Part 2 of 3
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
Guest Author: Timothy D. Welby, MD – board certified pediatrician at Pediatrics of NEPA and associate professor of pediatrics at GCSOM.
For centuries, millions of adults and children died around the world of illnesses that are now preventable with vaccinations. In fact, just a generation ago, most Americans knew a family who lost a child to measles or pertussis (whooping cough). Those of that era also knew someone who had been paralyzed for life by childhood polio. But, thanks to modern medicine and science, this is no longer a common occurrence or fear. For example, in 2000, measles was eliminated in the United States, according to the Centers for Disease Control (CDC). However, since 2000, outbreaks of these preventable diseases have reoccurred. In 2015, almost 200 cases of measles were reported at an amusement park in California. Last year, 18 cases were reported in New York in the Orthodox Jewish Communities and this year the count rises again. What do all these outbreaks have in common? Unvaccinated children!
The purpose of this column over the next few weeks is to discuss the prevention of common childhood diseases using vaccinations and to review potential side effects, both real and imagined.
While this column is not intended to present all of the diseases that childhood vaccines can prevent, it is imperative to discuss those which are most prevalent and important.
Measles virus infection causes high fever (as high as 105 degrees), cough, red eyes and a classic rash. It is highly contagious. One in every thousand people who contract measles will get encephalitis, a dangerous inflammation of the brain, which often causes lifelong damage. One or two in every thousand people with measles will die from respiratory or neurological complications. Prior to the measles vaccination in the United States in the early 1960’s, millions of children got measles annually and about 500 children died every year in this country alone. Even today, in countries too poor to afford vaccines, or with an underdeveloped medical care system, 115,000 children die each year of the measles. While measles has been eradicated in the United States due to vaccination, outbreaks still occur when measles is brought back to the states by travelers coming home or by people who caught measles in their home country and travel to the U.S. These outbreaks can spread quickly and become very deadly in areas where immunization rates are low.
Rubella Virus, or German Measles, is also highly contagious but usually causes a milder illness with fever, sore throat and a rash. However, its true danger is to infants in the womb. If a pregnant woman gets Rubella, the infant can die in the womb or shortly after birth. The infant is also at risk for congenital rubella syndrome, which can cause deafness, heart and brain defects and glaucoma. There is no cure for congenital rubella syndrome and before routine vaccinations for it in 1969, outbreaks were common. In 1964-1965, for example, an estimated 12 million people got rubella. 11,000 women lost babies in utero, 2,100 died at birth, and 20,000 were born with congenital rubella syndrome. Currently, about 10 people get rubella yearly in the U.S. and all of these cases were contracted outside the country.
Hepatitis B Virus and Human Papillomavirus (HPV) are unique among vaccine-preventable illnesses because they are a major cause of cancer in adults. Every year approximately 17,500 women and 9,300 men in the U.S. get diagnosed with cancers caused by HPV, and the most well known of these is cervical cancer in women and throat cancer in both men and women. It is well established that the current HPV vaccine used in adolescent girls and boys will prevent 90% of these cancers.
Hepatitis B virus causes infection of the liver. Symptoms of acute infection include vomiting, diarrhea and jaundice (yellow coloring of the skin). Some patients, children and adults, who get infected, progress to chronic hepatitis B infection which lasts for years and eventually can cause cirrhosis and liver cancer. 1800 deaths annually are directly related to this condition.
Influenza or Flu Virus is an annually occurring illness that sweeps across the globe during the midwinter months in each hemisphere. Because the virus mutates (changes) every year and the vaccination only provides immunity for about 6 months, immunity against the flu must be repeated every year. Influenza virus causes fever, cough, headache, muscle aches and fatigue. It sometimes causes vomiting and diarrhea, more often in children than in adults. Unfortunately, antiviral medications used to combat the flu are not very effective, especially in young children, elderly and those at risk of getting seriously ill from the flu. Every year, about 100 children and thousands of adults die from the flu in the U.S.
Source: NEPA Vital Signs - The Journal of the Lackawanna County Medical Society
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Read Part 3 on “Vaccinations”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.
Part 1 of 3
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
Guest Author: Timothy D. Welby, MD – board certified pediatrician at Pediatrics of NEPA and associate professor of pediatrics at GCSOM.
For centuries, millions of adults and children died around the world of illnesses that are now preventable with vaccinations. In fact, just a generation ago, most Americans knew a family who lost a child to measles or pertussis (whooping cough). Those of that era also knew someone who had been paralyzed for life by childhood polio. But, thanks to modern medicine and science, this is no longer a common occurrence or fear. For example, in 2000, measles was eliminated in the United States, according to the Centers for Disease Control (CDC). However, since 2000, outbreaks of these preventable diseases have reoccurred. In 2014, almost 400 cases of measles were reported in an Amish community in Ohio. In 2015, almost 200 cases of measles were reported at an amusement park in California. Last year, 18 cases were reported in New York in the Orthodox Jewish Communities and this year the count rises again. What do all these outbreaks have in common? Unvaccinated children!
