Part 3 of 3 on Dehydration
Because of the possibility of the life-threatening, and at best life-altering, consequences of dehydration, prevention is best defense against dehydration. We must take a proactive approach to ensure and/or encourage adequate fluid intake. Consider some of the following practical tips to promote optimal hydration.
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. Avoid beverages that contain caffeine or alcohol since both have dehydrating properties. Keep a 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.
Remember that simply breathing in and out uses more than a pint of water a day. On an average day, try to drink about two liters of water. You will need to hydrate more of you are experiencing vomiting, diarrhea, or an infection that causes fever. If you are exercising, drink slowly and frequently, especially in hot weather.
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!
Plan and provide “opportunities to drink”. Individuals typically consume more fluids in a social setting. I witnessed this first-hand. My mother, who was recently hospitalized, constantly complained about how bad the coffee tasted. One day after lunch, my mom, her roommate, and I were having a nice conversation. As our social visit jumped from one topic to another, I noticed that my mother was taking an occasional sip from her coffee cup. Not long thereafter her cup was empty! Another idea is to have a “taste-test”. Gather a group of friends at your home and have fun guessing the flavor of various juices or soft drinks. Invite some companions to meet at a local restaurant for an afternoon “tea” (or other preferred healthy beverage). One last suggestion is 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.
We must admit that we are all human and tend to judge a book by its cover. With that in mind, do not overlook the appearance of the beverage you offer! 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.
In addition to appearance, texture is an important factor to consider when encouraging fluid consumption. Create frozen liquids such as lemon ice, popsicles, gelatin desserts, Italian ices, and snow cones. These delicious drink ideas not only provide healthy hydration but also are a treat to eat.
Fluid substances are not the only way to prevent dehydration. Many types of solid foods contain a substantial amount of water. If an individual has difficulty swallowing liquids or is on a fluid-restricted diet, it may be possible to maintain adequate hydration by increasing the amount of moisture consumed in foods. Fruits and vegetables are great examples because they contain 80% to 90% water.
Knowledge of the symptoms of and the prevention of dehydration can reduce unnecessary hospitalizations and maximize health and well-being for the elderly individual.
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
Janet M. Caputo, PT, OCS – contributor, is an associate and clinic director at Mackarey Physical Therapy in Scranton, PA, where she specializes in outpatient orthopedic and neurologic rehab. She is presently working on her doctorate in physical therapy from the University of Scranton.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in theScranton 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 affiliated faculty member at the University of Scranton, PT Dept
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. Fluid loss also contributes and complicates many health issues. If you are elderly or care for the elderly, understand that this may be one problem that you can often control. It is important for you to understand the many conditions complicated by dehydration.
Good hydration prevents the development of the following ailments:
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
Janet M. Caputo, PT, DPT, OCS – contributor, is an associate and clinic director at Mackarey Physical Therapy in Scranton, PA, where she specializes in outpatient orthopedic and neurologic rehab.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune. Next Week: Part III of III “Prevention of Dehydration”
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 affiliated faculty member at the University of Scranton, PT Dept.
Dehydration Part 1 of 3: Dehydration and the Elderly
As the summer heat is upon us, so too is the risk of dehydration, especially in the elderly. While a potential problem year round in the elderly, the recent heat wave increases the risk of problems. 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.
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:
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!
Contributing Author: Janet M. Caputo, PT, DPT, OCS – contributor is an associate and clinic director at Mackarey Physical Therapy in Scranton, PA, where she specializes in outpatient orthopedic and neurologic rehab.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune. Next week, read Part 2 of 3 “The Benefits of Good Hydration.”
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
The summer is a great time to be outdoors in NEPA as so many activities are available such as: biking, hiking, running, walking, swimming, boating, golfing, and playing tennis to name a few. It is also a wonderful opportunity to discover your inner child, mix it up and try something new! Below are four new and exciting ways to stay active and have fun in the sun.
