly and frequently result in unsightly scars. The most dangerous type of skin cancer, called melanoma, results in an estimated 10,000 deaths per year. The good news? Nearly all skin cancers are preventable!

UV rays

The majority of skin cancers are caused by harmful ultraviolet (UV) rays from the sun. Two major types are UVA and UVB:
• UVA rays account for the majority of UV rays in sunlight (about 95%) and penetrate deep into the skin causing continual damage throughout our lives – a process called ‘photo-aging’ that results in wrinkles, sunspots, and uneven texture. UVA can also damage skin at a microscopic level, which may contribute to the development of skin cancers.
• UVB rays, while they do not penetrate as deeply, are what cause sunburns when we spend too much time under the sun. UVB rays are primarily responsible for the development of skin cancers.

Aging

In the field of anti-aging, advertisers make lofty promises for many products that claim to contain or boost collagen. Whether or not these work is a whole other discussion, but what is collagen and what does it have to do with wrinkles?

Collagen is the most abundant protein in the human body. It is found in nearly all tissues and organs, and plays a crucial role in maintaining structural integrity. Unfortunately, collagen production naturally decreases with age. This causes many of the findings we associate with older age, such as sagging skin and wrinkles, as well as joint pain. Collagen also works together with another important protein called elastin, which helps to maintain elasticity – a feature commonly associated with youthful skin.

When exposed to UV rays, these proteins can become damaged. For instance, studies have shown that skin exposed to UV rays increases the expression of proteins called matrix metalloproteinases, or MMPs. You can think of these MMPs as collagen’s enemy, as they cause their degradation. This results in a decrease in collagen’s structural function leading to loose and wrinkled skin. UV rays can also stimulate the production of reactive oxygen species. These are substances such as hydrogen peroxide and bleach, which further cause destruction of skin’s microscopic structure.

Sunscreen Tips & Tricks

So, you’re convinced and have decided to keep your skin healthy and youthful – what next? With so many different products on the market, choosing a daily sunscreen can become a difficult task. Here are a few pointers:

  • Look for the words “broad spectrum” or “UVA/UVB” on the label – this will ensure you are protecting yourself from all of the sun’s damaging effects
  • Chose a product that is water-resistant if you anticipate sweating or swimming.
  • Don’t stress over SPF. SPF stands for “sun protection” factor. An SPF 15 sunscreen blocks over 90% of UV rays. What’s more important is re-applying periodically throughout the day.
  • Don’t let the cold weather fool you – while they may not feel warm, the suns rays are still penetrating the layers of your skin.
  • Wear sunscreen even when it’s cloudy – harmful UV rays are invisible and are able to pass through.
  • Don’t forget your ears and lips! Some skin cancers are especially common in these areas.
    Another consideration when choosing a sunscreen is chemical versus physical blockers:
  • Chemical sunscreens typically contain a combination of the following ingredients: oxybenzone, avobenzone, octisalate, octpcrylene, homosalate, and octinoxate. These work by absorbing the UV rays and preventing their damaging effects. Make sure to apply at least 30 minutes before heading outside, as these take some time before they begin working effectively.
  • Physical, or mineral, sunscreens contain zinc oxide and/or titanium dioxide. These works by creating a layer over the skin that deflects or blocks the UV rays from penetrating. These are a great choice especially if you have sensitive skin.

If preventing skin cancer isn’t incentive enough to wear sunscreen daily and avoid excessive sun exposure (and indoor tanning booths!), then consider the rapid effects on aging the sun’s rays can have. While a tan may look good for a week, avoiding exposure to UV rays will both delay and prevent aging for years.

For more information on skin cancer and prevention, please visit the Center for Disease Control’s website (https://www.cdc.gov/cancer/skin/) and contact your physician for specific concerns regarding spots on your skin.

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 Gesinger Commonwealth School of Medicine.

Jul
09

Hit the trails and beat the heat

Dr. Mackarey's Health & Exercise Forum“The woods are lovely, dark, and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.” -Robert Frost

The purpose of this column is to present an alternative to traditional running that will allow training on more interesting and less stressful surfaces such as those used when hiking, mountain biking and horse riding trails in the beautiful woods of Northeast Pennsylvania.