The purpose of this column over the next few weeks is to discuss the prevention of common childhood diseases using vaccinations and to review potential side effects, both real and imagined.
Vaccines are pharmaceutical products developed through a vigorous scientific research process over many years. These products are designed to “trick” a patient’s immune system into producing immunity against a particular serious illness, usually caused by a bacteria or virus. When a child becomes infected with an illness naturally, the child becomes sick and their immune system recognizes the bacteria or virus as a foreign invader and mounts a response comprised of antibodies and white blood cells in their bloodstream. These antibodies hopefully defeat the illness and the child recovers. In the process, the immune system remembers the particular invader and the next time the child is exposed it will resist it more effectively. A child’s immune system is particularly good at developing memory antibodies to fight infection compared to an adult, however, it cannot do so if it does not get an opportunity. Unfortunately, some of the infections are serious and deadly, especially to infants and children whose nervous systems, hearts and lungs may not be developed enough to survive the infection.
A particular vaccine consists of multiple ingredients. The principle component is the actual “immunizing agent” which can be in one of three forms: a live attenuated (weakened) virus, a killed virus, a portion of a bacteria or virus or a group of proteins from an infecting microorganism. It is this immunizing agent that provokes the patient’s immune system to respond by fooling it to mount a protective response against the fake “foreign invader” without causing the actual illness. Therefore, when exposed, this allows the patient to either fight off the viral or bacterial infection entirely or partially without serious or deadly consequences. Often, vaccines also contain other products such as aluminum salts to improve the immune response to the immunizing agent, preservatives to prevent bacterial or fungal contaminations and stabilizers such as sugars (sucrose), amino acids (glycine), or proteins (gelatin), to ensure that the vaccine maintains its potency. Some patients can have an allergic reaction to these additional vaccine components.
Infants and children are the most obvious people in need of protection from serious illness and death; however, many adults are also at risk. Older and sickly adults with poor immune systems are also at great risk for serious illness and death when exposed to many childhood illnesses that are preventable with vaccines. Children who are ill shed large amounts of the virus or bacteria that they are infected with in various ways; coughing, sneezing, vomiting, and other unpleasant means. Therefore, it is also important to understand that high childhood immunization rates help keep vulnerable children and adults healthy. High childhood immunization also protects vulnerable young children who cannot be immunized for valid reasons such as those resistant to vaccine effectiveness. For example, a child under one year of age who has partial immunization through their mother cannot get effectively vaccinated. Because the antibodies from their mother aren’t very effective, especially in young infants, they are at grave risk if the children around them are not immunized. Others at risk include children born with weak immune systems from birth and those taking strong medications like chemotherapy for cancer which weaken their system. These cases clearly illustrate how critical it is to attain the highest immunization standards possible because the greater the number of healthy children receiving immunization, the more we protect them, the children and adults close to them, and any other vulnerable people their communities.
Source: NEPA Vital Signs - The Journal of the Lackawanna County Medical Society
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week Read: Part 2 of 3 on Vaccinations.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.
NEW RESEARCH DEMONSTRATES ONE TYPE OF EXERICSE MAY HAVE SUPERIOR FAT-BURNING AND ANTI-AGING BENEFITS
HIIT is the new hit! If the primary reason you exercise is to burn fat and lose weight than you many want to rethink your training program. High-intensity interval training (HIIT) is the “new buzz” in exercise. Like all new trends, participants are excited and quick to swear to its positive effects. As popular and common as exercise is little is known about the influence and impact it has at the cellular level. Over the past few years, researchers decided to explore the effects of HIIT. Last year, a research team at Mayo Clinic determined that HIIT exercises have anti-aging effects in the muscles at the cellular level. A more recent study published in the January issue of The British Journal of Sports Medicine decided to investigate the impact of HIIT on body fat.
The Mayo team chose 72 men and women and separated them into two groups; 30 and under and older than 64. All subjects were healthy but sedentary. Pre test analysis was performed for blood sugar levels, gene activity, muscle cell mitochondrial health, and aerobic fitness level. Group One: Vigorous weight training 3-5 times per week, Group Two: HIIT aerobic exercise on a stationary bike (pedaling hard and fast for four minutes followed by a recovery at a slow pace for three minutes then repeating the sequence 3 or more times) 3 times per week, Group Three: Moderate aerobic exercise on a stationary bike for 30 minutes 2-3 days per week and light weight lifting on the other 2-3 days, Group Four: Control group who did not exercise. After 12 weeks, lab tests were repeated and data compiled and analyzed.
