Most of us are all too familiar with someone in our family or workplace that can be
described as a hyperactive or high energy person. I am sure members of my family or
coworkers in my office are thinking that this statement is a self-description.
Consequently, based on doctor’s advice, it is best to limit me to one cup of coffee or pay
the price when I become a hyperactive taskmaster. Now, after further research on this
topic, I have concluded that it may be that I may be hyperactive by nature, regardless of
my caffeine intake. While many of you may find the following facts hard to believe, and
the effects of caffeine may vary for everyone, the facts are still the facts.

Caffeine

Approximately 80% of the world's population consumes caffeine on a daily basis. While
research is constantly being done on health benefits and side-effects of caffeine, great
controversy and misconception persists. The purpose of this column will be to discuss the
“current wisdom” and present the truth about caffeine.
Caffeine is completely absorbed within 30 to 45 minutes of ingestion and its effects
linger for about three hours. Eventually it is excreted and there is no accumulation in the
body. Caffeine has been shown to affect mood, stamina, the blood vessels in the brain, as
well as stomach and intestinal activity. However, for most people, when used in
moderation (200 to 300mg or 2-3 cups), caffeine use is perfectly safe and may offer some
health benefits.

Sources of Caffeine

Caffeine is a natural substance found in certain leaves, seeds, and fruits of over 60 plants
worldwide. In our culture, the most common sources in our diet are coffee, tea leaves,
cocoa beans, cola, and energy drinks. Caffeine can also be produced synthetically and
added to food, beverages, supplements, and medications. Consumption of 130 to 300 mg
of caffeine per day is considered minimal to moderate. Amounts exceeding 500 mg are
moderate to heavy and more than 1000 mg/day is excessive. The average daily caffeine
consumption among Americans is about 280 mg/day and 20% to 30% consume more
than 600 mg/day.

Caffeine contents in some of the more popular forms are:

• 8 oz. brewed coffee                  - 133 mg caffeine
• 8 oz. decaffeinated coffee           - 5 mg caffeine
• 2 oz. Starbucks dble expresso - 150 mg caffeine
• 12 oz. Diet Coke                           - 47 mg caffeine
• 8.3 oz Red Bull                           -80 mg caffeine
• 8 oz hot cocoa                              -9 mg caffeine
• 12 oz Jolt Cola                             -72 mg caffeine
• 8 oz black tea                               -53 mg caffeine

THE TRUTH ABOUT CAFFEINE

Caffeine is Not Addictive

Caffeine can be habit-forming, but it is not addictive. The American Journal of Drug and Alcohol Abuse states that caffeine is a mild stimulant but does not have the qualities of addictive stimulants like cocaine and amphetamines. However, sudden abstinence from caffeine can produce mild withdrawal symptoms such as headache, restlessness, and irritability. Therefore, it is recommended to slowly wean off caffeine over a week or two to lessen these symptoms.

The need to eliminate caffeine from your diet is not supported in the literature. In fact, studies show that moderate caffeine use can enhance your mood and improve focus and alertness. The American Dietetic Association suggests limiting caffeine intake to 200mg to 300mg (2- 3 cups of coffee) per day.

Caffeine Does Not Necessarily Cause Dehydration

While caffeine is a diuretic, its effects are very mild. However, like all diuretics, it will cause you to urinate more often and therefore, lose fluids. The more fluids you lose, the greater the chance for dehydration, especially if you are at risk due to health issues. Also, long distance runners and athletes performing in conditions of extreme heat must use caution. Minimal to moderate caffeine intake with generous use of water and sports drinks should suffice.

Caffeine Does Not Contribute to Heart Disease

A study conducted at the University of Madrid of more than 126,000 people found that women who drank 2-3 cups of caffeinated coffee per day had a 25% lower risk of heart disease. Also, a 33-yearlong study of more than 1,000 participants at Johns Hopkins University found that coffee had no significant effect on the risk of hypertension. Moderation seemed to be the key component in these studies. Interestingly, caffeinated colas did increase the risk of hypertension; however, it was believed to be due to the high amounts of sugars and other ingredients in the drink.

However, for many reasons, physicians tell their cardiac patients, especially those with high blood pressure or abnormal heart rhythms, to avoid caffeine. This matter should be discussed in more detail with your physician before using caffeine. Tea, especially black and green, contains a much smaller amount of caffeine than coffee, is often recommended for the health benefits of antioxidants.

Caffeine Does Not Cause Hyperactivity in Children

While studies show that moderate caffeine (40 – 200mg) in children does not make them hyperactive, others demonstrate that a 12 oz can of cola with only 35 mg of caffeine makes them bounce off the walls. It has been concluded that it is the sugar and other ingredients in the soda that makes them hyperactive. In fact, some studies show that small amounts of caffeine can work like Ritalin and improves focus in children with attention disorders.

Caffeine Does Not Cause Bone Loss

Caffeine has been shown to increase calcium excretion when taken in large amounts. Unless a child drinks caffeinated coffee in place of milk, there is no scientific evidence that bone loss will occur. When caffeine is used in moderation, no evidence of bone loss exists.

Caffeine Does Not Cause Fibrocystic Breast Disease

There is no scientific evidence to support the claim that caffeine causes fibrocystic breast disease or breast cancer. Confusion may lie with the fact that caffeine is associated with increased breast pain during monthly hormonal changes. If so, women are well advised to reduce the intake of caffeine during this time.

Source: www.LifeScript.com

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

Read Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/forum/

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.