Moreover, running in the woods on shaded trails is a better alternative to asphalt roads. A few years ago during a heat wave in NEPA, my family and I went kayaking at Lackawanna State Park. As a typical runner, after a few hours of relaxation on the lake, I needed to do something different. Of course, I had my running gear in the car (just in case) and went for a run. As I set out on State Road 348, the sun was beating down on me. I happened to see a sign that read, “Orchard Trail, Bull Hill Trail, Tree Line Trail.” I thought it might be a good idea to find some shade and decided to run on this path normally used for hiking, mountain biking and horseback riding. It turned out to be a great decision because I was forced to run 25% slower due to the uneven terrain. I was able to practice “light running” techniques by running with short strides on the balls of my feet. I felt much more refreshed as I avoided the direct sunlight under the cover of the trees. Furthermore, I enjoyed the up close view of nature as I ran by cool streams and wet mossy rocks. I saw beautiful flowers, rhododendron, and mountain laurel. I observed deer, chipmunks and birds. In my quest to avoid the hot sun, I discovered the beautiful underworld of “trail running” – a growing trend in today’s running community. If you, like me, have been running for many years, trail running can help you rediscover why you love to run. It is beautiful, peaceful, natural and unique. It is fun to get in touch with your inner child as you run in the woods and get muddy. Trail running makes running fun!

The trail running community purports that trail running is popular because it satisfies a primal need for man to move through nature, derived from hunter/gatherer days. Others who promote trail running feel the popularity is due to the many advantages it offers. One, trail running prevents impact injuries due to soft surfaces. Two, the training style of running with shorter strides on the ball of the foot, lessens impact. Three, this type of running will develop stronger ankles and trunk core muscles while improving balance, coordination and proprioception from running on uneven surfaces. Lastly, the ability to release copious amounts of endorphins while breathing fresh air instead of roadside fumes is invaluable.

Trail Running Gear

  • Clothing – Trail running clothes can be the same as those worn for road running except be sure you don’t mind if they get dirty and a little torn or snagged.
  •  Shoes – While you can begin trail running in the same shoes you road run in, you will find that a different pair is necessary due to excess dirt and water. Also, if you decide to get into trail running, it is worth purchasing trail shoes which are stronger, more water proof and offer better traction (Salomon Sense Pro Max;
    Asics Gecko XT; New Balance FuelCore NITREL Trail).
  • Water – a hand held water bottle or a water bottle belt is essential. The belt offers little pouches for money, keys, ID, and power bars for longer runs.
  • Insect Repellent – a must to prevent bug and tick bites.
  • Headlamp – necessary for evening runs because it gets very dark in the woods. Also, it gets dark earlier in the woods than on the roads and you need to see the terrain clearly.
  • Change of Clothes – it is a good idea to have a first-aid kit, towel and change of clothes in your car to change into before you drive home.
  • Light Pack – because your running slower than normal, carrying a light pack is not a problem and allows you to tote your supplies.

Tips to Begin Trail Running

  • Find a Trail – Start by asking around. Hikers, mountain bikers, and horseback riders are a good start. The American Trail Running Association has a website with a free directory of trails in the United States. PA State Parks such as Lackawanna State Park in Dalton, offer many options (www.visitPAparks.com). Learn the difference between “non technical trails” which are wider with a paved, dirt or gravel base and much easier than “technical trails” which are narrow, rocky, hilly and challenging.
  • Run Slowly – To be safe, run 25% slower when running a trail in the woods. Use a short stride and land on the ball of your foot. Forget about the pace, feel the dirt under your feet, work on balance and stability. It is a different type of running.
  • Walk – Don’t hesitate to walk when necessary, especially up rocky and slippery hills.
  • Keep Your Eye on the Trail – Pay careful attention to the terrain by looking 5 to 10 feet ahead.
  • Anticipate Slippery Rocks and Stumps – Pick your feet up higher and bend your hips and knees more when necessary to avoid tripping over a log. Walk over obstacles if necessary.
  • Keep a Distance – Don’t crowd the trail. You may have to share it with other runners, bikers and hikers. Pass with care.
  • Be Safe/Be Prepared– Remember the first-aid kit, cell phone, extra clothes and food in the car and make sure someone knows where you plan to run. Run with a friend.

Sources: American Trail Running Association, Trailspace.com

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.

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