The British Journal publication was a retrospective review of 36 studies involving more than 1,000 participants, young and old, male and female. The purpose of the inquiry was to compare body fat changes before and after two different types of exercise: Group One: moderate-exercise routines including walking, running, cycling or swimming for at least 45-60 minutes. Group Two: 30-40 minutes of high-intensity interval training (HIIT), including a warm-up and cool-down.
Both groups performed their exercise routines for at least 4 weeks and had pre and post body fat analysis.
The Mayo study found all three experimental groups improved in fitness level and blood sugar regulation. As expected, the vigorous weight training group, showed the greatest gains in muscle mass and strength. Also, not surprising, the HIIT group, had the greatest gains in endurance. However, the most unexpected results came when retesting the muscle cells by biopsy. Only the HIIT group demonstrated the most significant improvement in the activity levels of their genes in both the young and older groups, when compared to the vigorous weight training and moderate exercise groups.
It is well know that loss of muscle mass and strength is common with age. Specifically, older muscles have been found to regenerate slowly and incompletely and the problem runs as deep as the cellular level as the mitochondria diminish in quality and quantity. However, this study suggests that HIIT can actually regenerate and reverse the aging mitochondria. Healthier mitochondria are able to produce energy for muscle cells to function at a higher level.
In addition to anti-aging, HIIT may also address the number one reason people exercise; to burn fat and lose weight. The good news is that all forms of endurance exercise moderate or intense, promote weight loss when compared to controls. However, HIIT allows participants to lose a significantly greater amount of body fat in a shorter amount of time (30 minutes compared to one hour).
Interval aerobic exercise can have anti-aging effects. In fact, the older your muscles, the more you will benefit from, not just moderate exercise, but more vigorous interval aerobic exercise. Furthermore, interval training may be applied, not only to aerobic exercise, but to weight training for the upper and lower body. According to the American College of Sports Medicine, high intensity interval training, also called HIIT workouts, involves a repetition of a series of high-intensity exercise (aerobic or weight training) for a specific period of time (3-5 minutes) followed by a specific period of rest or low-intensity exercise (1-3 minutes). The intensity can be increased by speed or resistance.
Depending on one’s ability to tolerate higher intensity exercises, it may be wise to consider incorporating HIIT into your exercise routine. However, do not attempt to increase the intensity of your exercise program without consulting with your physician first. Once medially approved, consult with a doctor of physical therapy to create a program specifically designed for you.
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
When computer technology was first applied to medicine, many were concerned that it would negatively impact the quality of patient-physician communication. While some may feel that technology has lead to more distant interaction, others feel that it has contributed to more informed, involved and empowered patients.
In a recent report released by the Joint Commission, it was determined that poor patient-clinician communication is responsible for approximately 70 percent of serious adverse health outcomes in hospitals. It may be fair to assume that this problem also occurs in outpatient and in home health services. Therefore, any opportunity to improve patient-clinician communications, including mobile apps, must be considered. The most effective apps should allow patients to securely list medical history and medications, as well as, quickly search for and access physicians, hospitals, clinics, first aid, and other health information. Other important features allow patients to be empowered through safe self management with texting, voice mail, and video communications. For those with chronic illnesses, some patient engagement apps will allow for direct communication between patients, health care navigators and other members of the health care team. Many physician groups and hospitals offer mobile apps for patient – physician communications with privacy protections.
Some tools improve engagement between physician and patient while others focus on research, tracking and logging to improve health and wellness. The suggestions below are considered to be some of the best for patients according to leaders in technological applications in medicine:
1.Apple Health App; GenieMD; CapzulePHP – are highly rated health record apps designed to help uses visualize and store their health records from multiple institutions along with data which can be added manually
2. My Medical App – The Personal Medical Record is a comprehensive medical record-keeping which works as a digital file cabinet. It securely organizes and safes appointments, medical records, lab results, medications and other essential medical data.
3. Epocrates; PEPID; UpToDate; Medscape – top medical reference apps
4. MySugr App – Blood Sugar Control, Glucose Tracker, Insulin Use and Carb Counter: This app created by people with diabetes to assists patients with diabetes often struggle to monitor their condition at home. This app provides a food database for patients to track their consumption and allows physicians to monitor any fluctuations. A free app is available for trial.
5. iCookbook Diabetic – Recipes, nutritional information and health articles for people with diabetes: a great app, created by dietary professionals, to provide healthy alternatives for cooking healthy. It provides various tools for meal planning and grocery shopping for the diabetic.