November is also Native American Heritage Month!

Happy Thanksgiving! Like most of you, I am most thankful for the love and support of my family and friends. I am also very thankful for health and wellness. But this year, the year of the global pandemic which has limited my access to the warm hugs and smiles of those I love, I am more grateful than ever for simple things…the beauty of nature and the great outdoors in NEPA!

With this in mind, I am also grateful to the first environmentalists in the Americas…Native Americans! Long before John Muir and the Sierra Club, Native Americans were stewards of the planet. Native Americans feel that everything in nature has a soul… living creatures, trees, mountains, rocks and even water! Therefore, they believe that all of nature must be treated with respect and honor.  Today, when being outdoors in nature is more important than ever, we are the beneficiaries of their stewardship. Now it is our turn to enjoy, respect and protect nature for future generations!

GET THE HECK OUTSIDE!

Research shows that spending time outdoors has many positive effects on your health. With a little imagination, one can find many year round activity options in Northeastern Pennsylvania. While swimming, boating, kayaking, biking and golfing may be winding down, consider other options this winter. With proper equipment and clothing, walking, running, hiking, fat-tire biking, snowshoeing, cross-country and downhill skiing can be enjoyed. Studies show that even less vigorous activities such as barbequing or reading a good book on the porch are healthier than being indoors... so bundle up next to a good fire pit or outdoor propane heater and get outdoors!

Even before the pandemic, it was reported that Americans spend 90% of their lives indoors and that number increases with age. Worse yet, for some, venturing outdoors is considered risky behavior with fear of the sun, heat, ticks, wind, cold, mosquitoes and other creatures of God. Well, the truth of the matter is the risk of being one with nature is far less than the ill effects of a life stuck indoors. Please consider the following benefits of spending time outdoors.

• Nature’s Vitamin D – Current research suggests that Vitamin D (The Sunshine Vitamin), may offer significant disease prevention and healing powers for osteoporosis, some forms of cancer and heart disease. Of all the methods of getting an adequate amount of Vitamin D, none is more fun than spending time outdoors in the sunlight. It seems that health concerns of ultraviolet light, sun burn and skin cancer have created an overreaction to the point of Vitamin D deficiency in many. Balance and common sense go a long way. One can attain normal levels of Vitamin D by being outdoors in the sun and exposing their arms and legs for 10 -15 minutes a few times per week. Additional time in the sun warrants sunscreen and Vitamin D supplements can be used if necessary.

• Increase Activity Level – While exercising indoors in a gym is valuable, research shows that time spent indoors is associated with being sedentary and being sedentary is associated with obesity, especially in children. Some studies show that children in the United States spend an average of 6 ½ hours per day with electronic devices such as computers, video games and television. It is also reported that a child’s activity level more than doubles when they are outdoors. So, get out of the office, house and gym as often as possible. Consider weight training at the gym and doing cardio by walking, biking or running outdoors.    

• Improved Mental Health – It is well documented that light affects mood. So, unless you live in a glass house or a light box, getting outdoors is important to your mental health. Furthermore, studies show that exercising outdoors in the presence of nature, even for as little as 5- 10 minutes has additional mental health benefits. For those less active, read or listen to music outdoors next to a fire.

• Improved Concentration – Richard Louv, author of the book, “Last Child in the Woods,” coined the term, nature-deficit disorder.” This term is supported by research that found children with ADHD focus better when outdoors. Furthermore, it was discovered that these children scored higher on concentration tests following a walk in the park than they did after a walk in their residential neighborhoods or downtown areas, showing the benefit of the “green outdoors.”

• Improved Health and Healing – Researchers at the University of Pittsburgh found that patients recovering from surgery recovered faster with less pain and shorter hospital stays when they were exposed to natural light. Next time you’re recovering from an illness, discuss this with your physician.
• Improved Breathing – In general, breathing fresh air is good for you. Some exceptions might be those with severe allergy problems when the pollen count is high. In spite of this, it may be better to take allergy medicine and enjoy the benefits of being outdoors than to be stuck inside. Many pulmonologists believe people with pulmonary problems would benefit from outdoor activities such as a 10-15 minute walk because they are prone to osteoporosis and Vitamin D deficiency.  Local pulmonologist, Dr. Gregory Cali, DO, agrees and also adds that studies do not show that high humidity is dangerous for respiratory patients but it may be uncomfortable. In cold temperatures, those with pulmonary problems must avoid directly breathing cold air by covering up their mouths when walking outdoors. Overall, the benefits far outweigh the risks.

Read “Health & Exercise Forum” – Every Monday.  

OR access ALL of Dr. Mackarey's content at https://mackareyphysicaltherapy.com/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.

Lung Cancer is a deadly disease. Until recently, there was not an effective and safe screening test. A chest X-ray, often used only after patients developed symptoms, discovered the disease when it was in its late stages. This is about to change. Those who are at high risk for lung cancer can now be screened annually using low-dose spiral CT scans

Lung Cancer Facts:

One of the reasons for the high mortality rate in lung cancer is that the disease is often not discovered until it is advanced and treatment options are limited. Some of the most common signs and symptoms of lung cancer are easily mistaken either for a mild illness or for things such as “smoker’s cough”.  By the time many patients are diagnosed, their disease is advanced and may involve lymph nodes or other organs. 

For some cancers, there are established screening tests that help to identify these cancers at an earlier stage.  For example, routine screenings through colonoscopies, mammograms, and pap smears are well established and have saved thousands of lives.  Until recently, lung cancer has not had such a screening test.

