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

Apr
02

Break out of an exercise rut: Part 1 of 2

Dr. Mackarey's Health & Exercise ForumSTUCK IN AN EXERCISE RUT? Part 1 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. While initially responding favorably to exercise, after 6 -9 months or more, they do not notice progress in weight loss, strength, tone, endurance or daily function.

The purpose of this column will be to offer suggestions on how to improve or get more out of a “stale” exercise program. Step one is to build an exercise program that is grounded in the basics. Step two, which begins after the basics have been mastered, includes the components necessary for a healthy mind, body and spirit connection and translates into functional activities of daily living including work and leisure sports.

STEP ONE: CARDIOVASCULAR; STRENGTH; FLEXIBILITY

Make sure your routine has all three fundamental components of a well-balanced exercise program; cardiovascular, strength and flexibility training. 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. A well-balanced program includes what you like and need! In fact, recent studies show that those performing all three components surpassed those performing one or any combination of two of the training types when tested for efficient oxygen uptake (VO2 Max), production of HDL (good cholesterol), lower body fat percentage, and lower blood glucose levels.

CARDIOVASCULAR TRAINING

Cardiovascular exercise is any activity that raises your heart rate and respiratory rate. This type of exercise strengthens the heart muscle and the muscles that assist in breathing. When these muscles are stronger, they in turn work more efficiently to deliver oxygen to your muscles and other parts of the body. Ultimately, these oxygenated muscles can work harder and longer to burn fat during exercise and at rest.

Examples of Cardiovascular Exercises: Running, Brisk Walking, Swimming, Biking, Rowing, Elliptical Training and Stepper Training. Most experts recommend at least 30 minutes of sustained cardio, 3-4 days per week. However, recent studies support the notion of performing 10-15 minutes, twice daily, 4 days per week. For those “stuck” in a fitness rut, to advance your program, cardio should be performed 5-6 days per week for 45-60 minutes.

Improving a Cardio Training Program:

• Alternate Types of Cardio: run walk one day, bike the next, and use the stepper or elliptical a third day.
• Alternate Direction: when using equipment that allows changing direction such as the elliptical or treadmill, go forward for 5 -10 minutes then backwards for 3-5 minutes, even if you have to slow the speed down.
• Alternate Intensity: interval training for cardio can be invaluable to improve benefits. Interval training includes performing 1, 2 or 3 minute bursts of high intensity cardio followed by a 2 or 3 minute recovery at a slower speed and lower resistance. 15 to 20 minute intervals should always begin with a warm-up and end with a cool down.

STRENGTH TRAINING

Strength training is an activity that provides any type of resistance to muscle contraction to build strength in the muscle. The resistance can be without movement against an immovable object such as pushing against a wall (isometric) or with movement such as lifting up or lowering a weight down against gravity (isotonic/dynamic). There are two types of isotonic muscle contraction; concentric, which involves raising the weight against gravity as the muscle shortens and eccentric which involves lowering a weight against gravity as the muscle lengthens. A standing biceps curl is an example that incorporates both concentric and eccentric contractions. A progressive strength training program includes all three types of muscle contraction. By using the classic bicep muscle curl these photos will demonstrate all three types of muscle contraction:

  • Photo A: Isometric Bicep Muscle Curl – pull up on door knob without allowing any movement of the arm.
  • Photo B: Concentric Bicep Muscle Curl – raise a dumbbell up against gravity as the muscle shortens.
  • Photo C: Eccentric Bicep Muscle Curl – lower a dumbbell slowly (4-6 seconds) against gravity as the muscle lengthens.

Improving a Strength Training Program:

Incorporate the use of all three types of muscular contractions in the program.
Perform one set of exercises using isometrics as a warm up followed by a typical weight training program. Then, consider performing one set using only eccentrics (lowering the weight). To do so, a training partner may be necessary to help lift the weight up before it is lowered eccentrically.

Vary the Weight: warm up with lighter weight and gradually progress.

Vary the Speed: one day lift and lower to a 10 count and the next increase the speed to a 2 count – even if requires using a lower weight.

Vary the Types of Resistance. Mix up the routine with exercise bands, dumbbells, weight lifting machines and weighted balls. Also, incorporate using the weight of your body (push ups, planks, lunges).

Vary Body Parts. One day exercise the upper body and the next the lower body. Include core exercises for both.

Sources: National Institutes of Health; American Council on Exercise

Model: Heather Holzman

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Read Stuck in an Exercise Rut…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 Geisinger Commonwealth School of Medicine

Mar
26

Certain types of exercise may have anti-aging properties

NEW RESEARCH DEMONSTRATES CERTAIN TYPES OF EXERCISE MAY HAVE ANTI-AGING PROPERTIES

Dr. Gino Mori, traversing Zion National Park with trekking poles.

This column is dedicated to my friend and mentor, Dr. Gino Mori, who sent me this research study as a contribution to my column to raise the level of awareness and improve the health and wellness of the people of NEPA. Dr. Gino, who recently turned 85 years young, is the consummate “Renaissance Man,” who strives to challenge himself to be better; physically, spiritually and intellectually! Thank you Dr. Gino!

The deterioration and degeneration of the body associated with the aging process is well-documented and the musculoskeletal system is no exception. As we age, weight bearing joints of the lower body (hips and knees) frequently suffer from wear and tear degeneration. Loss of muscle mass and strength is also common with age. Specifically, damage to older muscles has been found to regenerate slowly and incompletely and the problem runs as deep as the cellular level as the mitochondria diminish in quality and quantity. However, there is good news: a recent study published this spring in Cell Metabolism suggests that certain types of exercise can actually regenerate and reverse the aging mitochondria.

As popular and common as exercise is, little is known about the influence and impact it has at the cellular level. A research team at the Mayo Clinic decided to answer this question and conducted an experiment to determine the cellular effects of different types of exercise on aging muscles.

THE STUDY

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

THE RESULTS

In the 30 and under group as well as the over 64 group, all three experimental groups improved in fitness level and blood sugar regulation. As expected, Group One, the vigorous weight training group, showed the greatest gains in muscle mass and strength. Also, not surprisingly, Group Two, the interval training group, had the greatest gains in endurance. However, the most unexpected results came when retesting the muscle cells by biopsy. Only group two, the interval aerobic exercise group demonstrated the most significant improvement in the activity levels of their genes in both the young and older groups, when compared to the vigorous weight training and moderate exercise groups. Moreover, the positive improvements in the genes of the older group far surpassed that found in the younger group. For example, in the younger group, 274 genes improved compared to 170 genes in the moderate exercise and 74 in the vigorous weight training. In the older group, 400 genes were improved in the interval aerobic group while 33 for weight training and 19 for moderate exercise groups.

CONCLUSION

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

TAKE HOME

Interval aerobic exercise can have anti-aging effects. In fact, the older your muscles, the more you will benefit from, not just moderate exercise, but more vigorous interval aerobic exercise. Furthermore, interval training may be applied, not only to aerobic exercise, but to weight training for the upper and lower body. According to the American College of Sports Medicine, high intensity interval training, also called HIIT workouts, involves a repetition of a series of high-intensity exercise (aerobic or weight training) for a specific period of time (3-5 minutes)  followed by a specific period of rest or low-intensity exercise (1-3 minutes). The intensity can be increased by speed or resistance. HIIT workouts have been associated with increased caloric expenditure with less exercise time, as well as improved strength and endurance. Most recently, it has been found to improve cell energy in the aging population. However, do not attempt to increase the intensity of your exercise program without consulting with your physician first. Once medially approved, consult with a doctor of physical therapy to create a program specifically designed for you.

Therefore, if your gene pool is questionable like most of us, don’t use that as an excuse.  There are things you can do to have a positive impact on your DNA to live longer and healthier…one of them is EXERCISE!

Visit your doctor regularly and listen to your body.