6. Lose it; Fooducate Nutrition Tracker- Apps for Weight-loss and nutrition are invaluable tools to promote weight control by helping to track meals, exercise, calories, and nutrition. It uses a built-in barcode scanner and menus from popular restaurants.
7. Blood Pressure Companion – A useful app for patients on the go to monitor their blood pressure and weight. It also provides lifetime data visualization and statistics with displays for medication correlations.
8. Apple Watch Series 4 with ECG and Atrial Fibrillation Features – this device, released in December of 2018 may be the most important technological devices for those with a history of cardiac problems, specifically atrial fibrillation. In fact, for those between the ages of 60 and 64 there is a 76 percent positive prediction value which significantly improves with older users.
9. Best Fitness Apps - MyFitnessPal; Headspace – are fitness apps which tract exercise and diet to best meet your goals. Fitness watches and wrist devices such as Apple Watch and Fitbit are also very useful.
10. Pocket First Aid & CPR – In addition to general first aid instructions, this app also shares the American Heart Association’s guidelines on CPR. It offers high-quality videos and illustrations to assist those in need.
10. iCalcRisk– Cardiac Risk Tracker: Calculates cardiac risk to promote healthier choices. Physicians can use the visualizations to assess the patient’s ability to manage their cholesterol, blood pressure, and lowering their risk of heart attack.
SOURCES: Modern Medicine Network; American Heart Association
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
PIAA Spring Sports (Track & Field) Begins today, March 4Th! To prevent injuries such as shin splints and stress fractures, participants, especially female athletes, must take time to properly prepare for your event.
Have you notice more local running enthusiasts in the past few years? Moreover, have your noticed that most of the runners are women? Scranton Running Company has contributed to NEPA’s participation in a national trend; more women are engaged in running than men! Female runners account for 9.7 million runners (57%) while 7 million males run on a national level.
With this surge, the female runner has been subjected to a host of related injuries, including shin splints, which often lead to stress fractures. New research has found that stress fractures may be related to the loss of weight and body mass associated with the sport.
A recent study from Ohio State University found that female runners with a Body Mass Index (BMI) below 19 may have a higher risk of developing stress fractures than women with a BMI of 19 or above. Furthermore, the study also found that these women took longer to recover from these injuries.
According to Timothy Miller, MD, “When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture,”
The study also found that female runners with a BMI of 19 or higher with severe stress fractures required 13 weeks to recover from their injuries and return to running. Runners with a BMI lower than 19, however, took more than 17 weeks to recover.
They concluded that women should know their BMI and consult with a medical professional to maintain a healthy number. Additionally, women should cross-train and include resistance training to improve the strength and muscle mass of the lower extremities to prevent injury.
The current BMI wisdom, according to the National Institutes of Health, is 19.8 for men and 24 for women, however, strong and competitive women tend to have a BMI of 26. A BMI of 18 is considered malnourished.
Body mass index (BMI) is a measure of body fat based on height and weight of adult men and women over 20 years of age, according to the National Institutes of Health.
BMI = (weight in pounds / height in inches squared) X 703)
Example 1: a person who weighs150 pounds and is 68 inches (5 feet 8 inches) tall has a BMI of 22.8
Example 2: a person who weighs 110 pounds and is 66 inches (5 feet 5 inches) tall has a BMI of 17.7
Underweight < 18.5%
Normal weight 18.5 to 24.9%
Overweight 25 to 29.9%
Obesity 30 and over
A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia (shin bone) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.
FEMALE RUNNERS WITH BMI LOWER THAN 19 – is a primary risk factor.
10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are: sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.
The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).
Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.
Mix run & walk every 10 minutes
Source: Ohio State University, Science Daily
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.
It is a well established fact in the medical literature that the benefits of regular exercise and physical activity are numerous, from reducing blood pressure to lowering the risk of falls. However, a study recently conducted in the Human Performance Lab at Ball State University and published in The Journal of Applied Physiology found that people in their 70s who have been exercising regularly for decades have defied the aging process…maintaining heart, lung and muscle fitness of healthy people at least 30 years younger!
As it turns out, many people who began exercising in the 1970’s running and aerobic boom have continued to do so for 50 years without interruption. Researches felt that this population of lifetime fitness enthusiasts would be interesting to study and compare to their contemporaries and younger people.
Subjects were divided into three groups; Group One: Lifelong Aerobic Exercisers with an average age of 75 years, who engaged in a structured aerobic program of running or cycling, four to six days a week, seven hours per week. Group Two: No Structured Exercise throughout life, with an average age of 75 years, who may have occasionally walked, golfed or participated in leisure activities. Group Three: Lifelong Aerobic Exercisers with an average age of 25 years, who, like their senior counterparts, engaged in a structured aerobic program of running or cycling, four to six days a week, seven hours per week.
