This is the third of three columns dedicated to healthcare for college students. Please find these “10 Tips to Keep Yourself Healthy in College” helpful. However, no discussion regarding the health and wellness of college students would be complete and thorough without addressing what health care and university experts consider the two most dangerous behaviors on college campuses across the nation: binge drinking and unprotected sexual activity.
While it is not my intent to offend the religious and moral values of any reader, it is my purpose to provoke direct and meaningful conversation between parents, religious leaders and students. To prevent serious health problems in college, parents must share their experience and discuss their values regarding sexual activity and alcohol consumption with children before they leave home to live independently in college. If you are unable to have a direct conversation about these issues, consider doing what several readers have done; mail a copy of this column to your child!
SOURCES: American Academy of Pediatrics
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

This is the second of three columns dedicated to healthcare for college students. As part of the preparation, think about a first aid kit, health care history, and insurance file. For parents without other children at home, once you finish with these preparations and your child departs for college away from home, plan to take dance, art history and conversational Italian classes to occupy your time without children. Resist the temptation to be a helicopter parent…life goes on!
Remember, living in a large community and sharing close quarters makes the development and spread of disease a natural progression. College life can be very unhealthy for many reasons: lack of sleep, poor eating habits, poor hygiene and stress.
Last week we discussed common illnesses among college students, how to manage and when to seek professional help. Below you will find a list of symptoms that should never be ignored. The college health services department should be contacted if you have any of the following symptoms:
Get a small/medium plastic storage box and use it to keep all the following health care items together in one place.
SOURCES: American Academy of Pediatrics
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy. Next Week: “Health Tips for College Students – Part III of 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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

It is hard to believe it is that time of year when parents and students are preparing to return to school. Many will leave home for the first time as college freshmen. Over the past month I have received several requests for a copy of my three-part series of columns on health tips for college students. In view of this, I thought other parents preparing to send a child off to college this fall might also find this information valuable.
To fully appreciate the importance of this topic, one must keep in mind that living in a large community and sharing close quarters is the first ingredient in the development and spread of disease. College life can be very unhealthy for many reasons. Lack of sleep, poor eating habits and stress add spice to the recipe for disease. Lastly, poor hygiene added to the equation will really get the Petri dish cooking up some nasty germs.
SOURCES: American Academy of Pediatrics
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Human beings were designed to move…walk, run, climb, lift, hunt, and gather. Contemporary man has suffered greatly from a technologically driven inactive and sedentary lifestyle. Inactivity is associated with many health problems; obesity, adult-onset diabetes, high blood pressure to name a few. Other problems associated with lack of movement are;
SOURCE: WebMD

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what type of exercise is best for those suffering from osteoarthritis (OA). Osteoarthritis is also known as degenerative arthritis. It is the most common form of arthritis in the knee. Osteoarthritis is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle. It causes gradual onset of pain, swelling and stiffness in the involved joint, especially after increased activity and weakness with loss of function due to disuse.
However, OA is not an excuse to avoid exercise, but it is important to be smart about it. Regular exercise is essential to maintain a normal lifestyle for those with OA. However, if you do the wrong exercise, use poor technique, or are too aggressive, you could flare up your joints and do more harm than good.
When performed correctly, exercise for those with Osteoarthritis has many benefits:
SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons; www.lifescript.com
Visit your doctor regularly and listen to your body.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

