I know that we are all tired of wearing masks. It can be hot, hard to breath and difficult to speak. People feel claustrophobic or confined behind them. Personally, I, too, feel exhausted after a full day in my mask. However, they continue to serve an important role in controlling the spread of COVID … even after we are vaccinated. Evidence has proven that wearing a mask reduces the risk of infection up to 89% and can block 70% of expelled droplets and particles (CDC.org).
Both Pfizer and Moderna vaccines have been released for public use. Many are fearful or wary of them for a variety of reasons. A main concern is that they were “rushed to market.” Last week’s article dispelled many of the myths and concerns the general public is having with the vaccines. The two vaccines have been put under rigorous testing and analysis, more than most vaccines on the market today. Concerns about the vaccines are understandable, but negative outcomes have been few and far between. However, due to the timely release of the vaccines and our inability to examine long-term effectiveness, several factors suggest that wearing a mask will continue to be vital in our fight against COVID-19. Therefore, we will not be shedding our masks anytime soon.
The distribution of the vaccine requires that each vial be frozen at very cold and constant temperatures. As they thaw, they lose effectiveness. Many facilities, especially in the rural parts of the country, do not have the capabilities to properly store the vaccines under the ideal conditions. It will take time to make these vaccine storage facilities safe for COVID vaccines. But fear not, as the details and logistics improve as you read this column, the vaccine will be available to the general public soon!
It is estimated that we need 80% of the population to get vaccinated for the infectious rate to swing in our favor. This means that we need the general public to unite and work as one to fight the spread of the virus. Yes, it is scary taking a new vaccine that has no long-term data, however, with over 1.5 million dead from COVID-19 it seems this is the best option. As a community, we have to band together, trust our science and act in the best interest of all.
Do not have a false sense of the security immediately following your vaccination! Pfizer reports that “it takes a few weeks” and Moderna reports 2 weeks for people to build up an immunity of 50% after the first vaccine. The timeline repeats again after the second vaccine resulting in 95% immunity. During that time, you are still able to contract and spread COVID-19. The use of masks during this time is necessary to keep yourself and others safe.
The clinical trials conducted on the vaccines did not examine if the participants should continue to wear masks. The study only investigated if the individual built up enough antibodies to become immune themselves. Therefore, we do not know if the participants could still be carriers of the virus and continue to infect others that were not vaccinated.
Anthony Fauci, MD, director of the National Institute for Allergy and Infectious Diseases and lead member of the COVID Task Force, recently reported that there is some evidence that the Moderna vaccine may provide a vaccinated individual protection against spreading the virus. However, more time and data are required to confirm these findings.
It is important to remember that many immunosuppressed, autoimmune and pregnant individuals are not suitable for the vaccine. Until we are confident that vaccinated people are not “silent carriers” of the virus, the continued use of a mask is an important measure in protecting the most vulnerable people in our communities.
Until long-term data is available on the vaccines, we do not know how long our immune system will continue to produce antibodies. Antibodies protect us against the virus. This will be monitored as the distribution of the vaccine continues. The good news is, that we have observed individual’s immune system maintain antibodies up to six months in those who recovered from COVID-19. It is expected that the vaccine will at least mimic that immune system response.
There is some light at the end of the tunnel … 2021 will be known as the year that the world took control of COVID-19! We will be shedding our face-protecting cloth companions soon enough. For now, we must wait, stay the course and continue to wear our mask, even after we are vaccinated. As time passes, we will know more about the vaccines and many of the uncertainties in this article will be answered. Until then, mask up, get vaccinated and be safe for yourself and others.
GUEST COLUMNIST: Paul Mackarey, Jr. DPT is clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC where he specializes in the prevention and treatment of neck and LBP.

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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
For all of Dr. Mackarey's articles visit our website: 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 in downtown Scranton and is an associate professor of clinical medicine at GCSOM.
Visit your doctor regularly and listen to your body.
The New Year brings renewed energy in our collective efforts to win the race against a common foe. If we intend 2021 to be a year of joy and hope — we absolutely need to use all viable tools at our disposal and unite in our efforts to beat the coronavirus. One such tool is vaccines, considered one of the most important advances in modern medicine, and has been responsible for greatly improving our quality of life over centuries. Vaccines have allowed us to triumph over serious adverse diseases by reducing or eliminating many dangerous infectious diseases we don't even think about anymore.