All subjects were assessed for cardiovascular fitness on an indoor bike to determine maximum oxygen uptake (VO2 Max). Muscle biopsies were also performed to assess microcirculation to the muscle and blood work was conducted to examine enzyme levels related to carbohydrate and fat metabolism.
Results showed that those engaging in aerobic exercise consistently throughout their lives had both muscle and cardiovascular benefits similar to those 30 years younger.
It is important to note that in this study an aerobic program consisted of running or cycling, four to six days a week, seven hours per week. This level of lifelong commitment is limited to a very select group of individuals. However, many other studies have demonstrated the value of any aerobic exercise program, even if less intense.
In general terms, aerobic exercise is any type of sustained exercise that strengthens the heart and lungs to improve the body’s use of oxygen. This may include running/jogging, brisk walking, cycling, swimming, rowing, and the use of a treadmill, elliptical, stepper or similar device, at light to moderate intensity which requires the use of oxygen to adequately meet the oxygen demands of the body for an extended period of time. The generally accepted time and frequency is at least 30 minute sessions performed three or more times per week.
Moreover, it is important to remember that everyone ages differently. With the onset of age related osteoarthritis and other illnesses, one may not be capable of maintaining regular exercise with the intensity described in this study. Regular exercise, even at a low to moderate level has many benefits. In fact, studies continue to support the fact that a well-balanced and individualized exercise program including aerobic, strengthening, stretching and balance activities contribute to, not only longevity, but quality of life.
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
It is a well established fact in the medical literature that the benefits of a healthy diet, regular exercise and physical activity are numerous, from reducing blood pressure to lowering the risk of falls. (SEE BOX A Below) However, a study recently published in journal Neurology, reported that a healthy diet along with regular aerobic exercise may also improve brain health and improve cognitive tests, even in those already showing signs of an aging brain. Prior to these new findings, it was unclear if this healthy behavior initiated later in life would reverse signs of an already aging brain when compared to those following a poor diet and sedentary lifestyle.
Researchers observed 160 subjects over the age of 55 who began showing signs of a slowing brain similar to people in their 90s, which was an average of 28 years older than their actual age. All subjects were sedentary at the time of the study, had at least one risk factor for heart-disease and showed signs of cognitive decline, without any signs of dementia.
The subjects were divided into one of four groups; Group one participated in aerobic exercise; Group two followed a healthy diet; Group three followed a healthy diet and participated in aerobic exercise; Group four only participated in education sessions about improving brain health but did not alter their diet or engage in exercise.
Aerobic exercise in this study was defined as three months of supervised physical activity at a research facility in which subjects attained 70% of their peak heart rates on a treadmill or stationary bike three times a week. Diet in this study was defined as the Dietary Approaches to Stop Hypertension (DASH) which emphasizes reducing salt and increasing fiber to control blood pressure and improve heart health.
The results found improvement only in group three, the healthy diet and aerobic exercise group, who improved their scores by nine years. The control group continued to decline in brain function while the exercise only and diet only groups did not show signs of improvement.
In this study, people who followed the DASH diet and performed aerobic exercise for no less than 30 minutes, three times per week at a 70% peak heart rate for three months improved their performance on cognitive tests. Moreover, in those with evidence of cognitive impairment, it is not too late to derive benefits from a healthy diet and aerobic exercise. These results reinforce previous research that supports the fact that heart health promotes good circulation throughout the body and brain, which is important for maintaining oxygen-rich blood to fuel its activities, including cognition.
Aerobic exercise was strictly defined in this study but should not intimidate those interested in exercise. In a broader sense, aerobic exercise is any type of sustained exercise that strengthens the heart and lungs to improve the body’s use of oxygen. This may include running/jogging, brisk walking, cycling, swimming, rowing, and the use of a treadmill, elliptical, stepper or similar device, at light to moderate intensity which requires the use of oxygen to adequately meet the oxygen demands of the body for an extended period of time. The generally accepted time and frequency is at least 30 minute sessions performed three or more times per week. For those with back, hip, knee and other lower body pain, consider low-impact or partial weight-bearing activities such as a recumbent bike or stepper or upright bike instead of a treadmill.
For More Information: Dietary Approaches to Stop Hypertension (DASH) – National Heart, Lung, and Blood Institute at National Institutes of Health.