In 2013, The United States Preventative Task Force (USPTF), an independent committee charged by congress to evaluate current data, recommended that all persons who are at high risk for lung cancer should be screened annually using low-dose spiral CT scans.  High risk persons are identified as those who are between the ages of 55 and 79, who have a history of 30 pack years or more of smoking, and who are either still smoking or who have quit within the last 15 years.  A “pack year” is defined as smoking 1 pack of cigarettes a day for a year. For example, a person could have 30 pack years of smoking if they smoke 1 pack of cigarettes a day for 30 years.  Similarly, they could have a 30-pack year history by smoking 2 packs of cigarettes a day for 15 years.

CT, or computed tomography, scans are a form of three-dimensional imaging used by clinicians to visualize the organs and other anatomy of patients.  The scan can detect abnormalities on a patient’s lung with much earlier and with greater sensitivity than an x-ray.  Much like a mammogram, low-dose CT scans do not diagnose cancer but are a way to identify patients with abnormalities that need to be investigated further for the possibility of cancer.  This new screening test will allow physicians to see possibly cancerous abnormalities of the lung before the disease can spread and become impossible to cure.  The scan is non-invasive and generally considered very safe. Low-dose CT scans carry about 5 times less radiation than traditional high-dose CT scans and are equivalent to about 15 x-rays.

This screening practice can save the lives of between 15 and 20% of those diagnosed with lung cancer by detecting cancers before they can progress to the point that they are resistant to medical treatment. While this screening is a major step in the detection and treatment of lung cancer, it is not a substitute for quitting smoking.  The best proven methods to prevent lung cancer and its deadly consequences is to not smoke, use other tobacco products, and avoid exposure to second-hand smoke. If you or a loved one need help quitting tobacco products, you may contact your physician or call 1-800-QUIT-NOW or visit www.lung.org.

Signs and Symptoms of Lung Cancer:

• Cough that does not get better with time
• Chest pain that gets worse with deep breathing
• Hoarseness
• Coughing up blood
• Shortness of breath
• Weight loss and appetite loss
• Tiredness and weakness
• Recurrent respiratory infections
• New onset wheezing

NOTE: These signs and symptoms can be attributed to many different causes and are not exclusive to lung cancer. Always discuss your symptoms with your physician.

Who should be included in annual low-dose spiral CT screening for lung cancer?

Patients who fit all of the below criteria:

• Between the ages of 55 and 79
• 30 pack years of smoking or more*
• Still smoking or having quit within the last 15 years

*A pack year is defined as 1 pack of cigarettes per day for a year

Contributions: Sarah Bashaw, MD: participated in this column as a third year medical student while studying at TCMC (GCSOM).

Medical Reviewer: Greg Cali, DO, Pulmonologist, Dunmore, PA

Read “Health & Exercise Forum” – Every Monday.  This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Read all of Dr. Mackarey articles in our Health Care Forum at: https://mackareyphysicaltherapy.com/forum/

Exercise and be Happy!

Part II of II

Last week in Part I on Depression I discussed the importance of laughter for the prevention of depression. In this column, I will discuss one of the most understated benefits of exercise – mental health! Specifically, aerobic exercise (exercise that increases your heart rate for 30 minutes or more) such as walking, biking, running, swimming, hiking, elliptical & stepper machines to name a few, is the secret to “runner’s high.” This exercise euphoria is not limited to runners alone, but all who engage in aerobic exercise are more likely to experience high energy, positive attitude, and mental wellness.

Physical activity, specifically aerobic exercise, is a scientifically proven useful tool for preventing and easing depression symptoms. Studies in the British Journal of Medicine and the Journal of Exercise and Sports Science found that depression scores were significantly reduced in groups that engaged in aerobic running, jogging or walking programs, 30-45 minutes 3-5 days per week for 10-12 weeks, when compared to a control group and a psychotherapy counseling group.

Depression is the most common mental disorder and is twice as common among women as in men. Symptoms include: fatigue, sleeplessness, decreased appetite, decreased sexual interest, weight change, and constipation. Many of these symptoms are likely to bring an individual to their family physician. Unfortunately, depression is on the increase in the United States. According to the National Ambulatory Medical Care Survey, in the early 2000’s, 7 million visits to a primary care physician were for the treatment of depression. 10 years later the number doubled.

HOW EXERCISE REDUCES DEPRESSION

            According to research reported in The Physical and Sportsmedicine, exercise reduces depression in two ways, psychologically (mentally) and physiological (physically). 

Psychological or Mental Benefits of Exercise on Depression:

• Helps a person gain control over their lives
• Increases self-esteem
• Diverts attention away from worry, concern or guilt
• Improves mood – with visible signs of improvement in physique & body weight
• Increases sense of pleasure and satisfaction
• Anger management – release pent-up frustration, anger and hostility

Physiological or Physical Benefits of Exercise on Depression:

• Increase in brain serotonin (natural mood elevator chemical in brain)
• Increase in beta-endorphins (natural mood, stress & pain control chemical in brain)
• Improvement in natural sleep patterns

HOW TO BEGIN EXERCISE FOR DEPRESSION

• First and most importantly, consult your primary care physician to confirm the diagnosis of depression. Be sure that your symptoms are not related to other health problems. Also, if you are using antidepressant or other medications discuss the impact it may have on your exercise program with your physician.
• Recognize and fight depression symptoms that are contrary to or prohibit physical activity such as: fatigue, lack of energy, slow motor skills.