Vaccination research and development has never stopped. Global partnerships have been formed to create faster, more efficient platforms and new technologies to help us against the onslaught of diseases like Ebola, Zika, and the coronavirus family — SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), and now SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).
The victory of vaccines, our most promising counter-pandemic measure, in our fight against a pathogen like SARS-CoV-2, the virus that causes Covid-19, relies on a critical mass of people becoming immune to the virus. This breaks the chain of transmission and, most importantly, protects the most vulnerable people in our community who cannot develop immunity through vaccination. This is called herd immunity — vaccines go beyond our individual benefit; it protects us as a community. Imagine this vaccinated community surrounding a pregnant mother who cannot get vaccinated now; she is protected through this invisible shield of the community blocking SARS-CoV-2 from reaching her.
Vaccine safety requirements are among the highest in the nation because they are widely distributed. Two vaccines (Pfizer/ BioNTech and Moderna) received U.S. emergency use approval (EUA) from the FDA. Nearly 2.8 million people in the U.S. have received a Covid-19 vaccine to date. Dr. Francis Collins, director of the U.S. National Institutes of Health, received the Moderna vaccine on December 22, 2020 — saying the two vaccines had been examined and put through more rigorous analysis than most vaccines to date. Nonetheless, some common myths are surrounding both vaccines:
Both approved U.S. vaccines contain no virus or viral particles. You are not injected with any part of a virus. The vaccines use synthetic messenger RNA (mRNA) that our cells can read to make a specific piece of the virus, which on its own cannot harm. This piece is the protein spikes on the outside of the virus, and it is what helps the virus dock onto a human cell and allows it to infect us. By allowing our cells to reproduce this spike temporarily, we teach our immune system what to look for in the face of a future coronavirus attack. This memory of what to look for provides us immunity and allows us to respond much faster.
The development of the current vaccines did not start in January 2020. Science has been paying close attention to the coronavirus family for many years. Research into the messenger RNA technology used in the Pfizer/ BioNTech and Moderna vaccines has been in development for close to 15 years. The perceived speed in getting the vaccines to the public is partly due to unparalleled worldwide emergency cooperation, free sharing of information, and new faster technology platforms. Also aiding has been billions in private and public funding, allowing vaccine firms to run preclinical and phase I, II, and III trials in parallel instead of sequentially. The FDA completed a meticulous safety review, and the independent Advisory Committee on Immunization panel scrutinized safety and efficacy data from the clinical trials.
Your cell's DNA is securely kept inside a nucleus in the cell. The snippet of mRNA that gets injected does not gain access to the nucleus and never comes in contact with your DNA. Your cell machinery translates the mRNA and manufactures the viral spike protein needed to present to your immune system. Once the instruction is read, human cells break down and get rid of the mRNA.
Currently, we don't have enough information to definitively know how long after infection someone might be protected from getting reinfected with Covid-19. Early indications suggest this natural immunity may not last very long. The CDC recommends getting vaccinated. However, if you are currently infected with Covid-19, the recommendation is to delay vaccination until the illness has resolved.
According to Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, getting rid of public health measures like wearing a mask is only possible once there are extremely low levels of circulating virus left. For this to happen, we need 75-95 percent of people to have immunity to the coronavirus.
Both Pfizer/ BioNTech and Moderna have reported that their vaccines contain no preservatives. The vaccines are created using a novel methodology to synthesize the mRNA, encapsulated for protection in a lipid or oily shell. This technology allows the vaccine to be free from materials of animal origin, egg, and without preservatives. However, mRNA is fragile and can break down easily. Storing vaccines in ultracold environments keeps them stable and safe. Vaccines are thawed before injection.
Life and vaccines never present us with absolute safety in usage. We must acknowledge this — vaccines do carry some risks. Of the close to 2.8 million U.S. vaccines to date, very few recipients reported short-term mild or moderate symptoms that resolved without complication within a day or two. These included sore arms, redness at the injection site, headache, chills, fatigue, muscle pain, or fever — all expected indicators that your immune system is responding to the vaccine — and comparable to side effects seen with the shingles vaccine. As of December 23, 2020, the U.S. has seen 10 cases of anaphylaxis. Anaphylactic reactions can occur with any vaccine but are extremely rare. The cases occurred in people with a significant history of severe allergies and were safely managed with epinephrine, and the CDC has distributed safeguard protocols to vaccine sites.
