Winter in NEPA can be the perfect opportunity to try something new. For example, for those who enjoy running or walking you can continue to do so in the winter, with a few adjustments. Equipment, such as treaded sneakers, allows you to run or walk in the snow. Snow shoes are a great way to hike and walk in the snow while cross country skiing simulates running in the snow. But, in the last few years, another outdoor activity has become a winter sport; mountain biking in the snow has become popular.
Many mountain biking enthusiasts in NEPA enjoy 7-8 months of trail riding at our beautiful state parks. Now, with a few modifications, mountain bikers can continue year round. In fact, the adventure in the snow may be an exciting new experience.
The physical and psychological benefits of outdoor activities are many: each season brings its own unique beauty, and winter is no different. Most will not have to abandon outdoor activities, but some adjustments in equipment, clothing, and food are necessary for each season and the temperature changes that it brings.
While recommended, it is not necessary to purchase a bike specifically for mountain biking in the snow. With a few simple modifications and adjustments, you can prepare a regular mountain bike for winter use.
In addition to rocks and stumps, winter biking offers the challenges of snow banks and ice chunks. The air pressure in your shock system will be affected by temperature. Additional air pressure will be required to improve shock absorption and in extreme cases, using less viscous oil will be required.
It is important to layer clothing. Use DryTech or UnderArmor type materials (headgear, gloves, shirts and pants) to allow sweat to breath away from the skin to the next layer of clothing. Use a facemask to cover your mouth and nose to prevent frost bite and warm air before it enters the lungs. Chemical hand and toe warmers are great. Try winter running or walking shoes as described below.
There are running shoes specifically designed for use in wet, cold and sloppy winter conditions. These “winterized” running shoes, which can also be used for walking, offer waterproofing, sealed seams, gaiter collars to keep out snow and slop, slip resistant fabric, anti-roll stability features, anti-microbal material and aggressive tread patterns for traction on slippery surfaces. Some shoe recommendations for both winter walkers and runners include
Additionally, walking or trekking poles will improve balance and safety when briskly walking in winter conditions. I am a strong proponent of using these tools. They are lightweight, adjustable, and collapsible. Some examples are: Black DiamondR Trail Back - $56.95 and MountainsmithR Rhyolite - $35.09. Alternatively, an old pair of ski poles will work just fine.
These activities should also be considered as a viable option for the winter walker and runner. These are great cross-training alternatives with tremendous aerobic benefits.
Snowshoes work by distributing your weight over a larger surface area so your foot does not sink completely into the snow. Commonly used by fur traders, trappers and forest rangers, snow shoeing has become very popular among many outdoor exercise enthusiasts. It is relatively safe and inexpensive. Some snowshoes include the Tubbs Flex Alp - $197 and Redfeather Hike - $95.00. Boots and poles are also required, but ski or trekking poles along with hiking boots or winter running shoes can be used.
Cross country skiing has also gained tremendous popularity among winter outdoor exercise enthusiasts. It is a cross between running and skiing in which the participant propels through a snow-covered trail by pushing and gliding with a running or fast-walking motion. Some examples of equipment packages that include boots, pole, bindings and skis are Alpina Sports Tour – no wax for $249.00 and Rossignol X 5 from LL Bean at $289.00.
Many of the area’s state parks, such as Lackawanna and Promised Land, offer wonderful trails for winter walking, hiking, running, snow shoeing, cross-country skiing and biking.
For the more casual walker in need of protection from the snow and ice, it may be treacherous just to walk the dog or go to the bank, post-office or grocery store. Consider traction devices that easily slip on and off your shoes or boots such as StabilicersR (cleats-type device) or YaktraxR (chain-type device).
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “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 The Commonwealth Medical College.
Lois Margaret Nora, MD, JD, MBA
Co-authored by: Dr. Paul J. Mackarey and Lois Margaret Nora, MD, JD, MBA, Interim President and Dean, TCMC
Happy New Year! Try Something New! Health and Exercise Forum Welcomes The Commonwealth Medical College!