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

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

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

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

Mar
19

10 best exercises to prevent Osteoporosis. Part 3 on osteoporosis and preventing the pain of aging

Dr. Mackarey's Health & Exercise ForumWhile there is no cure for osteoporosis, being proactive can prevent, slow or stop the progression of this disease. As discussed in last week’s column, a healthy lifestyle, avoiding smoking and excessive alcohol use, a well – balanced diet – rich in calcium and vitamin D, and weight –bearing exercises – such as walking and weight training are essential in the prevention and treatment of this disease.

TEN BEST EXERCISES FOR OSTEOPOROSIS THAT YOU CAN DO AT HOME

All of the following exercises can be performed at home without purchasing any equipment except exercise bands.

• Weight Bearing Aerobics – Walking, Hiking, Jogging
An exercise that requires you to support the weight of your body through your bones is an essential component of a program designed to prevent osteoporosis. Therefore, swimming and biking, while good forms of aerobic exercise, are not as valuable as walking, hiking, light jogging, cross-country skiing, and elliptical and stepper machines. (3-5 times per week 30-45 minutes)

• Standing Hip Hikes (Photo 1)
Face a countertop and hold onto it with both hands. Hike your hip and knee up to 90 degrees as if you are marching. Hold the position for 3-5 seconds on one leg and lower slowly. Repeat this on the other leg and alternate 10 times.

• Standing Hip Scissor Kicks (photo 2)
Face a countertop and hold onto it with both hands. Lift your leg up 30 degrees as if you are spreading your legs apart. Hold the position for 3-5 seconds on one leg and lower slowly to cross over the middle. Repeat this on the other leg and alternate 10 times.

• Standing Squats (photo 3)
Face a countertop and hold onto it with both hands. Bend your hip and knee down to 45 degrees to a squatting position. Hold the position for 3-5 seconds on both legs and return to standing slowly. Repeat this 10 times. Once strong enough try on one leg at a time and alternate.

• Step Ups
Slowly climb steps by marching and hold one leg at the peak of each step for 2-3 seconds. Repeat slowly going down steps. Use two rails in the beginning until strong enough to use one or none.

• Standing Wall/Countertop Push – Ups (photo 4a, 4b)
Face a countertop and hold onto it with both hands. Bend your elbows down to 45 degrees to a push-up position. Hold the position of 3-5 seconds. Then, straighten elbows slowly. Repeat this 10 times. Once strong enough try on one arm at a time and alternate. Also, focus on trunk core stabilization while performing this exercise by keeping trunk stable.

• Chair Push – Ups (photo 5)
Sit in a chair with arm rests. Get out of chair using arm rests to extend elbows like a push-up. Hold the position for 3-5 seconds and return to sitting by bending elbows slowly. Repeat this 10 times. Also, focus on trunk core stabilization while performing this exercise by keeping trunk stable.

• Shoulder Shrugs (Photo 6)
Stand with both feet on exercise band. Hold band in both hands and slowly shrug shoulders up toward ears. Lower slowly. Also, focus on trunk core stabilization while performing this exercise by keeping trunk stable.

• Bicep Curls (Photo 7)
Stand with both feet on exercise band. Hold band in both hands and slowly bend elbows up toward shoulders. Lower slowly. Also, focus on trunk core stabilization while performing this exercise by keeping trunk stable.

• Trunk Rows/Lats (Photo 8)
Stand and face door. Attach exercise band to inside door knob and hold in both hands. Pinch shoulder blades together while performing a “row the boat” movement. Return slowly. Also, focus on trunk core stabilization while performing this exercise by keeping trunk stable.

Photos: Jen Hnatko, Model: Dominique DelPrete

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

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

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

Mar
12

Osteoporosis: A Strategy to Preventing the Pains of Aging. Part 2

Ian Coote, MD3

Ian Coote, MD3

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

Guest Columnist: Ian Coote 

Ian Coote, MD3 originally from Rogersville, PA is a third-year medical student at Geisinger Commonwealth School of Medicine. Ian majored in Biological Sciences at Ohio Northern University before graduating in 2015. He hopes to pursue a career in emergency medicine upon graduating from GCSOM.

Growing old is one of life’s inevitabilities. While growing old is something we all hope to achieve, as we age our bodies start to wear down. Many people start to have more aches and pains as they grow older which can seriously impact their happiness and overall quality of life. It is important for us to take care of our bodies when we are young and to continue to take care of ourselves as we get older. Knowing how to care for our health and being aware of some the things to watch out for as we age is essential. One of the more common issues that people experience as they age is problems with their bones, specifically osteoporosis.

What are the complications for osteoporosis?

As mentioned earlier, individuals with osteoporosis are at an increased risk for developing bone fractures. Healthy bones are stiff enough to endure the pressure exerted on them by normal activity such as walking and lifting things. They are also flexible enough to bend and stretch somewhat which allows them to avoid shattering like glass. Individuals whose bones have been damaged by osteoporosis are weak and brittle, and so are unable to withstand pressure nor are they able to flex without shattering. Fractures in people with osteoporosis occur under low-impact circumstances. Falls from a sitting or standing position to the floor can result in hip fractures. Wrist fractures are also common in low-impact falls. Being jostled in the car by hitting potholes or simply lifting a box that is a little too heavy can cause vertebral fractures. Fractures due to osteoporosis often cause sharp or dull nagging pain in the area of the fracture that is made worse with movement. People with fractures due to osteoporosis often chose not to move or do much at all for fear of making their pain worse. Immobility can lead to a host of other medical problems such as blood clots and pneumonia.

What are the most effective treatments for osteoporosis?

Medications

There are a number of medications designed to prevent fractures related to osteoporosis from occurring. Many drug classes are aimed at decreasing the bone reabsorbing activity of the osteoclasts. Bisphosphonates are one such class that bind to a component of bone called hydroxyapatite and when taken up by osteoclasts they inhibit osteoclast activity. Selective estrogen receptor modulators (SERMs) are a class of drug that act similarly to natural estrogen and inhibit the activity of osteoclasts. Other classes of drugs focus on increasing the activity of the bone building osteoblasts. These classes are designed to mimic parathyroid hormone (PTH) which is a chemical that is involved in the production of bone. Supplementation of the vitamins and minerals that make up bone such as vitamin D and calcium has also been shown to slow the rate of bone loss.

Diet

There are simple things we can do in our daily lives that can prevent some of the aches and pains that are so common in our elderly population. Eating a diet rich in the vitamins and minerals that our bones need to grow strong and repair themselves is one step we can take. Calcium and vitamin D are essential components to bone health and can be found in dairy products such as low-fat milk and yogurt. Fresh fruits and vegetables provide a number of other vital building blocks of healthy bones including vitamin K, vitamin C, magnesium, and potassium. People who eat healthy amounts of seafood like salmon or tuna have been shown to have stronger bones than those who do not eat seafood. Studies have shown that both men and women who eat healthy amounts of dairy products, seafood, and lots of fruits and vegetables have significantly stronger bones and have lower rates of bone loss as they age.
Eating the things that aid bone health is very important, however, it is just as important to avoid excessive amounts of the things that hurt our bones. High levels of salt in our diet are linked to a number of poor outcomes such as weaker bones, high blood pressure, and poor heart health. Processed foods like hot dogs, TV dinners, fast foods, and canned soups are very high in salt and should be limited. Many soft drinks contain a substance called phosphoric acid which can actually cause our bodies to lose the calcium that makes up strong healthy bones. Tobacco use is harmful to many of the organ systems that keep our bodies strong including our bones.

Exercise

Sedentary lifestyles have been shown to cause poor bone health. Regular exercise is important for many aspects of our health including our heart, brain, and bones. Low impact activities like walking, swimming, or aerobics are great ways to stay healthy without causing joint pain. Regular exercise strengthens our muscles which can help decrease pain and lowers the risk of fractures. Strong muscles help with balance and improve posture which decreases the likelihood of falling. In addition to improving overall fitness, exercise also helps with weight loss. Being overweight increases the force exerted on our bones and so can increase the risk of fractures in people with osteoporosis.

