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.

Jul
02

Culture of Obesity–Part 2 of 2

Carolena Trocchia, MD1

Carolena Trocchia, MD1

Culture of Obesity – Overeating vs. Undereating. Part II of II

Carolena Trocchia, MD1 Student at Geisinger Commonwealth School of Medicine

Carolena Trocchia, MD1, originally from Long Island, NY, is a first-year medical student at Geisinger Commonwealth School of Medicine. Carolena received an undergraduate degree in science from Stony Brook University and a Masters degree in public health from SUNY Downstate Medical Center. She has participated in research projects on obesity and the role of health equity on disease. She hopes to pursue a career in pediatric oncology upon graduating from GCSOM.

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

Culture of Obesity

It is no secret that the United States is currently suffering from an obesity epidemic. More than 1 in 3 adults (greater than 30%) and 1 in 6 children are currently considered obese. Obesity, in medical terms, is considered to be a form of hyperexia or a condition of overeating. Within the past 20 years (roughly 1995-2015), we have seen obesity rates more than double in most states, with some areas fairing worse than others. Some experts feel that obesity is a complicated condition that includes political, psychological, social, financial, and biologic factors.

Research

Thanks to new research findings, we now understand that there are a host of factors related to obesity that move so much farther beyond the individual’s behavioral habits. Obesity is an issue of socioeconomic status: those who have lower income tend to have higher rates of obesity. This can be for many reasons that include where you live, what food sources you have access to, what types of food or exercise facilities you can afford, and even access to and type of medical insurance. Studies also show that race, gender, and immigrant status has an impact on socioeconomic status, which effects obesity. Another major influence is an individual’s biological and genetic composition. Research recently published in The Journal of the American Medical Association shows the effects of genetics on obesity levels. There are certain genes, diseases, medications and other biological influences that contribute to a person’s weight gain and weight loss ability. The research shows that the interplay between individual genetics and the environment, both of which contribute to an individual’s eating behavior must be studied in more detail. It appears that not all individuals with ‘obesity-promoting genes’ develop obesity due to the influence of their surroundings (lifestyle, access to healthy foods and opportunities to exercise, income and occupation status etc).

Studies also show that in recent years, the term ‘weight stigma’ has become progressively more popular. It refers to the negative judgment based on a person’s weight, shape or body size. Amazingly, this judgement is observed as young as 3 years old and only progresses through the elementary and high school years. Once in college, many students with a weight stigma see overweight individuals as lazy, unattractive, having low-self-esteem and unmotivated. These negative stereotypes do not change among genders, ethnicities, ages or even occupation. We can see evidence of this weight stigma on a social level in terms of what body types our country promotes, what we decide to be ‘attractive’ and even how we portray obese individuals in the media. Think of a time when the news ran a piece relating to obesity: did it show an obese person in overly tight clothing, eating some type of fast food, or demonstrate them as inactive? Therefore, we need to begin to break the stigma against obesity (and against anorexic conditions as they exist as well) using a multi-factorial approach.

Raise Awareness – Change AttitudesLooking forward, we need to approach obesity with a fresh and comprehensive attitude that discourages so called ‘fat shaming’ or scare tactics. We have begun to use strategies that target the many variables that contribute to obesity (i.e. access to healthy foods, affordability, geographic location, culture etc) and must continue to push in this direction. On a social level, we must reduce the weight stigma associated with this condition and replace it with a healthier perspective. Interestingly, we have observed that in conjunction with the rise in prevalence of obesity, is the rise in culture of the “Fat Acceptance’ Movement”. This campaign promotes the social acceptance of different body sizes, shapes and encourages individuals to love and accept their bodies. Although this is a very positive movement, it has become a concern for some health professionals in the field who fear this movement will mislead individuals into thinking that obesity is a healthy state of being, and may tip the perspective too far in the other direction. Thus, we want to find a balance between finding self-esteem and acceptance, and understanding what a state of true health means for each and every individual.

Lastly, I’d like to encourage you to reflect on your own perspectives towards weight in general. Is it something you struggle with or fear? Do you notice you have different opinions towards overweight individuals? What approaches do you think will be most beneficial to combat this epidemic: providing patients with medication, offering more affordable means for diet and exercise, or just telling people they need to change their habits due to risk of disease? Let’s make an effort to reduce weight stigma by changing our perspectives of others who struggle with their weight, whether it be from one extreme to the other.

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.

Jun
25

Culture of Obesity – Part 1 of 2

Carolena Trocchia, MD1

Carolena Trocchia, MD1

Culture of Obesity – Overeating vs. Undereating. Part I of II

Carolena Trocchia, MD1 Student at Geisinger Commonwealth School of Medicine

Carolena Trocchia, MD1, originally from Long Island, NY, is a first-year medical student at Geisinger Commonwealth School of Medicine. Carolena received an undergraduate degree in science from Stony Brook University and a Masters degree in public health from SUNY Downstate Medical Center. She has participated in research projects on obesity and the role of health equity on disease. She hopes to pursue a career in pediatric oncology upon graduating from GCSOM.

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

Culture of Obesity

It is no secret that the United States is currently suffering from an obesity epidemic. More than 1 in 3 adults (greater than 30%) and 1 in 6 children are currently considered obese. Obesity, in medical terms, is considered to be a form of hyperexia or a condition of overeating. Within the past 20 years (roughly 1995-2015), we have seen obesity rates more than double in most states, with some areas fairing worse than others. Some experts feel that obesity is a complicated condition that includes political, psychological, social, financial, and biologic factors. However, we still have yet to see a cultural shift in the perspective towards those who are obese. This is an issue that is shared from top ranking physicians, researchers, and healthcare providers, to the lay population. Thus this bias is not a matter of medical knowledge, but from a cultural belief that obesity is due solely to weakness of the individual. We have this notion that if you are overweight it is your fault for overeating or eating the wrong foods, and therefore is your problem. Ironically, when it comes to diseases of the other extreme eating disorders such as anorexia or bulimia, we tend to have more empathy for the patient and see them as a victim of a psychological barrier they cannot overcome. Yet, both diseases involve disproportional control and intake of calories. So, why do we treat one as damsel in distress, and the other as the villain?

