ANNOUNCEMENT: Attention Health Care Professionals
The Commonwealth Medical College will host a one day symposium on infectious diseases on Saturday, April 5, 2014 from 8 am to 12 noon.
Location: TCMC 525 Pine Street, Scranton, PA
For more information contact: JoAnn Babish, 570-207-3686 or visit www.thecommonwealthmedical.com/keystone
Health & Exercise Forum will dedicate the next three weeks to columns related to infectious diseases to raise the level of awareness in NEPA.
“Superbugs” are drug-resistant bacteria affecting more than 90,000 Americans each year. However, it is important to recognize the fact that these infections do not only affect weak and hospitalized but also young, healthy athletes. In fact, there is a serious concern by medical professionals about the significant rise in cases of antibiotic resistant bacterial infections among the community at large including athletes. This dreaded bacterium is called Methicillin-Resistant Staphylococcus Aureus (MRSA).
Recently, the Centers for Disease Control (CDC), reported cases throughout the country among high school, college and professional athletes. While more common in contact sports such as football and wrestling, other athletes in non-contact sports such as fencing, have been infected in large numbers.
The CDC reports that MRSA is spread in many different ways including contact associated with sports. The bacteria can be spread by direct contact with infected persons or indirect contact through shared towels, clothing or equipment. Normally benign cuts or scrapes can put an athlete at great risk.
The CDC does not feel that this is a temporary problem or fluke. The numbers continue to rise among athletes. In fact, every medical team in the National Football League was notified about MRSA by the CDC. The CDC feels that this trend is directly related to the growing use of antibiotics and an increase in resistance to them.
According to Mark Frattali, MD, a local otolaryngologist, in addition to those with weak immune systems, he has seen a significant number of young healthy individuals such as construction workers and high school soccer and football players, who have contracted MRSA.
While most MRSA infections are not fatal, some can be life-threatening. Also, health experts have great concern about the rapid spread of the stubborn and resistant bacterium. But, it is important to keep in mind that in the vast majority of cases, MRSA is treated with success. Some antibiotics can still work well and are often given intravenously at first and followed by oral medicine.
Prevention:
The primary cause of the spread of MRSA is contact. Prevention involves avoiding and combating contact. The CDC state that MRSA is spread by: close skin-to-skin contact, cuts, abrasions, contaminated clothes and equipment, crowded living conditions, and poor hygiene
SOURCES: Mark Fratalli, MD, WebMD, Centers for Disease Control: www.cdc.gov
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” 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 and is an associate professor of clinical medicine at The Commonwealth Medical College.
Guest Columnist: Shreya Trivedi, 3rd Year Medical Student The Commonwealth Medical College
ANNOUNCEMENT: Attention Health Care Professionals
The Commonwealth Medical College will host a one day symposium on infectious diseases on Saturday, April 5, 2014 from 8 am to 12 noon.
Location: TCMC 525 Pine Street, Scranton, PA
For more information contact: JoAnn Babish, 570-207-3686 or visit www.thecommonwealthmedical.com/keystone
Health & Exercise Forum will dedicate the next three weeks to columns related to infectious diseases to raise the level of awareness in NEPA.
It’s just 10 o’ clock in the morning at work and you are starting to get the sniffles. You are falling behind on your work as your head begins to start pounding. By late afternoon, you are coughing up a storm and your desk is covered with discolored Kleenex tissues. By now it’s crystal clear you’ve come down with something. Bad colds, sore throats, bronchitis, the flu are quite common this time of the year and the typical reflex reaction is to call your family physician and get antibiotics. The latter part of this knee-jerk reflex might not be, ironically, a healthy thing.
Last week we discussed what exactly an antibiotic is and the history of antibiotics. This week’s column will discuss when antibiotics are most effective and appropriate.
However, keep in mind that use of antibiotics can easily turn into abuse for these common viral infections below.
Since antibiotics are ineffective in destroying a virus, you are only subjecting yourself to the side effects of them– the most common being diarrhea and upset stomach. More importantly, the unnecessary antibiotics will kill off the good bacteria natural to your body that are helping your digestive system and helping your body fight infections. Thus, only bacteria that are resistant to medicine will remain. This creates an empty playground for those resistant germs to grow and multiply. One unfortunate outcome could be that later on, if you could get sick from resistant bacteria, the antibiotics that you actually need this time might not work against the resistant strain.