Sunset Kayaking
Spending time on any of the beautiful lakes in NEPA is time well spent. From an exercise standpoint, rowing, canoeing and kayaking offer a very special experience. In particular, a kayak is light weight, easy to use and maneuverable on a lake. Sitting low on the water offers a unique perspective as you feel yourself glide across the lake. I am fortunate to kayak at least twice a week in the summer. A few weeks ago, I had the opportunity to “mix it up” and try something new with my kayak. At the end of June, when the moon was 98% full, The Countryside Conservancy in partnership with Lackawanna State Park, sponsored a moonlight kayak event on the lake at the park. Greg and Celeste Cali joined my wife Esther and me for an experience we will not soon forget. We embarked at 8 pm and returned at 10 pm. We had bug spray and headlights as we enjoyed the sunset and moon rise on the lake and felt like kids breaking the rules of the park being on the water after dark! It is fair to say that we enjoyed discovering the child within us.
NOTE: Try kayaking in the daytime first and then advance to sunset trips before staying on the water for the moonlight. Rentals are available at the park.
Kayaking Gear:
Website: www.countrysideconservancy.org
Stand-Up Paddleboarding
Stand up paddleboarding (SUP) is becoming a fast growing sport among water enthusiasts. It is a fun way to exercise your core, improve balance, and tone your upper body. It requires minimal equipment; a board that is essentially a long and wide surf board and a long paddle to use while standing on the board. It can be done in the ocean surf, bay, lakes or rivers; however, beginners would be wise to stay in calm water. Rentals are available at most beaches.
Check out the website below for more information and a video demonstration.
www.rei.com/expertadvice/
Zumba is a very popular form of dance aerobics spiced up with Latin music. When adding water and sun to this already cool activity, you are assured to have fun while exercising. As with any aquatic exercise, the added resistance from the water gives arm rows and leg kicks more challenge. Female participants report an additional benefit; they are uninhibited to “shake that thing” to the music under the cover of the water. So, beat the heat, let loose and get some fun in the sun while you exercise.
NOTE: Consider trying regular Zumba first to get the hang of it.
Website: www.zumba.com
Kangoo Jumps, developed in Switzerland in the 1990’s, is beginning to gain attention in this country, especially in urban areas like New York City’s Central Park. The product looks like a ski boot with an elliptical spring attached to the bottom. The activity requires a certain amount of strength, balance and coordination, but may be a good alternative for those looking for an exercise that is less stressful on the feet, ankles, knees, hips and lower back. The makers of this product claim the shoes are joint friendly by reducing impact by 80% and the users report a great workout with lots of laughter. Either way, it provides another option to running while trying something new to have fun in the sun!
NOTE: First, practice bouncing on a trampoline or slowly jog on the balls of your feet to develop a sense of bounce and balance before you pogo.
Website: www.kangoo-jumps.com
I love this idea…why didn’t I think of it first! In the gym I enjoy the elliptical machine because it simulates running without the impact on my joints but of course, I would rather be outdoors. Well, this is the answer to my prayers…an elliptical machine that is attached to a bike with handle bars and brakes included. I think it will probably be difficult on steep hills but it is something I MUST TRY!
Website: www.elliptigo.com; www.mywingflyer.com
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.
Naysayers often say, “Exercise junkies are killing their joints!” Well, it has always been my position that those who do nothing and are overweight destroy their joints as well. And, I would rather DO SOMETHING than nothing! New research from Ottawa, Canada supports my opinion.
In addition to being a risk factor for many serious health conditions (i.e. high cholesterol, high triglycerides, type 2 diabetes, high blood pressure, heart disease, stroke, and cancer), research shows that obesity also increases the risk for developing knee osteoarthritis by four times, as compared to people with a normal body mass index. Obesity, a global health problem, increases mechanical stress on the knee joints, resulting in osteoarthritis, which causes inflammation and pain. Because knee pain reduces physical activity, osteoarthritis can impair a person’s functional abilities and quality of life. Soon the individual becomes part of a vicious cycle: obesity → knee pain → physical inactivity → obesity…
Obesity has both non-modifiable and modifiable risk factors. But no factor serves as a valid excuse to give up and do nothing! Heredity, smoking cessation, pregnancy, age, certain medications, and socio-economic issues can all be considered non-modifiable risk factors contributing to obesity. Genetic predisposition can play a role in the amount of body fat you store, how efficiently your body converts food into energy, and how your body burn calories during exercise. Even though smoking cessation contributes to weight gain, the benefits outweigh the risk of obesity! Women often gain weight during pregnancy and some find losing the “baby weight” difficult. As we get older, hormonal and metabolic changes contribute to obesity. Drugs, including anti-depressants, anti-seizure drugs, diabetic medications, steroids, and beta-blockers, can lead to weight gain. As a child and young adult, you may not have been taught healthy lifestyle habits or, as a mature adult, you may not be able to afford healthier foods. Despite all of these “non-modifiable” risk factors, you CANNOT lose the battle against obesity!