For many years I have encouraged readers of this column to celebrate the New Year by “trying something new”…exercise, diet, activities, people, places. This year, I am pleased to “try something new” with the hope that it will benefit the health and wellness of many.
It is with great excitement and enthusiasm that I announce the collaboration of The Times-Tribune “Health and Exercise Forum” and The Commonwealth Medical College (TCMC) for the advancement of community education in medicine, health and wellness. TCMC is a tremendous asset to our community as it offers an innovative and community-based curriculum. Community education is a vital component of their mission and “Health and Exercise Forum” will be a vehicle by which they can accomplish this goal to promote health, wellness and prevention of illness.
Beginning January 2012, some TCMC students will participate in a Healthcare Journalism Club and will learn how to share the information they learn in the classroom through the media and various journalism activities, including with readers of The Times-Tribune through this column. The ultimate goal is that TCMC students, faculty and administration will be featured as guest columnists once a month.
As always, this column is YOUR column and I invite you to continue to communicate your interests and concerns so that I may continue to satisfy your needs. Please join me in welcoming Dr. Nora:
I’m pleased that our students will be partnering with Dr. Mackarey and The Times-Tribune to share valuable health information for the benefit of our community. Serving the community in many ways, such as sharing health information, is important to our students’ education, their experience at TCMC, and lifelong learning as a healthcare professional.
TCMC’s three classes of Medical Degree (MD) students and the Master’s of Biomedical Sciences (MBS) students are committed to community service; in fact, they’ve already logged more than 7,262 hours with 85 organizations across northeast and north central Pennsylvania.
Our community-based curriculum introduces medical students to patients early in their education with clinical experiences in their first and second years of study. These experiences prepare students for the third year when they live and work full-time in our regional campuses shadowing doctors and health professionals in their offices and area
hospitals. This model places patients and their families at the center of the learning process. You may have already seen our students during one of your recent healthcare experiences.
Sharing their acquired knowledge with the community is a natural progression of our medical student’s education and another demonstration of their commitment to the community. Students are learning that classroom knowledge, compassionate care, interprofessional healthcare teams, and effective communication are essential to become a
community-minded physician, prevent illness, and positively affect the health of the region.
I’m pleased that this column will serve as another great example of how TCMC students demonstrate their commitment to community service. I hope the topics they discuss will benefit you and your family now and in the future.
Co-author: Lois Margaret Nora, MD, JD, MBA, Interim President and Dean, TCMC
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 The Commonwealth Medical College.
May the faith, hope and love of this season be the foundation for you to enjoy a healthy mind, body and spirit throughout the year! All major religions promote physical and spiritual health, wellness and respect for life.
To be completely healthy, one must have a healthy mind, which requires intellectual stimulation. Also, one must have a healthy body by eating well and engaging in physical activity. Lastly, one must have a healthy spirit, filled with faith, hope and prayer and meditation. This holiday, consider the following tips to promote a healthy mind, body and spirit throughout the year:
Beginning your meal with healthy vegetables and salads will fill you up and reduce the temptation to over-indulge in high-fat, high-calorie foods. Drinking plenty of water
throughout the day is also very important for good health.
Physical activity is one of the most important factors in improving a lifestyle in a positive way. But, it does not have to be complicated. A minimum of 30 minutes of physical activity, 3-5 days per week will have many positive effects on your body.
Some simple suggestions for beginning an exercise program are:
One cannot be completely healthy without a healthy mind. Like your body, you must continue to challenge your mind in order for it to remain strong, learn, expand, and grow. Read a good book, do crossword puzzles or try something new...piano lessons!
Prayer, meditation, or chanting has been known to reduce your heart rate, blood pressure and stress level. These activities can lead to a sense of peace, serenity, joy, and faith.
Learn to Love Who You Are Not Who You Want to Be! Those who love themselves are more likely to take care of their bodies. People who are not comfortable in their own skin are never satisfied with their appearance and often attempt to change their body. For example, men use steroids to appear “bigger and better” or women have cosmetic surgery to appear “younger and better.” It is impossible to love others if you don’t love yourself. You must learn to accept and embrace change in your body and life in order to have a healthy mind, body and spirit.