Antibiotics resistance is one of the world’s most pressing public health problems. At the heart of the problem is the physician-patient relationship. A study reported by the Center of Disease Control showed that pediatricians prescribe antibiotics 62% of the time if they perceive patients expect them versus only 7% of the time if they feel patients do not expect them to do so. Many patients demand antibiotics as a quick fix when they come down with something, not knowing that antibiotics have no power against a viral bug or won’t make them get better faster. It is natural instinct to want to do something or take something to feel better. Physicians also need to prescribe antibiotics only when necessary and focus on educating and explaining their decisions and treatments to the patients. This way, both the physician and patient must play their part in helping change the future of antibiotic use.
But at the end of the day, you resemble Rudolph the red-nose reindeer with your bright red nose and you still feel like a zombie. After you’ve gone to the doctor and she has told you that it is something viral and doesn’t require antibiotics, what can you do? Rest, take fluids, use a cool mist vaporizer with some TLC are all natural and worthwhile measures you can take while the virus runs its course; Tylenol and Motrin will also help relieve any pain or fever. Your nose will go back to its normal shade and you will be able to put the Kleenex back in your desk drawer soon enough.
Guest Columnist, Shreya Trivedi is a 3rd year medical student at The Commonwealth Medical College. Shreya was born in India but grew up in Randolph, NJ. She was a Biology and Honors Major with a philosophy minor at Villanova University where she was involved in researching uterine matrix remodeling of the endometrium. She also worked as a tour guide, orientation counselor and leader of many diversity initiatives, such as President of the South Asian Club. As a Fulbright Scholar, Shreya studied in South Korea, where she taught and worked on various health projects in the community. After medical school, she aspires to complete an internal medicine residency.
Medical Reviewer: Dr. Susheer Gandotra is an infectious disease specialist at Pocono Medical Center
Read “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 of 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
Guest Columnist: Shreya Trivedi, 3rd Year Medical Student The Commonwealth Medical College
ANNOUNCEMENT:
Attention Health Care Professionals
The Commonwealth Medical College will host a one day symposium on infectious diseases on Saturday, April 5, 2014 from 8 am to 12 noon.
Location: TCMC 525 Pine Street, Scranton, PA
For more information contact: JoAnn Babish, 570-207-3686 or visit www.thecommonwealthmedical.com/keystone
Health & Exercise Forum will dedicate the next three weeks to columns related to infectious diseases to raise the level of awareness in NEPA.
It’s just 10 o’ clock in the morning at work and you are starting to get the sniffles. You are falling behind on your work as your head begins to start pounding. By late afternoon, you are coughing up a storm and your desk is covered with discolored Kleenex tissues. By now it’s crystal clear you’ve come down with something. Bad colds, sore throats, bronchitis, the flu are quite common this time of the year and the typical reflex reaction is to call your family physician and get antibiotics. The latter part of this knee-jerk reflex might not be, ironically, a healthy thing.
The purpose of this column is to dispel common myths about antibiotics.
Antibiotics can be traced as far back as Ancient Greece when molds and other plant extracts were used to cure infections. The first documented discovery of antibiotics was made by Robert Koch and Louis Pasteur in 1877. However, the “Father of Antibiotics” was Seiman Waksman, who discovered streptomycin, which was first used to treat tuberculosis and became one of the top ten patents that changed the world. In 1928, Alexander Fleming discovered Penicillin and is credited with saving countless lives.
It was during WWII that the use of antibiotics gained momentum, curing serious wound infections and pneumonia. Before long, newspaper headlines praised it as a miracle drug. This sparked a race for research and production of other antibiotics. Thanks to the vast research post-WWII, doctors have had a number of antibiotics available to choose from for the past few decades. However, misinformation and miscommunication between the medical community and patients led many patients to believe this “quick-fix” pill was necessary every time they began to sniffle. Patients want to do or take something to feel better, and similarly doctors want to help their patients feel better as soon as possible. Going home with the prescription of “fluids and rest” can be dissatisfying for both doctor and patient, and can damage the physician-patient relationship.
However, doctors and patients don't have that much of a luxury in terms of antibiotic choices anymore. The overuse of antibiotics has led to a rise in the resistance to antibiotic. The dreaded Methicillin-Resistance-Staphylococcus-Aureus (MRSA) is a perfect example; it is a strain of staphylococcus aureus that overtime developed resistant to many antibiotics. More and more strains of various bacteria are becoming difficult to treat, forcing patients to take a second or even third antibiotic when the first drug didn’t work. What if you are the next patient this antibiotic resistance nightmare happens to next? For this reason, we should all take a step back and understand when antibiotics are needed and when they are not.
It is important to think about what kind of bug is making you sick. Is it a virus or bacteria? The doctor will determine that but you must keep this in mind… if it is a virus (which it often is), antibiotics will not do anything to help you recover.