Next Week: Special feature… Exercises for the Prevention of Osteoporosis

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.

Mar
05

Osteoporosis: A Strategy to Preventing the Pains of Aging. Part 1 of 2

Ian Coote, MD3

Ian Coote, MD3

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

Guest Columnist: Ian Coote

Ian Coote, MD3 originally from Rogersville, PA is a third-year medical student at Geisinger Commonwealth School of Medicine. Ian majored in Biological Sciences at Ohio Northern University before graduating in 2015. He hopes to pursue a career in emergency medicine upon graduating from GCSOM.

Growing old is one of life’s inevitabilities. While growing old is something we all hope to achieve, as we age our bodies start to wear down. Many people start to have more aches and pains as they grow older which can seriously impact their happiness and overall quality of life. It is important for us to take care of our bodies when we are young and to continue to take care of ourselves as we get older. Knowing how to care for our health and being aware of some the things to watch out for as we age is essential. One of the more common issues that people experience as they age is problems with their bones, specifically osteoporosis.

What makes a bone?

The human skeletal system is made up of 206 bones. Our bones have several functions including physical support, transferring the forces produced by our muscles to allow us to move around the world, protection of our internal organs, mineral regulation, and serve as the location where our red blood cells are made. Each bone in our body is made up of three basic layers. The outermost layer is known as the periosteum and it is a thin fibrous layer that can be thought of as a sort of “plastic wrap” that serves as the outer layer of bone. This periosteum or “plastic wrap” has several purposes; it contains the blood vessels that supply nutrients to the bone, it contains nerves that allow us to feel, and it serves as the attachment point for muscles and tendons which allows us to move our arms and legs. The next layer of bone is called compact bone. It is made from tightly packed minerals and is very strong, stiff, and dense. The compact bone serves to provide support to our bones and to protect our internal organs. The innermost layer of bone is called cancellous bone. The cancellous bone is made up of the exact same minerals as the compact bone but is much more spongy and arranged in a mesh-like pattern. Cancellous bone serves to provide internal support to bones and is the region in which red blood cell production occurs.

How do bones get strong? Weak?

Our bones are constantly undergoing a process of being broken down and rebuilt. This means that old, worn-out bone tissue is being degraded and the minerals that make up the old bone are being recycled and made into new, healthier bone. This process is known as bone remodeling and there are two types of cells that are involved, osteoclasts and osteoblasts. The easiest way to understand how osteoclasts work is to think of them as the bone’s inspection and demolition crew. Osteoclasts search around bone to find weak or damaged bone and then release chemicals that dissolve the weak bone. The minerals or building materials of the bone are then recycled. Osteoblasts are the construction crew of the bones. They are constantly laying down the building material of bone and helping it to mature into strong healthy new bone. This process of bone remodeling is happening constantly and it is very important that there is a healthy balance between the activity of the bone demolition crew and the bone construction crew.

Osteoporosis is essentially an imbalance between the osteoclast “demolition crew”, and the osteoblast “construction crew”. In osteoporosis the demolition crew is working much harder and faster than the construction crew. This produces bone that is thinner, less dense, brittle, and overall weaker than normal healthy bone.

What are the risks factors for osteoporosis?

The group of individuals that is at the greatest risk for developing osteoporosis is post-menopausal women. The reason that women who have gone through menopause are at increased risk for osteoporosis has to do with estrogen.  Estrogen is a naturally produced chemical in the human body that is mainly produced by the ovaries. Estrogen has a role in maintaining bone health in that it inhibits the activity of the osteoclasts, which are the bone demolition crew. With the osteoclasts inhibited, the osteoblasts, the bone construction crew, are able to build strong healthy bone without being overwhelmed by the destruction that the osteoclasts cause. Women who have gone through menopause have decreased activity within their ovaries and therefore much less estrogen present in their bodies. This lack of estrogen means that the osteoclasts are not as inhibited as they were before the woman went through menopause and therefore the bone demolition crew starts to work faster than the bone construction crew. When this occurs, bones become thin and brittle and are much more likely to fracture.

While postmenopausal women are at the greatest risk for developing osteoporosis, they are not the only population at risk. As we age, our osteoblasts, or bone construction crew, become tired and start to slow down. It is also not unusual for older people to stop eating a well-balanced diet which leads to fewer of the essential components that make up bone to be present in the body. Therefore, it is not surprising to learn that 10 million Americans over the age of 50 have osteoporosis and that 2 million of these are men.

NEXT WEEK: Part 2: Ways to Prevent and Treat Osteoporosis

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.

 

 

 

Feb
26

Seasonal Affective Disorder

Brendan Bormes, MD3

Brendan Bormes, MD3

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

Seasonal Affective Disorder

Brendan Bormes, MD3: GCSOM GUEST AUTHOR

Brendan Bormes, MD3 is a third-year medical student at GCSM. A native of Clarks Summit and graduate of Scranton Preparatory School, he majored in biology and music at Bucknell University and received a masters in physiology and biophysics from Georgetown University. His interests after medical school include Anesthesia and Surgery.

It’s that time of year…the nights come early and last long. The sun is barely rising when you leave for work, and it’s setting by the time you get home. In the fall and winter, especially this far north, many people start to feel the gloom of their surroundings creep into their psyche…Is this normal, or a sign of something more serious?

Seasonal affective disorder, or SAD, is at the far end of a spectrum of seasonal mood changes. The mildest of these, “seasonality”, is a normal response to cyclical changes in weather and light exposure. However, when symptoms like depressed mood, lack of motivation, or a shift to more vegetative daily habits become severe and debilitating, SAD may be the cause. In fact, one study found that SAD affects up to 10% of primary-care patients, and that those with a previous diagnosis of depression are even more at risk. Fortunately, though, there are well established therapies that can help those afflicted with SAD to get through the dark winter months. The American Psychiatric Association defines SAD as a subtype of either Major Depressive Disorder or Bipolar Disorder, depending on the symptoms. It can consist of episodes that onset during either fall/winter or spring/summer, or have symptoms characteristic of either “major depressive” or “manic” episodes. The vast majority of those with SAD, however, experience a persistent overall depressed mood during the shorter days of fall and winter.

Symptoms of SAD:

  • Depressed mood
  • Lack of interest in previously enjoyable activities
  • Decreased energy level, impaired concentration
  • Changes in appetite
  • In more serious cases:
    • Excessive feelings of guilt or worthlessness
    • Slower or racing thoughts or movements
    • Suicidal impulses.

If enough of these symptoms are present for a long enough time and onset in a seasonal pattern, that can mean Seasonal Affective Disorder. Most people with the disorder find themselves sleeping more and eating more (especially carbs), and report that their symptoms can even resolve with relocation to a sunnier environment. Along the spectrum of disease is a less severe form called “subsyndromal” SAD, which can still be effectively treated. Periods of SAD tend to resolve with the coming of spring, but they can be immensely distressing and always deserve medical intervention. No one knows exactly why Seasonal Affective Disorder happens, but it appears to be associated with decreased exposure to natural light during the fall and winter months. One possible explanation is the “phase-shift” hypothesis. It states that your body’s circadian rhythms, which are regulated by hormones and the brain, become out-of-step with environmental sleep/wake cues as the days shorten. In other words, the light levels around you and your body’s internal clock are telling you two different things about when to sleep. This disruption of circadian rhythms, or “phase-delay”, likely contributes to the symptoms of SAD, although precisely how it induces changes in mood remains unclear. Another hypothesis for the mechanism underlying SAD involves abnormalities in the activity of serotonin, a neurotransmitter in the brain. Normally, serotonin regulates mood and attention. However, studies have found that people with SAD clear serotonin out of their brains faster, giving the hormone less of a chance to provide a boost in mood.