BOX A:
Some of the more important benefits of exercise are:Loss or Maintained Body Weight
Reduces LDL /Raises HDL Cholesterol
Reduces risk of type II diabetes
Improves Circulation and Blood Pressure
Reduces Risk of Heart Disease
Prevents Bone Loss
Reduces Stress/Muscle Tension
Lowers Risk of Depression
Improves Sleep Pattern
Improves Strength and Flexibility
Improves Balance/Reduces Risk of Falls
Improves Immune System
Improves Pain Threshold
Stimulation of Neurogenesis (formation of new brain cells)
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.
We are two weeks into the New Year and many of you are working hard to hold onto the number one resolution…to lose weight! Today, this column will offer some sage and practical advice on satisfying hunger with healthy snacks. You have probably noticed a lot of attention being paid to sugar lately. In fact, some people have decided to avoid all refined sugars with the goal of improving their health and wellness. Terms like simple sugars and simple carbs, which are purported to be bad, and complex carbs, suggested to be good, are being used ad nauseam. While medical research does not support the value of a short term “sugar cleanse,” it may have value for another reason. For example, it would be very beneficial if one engages in a “sugar cleanse” for the purpose of changing their palate with the hope of developing long term healthy eating habits.
While I am an advocate of moderation, I decided to provide my readers with some answers to some simple questions about the fuss over sugar. What is a simple sugar? What is a complex sugar? Which sugars are good for you? What are some good low-carb snacks?
Sugars, along with starches and fibers, are one of three types of carbohydrates (also referred to as a carb). A carb is “simple” or “complex,” based on its chemical composition and how it is processed in the body. It gets a little complicated because some foods have both simple and complex carbs. Typically, simple carbs are chemically more “simple” and basic, and therefore they are broken down more easily and serve as a quick source of energy. Some of these carbs are naturally simple (like fruit and milk) while others are processed or refined sugars such as those used in candy, soda and baked goods. To determine if a food product has good or bad simple sugar, you must also know how much fiber, vitamins and minerals are in the food. A food with a higher sugar content combined with a low fiber, vitamin or mineral content will be worse than a food with the same sugar content but high fiber and vitamins or minerals. For example: a candy bar, which is high in sugar without fiber or vitamins or minerals, is not as healthy as a fresh orange, which contains fiber, vitamins and minerals along with its simple sugar (fructose).
Examples of simple carbs:
Most candy products, non-diet soft drinks, cookies and cakes, iced tea and lemonade with sugar, energy drinks, and ice cream.
Complex carbs have a more complicated chemical makeup and take more time for the body to break down for use as energy. Therefore, these are considered “good” carbs because they provide a more even distribution of energy for the body to use during activity. They cause a more consistent and gradual release of sugar into the blood stream (as opposed to peaks and valleys caused by simple carbs) and provide energy to function throughout the day. Additionally, “good” carbs have the added benefit of providing vitamins, fiber, and minerals that are missing from simple carbs.
Examples of complex (carbs):
Whole grains: buckwheat, brown rice, corn, wheat, barley, oats, sorghum, quinoa, breads and pastas made with whole grains
Dairy: low fat yogurt, skim milk
Nuts, Seeds, Legumes: lentils, kidney beans, chick peas, split peas, soy beans, pinto beans, soymilk
Fruits and Vegetables: potatoes, tomatoes, onions, okra, dill pickles, carrots, yams, strawberries, peas, radishes, beans, broccoli, spinach, green beans, zucchini, apples, pears, cucumbers, asparagus, grapefruit, prunes
Remember that carbohydrates fuel the body and are an important source of energy, especially for active and athletic people. However, carefully selecting the type of carb you eat is critical to peak function and performance.
Simple carbs taste great (according to our modern brain raised on simple sugars) and are easy to breakdown into a quick source of energy. However, the sensation of hunger is quick to return because the sugar is released and used up in the body quickly, giving the sensation of needing more.
Simple carbs are often “refined” and therefore stripped of their fiber, vitamins and minerals, which is why they are often referred to “empty” calories.
Simple carbs lead to rapid spikes in blood sugar and insulin levels after meals. When these levels are not controlled over time, it can lead to obesity, which is ultimately related to adult-onset diabetes and high blood pressure.
Complex carbs make you feel full faster and longer and therefore, are an important component to weight loss.
Complex carbs keep the body fueled for an extended time.
Complex carbs are easier to digest and the fiber content allows for smoother digestion with less bloating and gas, and improved toxin removal.
Complex carbs from vegetables have been found to lower LDL cholesterol, blood pressure and heart disease.
10 Healthy Low-Carb Snacks
Sliced apples or pears are a great compliment to a variety of cheeses. With only 10 grams of carbs, the combination of protein, fat and fiber is, not only tasty, but will sustain you for hours.
2. Avocado Spread on a Low-Fat Cracker
Mash a ripe avocado and spread on a low-fat cracker or crisp. This delicious high-fiber snack has 17 grams of carbs.