Bacteria are a single-celled organism with structures, such as cell wall/membrane, nucleus and ribosomes, that allow it to live inside and outside our bodies. Antibiotics target such structures and therefore, bacteria are vulnerable to antibiotics. On other hand, viruses are significantly smaller non-cellular pseudo-organisms that lack the structures that antibiotics rely on to kill bacteria, like a cell wall, nucleus, and mitochondria. Consequently, antibiotics can’t fight against viruses and will not even hasten your recovery. In short, antibiotics work for bacteria and not viruses.
So when do these small pills do big things? Antibiotics can work wonders to expedite recovery, prevent complications and save lives in cases where bacterial infections are present.
Guest Columnist, Shreya Trivedi is a 3rd year medical student at The Commonwealth Medical College. Shreya was born in India but grew up in Randolph, NJ. She was a Biology and Honors Major with a philosophy minor at Villanova University where she was involved in researching uterine matrix remodeling of the endometrium. She also worked as a tour guide, orientation counselor and leader of many diversity initiatives, such as President of the South Asian Club. As a Fulbright Scholar, Shreya studied in South Korea, where she taught and worked on various health projects in the community. After medical school, she aspires to complete an internal medicine residency.
Medical Reviewer: Dr. Susheer Gandotra is an infectious disease specialist at Pocono Medical Center
Read “Health & Exercise Forum” – Every Monday. Next Week Read: Antibiotics 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 of 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
When is the optimal time to eat with regard to exercise? Will eating before exercise cause cramping? Will it negatively affect performance? Will eating after exercise make me nauseous or tired? These questions enter the minds of almost every amateur or competitive athlete engaged in exercise or sports.
Some people report upset stomach and cramping if they eat too soon before exercise; while others notice being tired and listless if they exercise without eating first. While the value of specific foods, quantity and timing of meals may vary with each individual with regard to sport and exercise, research supports the basic physiologic principle that active muscles need fuel. The fuel can be provided before or after exercise or both. The specific foods, timing and quantity of the meals must be individualized by self-experimentation.
Several studies support the benefits of eating after aerobic exercise:
Promoting “Afterburn” – to continue burning calories 1-3 hours after exercise
Aerobic exercise at a moderate/maximal intensity for 30 to 45 minutes, raises the metabolic rate to a level that will continue burning calories for 1-3 hours following the activity, depending on the intensity, according to a study conducted at the Health Promotion and Wellness Center at the School of Medicine at University of Louisville in Kentucky.
Converting Carbohydrates to Glycogen – rather than fat
Eating after exercise fosters depletion of muscle glycogen stores, therefore, carbohydrates eaten after exercise are more efficiently converted to glycogen rather than stored as fat.
Suppress the Appetite – for 30 minutes following exercise
If the intensity of the aerobic exercise is great enough, it can suppress the appetite for half an hour following exercise. 30 minutes at maximum/moderate intensity was found to be more effective than 60-70 minutes at minimum intensity in suppressing the appetite. It is theorized that this may be due in part to an elevation of body temperature, which suppresses the appetite until the body cools down.
Due to schedule conflicts or preferences, some people may choose to exercise after a meal. One must be cautious, due to the fact that during vigorous exercise the digestive tract may receive only 20% of its normal blood flow. The hard working heart and muscles take priority. This slows digestion and may cause stomach distress. However, if the right kind of exercise is performed, it can prove beneficial. Minimal to moderate, not vigorous exercise is appropriate after a meal. This would include a brisk walk, low intensity cycling, gardening, or playing catch. Also, the right kind of food is important such as a moderate amount carbohydrate and protein will go a long way to provide fuel for exercise. For example, a plain bagel (carbohydrate) with peanut butter (protein) is the preferred fuel source for many athletes.
In conclusion, active people must experiment with food types, quantity and timing of meals with exercise for individual preference. However, if weight reduction is a goal, plan your meals within 1-2 hours following exercise at moderate/maximum intensity for 30 to 45 minutes. This strategy will enhance your chances of benefiting from the weight reduction value of exercise: the benefits of depleting calories 1-3 hours after exercise, more efficiently converting carbohydrates to glycogen rather than fat, and appetite suppression. However, if you require fuel for a prolonged activity, try a bagel with peanut butter.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” 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 and is an associate professor of clinical medicine at TCMC.
How many times have you heard the phrase “My back is killing me?” Almost every American has had an episode of back pain or knows someone who has had significant back pain. Acute low back pain (LBP) is one of the most common health maladies in the United States and is the leading cause of disability in people younger than 45 years old. It is responsible billions of dollars in health care costs, and is a leading cause of missed work.