It is hard to believe that August is here but don’t panic, there is plenty of time to get outdoors and enjoy some sunny Vitamin D!
While protection from the sun is very important, too much time indoors playing computer games and watching television can lead to potential problems from lack of exposure to the sun. One must use good judgment and have balance as the potential exists for Vitamin D deficiency due to lack of sun exposure. This problem may be true for individuals who use too much protection or spend most of their day indoors due to occupation or poor health. Therefore, the purpose of this column will be to discuss the importance of Vitamin D for health and wellness.
Vitamin D, a fat-soluble vitamin, is found in food and can be made by your body after exposure to ultraviolet (UV) rays from the sun. The liver and kidney help convert Vitamin D to its active form. It assists with calcium absorption, which is essential for normal development and in forming and maintaining strong bones and teeth. Without it, bones can become thin, brittle and soft. The classic deficiency diseases are rickets in children and osteomalacia in adults. Rickets results in skeletal deformities. Osteomalacia is the softening of bones. Vitamin D is essential for normal bone health and may diminish or prevent the onset of osteoporosis in the elderly.
The requirement for Vitamin D is dependent on age, sex, degree of sun exposure and the amount of pigmentation in the skin. Since it can be produced by the body and retained for long periods of time by the body’s tissues, the precise daily requirement has been difficult to determine. Instead, an Adequate Intake (AI) level has been established. AI is a level of intake sufficient to maintain healthy blood levels of an active form of Vitamin D.
Vitamin D deficiency can occur when dietary intake of it is inadequate, when there is limited sunlight exposure, when the kidney cannot convert Vitamin D to its active form or when it is inadequately absorbed from the gastrointestinal tract. Season, geographic location, time of day, cloud cover, air pollution, sunscreens, living indoors and living in cities where tall buildings block adequate sunlight from reaching the ground affect UV ray exposure. Individuals with limited sun exposure are at risk of Vitamin D deficiency.
Homebound individuals, people living in northern latitudes (e.g. New England, Alaska), individuals who cover their bodies for religious reasons and people whose occupations prevent exposure to sunlight may need to supplement with Vitamin D. Sunscreens with a sun protection factor of 8 or greater will block UV rays that produce it. Older adults have a higher risk for deficiency because the skin’s ability to convert Vitamin D to its active form decreases with age and the kidneys, which help convert it to its active form, do not work as well when people age.
Individuals with pancreatic enzyme deficiency, Chron’s disease, cystic fibrosis, sprue, liver disease, surgical removal of part or all of the stomach or small bowel disease may need extra Vitamin D because it is a fat-soluble vitamin and they have reduced ability to absorb dietary fat. Vitamin D supplements are often recommended for exclusively breast-fed infants because human milk may not contain adequate amount. Consult with your pediatrician on this issue.
SOURCES: The National Institutes of Health; CDC