Work hard to recognize and overcome these symptoms to begin an exercise program. An aerobic exercise routine should eventually lessen these symptoms.

• Be realistic. Expect that aerobic exercise will take time to have a noticeable benefit. Do not get overly ambitious and set yourself up for failure.
• Begin with an aerobic exercise program that is practical and destined to succeed. For example: inactive and deconditioned people should begin walking 5 minutes per day, 3-5 days per week for 1 week. Then, add 3-5 minutes each week until you attain 30-45 minutes per walk 3-5 times per week. Younger and fitter people can begin to walk for 15 minutes and continue until they attain 45-60 minutes per walk, 3-5 times per week. Remember, what seems impossible today will be easier and routine in 3-4 weeks so JUST DO IT !
• Find a pleasurable environment: a beautiful park (Nay Aug), a scenic lake (Lake Scranton), quiet countryside (rural farmlands of Dalton). Use a mall in inclement weather.
• Find a friendly, uplifting group of  people to enjoy a good walk and talk. This may be more appropriate for people feeling isolated or withdrawn. Others may enjoy the peace and quiet of exercising and meditating alone.
• Be specific and compliant! Make a serious commitment. Keep a journal or exercise log. Mark a calendar. 30-45 minutes, 3-5 days per week – NO EXCUSES! Get and exercise buddy you can count on and help keep you compliant!
• Make it fun! Mix it up. Walk 3 days, swim or bike 1-2 days, some days alone, some days with a buddy.
• BE RELIGIOUS! Be religious about exercise BUT don’t get too compulsive!

Read Dr. Mackarey’s Health & Exercise Forum – every Monday

Access all of Dr. Mackarey's articles in the Health and Exercise Forum at: https://mackareyphysicaltherapy.com/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 in downtown Scranton and is an associate professor of clinical medicine at GCSOM.

Laugh and Walk Your Way to Happiness!

Part I of II

It has been 9 long months living with COVID 19! Most of us are weary and tired of social distancing, wearing masks, visiting with family from a distance or virtually. We miss the hugs and kisses of our family and friends. While it is critically important that we continue to stay vigilant, with no end in sight people are beginning to get “the COVID BLUES.” It only takes a few other problems like stress at work and health issues to put you over the edge…

Depression is the most common mental disorder and is twice as common among women as in men. It impacts life in many ways; family, friends, work, play and general health. Symptoms include: fatigue, sleeplessness, decreased appetite, decreased sexual interest, weight change, and constipation. Many of these symptoms are likely to bring an individual to their family physician. Unfortunately, depression is on the increase in the United States. According to the National Ambulatory Medical Care Survey, in the early 2000’s, 7 million visits to a primary care physician were for the treatment of depression. 10 years later the number doubled.

Recent research is very encouraging and supports the use of laughter and exercise to prevent and treat depression as a powerful adjunct to therapy and medication. While it is important to state that depression is no laughing matter, many mental health professionals support it as a method to confront an unpleasant situation and gain some level of control over it. One study showed that in elderly people who used humor on a regular basis, reported improved satisfaction in life as compared to their less humorous contemporaries.

4 Reasons Why Humor is Helpful in Battling Depression (based on recent studies)

1. Humor Demystifies Depression

Humor lets others know that you can be depressed and still be human…a productive and valuable member of society. For example, “I’m depressed but I am not a bad person and I can still be funny and fun to be around.”

2. Humor Improves Your Mood

Humor lightens temperament as it increases blood flow to the brain to release dopamine and endorphin, which are chemicals that improve mood.

3. Humor Relieves Stress

Humor increases chemicals in the brain that control the release of a stress release hormone called cortisol.

4. Humor Improves Self-Esteem

Telling a joke, being funny, and making others laugh, make YOU feel good about yourself…and feel more normal.

4 Tips to Improve Your Sense of Humor

1. Hang Around With Fun and Funny People

Whenever possible, try to associate with good people who “pick you up” and have good karma. Avoid people who are “downers” and tend to “such the oxygen” out of the room.

2. Listen to Jokes & Learn to Enjoy Them

While this may be difficult to do when your down, but it will go a long way to pick you up.

3. Learn to Tell a Joke

This is also not easy but very important to improve your sense of humor. It will help you rediscover your “inner child.” Ease into it and start slowly. Practice in front of a mirror in the privacy of your home. Begin using it on family and good friends.

4. Joke About Your Depression

It will be cathartic. For example, “oh my God, that would be so funny if I wasn’t depressed!” “Don’t tell my shrink I laughed so hard because he will take away my meds!” Don’t put yourself down, but laugh at yourself if you mess up telling a joke or trying to be funny. Then, try again.

Sources: LifeScript.com. If you or someone you know is in danger from depression contact the American Foundation For Suicide Prevention at 1-888-333-2377.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. Or view all of Dr. Mackarey's articles in out Health and Exercise Forum at: https://mackareyphysicaltherapy.com/forum/

Next Week, Part II of II - Exercise to Prevent Depression.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at GCSOM.

Part II of II

It is difficult to take care of a senior with many needs. The demands of care-giving can create situations in which abuse is more likely to occur. Even though many non-professional care-givers consider their role to be satisfying and enriching, the responsibilities can be extremely stressful. This stress can escalate, especially as the elder’s condition deteriorates, and can lead to mental and physical health problems causing caregivers to burn out, become impatient, and unable to restrain their frustration.