One of the most common questions that people ask is “Do I need to get an MRI if I have back pain?” However, at a time when healthcare spending is under tremendous scrutiny, it is not uncommon for expensive special tests such as MRI’s to be denied by insurance companies. In view of this, I have asked Jamie S. Stallman, MD, a local radiologist at Advanced Imaging Specialists, to address the indications for MRI testing for LBP.
LBP is divided into two very different categories. The first is uncomplicated LBP, and the second is complicated LBP. When pain is localized to the lower back (lumbar) region and there are no complicating factors, this is considered “uncomplicated” and no medical imaging is required. Uncomplicated LBP is usually a self-limiting condition, meaning that it goes away by itself without any treatment. Most people with this condition will experience relief of symptoms within a month and can resume normal activities without difficulty. Treatment for uncomplicated LBP is usually limited to over-the-counter medication, rest, and physical therapy. Imaging is not usually performed because the cause of the pain is related to muscles or connective tissue around the spine in the majority of cases.
In contrast, complicated LBP requires additional investigation by your health care provider. There are a few key features of complicated LBP that are important to remember. When any of these factors are present, it is possible that there may be a specific cause of the pain, such as a disc herniation, fracture, soft tissue lesion, spinal stenosis, or infection. The following is a list of “Red Flags” that puts back pain into the “complicated” category:
If any of these conditions apply to a patient with back pain, then a medical professional must be consulted. In most of these cases, the health care provider will order some type of imaging to try to identify the cause of the pain. An MRI is the most common test ordered to evaluate back pain but there are three other imaging modalities also used.
MRI: Magnetic Resonance Imaging is the best, and most commonly used imaging modality for spine problems. The MRI scanner utilizes strong magnets and radio waves to create images of the spine and surrounding anatomy. MRI provides the best pictures of disc hernations, ligaments, connective tissues, and nerves in the spine due to its superior pictures of soft tissues.
X-ray: These are pictures produced by passing x-ray beams through the area of interest. X-rays mostly depict abnormalities that occur with bony structures such as fractures, listheses (or “slippage”), and disc spaces.
Bone Scan: This test produces images from a radioactive chemical that is injected into a patient’s vein. Bone scans are very sensitive for detected bone abnormalities including fractures. Bone scans also have the ability to image the entire skeleton all at once.
CT Scan: CT, or Computed Tomography is commonly referred to as a “CAT” scan. Images are produced when a patient is placed lying down into the scanner (shaped like doughnut) where an x-ray tube rotates around in a circle. A computer then reconstructs highly detailed images of the bones and soft tissues of the spine.
A patient with complicated low back pain will be examined by a health care professional who will usually recommend that one or more of the above imaging modalities be considered. These tests are performed at most hospitals and outpatient imaging centers. The actual pictures are taken by a trained technologist. The radiologist, who is a physician specially trained in medical imaging, will then interpret the images and consult with the referring health care provider. Based on the imaging findings and clinical history, a treatment plan will then be initiated.
So the next time you have back pain, remember that you may not need anything more than over-the-counter medicine, but if any of the “Red Flags” are present you should contact your health care provider.
GUEST COLUMNIST: Dr. Jamie Stallman is radiologist at Advanced Imaging Specialists in Dunmore, PA.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum" 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 and is an associate professor of clinical medicine at The Commonwealth Medical College.
My grandmother, Rosina Scalese, lived to the wise old age of ninety- seven. I have inherited her coveted “pock a book” in which she always kept one dollar bills to give to any child kind enough to visit her. Now, I find myself hoping to inherit another prized possession from my grandmother… her longevity genes! She lived independently until she was 90 years old. She enjoyed walking all over her North Scranton neighborhood visiting her lifelong friends, Mrs. Costanzo and Mrs. Bonacci. She walked to Rossi’s Market to shop for groceries and Murazzi’s for suprasatta and provolone. Unfortunately, my grandmother’s independence was lost the same way more than one-third of a million people lose theirs… hip fractures! What I did not know then, that research shows now, is that her fracture, like many, was more than just an orthopedic problem. It involved age, gender, diet, exercise and vestibular problems (inner ear problems effecting balance).
Injuries due to falling are a very common problem in the elderly. Hip fractures are the most common injury due to falling in the elderly. According to the Centers for Disease Control (CDC), more than 300,000 persons over the age of 65 will fracture a hip in the United States this year and 18 to 33 percent of those who are older will die within one year of their fracture. Furthermore, approximately 25 to 75 percent of those who were independent before their hip fracture will not walk independently (50 percent will require a cane or walker) and will not attain their prior level of independence, requiring family assistance or home care. It costs an average of $37,000.00 per hip fracture or more than a billion dollars a year.
Several risk factors for hip fractures have been identified. While some factors are somewhat controllable and may improve bone quality, (diet, exercise, smoking, alcohol) others are not.