Have no fear; the modifiable risk factors are here! You can be the victor in the battle with your obesity because, even though unhealthy dietary habits, family lifestyle, sleep deprivation, and physical inactivity can all contribute to obesity, they can ALL be changed! Consuming more fruits, vegetables, and lean meats, while restricting fast and processed foods, will help reduce the amount of calories you consume each day. We all still love the foods that we grew up on but unfortunately we eventually lose that childhood metabolism. Try to reserve those rich, delicious ethnic foods for special occasions and holidays. If you sleep less than 6 to 8 hours each night, your appetite or your cravings for high calories foods may increase due to hormonal changes. Physically inactive people do not burn many calories and tend to consume more calories than their bodies require. Remember, obesity occurs when you take in more calories than you burn through daily activity and exercise!
Even though obesity and physical inactivity contribute to the development of knee osteoarthritis, YOU have CONTROL over these risk factors! You can reduce your body weight with healthy eating habits and exercise. If you eat more fruits and vegetables instead of fast and processed foods, you will consume fewer calories and feel much fuller. Limiting your intake of salt, sugar, and fat along with increasing your intake of lean sources of protein (i.e. beans, lentils, and soy) will also help you design a healthy dietary plan that will help you win the “battle of the bulge”! Physical activity and exercise will not only help you burn extra calories and increase lean muscle mass (our bodies require more calories to maintain lean muscle than fat) but also help with smoking cessation and depression.
However, most individuals with knee osteoarthritis have difficulty exercising because even the simple “exercises” cause increased knee pain! Do not despair, because you have many alternatives! If traditional “exercise” increases your knee pain, consider chair exercises, water exercises, Pilates, and cycling. Using hand held weights and resistive bands challenge your upper body muscles to increase your lean muscle mass and burn more calories. Exercising in water provides the buoyancy required to reduce stress on painful knees. Pilates strengthens our muscles while being soft on our joints. Cycling is another low impact alternative for people with painful knees which provides a muscular as well as cardiovascular workout. For those of you with knee pain that would prefer to “just walk” for exercise, consider using an assistive device (e.g. cane, walker with wheels) to reduce the stress and impact on your painful joints.
Please consult your physician before beginning any exercise program. Your physician may also recommend referral to a physical therapist to assist you in developing your exercise program as well as a dietician or nutritionist to help you design a healthy eating plan. Good luck and remember, “…just get out and exercise!”
Visit your doctor regularly and listen to your body.
CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.
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 in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.
My wife, Esther, loves to work in the yard! As a Pennsylvania Dutch girl growing up in Lebanon, PA, caring for plants and animals was an integral part of daily life. As for me, I am her loyal assistant cutting grass, mulching, planting, landscaping etc. I too, love the outdoors but I enjoy golfing, running, swimming, kayaking, and playing tennis more than cutting the grass! Therefore, this column is for those readers like me, whose goal is to get the job done safely, so as not to suffer any injuries that might interfere with our other outdoor activities!
People may not think of yard work as a form exercise, but it can be very strenuous. It can also be stressful to you bones, joints, muscles and tendons. For example, digging with a shovel can irritate your shoulders, elbows and hands with each push through the earth. Also, prolonged bending and twisting and repeatedly carrying heavy loads can create upper and lower back pain. Hand, wrist and elbow pain is associated with pruning, edging, cutting and clipping. Squatting and kneeling can play havoc with your knees and hips.
Research from The Johns Hopkins Bloomberg School of Public Health found that the most common gardening injury in adults is overstrained muscles, tendons and ligaments. Furthermore, the incidence of these injuries increases with age. Those most vulnerable are between 60 and 69 years of age while those 40 to 59 years old are a close second.
Read the 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 and is an Associate Professor of Clinical Medicine at The Commonwealth Medical College.