3. Yogurt and Cucumbers
Greek and Middle-Eastern cultures have long known the value of yogurt. By adding cucumber (slices or spears) for dipping or diced, the snack becomes high in protein (21 grams) while low in carbs (10 grams)
4. Chicken, Turkey, Porketta Lettuce Roll-Up
Use healthy, white deli meat but avoid the bread. Instead, use a lettuce to wrap the meat and maybe add spicy mustard. 1 ounce of sliced turkey has only 3.7 grams of carbs.
5. Cottage Cheese and Fruit
Add you favorite fruit, (blueberries, strawberries, raspberries, pineapple, peaches, etc) to low-fat cottage cheese and you get a tasty, healthy low carb (17 grams), low-fat with the additional benefit of fiber and protein.
6. Celery and Peanut Butter
2 stalks of celery filled with 2 tablespoons of natural peanut butter creates a simple, yet healthy snack loaded with fiber and protein and only10 grams of carbs.
7. Nuts
Mixed nuts, in moderate quantities, are a good snack because they offer a crunchy, salty, high protein option with 6 grams of carbs per ounce. However, some nuts are better for you than others: macadamias have more heart-healthy monounsaturated fats, cashews are high in iron and zinc and almonds are very high in fiber and vitamin E.
8. Edamame
Edamame are high-fiber, high-protein soybeans have only 6 grams of carbs in a half-cup. A frozen bag pops into the microwave to become a quick easy healthy snack.
9. Hummus
Hummus is a very popular and healthy chick pea dip. And, if not eaten with copius amounts of pita bread, it can also be low carb. Instead, dip carrots, celery, red bell pepper wedges, and zuchinni (16 grams of carbs).
10. Tuna-Stuffed Tomato
3 ounces of tuna stuffed into a fresh tomato half offers a healthy snack with only 3.5 grams of carbs.
Sources: webMD
Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
Especially in light of a recent spike (nine in one week) in overdose deaths in Lackawanna County
Guest Columnist: Dr. Gretchen Welby, PharmD, MHA
Dr. Welby received undergraduate degrees from Keystone College and Philadelphia College of Pharmacy and Science. She received a Master's Degree in Health Administration from the University of Scranton and a Doctor of Pharmacy degree from Temple University. She currently teaches at Marywood University as an Assistant Clinical Professor for the physician assistant program.
We are all aware of the opioid crisis facing our community, state, and nation today. In fact, nine people in Lackawanna County died in one week in December of 2018. According to the Center for Disease control (CDC), drug overdose deaths in the US for the year 2017 exceeded 72,000. Pennsylvania has one of the highest overdose rates in the country at 37.9 per 100,000. The percentage change in drug overdose deaths in Pennsylvania from 2015-2016 was a staggering 44.1%. The issue of drug overdose continues to be one that plagues our state.
One bright spot in this horrific crisis is Naloxone because of its potential to save lives. Also known by the brand name, Narcan,R it is a opioid antagonist (antidote) used to counteract the effects of an opioid overdose. In some states, like Pennsylvania and Connecticut, State Troopers report saving hundreds of lives, from ages 14 to 83.
Opioids are a category of drugs that are indicated for pain management. Prescription opioids are designated by the federal government through the Food and Drug Administration (FDA) according to their level of addiction potential. Drugs such as heroin are Schedule I agents indicating an extremely high level of abuse potential and no valuable medical purpose. Opioids such as oxycodone, fentanyl, and hydromorphone are Schedule II agents with a very high potential for abuse but with a recognized place in therapy to manage pain.
All opioid agents interact with opioid receptors in multiple locations throughout the body to produce effect. Opioid receptors are particularly concentrated in the brain where they influence pain relief. Other responses to opioids that are mitigated via brain opioid receptors include euphoria, sedation, nausea, and decreased respiratory rate.
Fatal overdose situations arise when an excessive amount of opioid is used which significantly interacts with the opioid receptors. The leading cause of opioid overdose death is respiratory arrest. The CDC lists these four risk factors for prescription opioid overdose; 1. Obtaining overlapping prescriptions from multiple providers and pharmacies. 2. Having mental illness or a history of alcohol or other substance abuse. 3. Taking high daily dosages of prescription opioid pain relievers. 4. Living in rural areas and having low income. Risk factors associated with illicit (obtained through illegal means, diverted, or heroin) opioid overdose include; coexisting drug use (in combination with amphetamines, alcohol, cocaine), prior abstinence or reduced use, and smoking.