Get the appropriate amount of uninterrupted sleep. A good sleep promotes healing and refueling for your body. When needed, sit, rest, or take a short nap to recharge.
Countless hours are wasted on feelings of anxiety, regret or worry about a past or upcoming event. This can be a waste of precious life time and adds stress to the body, which makes you more susceptible to disease. Stay focused on the beauty of the present moment!
When you associate with healthy people, you take on their healthy habits. You will drink less, eat healthier and exercise more if you are hanging around with those who engage in
these habits...they will have a positive influence on you! Do you know Jane Quinn author and founder of “Essential Eating?” A true role model for a healthy life!
The camaraderie of good friends is essential for a healthy mind, body and spirit. Make it a priority to associate with people who “celebrate life!” The health benefits from these positive-minded, healthy people who appreciate you for who you are will provide you with the support, love, and respect necessary to survive any challenge. Do you know Bob Knowles? I admire his positive spirit! Do you know Dr. John Mariotti or Dr. Dave Fitzpatrick? I enjoy how they celebrate life!
Studies show that laughter has health benefits and assist the body in healing. Laughter is contagious, so hanging around with people who are fun and funny, will bring fun and laughter
into your life. Try to look for humor in every situation and keep laughing. Do you know Dr. Ed Malloy and his wife Rosie? You can’t stop laughing when in their company.
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 affiliate faculty member at the University of Scranton, PT Dept.
Part 2 of 2
Guest Columnist: Janet Caputo, PT, DPT, OCS
Why do athletes sprain their ankles? Ankle stability depends on two-way communication between the brain and the ankle joint including the associated muscles and ligaments. During competition, an athlete’s brain receives a great deal of information from the environment that it must process to make decisions which allow the athlete to react to changes in his environment. As competition increases, the decision making process becomes more complex because the athlete’s brain is required to process even more information, but faster. Also, during intense competition, some athletes experience stress and fear. Increased demands for attention, concentration, and reaction time coupled with feelings of anxiety reduce the athlete’s ability to process information. In addition, damage to joint receptors from an ankle sprain reduces the ankle’s ability to communicate with the brain. Decreased processing speed and impaired ankle joint sensation result in loss of coordination and errors in judgment that place the athlete at increased risk for injury.
Furthermore, after an ankle sprain damages the ligaments, the body repairs the injured area with scar tissue that is 30% weaker than the original tissue. The weakened ligament is more vulnerable to re-injury because of its decreased ability to withstand force.
Risk Factors: Research has identified several risk factors and divided them into two groups: modifiable and non-modifiable. Those individuals with risk factors that can be modified benefit most from injury prevention techniques while those with non-modifiable risk factors (those that cannot be changed) require a different approach.
Risk factors that can be modified or changed include: body weight, sport, level of competition, and neuromuscular control/postural stability. For example, overweight athletes sprain their ankles more frequently and athletes involved in basketball, soccer, and lacrosse incur the highest incidence of ankle sprains. Also, as the level of intensity in competition increases, so does the occurrence of ankle sprains. While lowering your body weight can often be accomplished, changing sports and lowering intensity may not be as easy if you are a competitive athlete. Maybe the most important risk factor that can be modified is diminished neuromuscular control. Diminished neuromuscular control and postural stability increases the likelihood of an ankle sprain. Neuromuscular control occurs when your joints and ligaments communicate with your brain, your brain processes this information, and then your brain tells your muscles how to react. If your ligaments and joints do not send the right information, if your brain does not process the information correctly,
and/or if your brain does not give the correct commands to your muscles, you will sprain your ankle! While this may sound a little “heady” it can be improved with exercises specifically designed to address this problem. Studies show that this may be the most important risk factor to improve.
Non-modifiable risk factors include: gender, age, and previous ankle sprain. Males between the ages of 15 and 24 and females over the age of 30 experience higher rates of ankle sprains then their opposite-sex counterparts. Individuals under 25 years of age sustain ankle sprains while engaging in athletic activity, while those over 50 sprain their ankle during normal daily activity. A previous ankle sprain places an individual at a considerably greater risk for a subsequent ankle sprain.