Common characteristics of persons who are vulnerable for hip fractures:
**Some risks are due to osteoporosis and others from balance problems
A recent study by the American Physical Therapy Association found that patients benefited from a physical therapy evaluation to determine their risk level for falling. If a high-risk level is found on a falls assessment, physical therapy interventions can be successfully employed to improve strength, balance, and coordination and falls prevention. Also, a well-balanced diet, exercise, Calcium with vitamin D supplements and medications can help prevent or retard osteoporosis and prevent hip fractures.
***Always perform slowly, alternate right and left sides, limit other distractions and concentrate on the exercise to retrain the brain, 10-20 times each 2-3 times per day. Please use supervision or assistance if necessary.
Lying on Back:
Sitting:
Standing: **Caution: Do not perform standing exercises without assistance or supervision
If you feel you or a loved one may be at risk for falling or a hip fracture, ask your physician if a physical therapy consultation for a falls prevention program may benefit you.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” 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 and is an associate professor of clinical medicine at The Commonwealth Medical College.
Guest Columnist: Sarah Bashaw, 3rd Year Medical Student The Commonwealth Medical College
Recent headlines in The Times-Tribune reported with alarm that lung cancer rates in Northeastern Pennsylvania are on the rise, especially among women, while the incidence of the deadly disease is declining elsewhere in the country. In fact, according to the Northeast Regional Cancer Institute, NEPA’s rate is 15% higher than the expected average.
Lung Cancer is a very serious and often deadly disease. Until recently, there was not a well-documented study to support an effective and safe screening test. A chest X-ray, often used only after patients developed symptoms, discovered the disease when it was in the late stages. This is about to change… those who are at high risk for lung cancer can now be screened annually using low-dose spiral CT scans.
No new technology is without controversy. A recent study published in the Journal of the American Medical Association suggests that there is a possibility that CT screening may lead to over diagnosis of lung cancer. For example, it is predicted that for every 320 patients screened for lung cancer, while at least one life will be saved, 1.3 cases of previously undetectable slow growing and possibly non fatal tumors will be discovered. Currently, the medical community is unsure of how these patients will be best managed but it is hard to imagine when early detection is not advantageous, even if only to provoke a patient into living a healthier lifestyle and quit smoking.
FACT 1: Each year over 250,000 people in the United States are newly diagnosed with lung cancer.
FACT 2: Almost 90% of individuals who have lung cancer will eventually die of the disease, making lung cancer the most deadly cancer in the United States for both men and women. However, detection of early stage lesions has significantly higher survival rates.
FACT 3: 85% of all lung cancers is caused by smoking.
FACT 4: According to the Pennsylvania Department of Health, 22% of people aged 18 years and older residing in Northeastern, PA smoke as compared to 19% nationally.
FACT 5: The best prevention measures are; not smoking or using tobacco products, and avoiding second-hand smoke or high air pollution environments.
One of the reasons for the high mortality rate in lung cancer is that the disease is often not discovered until it is advanced and treatment is not as effective. Some of the most common signs and symptoms of lung cancer are easily mistaken either for a mild illness or for things such as “smoker’s cough”. By the time many patients are diagnosed, their disease is advanced and may involve lymph nodes or other organs.
For some cancers, there are established screening tests that help to identify these cancers at an earlier stage. For example, routine screenings through colonoscopies, mammograms, and pap smears are well established and have saved thousands of lives. Historically, lung cancer has not had such a screening test. This however, has changed due to recent research. This past summer, the United States Preventative Task Force (USPTF), an independent committee charged by congress to evaluate the most current data and make recommendations for disease screening, released a draft of a new proposal for a lung cancer screening test.
The USPTF now recommends that all persons who are at high risk for lung cancer should be screened annually using low-dose spiral CT scans. High risk persons are identified as those who are between the ages of 55 and 79, who have a history of 30 pack years or more of smoking, and who are either still smoking or who have quit within the last 15 years. A “pack -year” is defined as smoking 1 pack of cigarettes a day for a year. For example, a person could have 30 pack -years of smoking if they smoke 1 pack of cigarettes a day for 30 years. Similarly, they could have a 30 pack-year history by smoking 2 packs of cigarettes a day for 15 years.
CT, or computed tomography scans, are a form of three-dimensional imaging used by clinicians to visualize the organs and other anatomy of patients. The scan can detect abnormalities on a patient’s lung with much earlier and with greater sensitivity than an x-ray. Much like a mammogram, low-dose CT scans do not diagnose cancer but are a way to identify patients with abnormalities that need to be investigated further for the possibility of cancer. This new screening test will allow physicians to see possibly cancerous abnormalities of the lung before the disease can spread and become difficult to cure. Early stage nodules can be seen and surgically removed before they spread. The scan is non-invasive and generally considered very safe. Low-dose CT scans carry about 5 times less radiation than traditional high-dose CT scans and are equivalent to about 15 x-rays.
