On a recent bus ride to an Eagles game I asked my friend Dr. Gregory Cali, a local pulmonologist, (lung doctor) to help me with an article on exercise-induced asthma. The topic was chosen in response to an email question from a concerned mother of an athlete with asthma. Believe it or not, we spent almost two hours talking about asthma, which helped make the trip seem very short. Dr. Cali informed me that the first thing to know about exercise induced asthma (EIA) is that EIA is not a distinct disease in itself-but is one manifestation or presentation of asthma. Putting it simply EIA occurs in patients who have develop narrowing of the bronchial tubes ( bronchoconstriction) when they exercise. Some experts would rather we use the phrase exercise induced bronchoconstriction which is what happens when someone has an asthma attack. This bronchoconstriction occurs because of spasm of the tiny muscles of the airways, plugging of the airways with thick mucous, and swelling or edema of the cells lining the airways.
In fact it is inflammation of the airways, mostly due to allergies, that is at the root of most cases of asthma. This inflammation causes the bronchial tubes to become over-reactive-and predisposed to narrowing- when exposed to certain triggers. Exercise is one of those triggers in susceptible people. The patient with EIA complains of chest tightness, wheezing, and shortness of breath when exercising. Some patients only experience coughing with exercise. Symptoms are usually worse in cold, dry air. This is believed to be due to the drying and cooling of the airways, which occurs with exercise, especially if the patient opens his or her mouth while exercising. Nasal breathing is much better at warming and humidifying air and may help to reduce EIA.
Dr. Cali feels that the most important point about EIA is to make sure a specific diagnosis is made. It is difficult at times to differentiate asthma from the normal breathlessness, which occurs with exercise. The feature of EIA that distinguishes it from normal breathing, or being "out of shape" is the fact that EIA is ALWAYS associated with a decrease in airflow. This can be measured with either a peak flow meter or a spirometer. It is also important that a specific diagnosis be made so that a person will not be labeled as asthmatic when they may be "normal" or have other conditions such as heart problems or anemia.
Dr. Cali recommends before a person is labeled asthmatic, they have spirometric testing. An improvement in airflow after inhaling a bronchodilator is an important indicator of asthma. Sometimes a bronchial challenge test is needed to diagnose asthma. In this test, the subject breathes in a known bronchoconstrictor in small quantities and the response is noted. Patients with asthma almost always respond to the inhaled agent by a reduction in airflow.
Dr. Cali offers the following advice to prevent and manage EIA:
Whatever the patient can do to warm and moisten the inhaled air can help prevent EIA. Nose breathing during exercise or wearing a loose covering over the mouth in cold weather may help. Sometimes, in severe cases, switching to an indoor sport like swimming may be necessary. It is important to start out slowly and warm up first before exercising at full tilt.
Medications may be necessary. Quick- acting bronchodilators like albuterol used 15-20 minutes before planned exercise is recommended. This can be repeated once more during the exercise, but if tightness or wheezing occurs, the exercise should be stopped. Many patients with asthma require preventative treatment with anti-inflammatory medications. Inhaled steroids and/or leukotriene inhibitors may have to be added if the asthma is not controlled with albuterol alone. In fact, some patients with asthma who are overly reliant on quick acting bronchodilator medications can get into serious trouble if they do not use inhaled steroids.
In conclusion, people with asthma should not shy away from exercise. With proper precautions, people with asthma should be able to participate in all kinds of sports activities: football, soccer, swimming, baseball, tennis and running (even a marathon)! The key point is that the asthma needs to be under control and monitored by the patient and doctor as a team.
By the way, the Eagles went on to crush the 49ers !
Visit your doctor regularly and listen to your body.
The American Cancer Society has designated March as National Colorectal Cancer Awareness Month. The purpose of this designation is to increase public awareness about the facts about colon cancer. It is preventable, treatable and has a high survival rate. Regular screening tests, expert medical care and a healthy lifestyle, which includes a proper diet and exercise, are essential for success. Several studies have demonstrated that exercise can help prevent colon cancer.