Treatment for SAD:

Current medical treatment of SAD targets the changes in both circadian rhythms and serotonin metabolism. This can be accomplished with light therapy, antidepressant medications or a combination of both.

  • Light therapy – works by correcting the miscommunication between the body’s internal clock and its surroundings. It is administered as either “bright-light therapy” or “dawn stimulation.” Bright-light therapy involves the patient sitting or going about their activities while exposed to a very bright light for a certain amount of time every day. Dawn stimulation, on the other hand, gradually exposes the patient to more light as they wake up in the morning. In this way, dawn stimulation simulates a pattern of morning light-exposure more akin to what we experience in the summer.
  • Antidepressant Medications – most of the time, doctors begin with a “selective serotonin reuptake inhibitor” (SSRI), which remedies the dysregulation of serotonin signaling observed in patients with SAD. SSRIs block serotonin from being recycled in the brain, thus giving it more time to work.
  • Lifestyle Changes – behavioral and lifestyle changes can be instrumental in fending off seasonal depression. Below are some easy changes you can make that are proven to help with seasonal mood changes–whether it be the “winter blues”, subsyndromal SAD, Major depression with seasonal pattern…or just plain “seasonality”:
  • Maximize your sleep hygiene: 
    • Go to bed and wake up at the same time every day.
    • Try not to let your bedtime or wake time vary by more than an hour from day to day.
    • Have a regular, relaxing bedtime routine.
    • Doing the same thing every night, including taking time to just wind down, will help you sleep and optimize your circadian clock.
    • Create a comfortable sleeping environment.
    • Make sure your bedroom is quiet, dark, and not too warm.
    • Avoid using TV, computers, phones and other electronics before bed. Bright blue light from screens can interfere with circadian rhythms.
    • If possible, try to minimize exposure to bright light from any source for 2 hours before bed.
    • Limit caffeine intake later in the day. 4 to 6 hours after you have a cup of coffee, half of the caffeine from it is still in your body–keeping you awake! Be sure to check labels: coffee, soda, iced tea and dark chocolate are not the only things that contain caffeine.
  • Maximize Outdoor Activites
    • Get Outside! Take daily walks outside. Some experts believe that natural light can alleviate the symptoms of seasonal depression in exactly the same way as bright light therapy. Don’t stay in, even if it’s overcast. Even on a cloudy day, the outdoor light intensity is up to half that of prescription bright-light lamps. And on a bright day, the midday sun can be up to ten times their intensity!
    • Exercise! Engage in aerobic exercise like biking, running, or walking Regular exercise can improve the symptoms of seasonal depression, even in the absence of other lifestyle changes. If you can exercise outside when it’s sunny, you’ll be killing two birds with one stone. Early morning and late afternoon are the best times to exercise. Try to avoid strenuous activity right before bed.
    • Stay Positive! Always remember that spring sunshine is never all that far away!

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 Commowealth Medical College).

Feb
19

Augmented Reality Treatment for Parkinson’s Disease: Part 2

NEW TREATMENT FOR PARKINSON’S DISEASE

AUGMENTED REALITY: Part 2 of 2

BILL CONNELL, SPT3

Bill is a 3rd year doctor of physical therapy student at The University of Scranton and works as a student PT aide at Mackarey Physical Therapy. He is a graduate of Scranton Prep and plans to practice orthopedic and sports PT in California.  He and his classmates at completed a graduate research project on the use of augmented reality for Parkinson’s disease and will present it at The American Physical Therapy Association National Combined Section Meeting in New Orleans in February 2018.

Last week in this column, we discussed a disease that affects more than 1 million people in the United States, Parkinson’s disease. This neurodegenerative disease affects the way our brain produces and uses dopamine and therefore, it affects the way people living with the disease are able to move. The hallmark signs: a resting tremor, slowness of movement, muscle rigidity, and gait and balance disturbances can all be treated through medication, rehab therapy, or in severe cases, surgical intervention. Managing these symptoms is important an important part of maintaining a high quality of life and independence in daily activities. The problem with these treatments is that they can be time consuming, expensive, and not as effective after continued use. Luckily, recent research has proven that exercise and an active lifestyle can help our brains use available dopamine more efficiently.

One of the biggest barriers to an active lifestyle for people with Parkinson’s disease is problems with balance and walking. These problems include a slow, shuffling gait and difficulty with turning or changing from one surface to another, like stepping from a hardwood floor onto a carpet. Freezing of gait can also occur, where their movement is involuntarily halted, another major fall risk. All of these symptoms are more likely to occur in environments that are crowded and unfamiliar which can lead to a more sedentary or homebound lifestyle. While medications do help manage these problems for a time, they are characterized by having on and off periods throughout the day meaning they work for a few hours, and then the symptoms return for a few hours. As previously mentioned, an active lifestyle is vital to improve quality of life and so there has to be a better way to address this problem moving forward.

A group of my fellow classmates from the University of Scranton and I, conducted a systematic review of literature to find out how people with Parkinson’s could walk more safely in their environment by using augmented reality visual cues. Past research has suggested the use of audio or visual cues for training gait in therapy sessions, but until recently, these methods were difficult to translate safely to community ambulation. It is now theorized that, by using a visual cue, the person is able to use a different part of their brain to control walking, one that bypasses the basal ganglia, or the part of the brain most affected by Parkinson’s. Using this new technology could change the way people with Parkinson’s move.

“Augmented” reality is a computer generated projection into a person’s real environment. This differs from “virtual” reality which uses a computer generated environment. An example of augmented reality you may have seen before is on Snapchat where computer generated objects like crowns or dog ears are added to regular pictures. Our research team specifically focused on the use of augmented reality visual cues to improve the speed, length of each stride, and the cadence during ambulation. It was found that these visual cues are produced from various devices including a cane or walker with a laser attachment that projects a line onto the ground in front of the user when the base of the cane comes into contact with the floor. Another option used to augment reality is a pair of glasses or goggles that shows a cue across the lens that appears to be projected into the environment, cuing the user to step. The cues varied from horizontal lines, to vertical lines that flow with the user’s movement and, in with more advanced technology; a checkerboard pattern is projected over the walking surface to facilitate normal gait.

We found 8 studies that tested these measures in the past 10 years and after analyzing their results, we found statistically significant gains in all measures, including some studies that showed less in freezing of gait. These are promising results, but more high quality studies will be needed in order to determine if these devices will consistently produce the same results over time, find which cues work best, and additional benefits to their use. Practical application simply requires the use of walkers and canes with laser projections. They are readily available and are relatively inexpensive. The glasses, however, are not as easy to obtain. Much of the available research utilized glasses that aren’t available at retail, however, there has been research done with both Google Glasses and Epson Moviero BT Smartglasses. As technological advances continue, there is great promise that augmented reality glasses become more available and less expensive. Until then, obtaining and appropriately programming the glasses will be difficult for most, unless they are involved in clinical trials.

In February, my colleagues and I will present our research at the American Physical Therapy Association’s National Combined Sections Meeting in New Orleans, LA. If you are interested about learning more about this topic or other research being done by the University of Scranton PT Department visit:

http://www.scranton.edu/academics/pcps/physicaltherapy/pt-research.shtml. “The Effect of Augmented Reality Visual Cues on Temporal-Distance Gait Parameters in Individuals with Parkinson’s Disease: A Systematic Review” William Connell, Alexandra Crowley, Cassandra Fitzgerald, Samantha Marri, Dr. Renée Hakim

 

Visit your doctor regularly and listen to your body.