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

The list of diseases such as high blood pressure, diabetes, and stroke that can be managed, cured or prevented is endless. Certainly, cholesterol and heart disease are at the top of the list. Studies clearly demonstrate that managing cholesterol through education, medication, diet and exercise can significantly reduce the risk of heart disease.
Know your numbers. Learn the difference between unsaturated and saturated fats. Make yourself a student of healthy living through diet and exercise. Avoid fads and focus your effort on scientifically proven methods. Many experts feel that those with genetically high cholesterol should use exercise and diet to maintain health but will also need require the addition of a statin drug to manage cholesterol effectively.
There are many methods to lower your LDL (bad cholesterol). However, no method has been proven more successful than statin drugs. Multiple landmark studies confirm that for those individuals needing statin drugs to control their cholesterol, the benefits far outweigh the risks.
By inhibiting an enzyme in the liver, statin drugs limit the liver’s ability to produce cholesterol thereby significantly lowering LDL (bad cholesterol) and triglycerides and modestly increasing HDL (good cholesterol). As a result, their unique benefits include preventing and reducing plaque in arteries, stabilizing existing plaque, reducing inflammation of the arterial wall, and improving overall vascular function. Statin Drugs Include: Lipitor (atorvastatin); Lescol (fluvastatin); Mevacor (lovastatin); Pravachol (pravastatin); Zocor (simvastatin); Crestor (rosuvastatin).
Clinical studies that have shown that statin drugs significantly reduce the risk of heart attack and death in patients with proven coronary artery disease (CAD) and can also reduce cardiac events in patients with high cholesterol levels who are at increased risk for heart disease. And although statins are best known for lowering cholesterol, they may also have several other benefits: they may prevent Alzheimer’s disease, and they may also have a positive impact on diabetes and blood pressure.
Second only to statin drugs, no other method of the prevention of CAD has proven more effective than exercise, specifically aerobic exercise. It is well documented that physically active people have a lower incidence of CAD than sedentary people. For the prevention of CAD, the following exercises are defined as aerobic: High Amount/High Intensity – a caloric equivalent of jogging 20 miles per week at 65 -80 percent intensity, Low Amount/High Intensity – a caloric equivalent of jogging 12 miles per week at 65 to 80 percent intensity, Low Amount/Moderate Intensity – a caloric equivalent of walking 12 miles per week at 40 to 55 percent intensity.
Exercise is a valuable prevention tool on many levels: it reduces weight, LDL, and blood pressure, and it increases HDL. Research has found that the amount of exercise matters more than the intensity. For example, those exercising 5 or more days per week benefited more than those exercising less often. However, it is important to remember that ALL exercise groups showed improvement.
Following a Mediterranean diet is one way you can reduce CAD and cut your risks for other diseases. While no Mediterranean diet has more value than another, the following equation highlights the factors that make a Mediterranean diet so valuable. First, eat a variety of fruits, vegetables, whole grains, beans, nuts, and seeds, with olive oil as an important source of fat. Then, add moderate amounts of fish, poultry and fresh dairy. Finally, subtract red meat from your diet, or at least limit your consumption.
The Dietary Approaches to Stop Hypertension (DASH) diet is the American version of the Mediterranean diet and has been found to reduce blood pressure and LDL levels. It is rich in fruits and vegetables, moderate in low-fat dairy, and low in animal protein. It promotes the use of legumes and nuts as plant sources of protein.
Along with increasing your plant-based foods and decreasing your consumption of red meat, you may also want to replace some of the carbohydrates in your diet with proteins or monounsaturated fats. This switch can improve lipid levels.
Dietary soluble fibers such as pectin, wheat dextrin, and oat products will reduce LDL. Some suggest that a combination of soluble fiber with plant sterols may be beneficial. Walnuts, high in polyunsaturated fatty acids, have been shown to positively impact serum lipid levels. Almonds, pistachios and other nuts have shown similar results. Those consuming nuts more than four times per week showed the most significant improvement. Also, those with moderately high LDL who drank green tea once to twice per day while following a low-fat diet found more improvement in LDL reduction than they did with a placebo. Moderate alcohol consumption (1-2 drinks per day) has been shown to improve HDL levels. Red wine has the added antioxidant benefit even in its non-alcohol form.
Fat cells secrete chemicals that negatively affect lipid metabolism. “Maintaining a body that is slim and trim with consistent exercise and a low-calorie diet limited in saturated fats is the key”
While the internet is littered with information on thousands of supplements claiming to lower cholesterol and provide other life enhancing outcomes, few are proven effective. Of these, only fish oil, taken in concentrated high doses (> 6g/day) has been proven to lower triglycerides and LDL.
Multivitamins, soy proteins, and other grain products, while not cholesterol reducing, are valuable to many. But when it comes to reducing cholesterol, garlic, policosanol, Vitamin E, and isoflavone supplements have failed the scrutiny of scientific research. Plant sterols such as BenecolR sisosterol and campesterol, found in Promise activTM, have been shown to slightly reduce serum cholesterol levels; however, no studies have demonstrated their ability to lower the incidence of CAD. In fact, the Nutrition Committee of the American Heart Association has suggested that the general population not use these products until further studies determine their safety and efficacy, due in part to potential side effects.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

We are in the middle of another heat wave this summer and ice baths, which people do all year, may sound like a very refreshing thing to do! But, before you take the plunge, know the benefits and risks of a frigid bath.
Ice baths have become a new trend or fad in health and fitness, especially among elite athletes and some celebrities. In fact, it is impossible to scroll through social media without encountering someone “taking the frigid plunge!” However, it is far from a new treatment modality. The Ancient Greeks employed cold-water immersion for fever, pain relief, relaxation and socialization. In fact, Hippocrates documented the use of cold for medicinal purposes for its analgesic benefits.
Ice baths, a type of cryotherapy, is also referred to as cold water immersion (CWI) or cold-water therapy, involves immersing your body in ice water for approximately 5-15 minutes from the neck down at a temperature of 50-59 degrees. The ice baths are commonly used for pain, delayed-onset muscle soreness (DOMS), and inflammation and mood elevation.
In theory, the cold water lowers the temperature of your skin and body by vasoconstriction (narrow) of the blood vessels. When you get out of the cold water the vasodilatation (widen) of the blood vessels immediately brings fresh oxygen and nutrient-rich blood back to the tissues to warm the body and in the process, reduce pain, inflammation and promote healing.
Ice baths are not without risk and not everyone reacts the same way to ice immersion. It is recommended that one engages in ice exposure gradually, for short periods and in a controlled setting like a home shower. Furthermore, one must be mindful of age, general health, time of exposure, and water temperature. Remember, body temperature is 98.6 and water temperature of 65-70 degrees will feel very cold so 50-59 degrees can create problems such as:
If you have the following health conditions, ice baths may not be the best therapeutic modality for you. Before you consider trying an ice bath, consult with your physician to avoid potentially serious problems:
While some studies have shown that subjects report less muscle soreness following CWI when compared to rest, most studies suggest that the reported effects are placebo. Also, reports of improved circulation, reduced inflammation and improved recovery or performance has not been scientifically validated. In view of this, it is recommended that those considering the use of CWI for pain and inflammation management, reduced muscle soreness, and mood elevation, should consult their physician to determine if the potential risks are worth the purported benefits.
SOURCES: nih; health.com; health.clevelandclinic.org; prevention.com