Treatment Disparities

Studies further demonstrate that treatment options available for both extreme disorders of hyperexia and anorexia vary greatly. For example, in patients with hyperexia or ‘over eating’ related issues, most physicians leave the treatment in the hands of the patient by suggesting diet and exercise. Pharmaceutical intervention is typically provided only for the obesity related complications such as hypertension or diabetes. In more extreme cases, bariatric surgery may be an option for those that require a more severe form of intervention. Some patients may work with a healthcare team which includes their physician, a dietician, a personal trainer and other specialists to help them reach their weight goals.
However, in the case of individuals with anorexia, a similar team of professionals (physician, dietician, psychologist etc) are provided, however, the psychological aspect of treatment is focused on much more directly and intensely. The patient is often referred for individual and family based therapy, psychotic medications and the strategy of care is typically more proactive in making sure the patient and their surroundings are working together to improve their weight.
This disparity is even more shocking in light of the fact that the rates of anorexic type eating disorders constitute roughly 2% of the population, whereas obesity affects greater than 30%! (This does not mean we should ignore anorexic diseases by any means, but shows how severely behind we are in terms of obesity management: limited resources and treatment, and narrow perspective). Clearly, one can see that all members of the medical professional team would be valuable for both conditions and require an individual and community approach to treatment to make a serious approach to treating obesity effectively.

Research

Thanks to new research findings, we now understand that there are a host of factors related to obesity that move so much farther beyond the individual’s behavioral habits. Studies show that obesity is an issue of socioeconomic status, race, gender, and immigrant status has an impact on socioeconomic status, which effects obesity. Another major influence is an individual’s biological and genetic composition and the interplay between individual genetics and the environment, which will be discussed in more detail next week in Part II of Culture of Obesity..

NEXT WEEK:

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. Next week: Part II of Culture of Obesity. 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.

Jun
11

Health and safety tips for gardeners: Part 2 of 2

Dr. Mackarey's Health & Exercise ForumHealth and Safety Tips For Gardeners with Disabilities: Part 2 of 2

Summer is finally here and gardeners in northeast PA are anxiously working in their gardens and enjoying the fruits of their labor. Last week, Health & Exercise Forum presented tips for gardeners for preventing hand and arm injuries such as carpal tunnel syndrome. This week’s column is dedicated to prevention of lower back and lower body injuries when working in the yard and for gardeners with disabilities….

A relaxing and enjoyable activity for many, gardening can turn dangerous without proper precaution as repetitive stress injuries, back pain, muscle pulls, can stem from raking, weeding, digging and pruning, can turn into serious problems if not treated appropriately. Since prevention is the best approach, the US Dept of Agriculture promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

People with various disabilities enjoy gardening at different levels. For example, those suffering from neurological diseases with muscle weakness, paralysis and poor balance as well as those with musculoskeletal problems such as neck and LBP or hip and knee arthritis can safely enjoy gardening at some level. This outdoor labor of love is very therapeutic.

Warm up and stretching is important. Don’t garden first thing in the morning before you have a chance to warm up. Get up, go for a short walk, have breakfast and maybe warm up with a hot shower before working in the garden. Some stretches include;

  • Corner Stretch: (Photo 1)  Stand facing a corner wall with arms and shoulders at 90 degrees. Lean into corner and stretch shoulders and back.
  • Knees to Chest Back Stretch: (Photo 2) While lying on your back, bring both knees up towards your chest.

Note: These exercises should never be painful when completing them. You should only feel a gentle stretch. Hold the stretch for 10 seconds and repeat 5 times before you garden and every 2-3 hours while working. Should you experience pain, please consult your family physician or physical therapist.

The following guidelines to prevent injury and foster healthy gardening for those with and without disability:

  • Listen To Your Body – Aches and pains are signals from your body that you may be doing something wrong or overdoing it. Just like a baseball player in spring training, you must ease into a new activity slowly and stop before you get pain. Do not try to do it all in one day.
  • Take Frequent Breaks – Perform work in short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue and pain.
  • Change Positions Often – Alternate positions from standing, sitting, bending, and kneeling every 15 to 20 minutes.
  • Use Large Muscles- When possible use the large muscles of the body to do the work. For example, use your legs to push a shovel blade into the ground instead of your arms. Also, lift with your legs and not your back.
  • Avoid Awkward Motions – Do not squat, twist and bend at the waist for prolonged periods or with repetition.
  • Use Supportive Devices and Braces – Remember to wear wrist and knee supports if you have a problem. A lower back brace or corset is also advisable when working in the garden to protect the spine and add support.
  • Use Well Designed Tools. Use the right tools for the job. Padded, ergonomic handles with extensions to add reach are helpful.
  • Use Sun Block, Sun Glasses and bug spray – to protect your skin and eyes from the sun and ward off ticks and other bugs.
  • Plan ahead. Use a container with wheels to carry supplies to the garden. When necessary it should be carried/pulled with hands, distributing the workload equally and decreasing stress in the joints of your body.
  • Eat Well and Stay Hydrated – When working outdoors eat and drink properly for the climate and temperature.
  • Use Adaptive Devices – Special gardening carts, wheel barrels, motorized carts, and a garden tractor with a cart can make a job easier, especially for those with disabilities.
  • “Easy-Grip” tools are available for those unable to grip strongly. For example, hand shovels and weed cultivators that attach to the wrist/forearm with Velcro straps and tools with telescoping extensions are available. (www.wrightstuff.biz)
  • Mobile Adjustable Stools – with arm rests and 2-3 steps that allow you to go from sitting upright to a position closer to the ground.
  • Elevated and Raised Beds – allows gardening from a standing, sitting or wheelchair height for improved safety and enjoyment.
  • Pipe Planter or Seeder – a PVC pipe 5-6 feet long allows planting and seeding without bending or kneeling. For example, a 6 or 8 inch pipe allows plants to slide down and be tampered into a hole and a 1-2 inch pip allows seeds to slide down to the ground for cover or planting.
  • Kneeling Pads, Mats, Carts – are healthier for your knees and back.

Source: Karen Funkenbusch, MA; Willard Downs, PhD.: U. S. Department of Agriculture – Agricultural Engineering Extension
Model: Ryan Sod, PTA

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.

Jun
04

Health and safety tips for gardeners: Part 1 of 2

Dr. Mackarey's Health & Exercise ForumHealth and Safety Tips for Gardeners: Part 1 of 2.

Prevention of Hand Injuries Associated with Gardening

Memorial Day, the “kick off” day for gardening in NEPA without the fear of frost, was only one week ago, so it is not too late to get started. While gardeners are anxious to work in their gardens and enjoy the fruits of their labor, a relaxing and enjoyable activity can turn dangerous quickly. Precautions are necessary as repetitive stress injuries such as shoulder and elbow tendonitis and carpal tunnel syndrome can stem from raking, weeding, digging and pruning. Additionally, simple scrapes, blisters, and bites can turn into serious problems if not treated appropriately. Since prevention is the best approach, the American Society of Hand Therapists (ASHT) promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

ASHT recommends following these upper extremity warm-up exercises prior to gardening:

Note: These exercises should never be painful when completing them. You should only feel a gentle stretch. Hold 10 seconds and repeat 5 times. Should you experience pain, please consult a physician or hand therapist.