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

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

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

Feb
12

Augmented reality treatment for Parkinson’s Disease-Part 1

This column is a monthly feature of “Health & Exercise Forum”

NEW TREATMENT FOR PARKINSON’S DISEASE –AUGMENTED REALITY Part 1 of 2

Guest Columnist: BILL CONNELL, SPT3

Bill is a 3rd year doctor of physical therapy student at The University of Scranton and works as a student PT aide at Mackarey Physical Therapy. He is a graduate of Scranton Prep and plans to practice orthopedic and sports PT in California.  He and his classmates at completed a graduate research project on the use of augmented reality for Parkinson’s disease and will present it at The American Physical Therapy Association National Combined Sections Meeting in New Orleans in February 2018.

William Connell, SPT3

William Connell, SPT3

There are currently around one million people living in America with Parkinson’s disease (PD). That makes it the second most common, age related, neurodegenerative disease behind Alzheimer’s disease. The disease affects structures deep within the brain and changes its ability to produce and use dopamine, a neurotransmitter with many functions, including the ability to control certain aspects of movement. PD most commonly affects males and those above the age of 60, and to date there is no cure. The hallmark signs include a resting tremor, slowness of movement, rigidity or unyielding muscle tightness, and problems with balance and walking. Research suggests there may be some genetic and environmental causes for Parkinson’s but for the majority of cases, the cause is impossible to determine. While that may sound bleak, the good news is that the ongoing research for living with and treating Parkinson’s has shown encouraging results.

Parkinson’s disease has seen a surge research thanks to major foundations and prominent spokespeople like Michael J. Fox and Muhammed Ali. This recent research has provided an incredible wealth of knowledge. There are a wide variety of primary treatment options available that vary on an individual basis. These include medications, surgical interventions, and physical and/or occupational therapy. These options do work at easing symptoms, but the medications and surgical interventions can have negative side effects and therapy sessions can become expensive over the course of the disease. Luckily, research has found something to help those with Parkinson’s disease become more efficient at using their decreasing levels of dopamine, EXERCISE.

Research has proved that exercise can alleviate many of the symptoms that people with Parkinson’s live with including all of the hallmark signs, anxiety, depression, sleeplessness, and therefore improves quality of life. This research has led to the formation of many exercise groups that lead people with Parkinson’s through workouts using boxing, dancing, cycling or circuit training. These programs have made a huge impact for those who participate as they provide a social and supportive environment to do exercises people may not have ever thought they would do.

These treatments help, however they can’t be used at all times. They address many symptoms, but walking remains a problem for many people with Parkinson’s, especially in crowded or unfamiliar environments. People with Parkinson’s will typically walk with slow, uneven, shuffling steps and is often associated with a “freezing” of gait. Freezing gait occurs when walking is suddenly interrupted and the body is unable to progress with the movement. These abnormal characteristics of gait increase the risk of fall and therefore many people with Parkinson’s become more sedentary due to feeling unsafe while walking in the community. Recent technological advances may have given medical professionals a new, safe way to both train and assist people with Parkinson’s disease for community ambulation. This technology is called augmented reality. As more research about Parkinson’s disease emerges it has become evident that an active lifestyle can increase quality of life for people living with the disease. Using technology to make this lifestyle more safe and realistic may turn out to be the key to moving forward with Parkinson’s.

A group of my fellow classmates from the University of Scranton and I, conducted a systematic review of literature to find out how people with Parkinson’s could walk more safely in their environment by using augmented reality visual cues. Past research has suggested the use of audio or visual cues for training gait in therapy sessions, but until recently, these methods were difficult to translate safely to community ambulation. It is now theorized that, by using a visual cue, the person is able to use a different part of their brain to control walking, one that bypasses the basal ganglia, or the part of the brain most affected by Parkinson’s. Using this new technology could change the way people with Parkinson’s move.

Next week in this column, we’ll discuss augmented reality technology and how it works.

To find more information about Parkinson’s Disease visit: https://www.michaeljfox.org/ or http://www.parkinson.org/.

To see more of this research project, and others like it from the University of Scranton Physical Therapy Department, visit:  http://www.scranton.edu/academics/pcps/physicaltherapy/pt-research.shtml.

Visit your doctor regularly and listen to your body.

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

Feb
05

Ten best ways to prevent the cold and flu

Dr. Mackarey's Health & Exercise ForumGuest Columnist: Paul Mackarey, Jr. DPT

According to the Centers for Disease Control and Prevention (CDC), the 2017/18 flu season has been exceptional. Normally, elderly adults have the largest number of flu related hospitalizations while young children are second. This year, however, baby boomers between 50 and 64 years of age are the second most vulnerable. And, as of January 27, 37 pediatric flu related deaths have been reported. At the risk of creating an overreaction and promoting “germaphobic” behavior, if there is one time of year that diligent hygiene has merit, it is now…during flu season.

Contracting the cold or flu can make you feel run-down and under the weather for weeks. Unfortunately, your daily activities and responsibilities cannot take a sick day. The common cold and flu is most prevalent during late fall, winter and early spring. According to flufacts.com, “The influenza virus, more commonly known as the flu, is defined as a contagious respiratory infection that infects the nose, throat, and lungs. Each year approximately five to 20 percent of the population in America contracts the flu and related deaths caused by the flu virus average at 23,600.” Thankfully, there are several easy and effective preventive measures that can reduce the probability of contracting the cold and flu. These preventive measures are designed to help keep your immune system strong and healthy. A healthy immune system fights against pathogens, such as the cold and flu virus. This article will focus on the ten best ways to prevent the flu and cold this season.

1. Get Vaccinated

The vaccine produces antibodies that protect against the cold and flu virus within two weeks after vaccination. There are currently two different types of vaccines; an “intramuscular shot,” meaning it is injected into the muscle and a nasal-spray vaccination is available for people two to 29 years of age. The traditional intramuscular vaccine has been used for decades and has been approved for use in people six months of age and older. Recently, two new intramuscular vaccines are available. A hi-dose vaccine was designed for people 65 years and older and a vaccine designed for people 18 to 64 years of age is also available. NOTE: FOR THE 2017/18 FLU SEASON: The CDC does NOT recommend the nasal spray flu vaccine. Flu vaccines have been updated to better match current viruses.

2. Wash Hands Regularly

The most common way to spread the cold and flu virus is by direct contact. The virus can live on surfaces for hours and even days eagerly waiting to get picked up by the next individual.

3. Do Not Cover Sneezes With Your Hands

Germs attach onto your hands and can be passed onto other public surfaces. The most effective ways to cover a sneeze are to use a tissue or your sleeve.

4. Exercise Regularly

Exercising regularly causes an increase in your heart rate. Therefore, the heart can pump more oxygen rich blood throughout the body. Increased blood flow to the body has been proven to increase the body’s immune system and help to prevent illness.

5. Eat Well

Eating nutrient rich foods is the best way to keep your immune system strong. Phytochemicals are natural immune boosting chemicals found in plants, fruits and vegetables, specifically, dark green, red, and yellow vegetables and fruits. Yogurt is also an effective way to prevent illness. Studies have shown that eating low fat yogurt regularly can reduce susceptibility to colds by 25 percent. Research also suggests that the natural bacteria found in yogurt stimulates and strengthens the immune system.

6. Stay Hydrated

Staying hydrated is important. Water flushes your system by filtering out poisons as it replenishes your body. Dehydrated individuals feel tired and unfocused. A healthy adult requires eight 8-ounce glasses of fluid a day. The easiest way to determine if you are dehydrated is by the color of your urine. If it is dark yellow your body may require fluids.

7. Get Plenty of Sleep

Doctors recommend a full eight hours of sleep a night. The demands of your busy life sometimes make that difficult. However, during the cold and flu season, it is particularly important. If you are not well rested, your body becomes tired and “run-down,” leading to a weakened immune system and leaves you more susceptible to illness.

8. Do Not Smoke

Statistics show that smokers are at a higher risk of contracting more frequent and severe cold and flu symptoms. This is because the toxic chemicals in smoke are seen as pathogens or foreign contaminants in the body. As a result, your immune system is working overtime. Also, smoking is proven to paralyze cilia that line your nose and lungs. The cilia, or delicate hairs, are designed to remove cold and flu viruses out of your nasal passageway before they can infect the body. Smoking a single cigarette can paralyze the cilia for up to 40 minutes.