Among caregivers, significant risk factors for elder abuse are:

• Inability to cope with stress (lack of resilience)
• Depression, which is common among caregivers
• Lack of support from other potential caregivers
• The caregiver’s perception that taking care of the elder is burdensome and without psychological reward
• Substance abuse

Even caregivers in institutional settings can experience stress at levels that can lead to elder abuse. Nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities, are unsuited for care-giving, or work under poor conditions.

Several factors concerning the elders themselves, while they do not excuse abuse, influence whether they are at greater risk for abuse:

• The intensity of an elder’s illness or dementia
• Social isolation: the elder and caregiver are alone together almost all of the time
• The elder’s role, at an earlier time, as an abusive parent or spouse
• A history of domestic violence in the home
• The elder’s own tendency toward verbal or physical aggression

In many cases, elder abuse, though real, is unintentional. Caregivers may be pushed beyond their capabilities or psychological resources.

You can protect yourself from elder abuse by:

• Make sure your financial and legal affairs are in order. Obtain legal advice concerning arrangements for future disability (e.g. power of attorney).
• Review your will periodically.
• Arrange to have your social security check or pension check deposited directly into your bank account. 
• Avoid becoming isolated. Keep in touch with family and friends. Participate in social and community activities.
• Do not live with someone who has a history of violent behavior or substance abuse.
• Do not sign a document unless someone you trust has reviewed it.
• If you are unhappy with the care you are receiving, at home or in a facility, tell someone you trust.

Caregivers can prevent from becoming elder abusers by following some simple suggestions:

• Request help from friends, relatives, or local respite agencies so you can take a break.
• Find an adult day care program.
• Stay healthy and get medical care for yourself when necessary.
• Do not ignore your limitations and overextend yourself.
• Adopt stress reduction practices.
• Seek counseling for depression.
• Find a support group for caregivers of the elderly.
• If you are having problems with drug or alcohol abuse, get help.
• Do not offer personal home care unless you thoroughly understand the demands and can meet the responsibility and costs involved.

Elder abuse help-lines offer help for caregivers as well. Call a helpline if you think there is a possibility that you might cross the line into elder abuse. (REPORT ELDER ABUSE: PA Dept of Aging 24 Hotline 1-800-490-8505)

If you suspect elder abuse, report it. Look at the elder’s medications to see if the amount left in the bottle is consistent with the dosing schedule and date of the prescription. Watch for possible financial abuse by asking the elder if you may scan financial documents for unauthorized transactions. Call and visit the elderly person as often as you can. Offer to stay with the elder so that the caregiver can have a break.  

Many seniors do not report abuse. Many are ashamed, feel responsible or fear retaliation from the abuser. Others believe that if they turn on their abusers, no one else will take care of them. If you are an elder who is being abused, neglected, or exploited, tell at least one person: your doctor, a friend, or a family member whom you can trust. Every state has at least one toll-free elder abuse hotline or helpline for reporting elder abuse in the home, in the community, or in nursing homes and other long term care facilities. You can also call Eldercare Locator at 1-800-677-1116. For those over the age of 60, help is available through local Area Agencies on Aging (AAA).

Part I of II

One in seven senior citizens nationwide falls victim to some type of elder abuse, usually at the hands of a family member. The abuse can be financial, physical, or psychological and the consequences can be deadly. Statistics suggest that abused and exploited seniors die sooner than other seniors their age. Despite such devastating consequences, most elder abuse goes unreported because of fear or lack of knowledge. If you have been abused, you may be afraid of what might happen if you tell someone. If you suspect that an elderly neighbor or friend is being abused, you may not know where to turn for assistance.

(REPORT ELDER ABUSE: PA Dept of Aging 24 Hotline 1-800-490-8505)

Elder abuse is the use of power or control to affect the well-being and status of an older individual. The World Health Organization considers elder abuse as a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. The core feature of this definition focuses on harm which includes mistreatment by people the older person knows or with whom they have a relationship, such as spouse, partner, or family member, a friend or neighbor, or people that the older person relies on for services.

There are several types of elder abuse that are universally recognized:

• Physical: hitting, punching, slapping, burning, pushing, kicking, restraining, false imprisonment, confinement, giving too much or the wrong medication.
• Psychological/Emotional: shouting, swearing, frightening, blaming, ridiculing, constantly criticizing, ignoring, or humiliating a person. A common theme is identifying something that matters to an elder and then using it for coercion.
• Financial: illegal or unauthorized use of a person’s property, money, or other valuables (including changing the person’s will to name the abuser as heir), often fraudulently obtaining power of attorney, followed by deprivation of money or other property, or by eviction from own home.
• Sexual: forcing a person to take part in any sexual activity without consent, including forcing them to unwillingly participate in conversations of a sexual nature.
• Neglect: depriving a person offood, heat, clothing, comfort, or essential medication.
• Rights Abuse: denying the civil and constitutional rights of an elder who was not declared by court to be mentally incapacitated.
• Self-neglect: elderly persons neglecting themselves by not caring about their own health or safety.