1. Forward Arm Stretch: Fold your hands together and turn your palms away from your body as you extend your arms forward. You should feel a stretch all the way from your shoulders to your fingers. (PHOTO 1)
2. Overhead Arm Stretch: Fold your hands together and turn your palms away from your body, but this time extend your arms overhead. You should feel the stretch in your upper torso and shoulders to hand. (PHOTO 2)
3. Crossover Arm Stretch: Place your hand just above the back of the elbow and gently push your elbow across your chest toward the opposite shoulder. This stretch for the upper back and shoulder and should be performed on both sides. (PHOTO 3)

ASHT recommends the following guidelines to prevent injury and foster healthy gardening practices:

  • Wear gloves at all times. Bacteria and fungus live in the soil and a small irritation or cut can develop into a major hand infection. Glove choice should be specific to the specific task. Thick, leather or suede gloves may protect your hands from thorns, cuts and scrapes while pruning roses. Rubber or latex coated gloves may be appropriate to aid in grip when working in the soil.
  • Keep your hands and arms covered. Be especially careful if you live in an area where you may disturb a snake, spider or rodent living in your garden. You will be better protected from poison ivy, insect bites, ticks and other common skin irritants that may inhabit a garden.
  • Take a break every hour or switch to another activity. Overuse of repetitive motions, such as digging, and sustained/constant gripping can cause tendonitis of the wrist, elbow or lead to carpal tunnel syndrome. Break up large tasks into short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue.
  • Use a tool when digging into unfamiliar or new areas. Buried sharp objects can cause tendon lacerations or punctures. Use the correct tool for the task at hand in order to avoid accidental injury.
  • Store your tools to prevent accidents. Learn how to use and store your tools correctly to prevent accidents, and keep sharp tools out of the reach of children at all times. Also make sure to put all tools away after use to prevent future injuries.
  • Regular/periodic tool maintenance. Keep garden tools in top working order to reduce the physical effort required for yard and garden work.
  • Use well designed tools. Use tools with non-slip rubber or padded hands to protect the smaller joints in your hands. Make a circle with your index finger and thumb—that is how the grip of the tools should be. The shape of the handle should provide equal pressure along the palm.
  • Avoid awkward motions. Using better body positioning minimizes muscle pain. Work with the wrists in a neutral position by avoiding the extremes of motion (up, down and sideways). Hold objects with a light grasps or pinch. To avoid a tight sustained grip. Use both hands for heavy activities like lifting a bag of potting soil and alternate hands on more repetitive tasks like scooping dirt out of the bag into a pot.
  • Plan ahead. Use a basket or large handled container to carry supplies to the garden. The basket should be carried with both hands, distributing the workload equally and decreasing stress in the joints of your upper body.

Professional Contributor: Nancy Naughton, OTD, CHT, is an occupational therapist and certified hand therapist practicing in NEPA.
Model: Heather Holzman

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: “Prevention of Gardening Injuries” Part II of II.

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.

May
28

Preventing headaches in children: Part 2

Dr. Mackarey's Health & Exercise ForumPrevention of Headaches Associated with Neck Pain in Children and Adolescents: Part 2 of 2

Last week, Kelley German, MD3, GCSOM guest author wrote about the causes of headaches in children and adolescents. This week, we will discuss two additional causes, more mechanical than medical, but common none-the-less: poor posture and stress.

Neck pain and headaches, are among the most common ailments for children and adolescent students. It is widely accepted in the medical community that keeping fit, (flexible and strong), practicing good posture, and using proper body mechanics and ergonomics and managing stress are essential in the prevention of neck pain and headaches in children and adolescents.

PRACTICE GOOD BODY MECHANICS AND POSTURE

Children and adolescents are notorious for sitting, reading, using their computers, watching television or playing video games with poor posture. Over time, the forward head, rounded shoulders and slumped spine can shorten the muscles and ligaments of the spine and compress nerves and cause headaches. Once other causes of headaches has been ruled out by your physician, a physical therapist can teach posture stretching and strengthening exercises to prevent or alleviate this problem.

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.

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 (while sitting at your desk).

  • 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.

Sitting: When sitting, use an ergonomic chair at work station with a lumbar support and adjustable height. Get close to your keyboard and monitor. Stand up and perform the above postural exercises every 45-60 minutes. If you are working on a laptop or tablet, use a lap desk or place a pillow or two on your lap to elevate the device.

CONTROL STRESS

It is commonly known that stress and tension can cause headaches and children and adolescents often suffer from stress. Tension headaches often present as a dull ache, tightness or pressure across the forehead and tightness in the muscles of the shoulders and neck. Once other causes of headaches has been ruled out by your physician, a physical therapist can teach relaxation techniques along with postural exercises.

  • Physical Activity and Exercise – to improve posture and control stress. Simple physical activity can be helpful in children, however, a more structured program may be more appropriate for adolescents and teens.
  • Weight Training –
    • Performed 2-3 times per week, 20-30 repetitions with light weights through full range of motion
    • Avoid spinal loading from overhead lifting such as military or overhead press
  • Aerobic Exercises –
    • 3-4 times per week for 30-45 minutes at moderate intensity
    • Treadmill, bike, recumbent bike, elliptical, walk, cross-country ski
  • Core Exercises –
    • Core stabilization exercises designed to strengthen the neck, middle, lower back and abdominal muscles will help prevent injury. Core exercises should be performed while standing on a Bosu ball, discs or pillows to create unstable surface. Sitting on an exercise ball is another option. Once you are able to maintain a center of gravity and balance, try using light weights or bands and perform: bicep curls, shrugs, rows and lats.

Talk to Your Physician

If you believe your child is having difficulty with stress and may be the source of headaches and other physical problems, talk to your physician. It may be determined that counseling, along with exercise and relaxation techniques may be appropriate.

Progressive Muscle Relaxation
Progressive Muscle Relaxation is a relaxation technique used to release stress. It can relax the muscles and lower blood pressure, heart rate, and respiration. Progressive Muscle Relaxation is the tensing and then relaxing each muscle group of the body, one group at a time. Though this technique is simple it may take several sessions before it is ‘mastered.’ Progressive muscle relaxation may be done sitting or lying down.

Some people prefer to listen to an audio that guides one through progressive muscle relaxation.

Visit YouTube: Progressive Muscle Relaxation and select from a variety of videos.

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.