9. Drink Less Alcohol

Heavy alcohol consumption negatively affects the body and its immune system in several ways. Heavy drinkers are more prone to cold and flu illnesses because alcohol suppresses the immune system and significantly dehydrates the body.

10. Most Importantly Relax

It is important to relax and “unwind” at the end of a busy day. Relaxing lowers cortizol levels in the blood. Cortizol is a hormone released into the body’s blood stream when a person is feeling stressed or pressured. Over time, this hormone weakens the immune system. Relaxing causes interleukins, the main components of your immune system that fights against the cold and flu virus, to increase in your bloodstream. It is recommended that one makes time for at least 30 minutes of relaxation each day.

THE 10 MOST GERM-FILLED ITEMS YOU USE DAILY

(webMD)

…make a special effort to clean these areas frequently

1. CELLPHONE – it is with us at ALL times; kitchen, bedroom, bathroom, office car. Bacteria loves its warm dirty surface and has been found to be 10 times dirtier than a toilet seat as E.coli, a harmful and potentially deadly bacterium has been found on it. Wash your hands often and swipe the surface with antibacterial swipes frequently.
2. TV REMOTE CONTROL – stuck between the dark and warm pillows and sofa cushions, bacteria flourish on the surface of this device which has been touched by every family member and their runny-nosed friends.
3. COMPUTER KEYBOARD – like the phone and remote, it is the most touched and dirty places in your daily routine. Wash hands and swipe surface.
4. DISH SPONGE – considered the dirtiest item in your home or office. Ring it out after each use, soak in bleach, clean in dishwasher and replace often.
5. TOOTH BRUSH HOLDER – the germs from your mouth drip from the brush onto the holder two or three times a day. Overtime, a buildup of germs becomes overwhelming and dangerous as those with illnesses share the holder with others. Dry the brush after each use and clean the holder often. During an illness, do not share the holder and start a new toothbrush after an illness.
6. MONEY – as much as we love the feel of money in our hands, studies show that the average dollar bill has 3,000 bacteria. Wash your hands after handling money.
7. OFFICE KITCHEN – not everyone in your office practices good hygiene. The sink, sponge, towels, cups, silverware, and dishes in your office area potential Petri dishes. While it is good to use reusable products, take care to clean them carefully and use wash, dry, bleach, and replace.
8. LAUNDRY – some studies show that dangerous viruses found in undergarments are able to survive the spin cycle and dryer. For those items, hot water, bleach, and long hot drying cycles are recommended.
9. PURSES/BRIEFCASES – money, food, tissues, and hundreds of hands. It goes wherever you go…bathroom, countertop, bank, and office. Clean and empty regularly.
10. ATM – countless strangers touch the ATM keypad in a public area where dirty money is handled regularly. Use antibacterial swipes and wash hands.
Sources: www.flufacts.com; www.webmd.com; www.lifescript.com; www.cdc.gov

Guest Contributor: Paul Mackarey, Jr. DPT, is a Doctor of Physical Therapy.

Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Every Monday in The Scranton Times-Tribune.

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 in downtown Scranton, PA and is an associate clinical professor of clinical medicine at GCSOM.

Jan
29

Mindful Eating : Part 2 of 2

Dr. Mackarey's Health & Exercise ForumTRY A NEW APPROACH TO WEIGHT LOSS IN 2018…MINDFUL EATING! Part 2 of 2

 

WHAT IS MINDFUL EATING?

Mindful eating, also referred to as intuitive eating, is based on Buddhist teachings which focus on the experience of eating, AND ENJOYING, our food. The concept was presented in a feature column in The New York Times written by Jeff Gordinier, based on his time spent in a Buddhist monastery. He discovered that mindful eating practitioners eat in silence and chewed small pieces of food very slowly and deliberately to experience its taste, texture and smell.

THE RESEARCH

One study of 1,400 mindful eaters found that they enjoyed lower body weights, greater sense of well-being and suffered from fewer eating disorders. However, many feel the concept, while valuable, is very difficult to put in practice in the busy American family. Fortunately, research shows that the simple act of the family meal can have a powerful impact on mindfulness, health and wellness, even if it isn’t a picture-perfect meal.

In a country that thrives on a fast pace with over-booked schedules, families struggle to balance work and school and after school sports and activities. Consequently, fast food, eat-and-go habits have become the norm. According to some studies, most find it difficult to sit and relax for a family meal even once a week. And often, when families do pull off a family meal, it is often overwrought with school drama, sibling rivalry, and parental discipline about school, homework or social activities, making the situation stressful. Even so, despite the family conflict, studies strongly support the health values of the family meal.

A recent study from Columbia University that received national attention found that children who participated in a family meal regularly were less likely to have problems with drugs or alcohol and more likely to excel in school. Moreover, those children eating with their families at least 5 times per week benefited most. Other studies have found that there is a significantly lower incidence of teens who smoke, use alcohol, have sex at a young age, fight, get suspended from school or commit suicide among those who have meals with their family on a regular basis

6 TIPS TO CREATE MEALTIME BLISS

  1. FOR A MORE MINDFUL AND HEALTHY FAMILY MEALTIME (WEBMD): Now that you have learned the importance of mindful eating and family meals, you are probably wondering how one would incorporate the concept into the daily life of a busy family: working, going to school, playing sports, attending dance class and participating in multiple after school and travel activities. While not perfect, WebMD offers some tips to help create mealtime bliss in an attempt to make dining as a family a positive and healthy experience.
  2. TURN DOWN THE VOLUME: Lower the noise level in environment at mealtime. No TV, cell phones, computers or radios blasting in the background. Soft, soothing background music can be very helpful to set a stress free mood. To involve the entire family, let each member take a turn to choose mutually acceptable music for that meal.
  3. SET THE TABLE TO SET THE MOOD: A formal table setting is not necessary to create a special mood. However, tablecloths and napkins with bright colors or holiday imprints can spice up the room. Fresh flowers from the garden or grocery store are always a good idea!
  4. LET THERE BE LIGHT…SOFT LIGHT: Dim the light and add some candles to the dinner table to create a relaxing atmosphere at mealtime. Make “the lighting of the candle” a special event in which children participate.
  5. CONTROL THE CONVERSATION: Parents and children must avoid using mealtime as an opportunity to ambush a captivated audience. Discussions about family complaints and grievances should be deferred for after dinner meetings or other appropriate times. Avoid confrontation, to-do lists, medical problems and focus instead on planning a weekend activity or future vacation. Attempt to pull children and teenagers into the conversation with positive experiences that week or open-ended questions like, “if you could visit any place in the world…”
  6. KEEP YOUR COOL IN THE KITCHEN: While trying to make the kitchen a happy place, try to remember that the cook may be under stress to get a meal on the table within the time demands of work and after school activities. The experts suggest trying to do as much as possible ahead of time, use the weekend to make meals for the rest of the week, and assign portions of the meal to other family members: children can clean the vegetables and make salads.
  7. KEEP IT REAL: Be realistic…family meals will not happen every night and some family meals will end in conflict. But, if you don’t attempt to organize a family meal, it will NEVER happen and if you don’t try to control the conflict it will ALWAYS happen. Don’t be too rigid. If breakfast is easier to organize as a family, consider the option once or twice a week. Get a calendar each week and make a family schedule that includes family meal times. Always remember, research clearly shows that the benefits of a family meal far outweigh the hassle and inconvenience of planning it!

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.