Regardless of what your risk factors are, almost everyone can improve their ankle strength, balance, and agility? Consider the following exercises:
1. Ankle Strengthening Exercise
Heel Walk: While wearing sneakers, walk on your heels. Perform as a timed activity, beginning with 15 seconds and advancing as tolerated to 1minute. Repeat 3 times and perform 2 sessions daily.
2. Ankle Balance Exercise
Single-leg Stance: Stand on one leg for 30 seconds. Repeat 3 times and perform 2 sessions daily. Performing this activity barefoot, standing on a foam cushion, with arms crossed and eyes closed increases your challenge.
3. Ankle Agility Exercise
Side Step Overs: Place several cones on the ground greater than shoulder width apart. While standing with your feet shoulder width apart, tie an elastic band between your ankles. As quickly as you can, step over the cones moving left to right and then right to left. Perform as a timed activity beginning with 15 seconds and advancing as tolerated to 1 minute. Repeat 3 times and perform 2 sessions daily.
For a more comprehensive program, consultation with an athletic trainer or sports physical therapist would be required.
How do you know if you have an unstable ankle? Go to: www.pitt.edu/~neurolab/publications/1999/RozziSL_1999_JOrthopSportsPhysTher_Balance%20training%20for%20persons%20with%20functionally%20unstable%20ankles.pdf.
Complete the Ankle Joint Functional Assessment Tool. A score of ≥ 26 indicates that you may have a functionally unstable ankle and you would benefit from an aggressive program specifically designed for your needs.
Guest Columnist: Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation. Dr. Caputo is clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC.
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 affiliate faculty member at the University of Scranton, PT Dept.
Part 1 of 2
Guest Columnist: Janet Caputo, PT, DPT, OCS
The Lynett Tournament is only a few weeks away and marks the official start of the basketball season in NEPA and that means ANKLE SPRAINS! Basketball is notorious for causing ankle sprains. According to the statistics, 40% of all high-school basketball injuries are ankle sprains. Because of the prevalence of ankle sprains and the high recurrence rate, ankle sprain prevention is paramount.
The most common ankle sprain occurs when the foot or ankle rolls in (inversion), often when landing on the foot of another player after getting a rebound. This excessive motion stretches the ankle ligaments beyond their limits. Because the ligaments hold the ankle bones together and provide ankle stability, even a mild ankle sprain may cause chronic ankle instability and eventually arthritis.
Mild ankle sprains produce some discomfort but these symptoms usually resolve within a couple of days. Symptoms of moderate ankle sprains include swelling, bruising, and loss of ankle motion, and may persist for several weeks. Severe ankle sprains typically require a period of immobilization (i.e. cast or brace) and limited weight bearing (i.e. use of crutches).
The strongest predictor of an ankle sprain is a history of a previous ankle sprain for several reasons. First, once the ligaments are stretched, they never return to their original length, resulting in an unstable ankle. Second, the injured ligaments lose their ability to communicate with the brain, which impairs the ankle’s balance and coordination responses. Third, residual ankle stiffness places the ankle ligaments at risk for re-injury.
Taping, braces, shoe inserts, and high-top sneakers have been clinically tested for their effectiveness in preventing ankle sprains. The use of ankle taping in the prevention of
ankle sprains proved to be of limited benefit because the tape eventually loosened. Ankle braces and shoe inserts reduced the risk for ankle sprains, but did not decrease the severity of the ankle sprain. Ankle braces also restrict ankle mobility which reduces the athlete’s agility. High-top sneakers reduced the amount of ankle roll-over, but they did not lower the incidence of ankle sprains.
Footwear, in general, places the ankle at risk for injury.
First, footgear restricts the mobility of the foot. The bare foot has 28 bones, 33 joints, and 112 ligaments that allow the foot to adapt to the terrain which reduces the possibility of rolling the ankle.