Federal, state, and local governments have increased awareness of the opioid epidemic. Legislation has focused on altering opioid prescribing practices and increasing funding for education and addiction treatment. Another tool used in the efforts to prevent death from opioid overdose is naloxone. Naloxone is a drug that acts to block opioid receptors and prevent opioids from interacting with them to produce their characteristic effects. It is a drug free from side effects. It is safe to use for anyone. It is given in overdose situations to reverse the effects of opioids. The state of Pennsylvania has a provision to allow anyone to obtain naloxone from the pharmacy. Standing Order DOH -002-2018 is known as the “Naloxone Prescription for Overdose Prevention” act. This legislation was implemented in 2015 by Governor Tom Wolfe. The prescription order is signed by the current Physician General of Pennsylvania, Dr. Rachel Levine. This standing order may be used by as a prescription to obtain naloxone from a pharmacy if a person is unable to obtain a naloxone prescription from their provider.
Naloxone can be used for all types of opioid overdose. It can be administered via injection or through a nasal spray. It must be administered immediately upon recognition of an overdose situation. It is a short-acting agent. The effects of the opioid may outlast the effect of naloxone therefore it is vital that the patient receives medical attention after the dose of naloxone. It is recommended that all who obtain naloxone go through a training session to know how to use it effectively. Getnaloxonenow.org is a free site for naloxone training.
The opioid epidemic continues to afflict our communities. Work is being done to combat the issue and provide help to those addicted. Despite these efforts, deaths from opioid overdose continue to increase. Naloxone is a drug that can save lives. Through the PA Standing Order for Naloxone, access to this drug is available throughout the state. Ask your pharmacist or provider about obtaining naloxone.
FOR MORE INFO ABOUT NALOXONE ADDICTION SERVICES:
www.getnaloxonenow.org
www.drugabuse.gov
www.ddap.pa.gov/overdose/pages/Naloxone_Reversal.aspx
www.pa.gov/guides/opioid-epidemic/
Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
Happy Holidays! It is at this time of year that we celebrate life with great hope and faith. People of many faiths take time to reflect, respect, and resolve. Christians celebrate Christmas, the miraculous birth of Christ, the Son of God, and the Messiah. Jews celebrate Chanukah, the miraculous festival of lights, when one night’s oil provided enough light and safety for 8 nights. Both major faiths promote healthy lifestyles for the mind, body and spirit. These faiths are grounded in hope, faith, love and peace. It is no surprise that studies repeatedly demonstrate that people of faith outlive those without!
With this in mind, I purport, that to be truly healthy, one must have faith because complete health is multidimensional. Socrates preached this message to his students thousands of years before Christ. One must have a healthy mind, which requires intellectual stimulation with attainable goals related to education and intellect. One must have a healthy body by eating well, engaging in physical activity and have attainable goals related to his/her body. Likewise, one must have a healthy spirit with faith, hope, prayer and meditation, comrades and counsel, and set attainable spiritual goals.
How being religious or spiritual has been shown to benefit your mind, body and spirit…
High blood pressure (hypertension) can lead to heart disease and stroke, which are the leading causes of death in the United States, according to the Centers of Disease Control (CDC). It affects 1 in every 3 adults and only half of these people have their blood pressure under control. Well, religion and spiritually may help …
The health benefits of religion or spirituality are well documented. One study conducted at Duke University Medical Center on 4,000 subjects, older adults who described themselves as religiously active were 40% less likely to have high blood pressure when compared to those less active. Moreover, they were surprised to find that those who described themselves as spiritual rather than religious also were less likely to develop high blood pressure.
Research also indicates that religious people are more satisfied with their lives than those without faith. A sociology study determined that high satisfaction among church goers may be due to the strong social bonds that are developed within a religious congregation. Regular church attendees see the same people weekly and often more often, when participating in rewarding and gratifying church-related volunteer work.
In an impressive study published in the Journal of the American Medical Association, researchers interviewed 345 late-stage cancer patients to assess their spirituality as it related to their illness. 88% stated that they were religious as it related to their coping mechanisms. It was determined that those using religion for coping demonstrated a 7.4% rate of resuscitation as compared to 1.8% for those not using religion as a coping mechanism.
According to a Duke University study of 1,718 older adult participants, those described as “highly spiritual” were 50% less likely to have high levels of anti-inflammatory proteins that weaken the immune system and have been linked to some cancers, viral infections and autoimmune diseases. The outcome was similar for those who attend religious services at least once a week.
Those who attend religious services more than once per week are found to live and additional 7 years when compared to those who never attend services. Again, researchers feel that the social benefits of a belonging to a strong religious community may be a large part of the associated longevity. Additionally, the lifestyle of religious people is often healthier: members of these communities rarely engage in risky and unhealthy behaviors such as smoking, excessive drinking, indiscriminate sex, etc.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