2nd in Series of 2 Columns on Ankle Pain
Total ankle replacement (TAR) is recommended for severe ankle pain which has not responded to conservative treatment: weight loss, activity modification, physical therapy, anti-inflammatory medication and cortisone injections. Severe ankle pain can result from the following:
Ankle pain can manifest in the shin, ankle, and shin. It usually increases with activity and alleviates with rest. It may occur at night and prevent sleep. This pain is associated with stiffness, limping and functional limitation which significantly affects quality of life.
A TAR is the surgical implantation of an artificial ankle (prosthesis). The worn out joint surfaces of the end of the shin bone (tibia) and the top of the ankle bone (talus) are removed. Extreme care using precise instruments are used to insure a level surface for the implant. A metal and plastic implant is inserted into the prepared bone ends to create a new joint surface. Because the artificial ankle joint has smooth surfaces, like cartilage, complete, or near complete, pain relief is experienced which allows improved motion, enhanced function and less limping.
Ankle replacements have become better designed and more successful. A good candidate is older, less active with an average body weight. Therefore, a poor candidate is young (under 50 years old), active and overweight. For this group with disability and chronic pain an ankle fusion surgery may be more appropriate than a joint replacement.
Predicting the longevity of a TAR on an individual basis is impossible. According to Guido LaPorta, DPM, ankle implants of the 1970’s were not good and resulted in poor outcomes. Those of the 1990’s were good but not great. However, there is an 82 to 90% chance that new TAR’s will last 10-12 years in the appropriate patient.
Recovery following TAR takes 12 weeks. The ankle may be warm/swollen for 3 to 6 months (ice and elevation will help). The ankle will show improvements in function for up to a year. Overall a TAR relieves pain and stiffness, improves mobility and restores quality of life! Instead of limping in pain, you will return to walking painfree and maybe playing golf!
Contributor: Guido LaPorta, DPM, is president of LaPorta and Associates, a podiatric group with several offices in Northeast PA. He is also director of the podiatry residency program at Community Medical Center in Scranton, PA.
SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey's “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.
1st of 2 Columns
I have been advising my patients to exercise, keep active, and walk as long as they can in order to stay mobile and healthy. However, seniors often tell me activities that require prolonged walking is limited by ankle pain from arthritis. They often ask, “What is arthritis of the ankle?” How does it happen? What can I do about it?
Your family physician will examine your ankle to determine if you have arthritis. In more advanced cases you may be referred to a specialist such as a podiatrist, orthopaedic surgeon or rheumatologist for further examination and treatment. X-rays will show if the joint space between the bones in the ankle is getting narrow from wear and tear arthritis. If rheumatoid arthritis is suspected, blood tests and an MRI may be ordered. The diagnosis will determine if you problem if minor, moderate or severe.
In the early stages your treatment will be a conservative, nonsurgical approach, which may include; anti-inflammatory medication, orthopedic physical therapy, exercise, activity modifications, supplements, bracing, etc. You and your family physician, podiatrist, orthopedic surgeon or rheumatologist will decide which choices are best.
When conservative measures no longer succeed in controlling pain and deformity, improving strength and function then more aggressive treatment may be necessary.
Contributor: Guido LaPorta, DPM, is president of LaPorta and Associates, a podiatric group. Also, he is chief of the podiatry residency program at Community Medical Center in Scranton, PA.
SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons, Guido LaPorta, DPM, Dunmore, PA
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum in the Scranton Times-Tribune!” Next Week: Part II of II on Ankle Arthritis, “Ankle Joint Replacement.”
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.
3rd of 3 Columns on Balance Disorders and Falls Prevention
Preventing a fall can not only save your independence but also your life! Preventing injuries from falls reduces the need for nursing home placement. Injuries from falls are the seventh leading cause of death in people over the age of sixty-five.
The following suggestions will assist you in minimizing your risk of a fall:
Following these helpful hints will keep you safe by preventing a loss of balance and a potential fall!
Guest Columnist: Janet M. Caputo, PT, OCS is clinic director at Mackarey & Mackarey Physical Therapy Consultants, Scranton, PA where she specializes in the treatment of vestibular and balance disorders.
Medical Reviewers: Dr. Louis DeGennaro & Dr. Mark Frattali
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 affiliated faculty member at the University of Scranton, PT Dept.