Each different type of elder abuse has specific signs. Below are some indicators that you need to be aware of and may recognize when involved personally or professionally with an elderly person:

• Physical: Overt signs of physical trauma: scratches, bruises, cuts, burns, punctures, choke marks; signs of restraint trauma: rope burns, gag marks, welts; repeated, unexplained injuries: sprains, fractures, detached retina, dislocation, paralysis; inconsistent explanations of these injuries; repeated time lag between injury and medical treatment.  
• Psychological/Emotional: Caregiver misbehavior that you witness: threatening, belittling, or controlling; behavior from the elder that mimics dementia: rocking, sucking, mumbling to oneself; other psychological signs: ambivalence, deference, passivity, shame, anxiety, depression, hopelessness, helplessness, suicidal thoughts, confusion, disorientation; behavioral signs: trembling, clinging, cowering, lack of eye contact, evasiveness, agitation, hyper-vigilance.
• Financial: Unusual banking activity: large withdrawals during a brief period of time, switching accounts from one bank to another, ATM activity by a homebound elder, signatures on checks and other documents do not match the signature of the older person, addition of names to senior’s signature card; suspicious changes in financial documents: wills, power of attorney, titles, and policies; items or cash missing from senior’s household: jewelry, art, furs; elders living situation not commensurate with size of elder’s estate: lack of new clothing or amenities, unpaid bills, lack of medical care.
• Sexual: Bruises: breasts, genitals; unexplained diseases or infections: venereal, genital; unexplained bleeding: vaginal, anal; underclothing: torn, stained, or bloody.
• Neglect by caregivers or self-neglect: Signs of malnourishment and dehydration: weight loss, sunken eyes, extreme thirst; untreated physical problems: e.g. bed sores; unsanitary or unsafe  living conditions: dirt, bugs, soiled bedding and clothes, no heat or running water, faulty electrical wiring, other fire hazards; evidence that personal care is lacking or neglected: being left dirty or  not bathed, unsuitable clothing or covering for the weather  
• Rights Abuse: Caregiver withholds or reads elder’s mail; caregiver intentionally obstructs the older person’s religious observances: dietary restrictions, holiday participation, visits by minister, priest, or rabbi; caregiver has removed all doors from the older adult’s rooms.

Read “Health & Exercise Forum” next week to discuss the risk factors and interventions for elder abuse.

Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune.

Read all of Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/forum

Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. He is an associate professor of clinical medicine at GCSOM.

For most, walking can be the perfect pandemic activity. Walking is socially distanced, yet not isolated, while offering many health benefits.

Walking changes the world. Recently, when protesters demanding racial justice marched on Washington, they followed the footsteps of defiant walkers throughout history. From Mahatma Gandhi and the Indian independence movement to Martin Luther King, Jr., and the civil rights movement, walking and protest have been interrelated.

Walking is about more than walking, and always has been. Walking soothes. Walking inspires and sharpens the mind. The pandemic has taken away much... not only lives, livelihoods, but our need to feel free too. While there is much we can’t do, WE CAN WALK!

It might be said that with the right mindset, every walk is a pilgrimage. Many a breakthrough has been stumbled upon while putting one foot in front of the other. We run from problems. We walk toward solutions. While working on A Christmas Carol, Charles Dickens would walk 15 or 20 miles through the back streets of London, turning over the plot in his mind as the city slept. Beethoven found inspiration while ambling in the verdant Wienerwald outside Vienna.

Recent studies suggest that walking stimulates our creative mind is at its most creative at three miles per hour, the speed of a moderately paced stroll. Stanford University researchers divided participants into two groups: walkers and sitters. They then administered a test designed to measure creativity. They found that creative thinking was “consistently and significantly” higher for the walkers than the sitters. It didn’t take a lot of walking to boost creativity, either—anywhere from 5 to 16 minutes.

Studies have also shown that people who walk regularly are healthier and live longer than those who don’t. Surprisingly, you don’t have to walk very fast or far to enjoy this benefit. One recent study, published in JAMA Internal Medicine, put the 10,000-step myth to rest. It is an arbitrary number. People—older adults in particular—accrue health benefits by taking only a few thousand steps each day, and at a leisurely pace.

Benefits of Walking

In addition to stimulating creativity and reducing stress, walking has many benefits. “There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.”

According to the American Heart Association, walking as little as 30 minutes a day can provide the following benefits:

• Improve blood pressure and blood sugar levels
• Help maintain a healthy body weight and lower the risk of obesity
• Reduce the risk of osteoporosis
• Enhance mental well-being
• Stimulates creative thinking

Like everything, there is a right way of doing something, even walking. For efficiency and safety, walking with proper stride is important. A fitness stride requires good posture and purposeful movements. Ideally, here's how you'll look when you're walking:

• Head up, look forward – glance at the ground but don’t stare down.
• Relax your neck, shoulders and back – avoid a rigid upright posture.
• Swing your arms freely with a slight bend in your elbows.
• Keep your stomach muscles slightly tightened (work the core) with a straight back.
• Walking smoothly - rolling your foot from heel to toe.

Plan Ahead

• Gear Up – but don’t go overboard. Good running shoes with proper arch support and shock absorption. Wear weather appropriate dry tech clothing with bright, reflective visible colors.
• Select the Best Path – begin on level surfaces like a “rails to trails.” In inclement weather consider walking in a shopping mall.
• Warm up. Walk slowly for five to 10 minutes to warm up your muscles and prepare your body for exercise.
• Cool down. At the end of your walk, walk slowly for five to 10 minutes to help your muscles cool down.
• Stretch. After you cool down, gently stretch your muscles. If you want to stretch before you walk, remember to warm up first.

Set Realistic Goals

Anything is better than nothing! However, for most healthy adults, the Department of Health and Human Services recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, or an equivalent combination of moderate and vigorous aerobic activity. The guidelines suggest that you spread out this exercise during the course of a week. Also aim to do strength training exercises of all major muscle groups at least two times a week.