May
21

Headaches in children, Part 1 of 2

Headaches in Children: Part 1 of 2

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

Kelley German, MD3

Kelley German, MD3

Guest Columnist: Kelley German, MD3

Kelley German, MD3 is a third year medical student at Geisinger Commonwealth School of Medicine. She is originally from Pittsburgh, PA and graduated with a Bachelor’s of Science from the University of Notre Dame with a minor in Science, Technology, and Values. Kelley is interested in children’s health and wellness.

Parents, have your children ever complained to you, “Mom, Dad, my head hurts.” You are not alone. In fact, one of the most common chief complaints in the pediatric population is a headache. By age eighteen, more than 90% of children report having a headache. There are many reasons a child may be having a headache, some of which are more serious than others. As a parent, you should know what symptoms warrant a visit to the emergency room versus a visit to your pediatrician’s office.

Medically, we define headaches as primary and secondary headache disorders. Primary headache disorders include migraines, tension-type, and cluster headaches. Migraines are characterized by a throbbing pain that worsens with activity and may be accompanied by nausea, vomiting, light or sound sensitivity. Tension-type headaches present as a diffuse, non-throbbing pain that does not worsen with activity and is not associated with vomiting. Cluster headaches are associated with symptoms such as teary eyes, runny nose or redness of the eyes. If your child is having these symptoms, be sure to call your pediatrician so that your child can be evaluated and receive the appropriate treatment.

Secondary headache disorders are caused by an underlying condition. Some of these underlying conditions include the common cold, post-traumatic head injury, visual problems, medication side effects, meningitis, brain tumor, intracranial high blood pressure or bleed. These causes often warrant a thorough physical exam in addition to a complete medical and social history. If there is an abnormal finding on physical exam, your pediatrician will determine whether or not more testing is needed to diagnose your child.

Conditions Associated With Headaches:

  1. Strep Throat: Many parents think a strep infection must present with a sore throat, however, it can actually present solely as a headache and therefore must be evaluated in order to receive the appropriate antibiotic treatment.
  2. Teeth Grinding: This is another common cause of headache symptoms in the pediatric population. If you notice your child grinding his or her teeth at night and experiencing headaches, inform your pediatrician. Typically a mouth guard is all that is needed to resolve the headache.
  3. Sinusitis: Headaches caused by sinusitis are often misdiagnosed. Sinus cavities do not fully develop until puberty, thus sinusitis headaches are extremely uncommon in a patient below that age.
  4. Vision Problems: Children and adolescents with poor vision can also experience headaches from squinting hard in an effort to clearly see the white board or when reading. Be sure to see your eye doctor for an eye exam on a regular basis.
  5. Concussions: Another topic involving headaches worth mentioning is traumatic brain injury or a concussion. After a concussion is diagnosed, it is critical that a child not resume physical activity until fully recovered. Post-concussion syndrome is diagnosed when patients have persistent concussion symptoms despite adequate rest period. When the diagnosis is suspected, a referral is usually made to a specialist.

A key aspect of diagnosing headache disorders is being able to obtain a full history regarding the headache. This is why it is important for pediatric patients and their parents to come to appointments prepared with all the necessary information. Many headache specialists recommend keeping a headache diary. Parents should write down at what time of the day their child’s headaches occur, the intensity of the headache, any associated symptoms, what if any intervention was taken and if that intervention was effective in relieving your child’s headache. Use a pain scale of 1 to 10 (0 representing no pain and 10 being emergency room pain), to describe the intensity of the headache. Parents should also note what their child is doing when the headache begins, including the child’s diet because headaches can oftentimes be triggered by certain foods.

After creating this headache diary, make sure to inform the pediatric office why you are making the appointment and request extra time for the appointment so your doctor can appropriately discuss, examine and assess your child’s symptoms in order to create a treatment plan. You should not wait for all headaches to be evaluated by your pediatrician. Oftentimes, time is critical and a child with a headache needs immediate medical attention. If your child is experiencing any of the following symptoms, he or she may need further medical evaluation:

  • Loss of consciousness
  • Confusion, memory loss or unusual behavior
  • Nausea or vomiting
  • Shallow breathing
  • Double vision or pupils that are not responding to light

These are all signs of increased pressure surrounding the patient’s brain, which could be caused by a number of causes including a bleed within the brain, meningitis or a brain tumor. Headaches can present in a variety of ways and range in severity, duration, and associated symptoms. Approximately twenty percent of children from ages four to eighteen report having frequent or severe headaches in the past twelve months. It is important to make sure your child receives the appropriate medical attention based on symptoms. Hopefully, the more aware parents are, the better health care professionals are able to care for your child.

Medical Contributor: Lori Shipski, MD, PA-based Locum Tenens pediatrician with special interest in headaches, asthma, and smoking-cessation.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. ***Next week will discuss two additional common causes of headaches in children and adolescents… poor posture and stress………..

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.

May
14

Spend time outdoors to improve your health

Dr. Mackarey's Health & Exercise ForumSPEND TIME OUTDOORS – IT IS HEALTHY!

IT HAPPENED! SPRING HAS FINALLY SPRUNG…SO GET THE HECK OUTSIDE! Research shows that spending time outdoors has many positive effects on your health. While there are many year round activity options, in Northeastern Pennsylvania our short-lived summer is the inspiration to “suck the marrow out of a sunny day!” Summer in NEPA is enjoyed in many ways such as; walking, running, hiking, biking, golfing, playing tennis or bocce, horseback riding, boating, kayaking, and swimming. Studies show that even less vigorous activities such as; fishing, picnicking camping, barbequing or reading a good book on the porch are healthier than being indoors.

It is reported that Americans spend 90% of their lives indoors and that number increases with age. Worse yet, for some, venturing outdoors is considered risky behavior with fear of the sun, ticks, wind, mosquitoes and other creatures of God. Well, the truth of the matter is the risk of being one with nature is far less than the ill effects of a life stuck indoors. Please consider the following benefits of spending time outdoors.

Nature’s Vitamin D – Current research suggests that Vitamin D (The Sunshine Vitamin), may offer significant disease prevention and healing powers for osteoporosis, some forms of cancer and heart disease. Of all the methods of getting an adequate amount of Vitamin D, none is more fun than spending time outdoors in the sunlight. It seems that the health concerns of ultraviolet light, sun burn and skin cancer have created an overreaction to the point of Vitamin D deficiency in many. Balance and common sense go a long way. One can attain normal levels of Vitamin D by being outdoors in the sun and exposing their arms and legs for 10 -15 minutes a few times per week. Additional time in the sun warrants sunscreen and Vitamin D supplements can be used if necessary.