Second, lacing the shoe tightly may become uncomfortable, and if the shoe is not laced tight enough, then the excessive movement of the foot in the shoe makes roll-over more likely.
Third, elevating the foot on a sole increases lever action and produces a point of artificial instability at the outer edge. Despite all these drawbacks, playing basketball barefoot is not the
solution! So what is?
The Ektio® Basketball Sneaker may be the answer! Drs. Katz, Nordstrom, and Dribbon collaborated on The Ektio® and claim that their shoe decreases ankle sprain risk because it provides not only the desired stability, but also the required mobility. The Ektio ® design reduces excessive movement of the foot in the shoe and permits maximum mobility in all directions except inversion. Ankle sprains typically occur at 50° to 60° of ankle inversion. Since the Ektio ® limits inversion to 20°, this sneaker style possesses the potential to reduce the incidence of ankle sprains.
According to the designers, this shoe incorporates: (1) an interior strapping system to hold the foot firmly within the shoe, and (2) an exterior “bumper” in the form of a lateral flange that reduces ankle “roll-over” (i.e. inversion). Future prevention of ankle sprains appears hopeful based on preliminary data of the incidence of ankle sprains while wearing the Ektio ® sneaker. Testing conducted at New York’s Hospital for Special Surgery concluded that the Ektio design not only maintained foot-ankle agility, but also increased ankle stability. Research at Drexel University in Philadelphia concluded that Ektio significantly increased ankle support and limited ankle roll-over without interfering with ankle mobility in any other
direction. The inventors of the Ektio ® sneaker report that basketball players have been wearing their shoe for two years with only one, recent, occurrence of an ankle sprain in a college player with chronic ankle instability.
If long term studies prove that this sneaker has value in the prevention of ankle sprains, it will become an invaluable part of the basketball uniform! The Ektio Men’s Wraptor Anti Ankle Sprain Basketball Shoe costs $100 to $149.95 based on options and has been well reviewed by many. For more information on The Ektio® Basketball Sneaker visit: www.ektio.com.
Join us next week to determine the risk factors for and prevention of ankle sprains.
Guest Columnist: Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation. Dr. Caputo is clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC.
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 affiliate faculty member at the University of Scranton, PT Dept.
Every year, well-intended family members purchase expensive exercise equipment as Christmas gifts for loved ones with the hope of encouraging exercise and fitness for the New Year. I applaud the attempt to encourage wellness because the value of regular exercise is well known. However, a high percentage of these products serve as clothes hangers and diversions for visiting grandchildren before the holiday decorations are stored away. This year, I hope to offer sage advice to help avoid common mistakes and misconceptions about this equipment. Selecting the right product for the specific needs of the person using the equipment may lead to better compliance and success.
The primary advantage of a treadmill is the fact that it allows you to exercise doing one of the most natural things in the world –walk. Almost anyone who does not suffer from severe paralysis, advanced osteoporosis and pain in the lower extremities can walk for exercise. Also, a treadmill allows one to gradually advance the time, speed and intensity of the exercise. For some, walking may be advanced to running by alternating 1:5 minute walk/run ratio. For others, running will be the entire form of exercise on the treadmill. In either case, it is so natural that one can easily watch television while exercising. Another advantage is the fact that it can be used indoors regardless of the weather – hot or cold, rain or snow. The disadvantage is that it is 100% weight bearing on the lower extremities and those with lower back, hip, knee or ankle arthritis may have difficulty exercising on it for long periods of time. Another disadvantage is that some find the boredom, impossible to overcome.
Purchase: Buying a treadmill as a Christmas gift does not have to be difficult. Most walkers can purchase an $800 to $1000. unit for a satisfactory product. However, if you are buying it for a large frame person or someone who wants to run on it, you must buy a good one. The frame has to be solid: longer and wider than a low end product. A good home treadmill can cost $1,500 to $2,500.