As a general goal, aim for at least 30 minutes of physical activity a day. If you can't set aside that much time, try several short sessions of activity throughout the day. Even small amounts of physical activity are helpful, and accumulated activity throughout the day adds up to provide health benefits.

Remember it's OK to start slowly — especially if you haven't been exercising regularly. You might start with five minutes a day the first week, and then increase your time by five minutes each week until you reach at least 30 minutes.

For even more health benefits, aim for at least 60 minutes of physical activity most days of the week.

Track Your Progress

Keeping a record of how many steps you take, the distance you walk and how long it takes can help you see where you started from and serve as a source of inspiration. Record these numbers in a walking journal or log them in a spreadsheet or a physical activity app. Another option is to use an electronic device such as a pedometer or fitness tracker to calculate steps and distance.

Sources: National Geographic; Mayo Clinic

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!”  

Read all of Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/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.

TRY A NEW APPROACH TO WEIGHT LOSS, MINDFUL EATING!

WHAT IS MINDFUL EATING?

Mindful eating, also referred to as intuitive eating, is based on Buddhist teachings which focus on the experience of eating, AND ENJOYING, our food. The concept was presented in a feature column in The New York Times written by Jeff Gordinier, based on his time spent in a Buddhist monastery. He discovered that mindful eating practitioners eat in silence and chewed small pieces of food very slowly and deliberately to experience its taste, texture and smell.

THE RESEARCH

One study of 1,400 mindful eaters found that they enjoyed lower body weights, greater sense of well-being and suffered from fewer eating disorders. However, many feel the concept, while valuable, is very difficult to put in practice in the busy American family. Fortunately, research shows that the simple act of the family meal can have a powerful impact on mindfulness, health and wellness, even if it isn’t a picture-perfect meal.  

In a country that thrives on a fast pace with over-booked schedules, families struggle to balance work and school and after school sports and activities. Consequently, fast food, eat-and-go habits have become the norm. According to some studies, most find it difficult to sit and relax for a family meal even once a week. And often, when families do pull off a family meal, it is often overwrought with school drama, sibling rivalry, and parental discipline about school, homework or social activities, making the situation stressful. Even so, despite the family conflict, studies strongly support the health values of the family meal.

A recent study from Columbia University that received national attention found that children who participated in a family meal regularly were less likely to have problems with drugs or alcohol and more likely to excel in school. Moreover, those children eating with their families at least 5 times per week benefited most. Other studies have found that there is a significantly lower incidence of teens who smoke, use alcohol, have sex at a young age, fight, get suspended from school or commit suicide among those who have meals with their family on a regular basis

6 TIPS TO CREATE MEALTIME BLISS –

… FOR A MORE MINDFULL AND HEALTHY FAMILY MEALTIME (WEBMD)

Now that you have learned the importance of mindful eating and family meals, you are probably wondering how one would incorporate the concept into the daily life of a busy family: working, going to school, playing sports, attending dance class and participating in multiple after school and travel activities. While not perfect, WebMD offers some tips to help create mealtime bliss in an attempt to make dining as a family a positive and healthy experience.

1. TURN DOWN THE VOLUME

Lower the noise level in environment at mealtime. No TV, cell phones, computers or radios blasting in the background. Soft, soothing background music can be very helpful to set a stress free mood. To involve the entire family, let each member take a turn to choose mutually acceptable music for that meal.

2. SET THE TABLE TO SET THE MOOD

A formal table setting is not necessary to create a special mood. However, tablecloths and napkins with bright colors or holiday imprints can spice up the room. Fresh flowers from the garden or grocery store are always a good idea!

3. LET THERE BE LIGHT…SOFT LIGHT

Dim the light and add some candles to the dinner table to create a relaxing atmosphere at mealtime. Make “the lighting of the candle” a special event in which children participate.

4. CONTROL THE CONVERSATION

Parents and children must avoid using mealtime as an opportunity to ambush a captivated audience. Discussions about family complaints and grievances should be deferred for after dinner meetings or other appropriate times. Avoid confrontation, to-do lists, medical problems and focus instead on planning a weekend activity or future vacation. Attempt to pull children and teenagers into the conversation with positive experiences that week or open-ended questions like, “if you could visit any place in the world…”

5. KEEP YOUR COOL IN THE KITCHEN

While trying to make the kitchen a happy place, try to remember that the cook may be under stress to get a meal on the table within the time demands of work and after school activities. The experts suggest trying to do as much as possible ahead of time, use the weekend to make meals for the rest of the week, and assign portions of the meal to other family members: children can clean the vegetables and make salads.

6. KEEP IT REAL

Be realistic…family meals will not happen every night and some family meals will end in conflict. But, if you don’t attempt to organize a family meal, it will NEVER happen and if you don’t try to control the conflict it will ALWAYS happen. Don’t be too rigid. If breakfast is easier to organize as a family, consider the option once or twice a week. Get a calendar each week and make a family schedule that includes family meal times. Always remember, research clearly shows that the benefits of a family meal far outweigh the hassle and inconvenience of planning it!

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

Read all of Dr. Mackarey's articles on our Website: https://mackareyphysicaltherapy.com/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.

TRY A NEW APPROACH TO WEIGHT LOSS

MINDFUL EATING!