Increase Activity Level – While exercising indoors in a gym is valuable, research shows that time spent indoors is associated with being sedentary and being sedentary is associated with obesity, especially in children. Some studies show that children in the United States spend an average of 6 ½ hours per day with electronic devices such as computers, video games and television. It is also reported that a child’s activity level more than doubles when they are outdoors. So, get out of the office, house and gym as often as possible. Consider weight training at the gym and doing cardio by walking, biking or running outdoors.

Improved Mental Health – It is well documented that light affects mood. So, unless you live in a glass house or a light box, getting outdoors is important to your mental health. Furthermore, studies show that exercising outdoors in the presence of nature, even for as little as 5- 10 minutes has additional mental health benefits. For those less active, read or listen to music in a hammock or lying in the grass.

Improved Concentration – Richard Louv, author of the book, “Last Child in the Woods,” coined the term, nature-deficit disorder.” This term is supported by research that found children with ADHD focus better when outdoors. Furthermore, it was discovered that these children scored higher on concentration tests following a walk in the park than they did after a walk in their residential neighborhoods or downtown areas, showing the benefit of the “green outdoors.”

Improved Health and Healing – Researchers at the University of Pittsburgh found that patients recovering from surgery recovered faster with less pain and shorter hospital stays when they were exposed to natural light. Next time you’re recovering from an illness, discuss this with your physician.

Improved Breathing – In general, breathing fresh air is good for you. Some exceptions might be those with severe allergy problems when the pollen count is high. In spite of this, it may be better to take allergy medicine and enjoy the benefits of being outdoors than to be stuck inside. Many pulmonologists believe people with pulmonary problems would benefit from outdoor activities such as a 10-15 minute walk because they are prone to osteoporosis and Vitamin D deficiency. Local pulmonologist, Dr. Gregory Cali, DO, agrees and also adds that studies do not show that high humidity is dangerous for respiratory patients but it may be uncomfortable. In cold temperatures, those with pulmonary problems must avoid directly breathing cold air by covering up their mouths when walking outdoors. Overall, the benefits far outweigh the risks.

Read “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.

May
07

Lyme disease precautions for outdoor activities

Dr. Mackarey's Health & Exercise ForumLYME DISEASE! OUTDOOR ENTHUSIASTS BE AWARE!

“Health & Exercise Forum” regularly promotes active lifestyles and outdoor activities. However, being one with nature is not without its risks and attracting ticks which can lead to Lyme disease is one of them. Over the last few years, I have been amazed by how many ticks I find on my clothing and skin after being outdoors…year round! Last winter, for example, we had an unexpected warm-up in February, and with temperatures ranging from 30 degrees in the morning to 60 degrees in the afternoon, I decided to ski in the morning and snow-shoe on the trails at Lackawanna State Park in the afternoon. Due to snow cover, I occasionally wandered off the trail and hiked through some brush. Later that evening, I discovered a tick on my neck, despite showering, wearing winter clothing and it being outdoors in FEBRUARY! It is no small wonder why some experts blame climate change on the dramatic increase in cases of Lyme disease…the research supports it! Later that summer, while I was not formally diagnosed with Lyme disease, I did suffer from symptoms associated with the disease for about 8 weeks. This experience has caused me to pause and take precautions when I garden, kayak, hike, mountain bike or engage in any outdoor activity that takes place near brush or wooded areas.
According to the Centers for Disease Control (CDC), approximately 300,000 cases of Lyme disease occur each year in the United States. Lyme disease is a bacterial infection caused by the bite of an infected deer tick and most prevalent in wooded and grassy areas of the New England, Mid-Atlantic and upper Midwest States. A heightened awareness and preventative measures are recommended for those who live, work, play, camp, hike, or bike in these areas.

BE AWARE – PROTECT AND PREVENT

1. Know Where the Ticks Live
Ticks thrive in moist and humid environments, especially in and near wooded and grassy areas. Wear long sleeve shirts and long pants with socks when spending extended periods of time in risky environments.

2. Stay on the Trails
When walking, hiking, or biking, stay in the middle of the trail and avoid the brush.

3. Use Repellent
The CDC recommends repellent containing 20% or more DEET, Picaridin, or IR3535 on exposed skin. Use products with 0.5% permethrin on clothing, boots, pants, socks, tents and other gear. Visit the Environmental Protection Agency (EPA) for more information about product safety.

4. Control Ticks in Your Yard and Living Space
Keep your yard free of tall grasses and brush and use gravel or wood chips as a barrier. Mow the grass often and remove leaves quickly. Place playground equipment and toys in dry sunny area and away from brush and high grasses. Don’t feed or encourage deer to visit your living area. Chemical treatment for your yard and outdoor living space is available but should be used with caution and as a last resort.

5. Treat Your Pets
Use flea and tick treatments regularly on your pets such as Advantage IIR or Frontline PlusR and others. Ask your veterinarian for recommendations.

6. Perform Tick Checks
After being outdoors, perform a tick check. Use a mirror or family member to help you check hard to view areas. Also, carefully examine your clothing and pets for ticks before entering your home. Drying your clothing in the dryer on high heat will kill ticks.

The CDC recommends that you closely check these areas for ticks:

  • Under the arms
  • In and around the ears
  • Inside the belly button
  • Back of the knees
  • In and around all head and body hair
  • Between the legs
  • Around the waist

7. Remove Clothes and Shower
As soon as you enter your home (preferably through a mud room or basement), remove your clothes and take a shower.

8. Remove Ticks Immediately and Carefully
If you find an attached tick use a fine-tipped tweezers and carefully remove it as soon as possible. If a tick is attached to your skin for less than 24 hours, your chance of getting Lyme disease is very unlikely.

9. Be Alert For Signs or Symptoms
If you find a tick, keep an eye on the area for a few weeks. Look for signs or symptoms of Lyme disease such as rash or fever and contact a healthcare professional if you are suspicious.

10. Know the Signs and Symptoms of Lyme Disease
Some or all of these symptoms can be associated with Lyme disease and you should contact your physician if you are suspicious: Skin Rash, Fever and Chills, Fatigue, Muscle and Joint Pain/Ache, Headache.

In conclusion, it is well-documented that Lyme disease is on the increase, due in part to warmer winters in the mid-Atlantic and northeast US. However, while experts are encouraging people in risky areas to take precautions during the spring and summer months, they are also encouraging parents not to limit outdoor activities for children and others. Keep in mind that spending too much time indoors is far worse for your health than the risk of contracting Lyme disease in the long run. And, even if you are bitten by a tick, you only have a 100 to 1000 chance of contracting the disease.