There are two types of bikes to choose from: a standard upright bike and a recumbent bike. Both have advantages and disadvantages. The standard upright bike is good for young healthy fitness enthusiasts who bike outdoors in the summer. They are looking for a winter alternative to maintain their legs and aerobic capacity over the winter. However, if you have lower back pain, lower extremity arthritis and pain, or poor balance, then a recumbent bike is for you because it requires only partial weight bearing on the lower extremity because some of the weight is born by your butt. It offers cardiovascular fitness and lower extremity strengthening. Some home models are as inexpensive as $400 - $500. and offer a reasonable quality for small and moderate framed individuals. For larger framed people, or those interested in a more aggressive workout, a $600 to $800 model may be more appropriate. The next level for non-commercial use, $1,000 - $1,200 offers great options and durability but is not necessary for most people.
An elliptical is an upright exercise device that imitates the “elliptical” pattern that the legs and arms normally move when running. While it requires standing and full weight-bearing, its advantage is that it eliminates the pounding and compression associated with running. It is an excellent cross-training alternative to running. It requires good strength and balance and should not be purchased for someone that has never used it before. It is important to try it out in the store because each unit has a slightly different pattern and some are more comfortable than others depending on body type. Some home models are less expensive ($600. - $800.) and offer a reasonable quality for small and moderate framed individuals. For larger framed people, or those interested in a more aggressive workout, a $1,200. to $1,600 model may be more appropriate. The next level for non-commercial use costs $1,800 - $2,200 offers great options and durability but is not necessary for most people.
Don’t get carried away. For most novices, a set of hand held dumbbells and resistance bands will be adequate. Adolescents beginning weight training at 13-14 years of age might use 5 -10-15 pound and older newcomers to exercise might use 3 – 5 – 10 pound weights. Also, a variety of resistance bands in yellow, red, blue, green and black will be effective for most.
Balance and core equipment includes: (easy to difficult) Balance Balls ($15-20), which are used to sit on while Dynamic Discs ($25-30) and Bosu ½ Ball ($70-90) are used while standing. These devices allow balance training and core stabilization while using free weights or resistance bands.
Locally, beginners on a tight budget can find adequate equipment and service in the sporting goods and fitness departments like Sears or Dicks. While Sam’s Club and Wal-Mart offer these products, I am not sure about the knowledge of their staff and if they offer delivery or service. Specialty fitness stores in Northeastern Pennsylvania, such as Fitness Headquarters, usually have staff that are knowledgeable and offer, deliver set-up and maintenance. Ask questions and try the product out on the demo equipment on the display
floor.
Before you begin an exercise program, consult your family physician for medical clearance. Then, consult your physical therapist to help you design a program for your individual needs.
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 affiliated faculty member at the University of Scranton, PT Dept.
Hospice Care and the Concept of Bereavement: Part 3 of 3
Guest Columnist: Ralph DeMario, MD, CMO Hospice of the Sacred Heart
Over the past few weeks, we have discussed the role of hospice in the lives of those patients and families with a serious or terminal illness, all in honor of National Hospice Month. It indeed would be unusual to find a person whose life has not been touched by someone with a terminal illness or who has not benefited from this invaluable service. This week we dedicate Part III to those who survive the death of a loved one.
The concept of bereavement refers to the process of grief and mourning that occurs after any loss or delivery of bad news. It needs to be remembered that grief is a natural, normal and expected response to the loss of someone we loved and held dear. As a patient begins the journey of hospice, so begins the process of bereavement as well.
Many do not realize that after the loss of a loved one, bereavement services continue for at least one year and are included in the hospice benefit with no additional charge. The hospice bereavement team will assist family, caregivers and significant others through the grieving process – discovering and accepting the “new normal.” The team will help with the social, spiritual, and emotional aspects of the process.
It is important to realize that the grieving process is a very personal experience, although there are a few suggestions that may make the journey a little easier:
Many hospice agencies will offer support groups for bereavement, programs for children who have suffered a loss, and specialized sessions for spouses who are now living alone after the loss of a partner. If you are not sure of what services are available, ask your hospice professional. Discussing and talking about your loss is never a bad idea.
So remember that grief and mourning are your personal experience. There is no right or wrong way to grieve the loss of a loved one. Give yourself the opportunity and time to grieve in your own way and at your own pace.