But, compare these calculated vaccination risks to that of the virus itself — which has infected more than 83 million people globally and killed approximately 1.8 million — including more than 350,000 deaths in the United States. Now add in the devastation caused to economies and health systems. Dr. Walter Orenstein, the former director of the United States' National Immunization Program, wrote that if vaccines are not administered to the persons they are recommended for, there is zero impact. In the current pandemic, time is lives. We need an estimated 80 percent of people vaccinated to reach herd immunity to have a fighting chance to stop this pandemic in its tracks — and we need to get it done now.
We face a collective threat — a pandemic, and a moral dilemma on choosing to be vaccinated. Concerns over the vaccines' safety are understandable, but reports on negative outcomes are few and far outweighed by the benefits. This quarantine year has taught me that we are intrinsically bound to our community, only truly to thrive through community involvement and participation. We need each other, and we have an obligation to take care of one another. Getting a Covid-19 vaccine is not just about you; it is protecting your grandmother who has diabetes, your neighbor who is immuno-compromised — it safeguards everyone who is medically unable to receive a vaccine and needs you as their human shield against coronavirus reaching them. Vaccinations save lives — when your eligibility phase comes up, be a solid citizen, loving caring child, sibling, parent, and spouse…GET IT!
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
Author: Hendrik Marais, MD, MS
Hendrik Marais, MD, MS, received his Doctor of Medicine degree from Geisinger Commonwealth School of Medicine in 2015 and his Master of Science degree in Global Medicine from Keck School of Medicine at USC in 2019. He is passionate about creating positive and empowered patient health outcomes. He grew up in South Africa and currently calls Scranton, PA home – where he enjoys cycling, swimming, and discovering the beauty of NEPA. He is a member of the American Medical Association, American Public Health Association, and the International Society of Physical and Rehabilitation Medicine. He plans to pursue a clinical career in physiatry.

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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.
New Year’s Resolutions are very predictable. While most are health oriented, I purport that a healthy mind, body and spirit requires a healthy lifestyle. Interestingly, the ten most popular resolutions listed below, all have an impact on a healthy life. Moreover, after living with the COVID-19 virus in 2020, perspectives and priorities may have changed for all of us and forever. As such, before any other health tip can be followed, the number one, two and three health tips for 2021 are:
Polls repeatedly show that one of the most consistent resolutions for the New Year is to make more time to spend with family and friends. Moreover, research shows that the comfort and camaraderie of these people whom we love is important to our health and well-being. However, until we are all vaccinated we must do so with great care and precaution; Zoom, FaceTime, phone calls, drive-by visits, outdoor visits or activities, etc. Be Creative and be careful!
The benefits of regular exercise is no longer anecdotal, it is factual. Daily exercise, even in small doses, has been associated with more health benefits than anything else known to man. Studies clearly demonstrate that it reduces cholesterol and coronary artery disease and the risk of some cancers. Also, it increases longevity, helps achieve and maintain weight loss, enhances mood, lowers blood pressure, and even improves arthritis. In short, exercise keeps you healthy and makes you look and feel better. If done properly, there is no down side. So, make this year the year to do it! While a gym may not be the best option for those at risk, buy indoor home equipment or dress appropriately and use Mother Nature for healthy and inspirational walks.
Recent studies report that more than 66 percent of adult Americans are considered overweight or obese. As a result, weight loss is one of the most popular New Year's resolutions. However, adhering to a weight loss program is not easy. It requires many things, including, setting reasonable goals and staying focused. Often, professional help is required. While this may be one of the most difficult goals to attain, the ultimate reward and value is well worth the effort.
Second only to losing weight, this resolution, while extremely difficult, is another life-saving goal that must be attempted. Studies report that smokers try and fail four times on average before they are successful. SO, KEEP TRYING! Get help. Talk to your physician about using over-the-counter or prescription nicotine replacement therapy and proven quit-smoking aids. Consider smoking cessation classes, support groups and hotlines in addition to the meds. This is one goal that is worth the effort.
Due in great part to our hectic and stressful work and family demands, long before COVID-19, the United States is home to millions of people requiring the use of mood elevators and antidepressants. As a result, it is important to learn what really makes you happy in order to FIND YOUR SMILE. It requires the balance of a healthy mind, body and spirit. It might be a walk in the snow, taking virtual dance, exercise or enrichment class. One hint, smiles are often found in something simple and inexpensive. And, be sure to associate with upbeat, fun-loving and genuine people when possible.