SOURCES:
www.cdc.gov>lyme
www.epa.gov>insect-repellents

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

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

Apr
30

Ways to treat and prevent progression of osteoarthritis: Part 3 of 3

Antonio Adiletta, MD3

Antonio Adiletta, MD3

Ways to Treat and Prevent Progression of Osteoarthritis: Part 3 of 3

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

Guest Columnist: Antonio Adiletta, MD3

Antonio Adiletta, MD3 is a third year medical student at Geisinger Commonwealth School of Medicine from Lancaster, PA. During his first two years, he served as President of his class and helped create a General Surgery Interest Group. He is currently interested in Orthopedic Surgery.

Two weeks ago, in Health & Exercise Forum, Antonio Adilettta, MD3, GCSOM presented Osteoarthritis Part I and discussed the most common causes and areas of the body affected by osteoarthritis. Last week in part two, he discussed 3 of the 5 most effective methods of prevention and treatment and this week, part three we will present the last two of the most effective methods.

You may not realize, but osteoarthritis (OA) is more common than you think, affecting people like President George. W. Bush and First Lady Barbara Bush, who got hip replacements at age 76 and 72, respectively. Moreover, the Piano Man, Billy Joel had double hip replacements at age 61 and joked afterward saying, “I got a double hip replacement, and now I’m twice as hip as I used to be.”

Osteoarthritis, also known as degenerative joint disease and wear and tear arthritis, is the most common type of arthritis affecting approximately 27 million Americans. Osteo refers to bone, while arth comes from the Greek word arthron, which means articulation, or joint. Finally, itis, a commonly used medical term, refers to inflammation. OA is caused by damage to the cartilage, the rubber-like padding that protects the ends of bones at the joints.

As previously discussed, prevention and management of OA includes exercise, weight loss and protection of your joints. However, it is also important to manage your occupational risks and, in some cases, consider medications and surgical procedures.

Manage Occupational Risks

Certain jobs may predispose you to the development of OA. This includes jobs that require repetitive motion like kneeling, lifting, twisting, or walking every day. It has been shown that there is an increased risk of OA of the knee, hip, and fingers in workers who carry heavy loads as part of their daily job. Some common jobs include construction working or lumbar working. Lifting heavy objects improperly and without the correct assistance can lead to joint damage. Osteoarthritis can develop over years, slowly day by day, if constant damage is being done to your joints.

There are ways this day to day joint damage can be prevented. It’s recommended that you attempt to rotate different work jobs to prevent the repetitive insult to your joints. If possible take breaks when you feel like you are injuring your joints, use assistive devices, or ask for help. In summary, it is important to practice safe ways of working to prevent the repetitive damage that occurs. Here’s a short list of things you can do.

  • Learn how to lift correctly
  • Talk to your doctor about stabilizing joint braces
  • Rotate work assignments to prevent aggravation of existing injuries
  • Be familiar with good practices of postures and actions at work. Shifting position often, and using devices such as dollies to do the lifting and moving of goods can all help with arthritis prevention.
  • It is important to combat excess weight and abdominal obesity.
  • Some professions offer assistive lifting devices that should be used to prevent injury. Health care workers should use rolling gurneys, wheelchairs, and ask for help when trying to lift or transport a patient.

Medications and Procedures

There are a variety of anti-inflammatory medications that can be prescribed by your doctor to help with joint pain. Talk with your doctor about the use of acetaminophen, NSAIDs, COX-2 inhibitors and other analgesics that can help relieve your joint pain. Tell your doctor if you’ve ever had GI upset or have kidney or liver problems before taking these medications. Another option is glucocorticoid (steroid) injections. This injection is most beneficial to OA patients with one or a few joints that continue to cause pain despite oral medication therapy. With proper injection technique and medication intervals, side effects are minimal. Tell your doctor if you have diabetes before getting a steroid injection as it can raise your blood sugar.

Surgery is considered in patients who continue to have debilitating pain despite treatments with nonpharmacological and pharmacological therapies. In many cases, surgery is considered a last resort when the patient cannot tolerate the joint pain any longer and all other treatment modalities have been exhausted. All patients are different and have unique injuries and circumstances, so it’s important to talk with your doctor about what kind of treatment is best for your situation and goals in life. Partial and total joint replacements are surgical options to repair a damaged joint. Patients who undergo surgery often experience substantial improvements in pain and physical ability. According to the literature patients usually experience maximal improvement in the first 3 to 6 months after surgery. Talk with your doctor about your goals and concerns in finding the appropriate surgical treatment that best fits your wishes.

Medical Contributor: John Doherty, MD, Geisinger Orthopedics, Scranton, PA

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.

Apr
23

Ways to Treat and Prevent Progression of Osteoarthritis: Part 2 of 3

Antonio Adiletta, MD3

Antonio Adiletta, MD3

Ways to Treat and Prevent Progression of Osteoarthritis: Part 2 of 3

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

Guest Columnist: Antonio Adiletta, MD3

Antonio Adiletta, MD3 is a third year medical student at Geisinger Commonwealth School of Medicine from Lancaster, PA. During his first two years, he served as President of his class and helped create a General Surgery Interest Group. He is currently interested in Orthopedic Surgery.

Last week in Health & Exercise Forum, we discussed the most common causes and areas of the body most affected by osteoarthritis. This week we will present the 3 of the 5 most effective methods of prevention and treatment and next week, part three will conclude with the last two methods.

Osteoarthritis, (OA) also known as degenerative joint disease and wear and tear arthritis, is the most common type of arthritis affecting approximately 27 million Americans. OA is caused by damage to the cartilage, the rubber-like padding that protects the ends of bones at the joints. While living with OA can be challenging, there are things you can do to prevent and manage the problem such as exercise, weight loss and joint protection.

1. Exercise

It may seem confusing that exercise could be a recommended treatment for a disease known as the “wear and tear” arthritis, but research has shown that people with OA can and should exercise. The benefit of exercise is multifold for your joint pain. Exercise will help strengthen the muscles that stabilize your joint, increase range of motion, and decrease stiffness, all while benefiting your overall health and contributing to weight loss.

Flexibility: OA can cause your joints to become stiff and painful to move. Starting to lightly stretch your painful joints more and more each day will help to increase your range of motion. Work your way up every day to being able to stretch your joint through its full span of motion.

Cardio: Exercise that gets your heart beating will promote general physical fitness. This, in turn, can improve your mood, decrease your chance of developing diabetes, increase blood flow to damaged joints that will improve healing, and maintain a healthy weight.

It is recommended to exercise for either 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week. A standard way to access intensity is to follow the “220-age” rule for heart rate. Age-predicted maximum heart rate is 220 minus your age. If you are 50, for example, the average maximum heart rate is 220- 50 = 170. This can be used to access your intensity level while you are exercising by checking your pulse when you are done.