Jan
22

Mindful Eating: Part 1 of 2

Dr. Mackarey's Health & Exercise ForumTRY A NEW APPROACH TO WEIGHT LOSS IN 2018…MINDFUL EATING! (Part 1 of 2)

There are many reasons why losing weight, the number one resolution for the New Year, is the most elusive goal of all. Not the least of these is the psychology of eating . In the land of plenty, we eat mindlessly! Consider the facts. First, we blamed the food, thinking it was bad. But, when we chemically modify the food to remove or alter the fat or sugar and remove the calories, it fails to reduce our weight. In fact, it has been discovered that “fake sugar,” even though it does not have calories, can still increase blood glucose levels. Next, we decided that fat cells were the enemy, but when we removed fat cells from our body through liposuction, we failed to control weight gain. Then, we decided the problem was our digestive systems, so we placed bands or staples in the stomach or by-passed the small intestine. While these efforts helped many in the short run, long term, it failed as a long-term solution without a change in behavior. Many medical professionals have concluded that the problems people have with weight are not exclusively due to the food, fat cells, stomach or intestines, but rather, THE MIND!

WHAT IS MINDFUL EATING?

Mindful eating, also referred to as intuitive eating, is based on Buddhist teachings which focus on the experience of eating, AND ENJOYING, our food. The concept was presented in a feature column in The New York Times written by Jeff Gordinier, based on his time spent in a Buddhist monastery. He learned that mindful eating practitioners eat in silence and chewed small pieces of food very slowly and deliberately to experience its taste, texture and smell. He discovered that it requires full attention to the experience of eating and drinking on the body and mind. It is often referred to as “the opposite of diets” because with mindful eating there is no right or wrong way to eat, but rather varying degrees of awareness about WHAT WE EAT AND WHY. The goal of this exercise is to teach our mind and body to connect and communicate while eating so one can learn important cues such as: what are my hunger signals? What does my stomach feel like when it is half, three-fourths and completely full?

THE RESEARCH

One study of 1,400 mindful eaters found that they enjoyed lower body weights, greater sense of well-being and suffered from fewer eating disorders. However, many feel the concept, while valuable, is very difficult to put in practice in the busy American family. Fortunately, research shows that the simple act of the family meal can have a powerful impact on mindfulness, health and wellness, even if it isn’t a picture-perfect meal.

In a country that thrives on a fast pace with over-booked schedules, families struggle to balance work and school and after school sports and activities. Consequently, fast food, eat-and-go habits have become the norm. According to some studies, most find it difficult to sit and relax for a family meal even once a week. And often, when families do pull off a family meal, it is often overwrought with school drama, sibling rivalry, and parental discipline about school, homework or social activities, making the situation stressful. Even so, despite the family conflict, studies strongly support the health values of the family meal.

A recent study from Columbia University that received national attention found that children who participated in a family meal regularly were less likely to have problems with drugs or alcohol and more likely to excel in school. Moreover, those children eating with their families at least 5 times per week benefited most. Other studies have found that there is a significantly lower incidence of teens who smoke, use alcohol, have sex at a young age, fight, get suspended from school or commit suicide among those who have meals with their family on a regular basis.

TIPS FOR MINDFUL EATING: 6 Ways to Practice Mindful Eating – by Christopher Willard PsyD

Mindless Eating Vs. Mindful Eating

  • Mindless Eating=Eating past full and ignoring your body’s signals
    • Mindful Eating=Listening to your body and stopping when full
  • Mindless Eating=Eating when emotions tell us to eat (sad, bored, lonely)
    • Mindful Eating=Eating when our bodies tell us to eat (stomach growls, energy low)
  • Mindless Eating=Eating alone, at random times and places
    • Mindful Eating=Eating with others, at set times and places
  • Mindless Eating=Eating foods that are emotionally comforting
    • Mindful Eating=Eating foods that are nutritionally healthy.
  • Mindless Eating=Eating and multi-tasking
    • Mindful Eating=When eating, just eating
  • Mindless Eating=Considering a meal an end-product
    • Mindful eating=Considering where food comes from

From Christopher Willard PsyD:

  1. Let your body catch up to your brain: Eating rapidly past full and ignoring your body’s signals vs. slowing down and eating and stopping when your body says it’s full. Willard suggests that slowing down the process of eating may be the best way to get our mind and body to communicate their nutritional needs. For example, it is well documented that there is a 20 minute delay from the stomach to the brain…which is why we continue to eat when we are full, only to feel overstuffed 20 minutes later. Eating mindfully involves: slowing down, sitting and relaxing, chewing our food 20 or more times, setting your fork down between bites, and practicing other table manners that promote slower eating and allows you to listen to the hunger/full signals from your body.
  2. Know your body’s personal hunger signals: Are you responding to an emotional want or responding to your body’s needs? It is important to distinguish between your unique hunger signals from your BODY (stomach growling, low energy, lightheadedness) as opposed to EMOTIONAL signals (stress, sadness, frustration, loneliness or boredom). Mindful eating requires listening intently to your body…knowing your body.
  3. Develop healthy eating environments: Eating alone and randomly vs. eating with others at set times and places. Rummaging through kitchen cabinets in search of food and snacks and eating at random times and places are classic examples of eating mindlessly. Slow down, think about your hunger and how long it’s been since you have last eaten. Instead, plan a healthy snack or meal at set times and places. Plan you grocery list with this in mind. Keep a log or use a daily/weekly planner if necessary.
  4. Eat food not comfort: Eating foods that are emotionally comforting vs. eating foods that are nutritionally healthy. Certain foods, many that contain sugars and fats, stimulate the pleasure centers of the brain and become the source of “cravings.” However, over time, we can retrain the brain to derive pleasure from healthier foods. Mindful eating involves thinking first, eating second, and choosing healthy options such as carrots, apples, grapes, oranges as a snack instead of cake, cookies, or chips.
  5. Consider the life cycle of your food: Considering where food comes from vs. thinking of food as an end product. In hunter-gatherer cultures, people pay spiritual homage to those who provided the food and the plants and animals sacrificed in the process. Modern man/woman has been disconnected from their food and often eat without thought. Slowing down allows us to consider the farmer, butcher, baker, grocer, and those who prepare our food and bring it to the table. It can be both spiritual and thankful.
  6. Attend to you plate: Distracted eating vs. just eating. Mindful eating avoids distraction. The classic example of eating the big bowl of popcorn at the movies and wondering at the end of the movie who ate it? When we are distracted we cannot listen to our body’s hunger/full signals and we overeat. Try single-task eating without phones, tablets, computers, or televisions. Instead, share some light conversation with a friend or family member.

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.

Jan
15

Hypertension: Part 2 of 2

Dr. Mackarey's Health & Exercise ForumHypertension: Part 2

According to the Centers of Disease Control (CDC), Hypertension (HTN), also known as high blood pressure (HBP), affects one in three adults (67 million people) in the USA. Unfortunately, only one-half of those with high blood pressure control the problem and, as a result, are at great risk for heart disease and stroke.

Blood pressure numbers represent the force against the walls of your arteries. Normal blood pressure (BP) is defined as a systolic pressure (the top number) of 120 mm Hg and a diastolic pressure (the bottom number) of 80 mm Hg (120/80). The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has classified blood pressure as follows:

  • Normal: lower than 120/80 mm Hg
  • Prehypertension: 120-139/ 80-89 mm Hg
  • Stage 1 Hypertension: 140-159/90-99 mm Hg
  • Stage 2 Hypertension: 160+/100+ mm Hg

Risk Factors for HBP*

  1. African American
  2. Obesity
  3. Stress and anxiety
  4. Excessive alcohol use – more than 1 drink/day for women, 2/day for men
  5. Excessive salt intake
  6. Family history of HBP
  7. Diabetes
  8. Smoker

Medical Conditions or Medications Contributing to HBP*

  1. Chronic kidney disease
  2. Adrenal gland disease
  3. Hyperactive Thyroid
  4. Pregnancy
  5. Renal artery stenosis (narrowing)
  6. Medications: birth control pills, diet pills, cold and migraine meds

*(National Institutes of Health, Medline Plus)

Symptoms of HBP

For most people with HBP, there are no obvious symptoms. HBP is usually detected at a health fair or a routine visit with a physician. However, over time, HBP can cause problems with the heart and kidneys. Sometimes, a more serious condition can develop from very high blood pressure called malignant hypertension. Symptoms include; severe headache, nausea and vomiting, confusion, vision changes and nosebleeds. Notify your physician immediately if you develop these symptoms.