“Take my hand and lead me to salvation -
Take my love, for love is everlasting and remember the truth that once was spoken –
To love another person is to see the face of God.”
---Les Miserables
Guest Columnist: Ralph DeMario, MD, CMO, Hospice of the Sacred Heart
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 affiliate faculty member at the University of Scranton, PT Dept.
Hospice Care and Health Tips for the Caregiver
Part 2 of 3
Last week’s column discussed the role of hospice care in honor of National Hospice Month. It would be very unusual to find a person whose life has not been affected by someone with a terminal illness or has not benefited the invaluable services of a hospice. This week, for those incredibly dedicated people who care for someone in the later stages of life, Part II will offer important tips that may keep you mentally and physically healthy while you do God’s work.
NEPA is fortunate to have many wonderful people who are dedicated to God and family …you are our greatest natural resource! Many of you go on to do the very difficult task of giving care to your loved one at home for as long as possible. While this is truly God’s work, the caregiver’s job is arduous; physically demanding, emotionally stressful, and often thankless. I have had the benefit of observing many wonderful people care for their loved ones: my wife Esther, who cared for her mother at home, when stricken with Alzheimer’s Disease and Maureen Paskert, who beautifully cared for her husband Mark, when stricken with MS, 10 years ago, and passed away this September.
Source: Centers for Disease Control and Prevention (cdcinfo@cdc.gov)
Medical Contributor: Ralph DeMario, MD, CMO, Hospice of the Sacred Heart
Read Dr. Mackarey’s Health & Exercise Forum – Every Monday. Next week read “Hospice Care and Bereavement Part III." 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 affiliate faculty member at the University of Scranton, PT Dept.
November is National Hospice Month. It would be very unusual to find a person whose life has not been affected by someone with a terminal illness or has not benefited the invaluable services of a hospice. Moreover, for those incredibly dedicated people who care for someone in the later stages of life, Part II will offer important tips that may keep you mentally and physically healthy while you do God’s work. Part III will discuss the bereavement component to hospice services.
The word hospice is derived from the word hospitality and referred to a place of shelter for weary or ill travelers to rest from a long journey during the middle ages. The first modern hospice, St. Christopher’s Hospice, was founded in England in 1967.
Hospice care is a unique concept of health care serving the patient and family with a terminal illness. Most hospice care is provided at home or where the patient calls home, such as a
long term care or assisted living facility. While the goals are to alleviate symptoms and improve quality of life, hospice is most appropriate when there is a life expectancy of six months or less. Typically, hospice begins when curative treatments are no longer effective or a patient decides to discontinue them.
This end of life care is comprehensive and holistic addressing: medical, physical, emotional and spiritual needs of the patient and family. It must be emphasized that those who decide to receive hospice care are NOT GIVING UP! In fact, it might be better said that they are making a conscious decision to take control of their life. With the help of trusted medical professionals, they have decided to focus their energy on time spent in the peace and comfort of familiar surroundings and in the company of the friends and family who make their lives meaningful. They have courageously chosen life over death!
Having been through countless diagnostic tests and aggressive treatments, hospice patients are typically not new to the medical process. Many of these treatments such as
chemotherapy and radiation may have had a negative effect on their quality of life. Long hospital stays, missed family events and vacations, and lost time with loved ones, significantly impacts the conscious decision to participate in hospice. This decision is further reinforced when the treatment has not successfully impacted the disease.
When the time is right, hospices provide invaluable support and care for the patient and family in need. The decision to participate in hospice care can be difficult, however, once made; selecting the best hospice agency can be equally challenging and overwhelming.
To assist in this difficult decision, The National Hospice and Palliative Care Organization (NHPCO) has released a new, free worksheet that walks individuals through questions to guide the process of finding the best hospice for their unique needs.
With multiple hospices serving some communities, it can seem challenging to select one. Certainly, asking your family physician and calling local hospices to gather information is a good start to find the one that best meets the needs of you and your family.