Strength: Exercise that strengthens the muscles that support your painful joint. By improving the strength of your muscles, you are also stabilizing, supporting, and protecting your joint. Ask your doctor, physical therapist, or research ways to strengthen the muscles of your affected joint.

It is prudent to begin slowly when trying new exercises or exercising for longer than usual. It is important to listen to your body and to not do things that aggravate your joint. Be sure to see your doctor or physical therapist for an individualized recommendation on how you can strengthen your joint and decrease pain interfering with your daily activities. Exercise will also help with our next tip, weight loss.

2. Weight Loss

Being overweight is known to be a major contributing factor to the development of OA. The good news is that it’s something that can be worked on! Weight loss will decrease the stress on your joints, relieve pain, and help prolong the need for drastic measures such as surgery. The problem is that being overweight puts an increased amount of stress on your joints especially the knee. When a person walks it is estimated that a force three to six times the person’s body weight is applied to the knee. That means that any increase in body weight will increase the stress on your knees by 3 to 6 times per pound; underscoring the importance of preventing weight gain and striving to lose weight.

Interestingly, it has been shown that people who are overweight are also at an increased risk of developing hand OA; therefore it’s suspected that there are circulating systemic factors contributing as well. So weight gain does more than increasing the stress on your joints and it may contribute in an insidious way.

An easy way to learn how much weight you need to lose is to look up your body mass index (BMI). This can be done easily by looking up a BMI calculator online or asking your doctor. Overweight is a BMI of 25-29.9 while obesity is a BMI of 30 or greater. It is important to know where you stand because women who are overweight have a 4 time increased risk of developing OA while men have 5 times increased risk. Weight loss is so effective in decreasing OA that it has been shown that if a woman of average height loses 11 pounds she decreases her risk of developing OA by greater than 50%! Losing weight is an effective and essential part of decreasing the progression of OA and relieving your joint pain.

While exercise is an essential part of weight loss, eating right is just as important. The importance of exercise was talked about in our first tip. It is important to cut back on dietary fat and total calorie intake. Talk to your doctor about ways to improve healthy eating or talk to a dietitian.

3. Protect Your Joints

When a joint experiences major injury it can be left susceptible to OA. Fractures to the bone, or tears to ligaments that help stabilize the joint such as the anterior cruciate ligament (ACL) or meniscus in the knee and the labrum (the rim of cartilage in your hip socket) in the hip, can lead to premature OA. Injuries during physical activity or other accidents can cause damage to the cartilage in your joints. If these injuries are not taken care of they can lead to permanent alterations in the way your joint move and this can lead to more cartilage destruction. Therefore it is important to wear the correct protective gear and be cautious when playing sports or exercising.

Injuries can be avoided by taking care of your body and taking the right precautions. Warming up before strenuous activity, stretching, and knowing your limits are some ways that you can help prevent injury. Be sure you are using exercise equipment properly and are practicing safe ways to exercise or play sports. It is important to seek treatment if you think you have injured something in your joints. Injuries that are not treated properly can lead to improper healing and further damage. The earlier you seek treatment, the earlier you can begin on the proper road to recovery.

NEXT WEEK: Part 3 of 3: Ways to Prevent and Treat Osteoarthritis

Medical Contributor: John Doherty, MD, Geisinger Orthopedics, Scranton, PA

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.

Apr
16

Five effective ways to prevent joint pain caused by osteoarthritis: Part 1 of 3

Antonio Adiletta, MD3

Antonio Adiletta, MD3

Five Effective Ways to Prevent Joint Pain Caused by Osteoarthritis: Part 1 of 3

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

Guest Columnist: Antonio Adiletta, MD3

Antonio Adiletta, MD3 is a third year medical student at Geisinger Commonwealth School of Medicine from Lancaster, PA. During his first two years, he served as President of his class and helped create a General Surgery Interest Group. He is currently interested in Orthopedic Surgery.

You may not realize, but osteoarthritis (OA) is more common than you think, affecting people like President George. W. Bush and First Lady Barbara Bush, who got hip replacements at age 76 and 72, respectively. Moreover, the Piano Man, Billy Joel had double hip replacements at age 61 and joked afterward saying, “I got a double hip replacement, and now I’m twice as hip as I used to be.”

Osteoarthritis, also known as degenerative joint disease and wear and tear arthritis, is the most common type of arthritis affecting approximately 27 million Americans. Osteo refers to bone, while arth comes from the Greek word arthron, which means articulation, or joint. Finally, itis, a commonly used medical term, refers to inflammation. OA is caused by damage to the cartilage, the rubber-like padding that protects the ends of bones at the joints. Normally functioning cartilage allows bones to glide over each other and also serves to absorb impact from physical activity. In OA the surface layer of the cartilage becomes damaged, exposing the bones to one another. Once the cartilage is gone there is nothing separating bone from bone. Thus, bones, with nothing separating them, start to rub against each other and causes pain, swelling, and loss of motion of the affected joint.

There are many kinds of arthritis, how do you know if you have OA? Pain is the first thing people notice in their affected joint. The joint pain tends to get worse with activity or weight-bearing and will go away with rest. The pain experienced is commonly described as sharp, intermittent, and unpredictable. As the disease progresses, the pain becomes more constant and aching. Late in the course of the disease, the pain is brought on by minimal activity and may even occur at rest.

Another common type of arthritis is called Rheumatoid arthritis (RA). This form of arthritis tends to affect people at a younger age compared to OA. In RA the person’s immune system attacks the joints, causing pain, inflammation, joint damage, and eventually malformation. This is not the case in OA where wear and tear or damage is the cause of pain. Furthermore, persons affected by RA complain of being tired, feeling sick, and having a fever. Another major difference between OA and RA is that joints affected by RA are symmetrical; this means that if one knee is affected, the other knee is too. In OA the joint affected is commonly only on one side of the person’s body; such as the right knee or left hip. The final major difference is that people who have RA say that their joint pain will actually improve with physical activity; where people with OA say that the pain gets worse.

Joints Affected by OA

There are a few common joints that are affected by OA. These joints include the knee, hip, lower back, neck, and the ends of the finger. For people with OA, these joints become painful and stiff. The joint that is causing pain may get worse with increased activity or may become stiff when it is in one position for a long period of time. Here are some common places that people feel pain from osteoarthritis.

Knees: The knees are a very common joint affected by OA. You may experience stiffness, swelling, and pain that make it difficult to walk, climb, or get in or out of a chair. People with knee osteoarthritis say that the pain can either be localized or diffuse. They report having difficulty climbing upstairs or walking short distances.