This is one tip for a healthier New Year that I expect to receive plenty of flack about! This is especially true now because more alcohol is being consumed with the stress of COVID-19. But, I would be remiss if I did not mention this potentially harmful habit…excessive drinking. While many people use the New Year as an incentive to finally stop drinking, most are unable to adhere to such a rigid goal. Studies show that moderate drinking can offer many health benefits such as lowering cholesterol and coronary artery disease but that is defined as one or two 8 ounce drinks per day and red wine is preferred. However, many heavy drinkers would do well to taper off to a moderate level. For those with a problem and have decided to stop drinking altogether, there are plenty of help and support available such as Alcoholics Anonymous. There are also a number of treatment-based programs, as well as support groups for families of alcoholics.
This is one tip that few consider being health related. However, serious stress from financial problems affects millions of Americans every day. This cumulative stress can be very harmful to your health and can be lessened by initiating a plan. Get professional help and learn how to downsize and reevaluate your real needs. Less toys (adult and child) with less stress for a longer life! For those suffering from economic hardship due to COVID-19, contact social services and government agencies to determine if assistance is available to you and your family.
There may be no one thing more important to gaining a new perspective on life that to have learned something new. It could be as drastic as returning to school to prepare for a career change or as simple as learning to play bridge. Have you vowed to make this year the year to learn something new? Take a virtual course at local college or read a new book. Take a tour of some of the world’s greatest museums. Listen to a TED talk. It will enrich your life and make you a more interesting person. Most local colleges and universities offer virtual and adult education programs

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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.
Happy Holidays! It is at this time of year that we celebrate life with great hope and faith. People of many faiths take time to reflect, respect, and resolve. Christians celebrate Christmas, the miraculous birth of Christ, the Son of God, and the Messiah. Jews celebrate Chanukah, the miraculous festival of lights, when one night’s oil provided enough light and safety for 8 nights. Both major faiths promote healthy lifestyles for the mind, body and spirit. These faiths are grounded in hope, faith, love and peace. It is no surprise that studies repeatedly demonstrate that people of faith outlive those without!
With this in mind, I purport, that to be truly healthy, one must have faith because complete health is multidimensional. Socrates preached this message to his students thousands of years before Christ. One must have a healthy mind, which requires intellectual stimulation with attainable goals related to education and intellect. One must have a healthy body by eating well, engaging in physical activity and have attainable goals related to his/her body. Likewise, one must have a healthy spirit with faith, hope, prayer and meditation, comrades and counsel, and set attainable spiritual goals.
1. Healthy Blood Pressure: High blood pressure (hypertension) can lead to heart disease and stroke, which are the leading causes of death in the United States, according to the Centers of Disease Control (CDC). It affects 1 in every 3 adults and only half of these people have their blood pressure under control. Well, religion and spiritually may help …
The health benefits of religion or spirituality are well documented. One study conducted at Duke University Medical Center on 4,000 subjects, older adults who described themselves as religiously active were 40% less likely to have high blood pressure when compared to those less active. Moreover, they were surprised to find that those who described themselves as spiritual rather than religious also were less likely to develop high blood pressure.
2. Greater Sense of Satisfaction: Research also indicates that religious people are more satisfied with their lives than those without faith. A sociology study determined that high satisfaction among church goers may be due to the strong social bonds that are developed within a religious congregation. Regular church attendees see the same people weekly and often more often, when participating in rewarding and gratifying church-related volunteer work.
3. Greater Tolerance for Adversity: In an impressive study published in the Journal of the American Medical Association, researchers interviewed 345 late-stage cancer patients to assess their spirituality as it related to their illness. 88% stated that they were religious as it related to their coping mechanisms. It was determined that those using religion for coping demonstrated a 7.4% rate of resuscitation as compared to 1.8% for those not using religion as a coping mechanism.
4. Stronger Immune System: According to a Duke University study of 1,718 older adult participants, those described as “highly spiritual” were 50% less likely to have high levels of anti-inflammatory proteins that weaken the immune system and have been linked to some cancers, viral infections and autoimmune diseases. The outcome was similar for those who attend religious services at least once a week.
5. Greater Longevity Those who attend religious services more than once per week are found to live and additional 7 years when compared to those who never attend services. Again, researchers feel that the social benefits of a belonging to a strong religious community may be a large part of the associated longevity. Additionally, the lifestyle of religious people is often healthier: members of these communities rarely engage in risky and unhealthy behaviors such as smoking, excessive drinking, indiscriminate sex, etc
Source Health.com

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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.