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

This column is repeated every year at this time with the intent of raising the level of awareness to prevent death or serious illness from heat stroke in athletes and other active people in hot, humid weather.
It is mid-July, and we have managed to survive two “heat waves” in NEPA. While it is important to have fun in the sun, please be mindful of how your body reacts to high humidity and heat and take appropriate precautions. Athletes are particularly vulnerable due to daytime practice sessions. In response to this potential problem, the PIAA has established acclimatization guidelines for fall sports beginning in August. Visit www.piaa.org for more information. Keep in mind, you don’t have to be running a marathon or playing football in full uniform to suffer from heat stroke. Adults 65 and older, and infants/young children (5 and younger) are vulnerable. Those with chronic conditions such as diabetes, cardiovascular diseases, and obesity are also at higher risk.
Heat stroke, one of the most serious heat-related illnesses, is the result of long-term exposure to the sun to the point which a person cannot sweat enough to lower the body temperature. The elderly and infants are most susceptible, and it can be fatal if not managed properly and immediately. Believe it or not, the exact cause of heatstroke is unclear. Prevention is the best treatment because it can strike suddenly without warning. It can also occur in non athletes at outdoor concerts, outdoor carnivals, or backyard activities.
Some “old school” folks think that wearing extra clothing and “breaking a good sweat” is an optimal goal for exercise. However, it may be potentially very dangerous in hot and humid conditions. When exercising in hot weather, the body is under additional stress. As the activity and the hot air increase your core temperature, your body will try to deliver more blood to your skin to cool it down. In doing so, your heart rate is increased, and less blood is available for your muscles, which leads to cramping and other more serious problems. In humid conditions, problems are magnified as sweat cannot be evaporated from the skin to assist in cooling the body.
The American Academy of Pediatrics and The American College of Sports Medicine have the following recommendations which are appropriate for both the competitive athlete and weekend warrior:

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

It’s peak summer time … so make time to get to the water! Research shows that spending time outdoors has many positive effects on your health. Moreover, new research has found that being near a body of water makes us calmer and healthier. You know that special feeling you get when you drive to the lake or the beach and jump out of the car and smell the fresh air and hear the sound of splashing in the lake or the waves of the ocean? Well, it is not just because you’re on vacation…the water makes your muscles relax and breath deeper. Your brainwaves slow down to simulate the gentle roll of the water…lake or ocean! These “blue environments,” not to be confused with “blue zones” are the subject of extensive research at the University of Exeter Medical School in the UK.
Time spent near water promotes physical activity, general fitness and well-being. It is also associated with reducing the incidence of diabetes and other diseases associated with obesity. Additionally, time near the water slows down our heart rate, reduces stress hormones and improves mental health. In fact, the study also found that subconsciously, people consistently preferred pictures of natural environments (rivers, lakes, oceans) even when compared to attractive urban landscapes. In fact, urban landscapes with water (rivers, fountains etc) were far more popular than those without. And, health disparities between coastal and inland communities are more noticeable for low-income individuals who do not have the means to venture to the coast. This may be one of the reasons that four out of the five “Blue Zones” discovered by Dan Buettner are islands.
In addition to the benefits of being by a body of water, just being outdoors promotes better health and wellness:
Sources: NIH, Global News, Plume, L, University of Exeter Medical School in the UK.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