The American Cancer Society estimates that approximately 154,000 new cases of colorectal cancer will be diagnosed in 2007. Of these, 79,000 will be men and 75,000 women and one-third will succumb to the disease. It is the second leading cause of US cancer deaths for men and women combined. Northeastern PA has been fortunate to have an active colon cancer awareness program with the help of some very visible members of the community. On a personal level this disease has had a great impact on me because my father, Paul Mackarey senior, was diagnosed with colon cancer 18 years ago. Fortunately, with great medical care, numerous prayers and endless support from family and friends, he is a proud survivor as a healthy 82-year-old who winters in Florida with my mother. This experience has had a great influence on my lifestyle: daily exercise, low-fat vegetarian diet, nonsmoker, moderate drinker, and colonoscopy screening every 3 years since age 35.
Early detection is the key to survival. Colorectal cancer progresses very slowly, usually over years. It often begins as non-cancerous polyps in the lining of the colon. In some cases, these polyps can grow and become cancerous, often without any symptoms. Some symptoms that may develop are: blood in stool, changes in bowel movement, feeling bloated, unexplained weight loss, feeling tired easily, abdominal pain or cramps, and vomiting. Contact your physician if you have any of these symptoms.
The risk of colon cancer increases with age, as 90% of those diagnosed are over 50 years old. A family history of colon cancer increases risk. Also, those with benign polyps, inflammatory bowel disease, ulcerative colitis, or Crohn’s disease are at greater risk and should be screened more frequently.
While there have been many studies about the benefits of exercise for colon cancer, none have been more encouraging than a recent study from the Hutchinson Cancer Institute in Seattle. Patients with abnormal cells on the lining of their colons as found by colonoscopy, demonstrated positive changes and reversal of these cells after engaging in 4 hours of exercise per week for one year. Some studies have shown that exercise can reduce the risk of colon cancer by 50%.
The intestine works like a sewage plant recycling food and liquid needed by your body. However, it also stores waste prior to disposal. The longer the wastes remains idle in your colon or rectum, the more time toxins have to be absorbed from you waste into the surrounding tissues. One method in which exercise may help prevent colon cancer is to get your body moving, including your intestines. Exercise stimulates muscular contraction called peristalsis to promote movement of waste through your colon.
Exercise to prevent colon cancer does not have to be extreme. A simple increase in daily activity for 15 minutes 2 times per day or 30 minutes 1 time per day is adequate to improve the movement of waste through your colon. This can be simply accomplished by walking, swimming, biking, and playing golf, tennis, or basketball. For those interested in a more traditional exercise regimen, perform aerobic exercise for 30-45 minutes 4-5 days per week with additional sports and activities for the remainder of the time. For those in poor physical condition, begin slowly. Start walking for 5-10 minutes, 2-3 times per day. Then, add 1-2 minutes each week until you attain a 30-45 minute goal.
Colonoscopy – is the most accurate screening test for detecting polyps and colorectal cancer. A long, thin, flexible tube with a camera is used to visually examine the lining of the colon. Polyps can be removed at the time of the exam if necessary. While most people should have this test by 45 or 50, some high-risk people may begin at 40-45 or earlier.
Exercise – as described above is an essential component of colon cancer prevention and overall wellness.
Diet & Nutrition – limit high-fat foods especially from animal sources. Limit red meat and dairy. A diet consisting of fish, fruit and vegetables is valuable. Some researchers theorize that Brussels sprouts, broccoli, and cabbage may trigger a chemical process to turn on a gene to suppress tumors. Sunlight and vitamin D are thought to be important too.
Lifestyle & Personal Habits - Smoking and excessive alcohol use increases risk for colorectal cancer and other forms of cancer. Stress and anxiety can be cancer triggers.
Source: American Cancer Society
Visit your doctor regularly and listen to your body.
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.
Many people in Northeast Pennsylvania enjoy outdoor winter activities, but it’s easy to forget that frigid air, wind, snow and sleet can play havoc on your skin.