Hips: The hips are also a common joint affected by OA. Symptoms of this joint include pain and stiffness, with pain sometimes being experienced in the groin, inner thigh, or buttocks. The pain and symptoms of hip OA may make it difficult to dress, put on shoes, or do other daily activities.

Hands: Osteoarthritis of the hands has been found to be hereditary. That means, for example, if your mother or grandmother had OA in their hand then you are at a greater risk of developing it. People say that their fingers become painful and stiff and that gripping objects becomes difficult. Bony growths in the fingers make the knuckles bigger and swollen and can make it difficult to put a ring on or off.

Spine: OA of the spine tends to present itself as stiffness in the neck or the lower back. Sometimes, arthritis can cause compression of the nerves exiting the spinal cord and can cause weakness, tingling, or numbness of the arms or legs.

Medical Contributor: John Doherty, MD, Geisinger Orthopedics, Scranton, PA

NEXT WEEK: Part 2 of 3: Ways to Prevent and Treat Osteoarthritis

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.

Apr
09

Break out of an exercise rut: Part 2 of 2

Dr. Mackarey's Health & Exercise ForumSTUCK IN AN EXERCISE RUT? Part 2 of 2

PEOPLE WILL OFTEN ASK ME, “IS THERE SUCH A THING AS AN EXERCISE RUT?” THEY WANT TO KNOW WHY THEY DO NOT SEEM TO BE IMPROVING WITH THEIR EXERCISE PROGRAM…they exercise 3-4 times a week for 30 to 45 minutes and they feel frustrated and STUCK in a rut.

The purpose of this column will be to offer suggestions on how to improve or get more out of a “stale” exercise program. Last week’s column offered tips to improve a stale cardiovascular and strength program. This week we will discuss flexibility and functional training tips and include the components necessary for a healthy mind, body and spirit connection.

FLEXIBILITY TRAINING

Flexibility training involves the careful stretching of the muscles, tendons and joints to improve the range of motion in order to safely perform daily activities and sports without injuring or tearing soft tissues. It is probably the most neglected part of the fitness program. However, while the amount of inherent flexibility varies for each person, a minimal range is necessary as it relates to daily activities and sports. For example, as you age it is important to have enough flexibility in your back, hips and knees to wash your feet, put shoes and socks on. Flexibility exercises should always be performed after a warm –up activity and done slowly and gently. There are two types of flexibility exercises; dynamic and static. Dynamic stretching is performed with movement such as pushing the ankle up and down like a gas pedal. Passive stretching is performed using an outside force such as using a towel to pull the ankle up in order to stretch the calf. Dynamic should be performed before an activity (before running or playing tennis) and static performed after the activity is over in order to increase range of motion for future activities.

Improving a Flexibility Training Program:

  • Use Functional Dynamic Stretches: Functional dynamic stretches are those motions used throughout the day. For example; sitting/standing gas pedals for the ankles/calf muscles; sitting/standing marches for the hip; ¼ lunges for buttocks, hips, knees, ankles; clap hands overhead, arms behind head and arms behind back for the upper body.
  • Multitask and Perform Static Stretches: Static stretches should be held for a few minutes. Therefore, you can do use your electronic device to read or watch a podcast while you stretch. For example; while lying on your back, stretch your hamstrings on a wall in a doorway and read. Stretch your lower back while propping up on your elbows and read. Stretch your calf muscles while leaning into a counter top and read.
    • Photo A: Hamstring Wall Stretch
    • Photo B: ½ Cobra Lower Back Stretch
  • Vary the Stretching Time and Alternate the Body Parts
    Incorporate Complimentary Activities to Stretching Such as: Meditation, Yoga

STEP TWO: Mind, Body, Spirit; Nutrition; Core Fitness; Functional/Sports Specific Training; Leisure Sports and Activities

In order to prevent an exercise program from getting stale, one must incorporate all aspects of wellness…a healthy mind, body and spirit!

  • Mind Body and Spirit – consider massage, meditation, and yoga.
  • Nutrition – eat a well-balanced diet; little and often… proper nutrition requires that an individual has a diet with the proper amounts of carbohydrates, fat, protein, vitamins and nutrients, which can vary with personal goals, age, and activity level. Consult a nutritionist and consider using nutrition apps such as “Lose It” or “Calorie Counter.”
  • Leisure Sports and Activities – Too often fitness enthusiasts are so involved in their exercise routines that they forget to get outside and have fun! Incorporate sport and game into your exercise routines. Instead of walking on a treadmill for an hour at the gym, walk 9 holes while playing golf (3 ½ miles) or kayak on a lake for an hour (283 calories) more than biking (227 calories), but less than running (454 calories). Use fitness apps such as “Fitbit” or “Endomondo” to track sports and daily activities.
  • Core and Functional/Sports Specific Training – an essential and often overlooked part of a complete fitness program. Core exercise concentrate on the abdominal, trunk and spine muscles working in unison to create a “muscular corset” in order to protect the spine and provide a stable foundation for the extremities to work effectively. Core exercises can be incorporated into any program very easily. For example, performing bicep curls while sitting on an exercise ball or standing on a “Bosu” ball will simultaneously work the core muscles and biceps. Remember, a solid core will improve your ability to play tennis, throw a ball, or play golf.
    • Photo C: Bicep Curl on Exercise Ball
    • Photo D: Bicep Curl on Bosu Ball
  • Functional exercises focus on training and strengthening the body in preparation for specific activities of daily living and sports. For example, lunges are a functional exercise which will improve the ability to bend and pick up objects from the floor. They are also sports specific for skiing, tennis and many other sports.

In conclusion, it is easy for fitness enthusiasts to get so focused on maintaining a routine that they allow their program to become stale and ineffective. It is essential to reassess and update your program to prevent stagnation.

Make sure the routine has all three fundamental components of a well-balanced exercise program; cardiovascular, strength and flexibility training. Moreover, to be truly healthy, one must work toward a “Healthy Mind, Body, and Spirit. Therefore, in addition to traditional exercise one must incorporate the following: nutrition; meditation, relaxation techniques, yoga, core fitness; functional/sports specific training; leisure sports and activities

In order to prevent an exercise program from getting stale, one must incorporate all aspects of wellness…a healthy mind, body and spirit!

While each component offers its own specific benefit, the combination of all three cooperatively provides unique value. Too often, fitness enthusiasts concentrate on the exercises they LIKE or are good at more than the ones they NEED.

Sources: National Institutes of Health; American Council on Exercise

Model: Mariah Morrison

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 Geisinger Commonwealth School of Medicine

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