It is projected that this new screening practice will save the lives of between 18 and 20% of those diagnosed with lung cancer by detecting cancers before they can progress to the point that they are resistant to medical treatment. The draft of the new proposal for lung cancer screening that the USPTF released this summer was based off of a landmark article in The New England Journal of Medicine in 2011. In view of this, clinicians have been encouraged to implement these screening practices and insurance companies will use these recommendations to adopt their policies regarding coverage for testing.
While this screening is a major step in the detection and treatment of lung cancer, it is not a substitute for quitting smoking. The best proven methods to prevent lung cancer and its deadly consequences is to not smoke, use other tobacco products, and avoid exposure to second-hand smoke.
If you think that you or a loved may be in need of lung cancer screening, contact your family physician or pulmonary specialist for more details. For help quitting tobacco products, you may also contact your physician or call 1-800-QUIT-NOW or visit www.lung.org.
NOTE: These signs and symptoms can be attributed to many different causes and are not exclusive to lung cancer. Always discuss your symptoms with your physician.
Who should be included in annual low-dose spiral CT screening for lung cancer?
Patients who fit all of the below criteria:
*A pack year is defined as 1 pack of cigarettes per day for a year
Guest Columnist, Sarah Bashaw, is a third year medical student at TCMC. She has discovered a love for the heart and plans to become a cardiovascular surgeon. She also is dedicated to patient centered medicine and is eager to be an integral part of a health care team which is compassionate and focused on patients and their families. She comes to our area from a small town in Vermont and enjoys skiing and being outdoors. She received her bachelor’s degree in Chemistry from Skidmore College in Saratoga Springs, NY, in 2011 where she was also the president of the College’s Honors Forum.
Medical Reviewer: Greg Cali, DO, Pulmonologist, Dunmore, PA
Read “Health & Exercise Forum” in the Scranton Times-Tribune 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 of 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.
Guest Columnist: Sarah Bashaw, 3rd Year Medical Student The Commonwealth Medical College
Happy American Heart Month! It is no accident that Heart Month is celebrated in the same month as Valentine’s Day. However, this celebration of the heart is much deeper than chocolate and roses. To truly love someone, you must first love yourself and taking care of your heart is a good place to start.
Of the many wonders of the body I have learned about at The Commonwealth Medical College (TCMC) over the past three years, the small organ about the size of a fist that sits just underneath your ribs on the left side of the chest has captured my heart. Before birth, your heart has been beating away, usually without you even knowing it. It does not need to be told what to do, it speeds up and slows down to allow you to sleep or to climb a flight of stairs, and it doesn’t tire out the same way that your other muscles do. So, with all my heart, I hope that I can give you a few easy and helpful tips to keep yours happy and healthy, not just this month but for years to come.
The American Heart Association promotes seven key health factors that, when combined, contribute the most to your heart health – it’s called “Life’s Simple 7’s.” You should tailor this list to your personal health and life style and focus on those aspects that are most applicable to you.
Life’s Simple 7’s:
Weight: Doctors and other health care professionals use a body mass index, or BMI, to determine a healthy weight for you. There are several online calculators or ones for your phone where you can put in your height and weight to calculate your BMI. If your BMI is higher than it should be (a healthy BMI is between 18.5 and 24.9), it is suggested that you lose weight. Extra body fat affects your heart health by increasing your cholesterol and your potential for other health issues such as heart attacks or strokes.
Eat Well/Be Active: Make healthy choices. Instead of a hamburger, next time try a turkey burger. Swap your soda for seltzer water. Instead of taking the elevator, use the stairs. For most people, it is the culmination of multiple small unhealthy choices that lead to weight gain, so don’t forget that overtime; many small healthy choices can cause weight loss too.
Blood Pressure: The Joint National Commission recently released new guidelines on hypertension. It is recommended that patients under the age of 60 with blood pressure above 140/90 or over the age of 60 with a blood pressure over 150/90 be treated with medications for hypertension. While only your doctor can determine if you should be placed on medication, and which medication is best for you, there are things that you can do yourself to help reduce your blood pressure: lose weight, exercise at least 30 minutes most days of the week, reduce the salt in your diet, and reduce the amount of alcohol you drink. High blood pressure makes your heart work harder with each beat. Like other muscles in your body, the harder you heart has to work, the thicker your heart muscle becomes. Unlike your biceps, increasing the thickness of your heart muscle doesn’t make you more toned, but instead it reduces the volume of blood that can enter the chambers of your heart. Over time this can cause problems for both your heart and lungs, which can lead to heart failure.