Caring Connections, a program of NHPCO, has developed a worksheet “Choosing a Quality Hospice,” that provides suggested questions to ask a hospice when you contact them.
Once a hospice has been chosen, other important questions can be answered with the help of the agency. For example, a decision must be made when to begin hospice care. Also, if you are not ready to begin hospice, what alternatives are available in order to receive support and palliative care. A quality hospice agency, with a team of highly trained and specialized medical professionals, is best equipped to do this and more. No one is better trained to provide comprehensive care and assistance to people who need expert pain and symptom management, as well as support for family members caring for a loved one with a life-limiting disease trying to continue to live as fully as possible for as long as possible.
Download the free Choosing a Quality Hospice worksheet from Caring Connections.
To find out which hospices serve your community, call NHPCO’s HelpLine at 1-800-658-8898 or visit www.caringinfo.org/
Medical Contributor: Ralph DeMario, MD, CMO, Hospice of the Sacred Heart
Read Dr. Mackarey’s Health & Exercise Forum – Every Monday- Next week read Hospice Care Part 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 affiliate faculty member at the University of Scranton, PT Dept.
Guest Columnist: Anthony J. Yanni, MD, FACP, CPE
At this time every year, patients come to our office with questions and concerns about the flu shot. In an attempt to educate the public and dispel any fears or misconceptions, I have taken this issue directly to the experts… the people who manufacture the vaccine at Sanofi Pasteur in Swiftwater, PA. Anthony Yanni, MD, Director of Clinical Development at Sanofi was kind enough to assist me with this column for your health and wellness.
“Can the flu shot give me the flu?” This is one of the most common questions asked about the flu shot. As you are about to learn, the answer is NO! In fact, in well-designed scientific studies, where some people get flu shots and others get salt-water shots, the only difference in symptoms was increased soreness in the arm and redness at the injection site
among people who got the flu shot. There were no differences in terms of body aches, fever, cough, runny nose or sore throat.
1. You can catch the flu from flu vaccine: While many people may feel a bit lousy after a flu shot, it is not Influenza. There is a certain amount of normal and expected reaction that occurs after any vaccination. This is the body responding appropriately to the vaccine and building antibodies to prevent future infection. Of the 2 types of flu vaccine, neither injects the influenza virus that is seen in the environment. The live attenuated vaccine contains weakened virus designed to stimulate the immune system with virus strains that are expected to be in the community during influenza season, but in a much weakened form. While people with impaired immune systems should not receive this vaccine, it is safe in
individuals with normal immune systems. The inactivated vaccine contains no infectious virus; it is inactivated. As such, these types of vaccines do not cause influenza and are able to stimulate a protective immune response.
2. It’s too late to get the flu shot this year: Influenza typically peaks after the New Year and runs into the spring in the Northern Hemisphere. Receiving vaccine in December will still provide a good deal of protection. However, it’s a good idea to get vaccinated as soon as the vaccine is available in early fall.
3. Healthy people don’t need to get vaccinated: While individuals with chronic illnesses and the elderly are at higher risk for influenza, healthy people can get sick as well. Additionally, those who are healthy and unvaccinated can spread the disease to those around them if they do get sick with influenza. Healthy people should get vaccinated.
4. You don’t need to get a flu shot every year: Due to the potential for strain change (the specific types of influenza virus circulating in a particular year) vaccination with the most current vaccine is necessary. Additionally, an individual’s immune response, and thus protection, may not last long enough to protect over two seasons even if the strains are unchanged. To be certain you have the maximum protection, an annual flu shot is recommended.
5. Once I have the flu I don’t need to get vaccinated: While having a true case of influenza may protect you from that strain in that particular year, there are many different types of influenza in circulation. You will still be susceptible to any of the other strains despite your illness. You should still be vaccinated. However, vaccination should occur when you are well.
Visit your doctor regularly and listen to your body.
Guest Columnist: Anthony J. Yanni, MD, FACP, CPE, Director, Clinical Development Sanofi Pasteur, Swiftwater, PA.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: The Flu – Part 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 affiliated faculty member at the University of Scranton, PT Dept