There are many health issues associated with COVID 19 and gaining weight seems may be the most common of all. There are many reasons for weight gain during this stressful time and one of these is the psychology of eating. In the land of plenty, we eat mindlessly! Consider the facts. First, we blamed the food, thinking it was bad. But, when we chemically modify the food to remove or alter the fat or sugar and remove the calories, it fails to reduce our weight. In fact, it has been discovered that “fake sugar,” even though it does not have calories, can still increase blood glucose levels. Next, we decided that fat cells were the enemy, but when we removed fat cells from our body through liposuction, we failed to control weight gain. Then, we decided the problem was our digestive systems, so we placed bands or staples in the stomach or by-passed the small intestine. While these efforts helped many in the short run, long term, it failed as a long-term solution without a change in behavior. Many medical professionals have concluded that the problems people have with weight are not exclusively due to the food, fat cells, stomach or intestines, but rather, THE MIND! 

WHAT IS MINDFUL EATING?

Mindful eating, also referred to as intuitive eating, is based on Buddhist teachings which focus on the experience of eating, AND ENJOYING, our food. The concept was presented in a feature column in The New York Times written by Jeff Gordinier, based on his time spent in a Buddhist monastery. He learned that mindful eating practitioners eat in silence and chewed small pieces of food very slowly and deliberately to experience its taste, texture and smell. He discovered that it requires full attention to the experience of eating and drinking on the body and mind. It is often referred to as “the opposite of diets” because with mindful eating there is no right or wrong way to eat, but rather varying degrees of awareness about WHAT WE EAT AND WHY. The goal of this exercise is to teach our mind and body to connect and communicate while eating so one can learn important cues such as: what are my hunger signals? What does my stomach feel like when it is half, three-fourths and completely full?

THE RESEARCH

One study of 1,400 mindful eaters found that they enjoyed lower body weights, greater sense of well-being and suffered from fewer eating disorders. However, many feel the concept, while valuable, is very difficult to put in practice in the busy American family. Fortunately, research shows that the simple act of the family meal can have a powerful impact on mindfulness, health and wellness, even if it isn’t a picture-perfect meal.  

In a country that thrives on a fast pace with over-booked schedules, families struggle to balance work and school and after school sports and activities. Consequently, fast food, eat-and-go habits have become the norm. According to some studies, most find it difficult to sit and relax for a family meal even once a week. And often, when families do pull off a family meal, it is often overwrought with school drama, sibling rivalry, and parental discipline about school, homework or social activities, making the situation stressful. Even so, despite the family conflict, studies strongly support the health values of the family meal.

A recent study from Columbia University that received national attention found that children who participated in a family meal regularly were less likely to have problems with drugs or alcohol and more likely to excel in school. Moreover, those children eating with their families at least 5 times per week benefited most. Other studies have found that there is a significantly lower incidence of teens who smoke, use alcohol, have sex at a young age, fight, get suspended from school or commit suicide among those who have meals with their family on a regular basis. 

Tips for Mindful Eating

By Christopher Willard PsyD

1 Let your body catch up to your brain

Eating rapidly past full and ignoring your body’s signals vs. slowing down and eating and stopping when your body says it’s full.

Willard suggests that slowing down the process of eating may be the best way to get our mind and body to communicate their nutritional needs. For example, it is well documented that there is a 20 minute delay from the stomach to the brain…which is why we continue to eat when we are full, only to feel overstuffed 20 minutes later. Eating mindfully involves: slowing down, sitting and relaxing, chewing our food 20 or more times, setting your fork down between bites, and practicing other table manners that promote slower eating and allows you to listen to the hunger/full signals from your body.

2. Know your body’s personal hunger signals

Are you responding to an emotional want or responding to your body’s needs?

It is important to distinguish between your unique hunger signals from your BODY (stomach growling, low energy, lightheadedness) as opposed to EMOTIONAL signals (stress, sadness, frustration, loneliness or boredom). Mindful eating requires listening intently to your body…knowing your body.

3. Develop healthy eating environments

Eating alone and randomly vs. eating with others at set times and places

Rummaging through kitchen cabinets in search of food and snacks and eating at random times and places are classic examples of eating mindlessly. Slow down, think about your hunger and how long it’s been since you have last eaten. Instead, plan a healthy snack or meal at set times and places. Plan you grocery list with this in mind. Keep a log or use a daily/weekly planner if necessary.

4.Eat food not comfort

Eating foods that are emotionally comforting vs. eating foods that are nutritionally healthy

Certain foods, many that contain sugars and fats, stimulate the pleasure centers of the brain and become the source of “cravings.” However, over time, we can retrain the brain to derive pleasure from healthier foods. Mindful eating involves thinking first, eating second, and choosing healthy options such as carrots, apples, grapes, oranges as a snack instead of cake, cookies, or chips.

5. Consider the life cycle of your food

Considering where food comes from vs. thinking of food as an end product

In hunter-gatherer cultures, people pay spiritual homage to those who provided the food and the plants and animals sacrificed in the process. Modern man/woman has been disconnected from their food and often eat without thought. Slowing down allows us to consider the farmer, butcher, baker, grocer, and those who prepare our food and bring it to the table. It can be both spiritual and thankful.

6. Attend to you plate

Distracted eating vs. just eating

Mindful eating avoids distraction. The classic example of eating the big bowl of popcorn at the movies and wondering at the end of the movie who ate it? When we are distracted we cannot listen to our body’s hunger/full signals and we overeat. Try single-task eating without phones, tablets, computers, or televisions. Instead, share some light conversation with a friend or family member.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

Get all of Dr. Mackarey's articles at our website: https://mackareyphysicaltherapy.com/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.