It's critical to be aware of the time spent in the cold no matter what age you are and to recognize the importance of making skin protection part of your daily regimen. Dry, red, flaking, itchy and scaly skin can make you crazy and uncomfortable. And dry, cracked skin is an opportunity for a variety of bacterial, fungal and viral infections to enter your body.
Here are 10 winter skin safety tips for outdoor, active lifestyles, offered by health Web site Lifescript.com.
CONTRIBUTORS: Ted Stampien, M.D., is a dermatologist in Clarks Summit; Joanne Zenker, M.D., is a dermatologist at Lackawanna Valley Dermatology Associates in downtown Scranton.
A question I am frequently asked is, “Do you think I have carpal tunnel syndrome?” Over the past 10-15 years, carpal tunnel syndrome has moved to the forefront in medicine and has become water cooler conversation. So what is carpal tunnel syndrome and how is it treated?
Carpal tunnel syndrome (CTS) is a nerve disorder caused by compression of the median nerve at the wrist. The median nerve is one of three main nerves that provide sensation to the hand. This nerve specifically supplies sensation to the thumb, index, middle, and half of the ring finger. In CTS, compression on the median nerve occurs as it travels through a narrow passage in the wrist called the carpal tunnel. The carpal tunnel is formed by eight bones in the wrist (the floor of the tunnel) and the transverse carpal ligament, a strong ligament traveling across the roof of the tunnel. Within the tunnel there are nine tendons, which are a bit smaller than a pencil. These tendons share this space with the median nerve. In the case where there is swelling on the structures in the carpal tunnel, a person can experience pins and needles, numbness, and aching in the hand.
Common causes of CTS include:
Risk factors for CTS include:
Repetitive motion type jobs and activities (i.e. sewing, playing instruments)
Some common symptoms include:
To be properly diagnosed, a physician will discuss your symptoms and medical history, and examine strength and sensation. A nerve conduction study, electromyography (EMG), and x-ray may be ordered to provide information regarding sensation in the median nerve distribution and confirm compression at the carpal tunnel.
Treatment focuses on the causes. Therefore treatment suggestions may include activity modification and postural changes during activities. Other suggestions may include frequent rest periods, elevation, and exercises or stretching. Wrist splints are effective in relieving compression at the carpal tunnel and are typically recommended for night wear. Appropriate fit of the splint is vital. Occupational therapists or certified hand therapists can check the fit of pre-fabricated splints or can fabricate a custom splint. The above mentioned treatments all focus on decreasing inflammation and compression on the median nerve.Medication Your physician may order pain relievers or anti-inflammatory medication. A cortisone injection into the carpal tunnel may also be recommended to assist with decreasing inflammation near the carpal tunnel.
A referral to an occupational therapist or certified hand therapist may be made. A therapist can provide information regarding the diagnosis, appropriate treatment, and symptom reduction. They can make recommendations to introduce into daily activities to allow appropriate positioning of the upper extremities. A therapist will also instruct individuals on helpful stretching exercises or fabricate a wrist splint. Other treatments include ultrasound, iontophoresis, and massage. The focus of therapy is to introduce changes and interventions that reduce inflammation at the carpal tunnel to assist with symptom relief. Surgery
Surgery, referred to as a carpal tunnel release, may be indicated if symptoms are significant and impair functional activity performance.
To reduce your chances of getting CTS:
It is four weeks away from the 12th Steamtown Marathon. After training all spring and summer for the first 7 Steamtown Marathons, not a Columbus Day Weekend goes by without my thoughts of this great event. I am writing this column on a plane to Greece, where I plan to visit (and run) the original road from the town of Marathon to Athens. This will be the first of four columns dedicated to those dedicated runners preparing for the big day.
I would like to introduce this topic with some marathon history. In 490 B.C. Athens was under attack by the Persians and was outnumbered more than two to one. The Athenians fought bravely and defeated the enemy in the town of Marathon to keep the intruders 26 miles away from their families in Athens. To keep the anxious citizens of Athens calm, leaders immediately ordered a foot soldier, Phedippides, to the capital to share the news. Phedippides ran, in full armor, for 26 miles from Marathon to Athens, delivered the message and died immediately. Now, people do the same thing of their own free will!