Blood Sugar: Unless you heading out the door for a 10 mile run, when you eat glucose, or sugar, your body cannot use it as a fuel source immediately. As sugar enters your bloodstream, it is necessary for your body to make insulin to bind to the glucose or it will be unable to deliver the glucose to your cells. When you have high blood sugar, it means that your body has not produced enough insulin to bind with the sugar in your blood (this leads to high blood sugar) and therefore it cannot deliver it to your cells for energy. Over time, your body’s cells can starve if there is not enough insulin to bind to the glucose and make it useable for your body. The organs that are most easily affected by the inefficient use glucose or high blood sugar are your eyes, kidneys, nerves, small blood vessels and heart. In fact, heart disease and stroke are the number one cause of death among people with type 2 diabetes. If you have high blood sugar or diabetes, talk to your doctor about getting control over your blood sugar. The best thing you can do is to lose weight and eat healthy. Try a snacking on carrots instead of a piece of candy, and as always, stay active.
Control Cholesterol: Cholesterol is a sticky substance that can build up in your blood vessels. When your body has more cholesterol than it can handle, it can cause your blood vessels to narrow (atherosclerosis). It may also lead to small pieces, called plaques, to break off and cut off blood to vital organs such as your heart or brain. You may have heard of “good” and “bad” cholesterol. “Good” cholesterol is high density lipoprotein or HDL and it helps to keep the “bad” cholesterol from sticking to your blood vessels. “Bad” cholesterol is low density lipoprotein or LDL and it is the part of cholesterol that makes cholesterol sticky. It is recommended that HDL should be above 40 mg/dL and LDL cholesterol be below 100 mg/dL. Once again, the best thing you can do to lower your cholesterol is to eat healthy foods, stick to proper portion sizes, and stay active. If you have high cholesterol, your doctor may recommend medications to help control it.
Stop Smoking: Smoking is the single worst thing that you can do for your body and for those around you. Unfortunately, NEPA has more smokers than the national average and a greater incidence of related cancers as well. It causes over 440,000 completely preventable deaths each year. If you do not smoke, do not start smoking. If you do smoke, you have probably heard all of the reasons that you should quit hundreds of times. Nicotine is extremely addictive and quitting is never easy. Your doctor can help you set a quit date, choose a method of quitting that works best for you, and provide you with the support that you need to quit smoking. Even if you have quit in the past, every day that you do not smoke is a day that your body is not being harmed and can try to heal any damage that may be reversible. Your heart and lungs will thank you.
If you can make even a few of these simple healthy choices it will go a long way towards your heart health. For more information, please visit the American Heart Association and happy American Heart Health Month to all!
Guest Columnist, Sarah Bashaw, is a third year medical student at TCMC. She has discovered a love for the heart and plans to become a cardiovascular surgeon. She also is dedicated to patient centered medicine and is eager to be an integral part of a health care team which is compassionate and focused on patients and their families. She comes to our area from a small town in Vermont and enjoys skiing and being outdoors. She received her bachelor’s degree in Chemistry from Skidmore College in Saratoga Springs, NY, in 2011 where she was also the president of the College’s Honors Forum.
Read “Health & Exercise Forum” in the Scranton Times-Tribune 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 of 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.
Part 2 of 2
Last week, this column discussed the many benefits of snowshoeing as an option for those in NEPA to get outdoors and enjoy the winter. Today’s column will present another option for outdoor exercise when the weather is inclement…winter walking or running.
We live in such a beautiful environment. Each season brings its own unique beauty and winter is no different. Most will not have to abandon outdoor activities but you must make some adjustments in equipment, clothing and food for each season and temperature changes that go with it. These tips are also appropriate for those who qualified for the Boston Marathon in the spring and will be training all winter, as well as those who enjoy walking and running throughout the winter for exercise. Consider the importance of making changes and adjustments in training as well as clothing and equipment, according to the weather and temperature.
There are running shoes specifically designed for use in wet, cold and sloppy winter conditions. These running shoes, which can also be used for walking, are considered “winterized” because they offer waterproofing, sealed seams, gaiter collars to keep out snow and slop, slip resistant fabric, anti-roll stability features, anti-microbial material and aggressive tread patterns for traction on slippery surfaces. Some shoe recommendations for both walkers and runners include:
Salomon – SnowCross 2 CS - $ 200.
Asics - Gel-Arctic 4 WR - $110.
Brooks – Adrenaline ASR 10 GTX - $140.