2nd of 3 Columns on Balance Disorders and Falls Prevention
Guest Columnist: Janet M. Caputo, PT, DPT, OCS
Last week we discussed the causes of balance loss. Today, we will discuss treatment for this problem. Two primary treatments are medication and vestibular rehabilitation.
Medication for dizziness and loss of balance requires a visit to your family doctor. In a more involved case, your family physician may refer you to a specialist such as an ear, nose and throat physician or neurologist. There are many medications available for loss of balance. While this can be complicated, the specialist will determine the most appropriate one for your balance disorder.
Vestibular rehabilitation for dizziness and loss of balance is a great adjunct to medication to manage your balance disorder. It is a comprehensive program that addresses a wide range of problems that may cause imbalance such as: addressing the inability to tolerate motion, visual changes, providing balance rehabilitation, instruction in repositioning techniques for BPPV (benign paroxysmal positional vertigo), correcting postural dysfunctions, muscle weakness, joint stiffness, offering education for prevention, maintenance and self care after discharge. Through experience and motion, vestibular rehabilitation allows: formation of internal models (one learns what to expect from ones actions), learning of limits (learning what is safe and what is not) and sensory weighting (one sense, either vision, vestibular or somatosensory is selected in favor of another in maintaining balance).
In some minor cases, vestibular rehabilitation may be performed at home. However, more serious cases may require an evaluation by a physician specializing in the dizzy patient such as an ear, nose and throat physician or neurologist. These specialists will determine the nature of your problem and may enroll you in a more structured program under the direction of a physical therapist. Vestibular rehabilitation addresses not only vertigo (i.e. dizziness) but also balance problems.
Benign paroxysmal positional vertigo (BPPV) and vestibular hypofunction (e.g. unilateral and bilateral vestibular loss) are two causes of vertigo that can be addressed by a vestibular rehabilitation. Your physical therapist will tailor a program designed to address your specific vestibular disorder (i.e. BPPV or hypofunction).
If you have been diagnosed with BPPV, your therapist may take you through an Epley maneuver. In BPPV, particles in the inner ear become displaced and get lodged in an area that produces vertigo. Vertigo is experienced with tilting head, looking up/down and rolling over in bed. The causes include: infection, head trauma and degeneration. During the Epley maneuver the patient is guided through positional changes which clear these particles from the symptomatic part of the ear.
If you have been diagnosed with either unilateral or bilateral vestibular hypofunction, your therapist will most likely design a program to “retrain” your vestibular system with special exercises, including:
If you have a vestibular problem that primarily manifests as loss of balance, exercises to stimulate your balance responses, strengthen your legs, and enhance your joint position sense may be helpful. These exercises encourage reliance on vestibular and/or visual input. The exercises are performed on unstable surfaces (i.e. tilt boards, balance beams, and foam) and include a variety of tasks from simple standing to more complex arm and leg movements requiring coordination.
In addition to the above mentioned treatments, Posturography and Virtual Reality Training are computerized programs that may be used by your therapist to address your vestibular and/or balance problem. Also, Recreational Activities that involve using your eyes while head and body is in motion (i.e. dancing, golfing, tennis, walking while looking from side to side) are shown to be helpful in stimulating balance and vestibular responses. Furthermore, you may consider Alternative Balance Activities (i.e. Yoga, Tai Chi, Pilates) which incorporate slow gentle movements to improve strength, balance and posture as well as relaxation techniques for the anxiety that accompanies dizziness/off-balance.
Whatever you do, just DO NOT give into your dizziness. People that just “give up” become sedentary. A sedentary lifestyle further denies your body the necessary stimuli to challenge your vestibular system and make it stronger. Eventually, these people end up in a vicious cycle because the more they sit the dizzier and more off balance they get which only makes them sit more!
Remember, one fall increases your risk of another fall. It is imperative to determine what caused your fall and take action! Ask your physician to assess your fall risk.
Guest Columnist: Janet M. Caputo, PT, OCS is clinic director at Mackarey & Mackarey Physical Therapy in Scranton, PA where she specializes in balance and vestibular disorders.
Medical Reviewers: Dr. Louis DeGennaro, Dr. Mark Frattali & Dr. Seth Jones
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune. Next Monday Part III on Balance Disorders and Falls 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 clinical professor of medicine at The Commonwealth Medical College.