Diagnosis

Almost everyone has had their blood pressure checked with a standard or automatic blood pressure cuff. Sometimes, when a problem is detected, a home blood pressure unit is recommended to track BP throughout the day.

Treatment

  1. Eat Healthy – low salt, low fat diet which includes: fish, fiber, grains, fruits and vegetables
  2. Drink Plenty of Water
  3. Do Not Smoke
  4. Limit Alcohol to 1/day for women and 2/day for men
  5. Maintain a Healthy Body Weight
  6. Medication – not usually used for pre hypertension
  7. Limit Salt – less than 1,500 mg/day
  8. Limit Stress – consider meditation, tai chi, yoga
  9. Exercise – 30 – 45 minutes of aerobic exercise 4-5 days per week

Manage Stress

According to a recent long-term study, both men and women without a history of coronary artery disease or high blood pressure suffered from both diseases when they did not manage stress well. Those who allowed stress to upset them, (short fused and easily frustrated) had significant increases in cholesterol and blood pressure when compared with those who were more even-tempered and easygoing under stress.

Commit to Exercise

Exercise combats HBP and maintains a healthy body weight. The key to success when it comes to improving your life with exercise is to develop a regular, consistent program. A good program must include aerobic exercise (walking, jogging, biking) for 30 minutes (or 15 minutes twice a day) 4-5 days per week and mild/moderated weight training 2- 3 times per week.

Diet

  • A low salt, low fat diet which includes: fish, fiber, grains, fruits and vegetables is essential. Moreover, take care to avoid the “Seven Deadly Sins for High Blood Pressure” (Zee News):
  • Table Salt- Don’t add salt to your food because most foods have enough. Limit total salt consumption to 1,500 mg per day.
  • Deli Meat – These foods are loaded with salt as an additional preservative.
  • Red Meat – In excess, the trans and saturated fats in red meat can also damage the blood vessels of the heart over time. Limit consumption to 1 -2 times per week.
  • Alcohol – It causes the blood pressure to rise and in excess, can damage the blood vessel walls. Limit intake to 12 oz of beer, 8 oz of red wine daily.
  • Whole Milk – similar to red meat, the high concentration of saturated fats can damage blood vessels over time. A low fat substitute is a better option.
  • Pickles – Just 3 of these tasty cucumbers have more than the 2,300 mg of recommended sodium for an entire day.
  • Coffee – Caffeine can cause a temporary spike in blood pressure and should be consumed in moderation, especially for those at risk or with high blood pressure.

In conclusion, while HBP is a potentially serious medical condition, for most it is a controllable and preventable problem. Lifestyle changes such as diet, exercise and stress reduction have been found to be most effective.

SOURCES: Centers For Disease Control (CDC); American Heart Association (AHA), University of Pittsburgh Medical Center (UPMC), National Institutes of Health (NIH), Medline Plus, Zee News

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.

Jan
08

Hypertension (High Blood Pressure): Part 1 of 2

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

HYPERTENSION (High Blood Pressure): Part 1 of 2

 

Guest Authors: Michael Ambrose and Christian Bohan
3rd Year Medical Students at Geisinger Commonwealth School of Medicine (GCSOM) collaborated on this column.

Michael Ambrose, MD3, is from Coopersburg PA and attended college at the University of Scranton and is now a 3rd year medical student at GCSOM. His future interests include Emergency Medicine and cardiology.

Christian Bohan, MD3, grew up in Danville, PA prior to pursuing a degree in Neuroscience at the University of Pittsburgh. He is currently interested in neurosurgery and continues to enjoy learning about the different fields of medicine. In his free time, Christian can be found pursuing his interests of travelling and photography.

75 million people in the United States have been diagnosed with hypertension and hypertensive related diseases are the leading cause of death. Hypertension, otherwise known as high blood pressure, is defined as a constant elevation of blood pressure as opposed to a quick response to a stressful situation. A “normal” reading is 120/80 but can also be higher or lower based on an individual person’s body. A systolic pressure (top number) over 140 and a diastolic pressure (bottom number) over 90 is considered stage 1 hypertension. Usually, blood pressures below 140s/90s do not need to be treated medically, if you are less than 60 years old.

The purpose of this article is to bring awareness to the severe consequences associated with hypertension and the importance of regular checkups, early diagnosis, and treatment.
Perhaps the most obvious organ affected by hypertension is the heart but how exactly is it affected? There are two main diseases associated with the heart: coronary artery disease and congestive heart failure. Coronary artery disease is the narrowing of the vessels that supply the heart itself with blood. This can be caused by hypertension through turbulent blood flow which causes cholesterol to stick to the surface of the blood vessels. If one of these cholesterol plaques ruptures, it can cause a blockage in one of the coronary arteries, which would cause a heart attack. This is different from congestive heart failure, which is essentially the inability of the heart to pump enough blood to meet the energetic demands of the body (the heart gets tired). With increased blood pressure, the heart has to work harder to pump the same amount of blood through the system. Eventually the heart won’t be able to keep up, which will result in symptoms of fatigue and shortness of breath which gets worse with slight exercise such as walking up stairs.

Although not as obvious as the heart, the brain is also an organ that is severely impacted by hypertension. Although more blood to the brain may sound like a good thing, there are severe consequences involving the vessels. A stroke is caused when a part of the brain does not receive enough blood flow for a period of time. This can be caused by a blockage in an artery which prevents blood from getting to the tissue or it can be caused by a bleeding vessel which reroutes the blood away from the tissue that needs it. The first consequence is called an ischemic stroke, which means that part of the brain loses blood flow due to a blood clot causing an obstruction in the artery. This is associated with hypertension because turbulent flow is associated with clot formation. The second consequence is called a hemorrhagic stroke which occurs when the smaller arteries rupture (from increased pressure) causing bleeding within the brain. In both cases the result is the same: blood doesn’t reach its target and brain cells die.

The kidneys are another organ that can be affected by high blood pressure. This may not be obvious until you understand that the function of the kidney is to filter all of the blood in the body. In order to filter the blood effectively, the kidneys have a lot of tiny blood vessels that can be damaged from too much pressure. Over time, when high blood pressure is not kept in check these arteries can narrow, weaken or harden. When this occurs, the kidneys lose their ability to filter blood, leaving toxic substances in the body. What makes this even worse is that the kidney is also responsible for regulating blood pressure which can potentially make the hypertension worse.

High blood pressure also has adverse effects on the eyes. The eyes have small blood vessels and for the reasons we mentioned earlier, these vessels can be damaged with high blood flow. When the eye does not receive enough blood flow, the cells die causing blindness.

While this seems intimidating, there are steps you can take to decrease your blood pressure and lower your chances of developing these diseases. Perhaps the most important is regular monitoring of your blood pressure. You can do this by having regular checkups with your doctor, getting it checked at local pharmacies and there are even devices available for use in your own home. If you notice that your pressure is high, be sure to let your doctor know so you can come up with a plan to lower it. First and possibly the most important step in lowering blood pressure is diet and exercise. A low salt and low fat diet can help lower and keep it down at a manageable level. Aerobic exercise for 30 mins a day for at least 4-5 days a week is recommended to keep your heart healthy which further helps with maintaining a good blood pressure. Other steps you can take include limiting use of tobacco products and alcohol. If these methods aren’t adequate to lower your blood pressure, talk to your doctor about including medication into your care plan.

In conclusion, hypertension has a lot of widespread consequences but with diligent care, it can be easily

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Part 2 “Hypertension”

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).

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