Additionally, I am a strong proponent of walking or trekking poles for improved balance and safety when brisk walking in winter conditions. They are light weight, adjustable, and collapsible. Some examples are: Black DiamondR Trail Back - $56.95 and MountainsmithR Rhyolite - $35.09. Also, an old pair of ski poles will work just fine.
Over the past several years great strides have been made on understanding the effects of extreme temperatures on performance. Current wisdom from the University of Otago in New Zealand has found:
WARM-UP
THE BRAIN
Researchers have developed various strategies for athletes to stabilize their core temperatures in extreme hot or extreme cold conditions:
BELOW 45 DEGREES FAHRENHEIT – CAUTION/COLD:
45 TO 50 DEGREES FAHRENHEIT – OPTIMAL
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” 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 an associate professor of clinical medicine at The Commonwealth Medical College and is in private practice in downtown Scranton.
SNOWSHOE: MAKE WINTER FUN AND WALK IN THE SNOW! Part 1 of 2
When I was a young boy growing up in NEPA, one of my favorite winter activities was walking in the freshly fallen snow. I loved the feel of fresh crisp air through my lungs, the mesmerizing sparkle of snow falling in the moonlight, the peaceful sound of silence as pedestrian and motor traffic came to a halt and the only thing audible was the muffled sound of my boots as they crunched the snow beneath. Well, I am happy to share with you, as I struggle to hold on tightly to my “inner child,” I am as excited and inspired by a walk in the snow today, as I was 45 years ago. It is my hope, that this column will inspire my readers to consider a beautiful walk in the snow to rediscover their “inner child.”
While there are many options and opportunities available to enjoy winter in NEPA such as downhill skiing, cross country skiing, winter mountain biking, ice skating, and sledding, none is as easy and natural as snowshoeing. As a result, the popularity of snowshoeing is growing rapidly. According to the Outdoor Industry Association, the number of snowshoe participants have increased by 7.5% to 4.1 million in 2011 and 40.7% overall since 2008.
The advantages are many; there is NO learning curve; (if you can walk, you can shoe), little to no risk of injury (it requires more endurance than coordination); the equipment is inexpensive (as compared to skis); the walking and hiking trails are free (Lackawanna State Park, Rails to Trails or the snow covered streets of your neighborhood); the aerobic exercise is great and caloric expenditure tremendous (according to Weightwatchers, a person weighing 150 pounds will burn approximately 650 to 700 calories per hour of snowshoeing.)
(Raquettes GV, Quebec, Canada info@gvsnowshoes.com)
While the advent of the wheel is estimated to have been approximately 3,500 BC, the snowshoe had already been established and developed by 6,000 BC according to Stone Age engravings found in Norway. The snowshoe was an instrumental tool used by early humans to cross the Bering Strait into North America.
Some historians feel the snowshoe developed, like many great inventions, as an imitation of nature. For example, animals such as the snowshoe hare have expansive feet to increase their surface area, limit sinking and move more efficiently through the deep snow. Hardwood frames with leather webbed lacing comprised the early snowshoes used by fur trappers, traders, and Native Americans. More recently, materials have advanced and light but durable aluminum frames comprise snowshoes that are used by park rangers and winter recreation enthusiasts.
Choose the right Snowshoe from the 3 Available Types:
1. Recreational Hiking Snowshoes: Recreation snowshoes are a good choice for beginners to be used on easy terrain, paths and trails.
2. Aerobic/Fitness Snowshoes: Aerobic snowshoes offer a sleeker and lighter design for those interested in running or cross-training.
3. Hiking/Backpacking Snowshoes: Hiking snowshoes offer a strong and durable frame, slightly wider base of support and strong flexible bindings for difficult terrain.
Cost:
Like all sporting equipment, you usually get what you pay for and snowshoes range in cost from $50.00 to $300.00. But most people will be fine in a good pair for under $120.00. LL Bean and Dick’s Sporting Goods offer several affordable options.
Some equipment examples are Tubbs Flex Alp - $197 and Redfeather Hike - $95.00. Ski poles are recommended for efficiency when snowshoeing. Traditional ski poles or adjustable hiking poles can be used. Warm and supportive winter boots or hiking shoes are essential.
With a good winter ski jacket and pants, hat and gloves, you are ready to go! The next time a snow storm dumps 8 – 10 inches on NEPA, get outside BEFORE the streets are plowed. Put on you warm winter boots, strap them into the bindings of your new snowshoes, walk out your front door and explore your neighborhood as you have never seen it before...white, clean, glistening, crisp and quiet. Let your mind wander and rediscover your inner child!
Next Week: Part 2 of 2...Winter Walking and Running
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey "Health & Exercise Forum" 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 an associate professor of clinical medicine at The Commonwealth Medical College and is in private practice in downtown Scranton.