Each year at this time, dozens of runners preparing for the Steamtown Marathon come to my office with severe shin pain known as shin splints. Unfortunately, in many of these athletes, this problem can lead to a much more severe and advanced problem with shin splints called a stress fracture. Some very good athletes have been hindered by this problem.
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 but also the femur (thigh) and foot. Occasionally, it occurs in the arm.
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.
Visit your doctor regularly and listen to your body.
Judging by my email inquiries on this topic, it is fairly safe to say that most readers of this column either directly or indirectly know of someone who has Multiple Sclerosis (MS). MS has been a part of my life as a physical therapist, friend, and relative of some very incredible people and their families, affected by this disease. According to the National Multiple Sclerosis Society, MS affects approximately 400,000 people in the United States. MS is second only to trauma as the most common cause of neurological disability for those in early to middle adulthood. MS is almost three times as common in women. MS is very uncommon before adolescence or after 50. However, the risk increases from teen years to age 50.
Multiple sclerosis is considered to be an autoimmune disease. The immune system of the body does not work properly when it fails to attack and protect the body against substances foreign to the body such as bacteria. Instead, the system allows the body to attack normal tissues and create diseases such as MS, rheumatoid arthritis and lupus. In MS, the immune system attacks the brain and spinal cord of the central nervous system. Each nerve has an outer covering of a fatty material (myelin) for insulation to improve the transmission and conductivity of impulses or messages to and from the brain. The damage to the myelin of the nervous system interrupts the ability of messages to travel to and from the brain, through the spinal cord and to other areas of the body such as the muscles in the arms and legs. Due to this “short circuiting” the brain becomes unable to send or receive messages. In multiple sclerosis, scar tissue or plaques (sclerosis) replaces the fatty myelin in “multiple” areas. This is also called demyelination.
The symptoms associated with MS vary greatly from person to person. The amount, frequency and speed of the demyelination process vary greatly and are directly related to the loss of strength and function in daily activities. Some people are independent and ambulatory with mild and infrequent episodes of weakness and disability and live a relatively normal life. Others suffer from frequent and aggressive episodes that significantly weaken and disable. Some common symptoms in the early stages include: muscle weakness, loss of coordination, blurred vision, pain in the eyes, double vision. Some common symptoms as the disease progresses are: muscle stiffness with muscle spasms, pain, difficulty controlling urination, difficulty thinking clearly.
The diagnosis of MS can be very difficulty in the early stages because the symptoms are often vague and temporary. Also, MS symptoms are very similar to other neurological problems. A neurologist will run several tests to rule out other possible problems. However, an MRI showing demyelination of the nerves is a primary confirmation.
Treatment for MS depends upon many factors and requires consultation with your physician. Some medications can control the frequency and severity of MS symptoms such as pain, weakness, and spasticity. Also, some drugs can slow the progression of certain types of MS. Additional treatments for MS include: diet, exercise, physical therapy, support groups, and counseling for the MS patient and their family. Part II of Multiple Sclerosis will discuss these options in further detail.
Visit your doctor regularly and listen to your body.
Multiple Sclerosis is a chronic disease. While it may lay dormant and stable for a period of time, living a healthy lifestyle will make a positive contribution toward how you and your family live with MS. Studies show that a life of family love and support are essential to maintain a positive attitude with a chronic illness. This combined with a healthy diet and proper exercise can contribute greatly toward taking control and living a relatively normal life with MS.
As I have mentioned in many other columns, studies show that people with good attitudes and great faith live longer than others. This is especially helpful when living with chronic disease. The Cleveland Clinic offers some suggestions how to maintain a positive attitude:
Many sources, including the Cleveland Clinic suggest that exercise, when performed properly, can have a positive impact on MS symptoms both physically and psychologically. However, because you have a chronic illness, you should consult with you family physician and physical therapist before beginning an exercise program. They will advise you on the proper type and amount of exercise.
Visit your doctor regularly and listen to your body.