The American Academy of Pediatrics (AAP) cited studies suggesting that heavy use of
electronic media may interfere with children’s speech and language development replace
important playtime with parents and lead to obesity. Studies also have found that more than 90
percent of U.S. kids have used mobile devices and most started using them before age 1. The
pediatricians’ group recommends no screen time for children up to age 2. Moreover, they
recommend total screen time, including TV and computer; use should be less than one hour daily
for ages 2 and older. Pediatricians don’t want parents to overreact. They understand that a little
screen time on occasion is not likely to harm a child, especially if they are typically active and
creative most of the day.
Dramatic increases in virtual education makes this information more alarming. This may be the
year to consider safe and appropriate gifts that promote physical activity. The academy’s website
offers suggestions on ideal toys for young children, including balls, puzzles, coloring books and
card games. Visit: AAP.org or HealthyChildren.org, the official parenting website of the AAP.
Giving gifts to children is a favorite part of the holidays, whether they're wrapped under a tree or exchanged with the lighting of a candle. When choosing a toy for a child, the American Academy of Pediatrics recommends the toy be appropriate for the child's age and stage of development. This makes it more likely the toy will engage the child – and reduces the risk it could cause injury. Below are some additional tips from the AAP on toy selection and safety:
SOURCE: American Academy of Pediatrics

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 all of 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.
Osteoarthritis, the most common type of arthritis, is often considered to be a normal part of aging. Usually by the age of forty our joints, especially those which are weight bearing (lower spine, hips, knees, ankles, feet) begin to show signs of wear and tear. The cartilage begins to thin, joint surfaces are not as smooth, and fluid which lubricates the joint becomes diluted, dehydrated and less protective. Consequently, these aging joints become stiff, sore, weak, and swollen. Most people with osteoarthritis report additional pain and stiffness in the winter and early spring due to cold, damp weather and NEPA has plenty of it! The cold, for example, restricts the flow of blood to the joints, leading to more pain and stiffness. While moving to a warmer and less humid climate is one solution, it is not practical for most. But all is not lost because there are other alternatives to protect and keep your joints healthier this winter and early spring. And, if you are looking for some practical gift ideas for your loved ones suffering from arthritis, these tips may be valuable.
1.Parafin Bath and Hot Packs:
A paraffin bath is one of the best methods to apply heat to your hands and feet to ease pain and stiffness associated with osteoarthritis. A special heating unit works like a crock pot to melt the wax to liquid form. The hands and/or feet are dipped into the wax several times to create a warm coating around the entire area. A 20 to 30 minute treatment while watching TV or listening to good music will provide pain relief, improve mobility in the joints and bring life back to winter damaged skin. $39.99 to $159.99 (www.bedbathandbeyond.com). Hot packs, electric and microwavable, offer heat to bring blood flow and lessen joint pain and stiffness. They are great for neck and lower back pain, depending on the shape of the pad. Consider rectangle for lower back and cylinder/round to wrap around neck and joints of arms and legs. SourceMed.com offers an electric pad which creates moist heat for $59.95 and a microwave “bed buddy” (herbal or nonherbal) can be found for $9.99 to $43.95 at TheWarmingStore.
2.Hand and Toe Warmers:
Hand and toe warmers are small packets placed in the gloves or boots of skiers, campers and hikers to keep the hands and feet warm. These throw away warmers can also be used by anyone with cold hands or feet whether you are shoveling snow, attending an outdoor event in the cold or sitting in a cold, drafty room watching TV. (Walmart, Dick’s, Gander Mountain, www.amazon.com)
3.Knee, Ankle, Wrist, Elbow, Wrist Sleeves:
Supportive sleeves for the joints can provide protection and warmth year round, but especially during the cold winter and early spring. Those made with neoprene material offer warmth and compression and can be valuable when participating in activities such as skiing, walking, running, basketball name a few. Additionally, it can be helpful for those having joint pain with daily activities such as grocery shopping or house work. These devices should not be used when sitting for prolonged periods of time or sleeping. There is no scientific evidence that supports the use of cooper or magnets weaved into the sleeves for additional pain relief. (available at most pharmacies and medical equipment stores)
4.Compression Shorts and Shirts:
Similar to neoprene sleeves, compression shorts, pants and shirts can be invaluable to those participating in outdoor activities in cold temps. UnderArmor, Reebok, Nike, and others make these products which can also be worn indoors for those working in cool, drafty environments.
5.Hot Tub:
It seems obvious how and why hot water and massaging water jets can soothe the sore joints and muscles. To ensure additional pain and stress relief, add a candle, soft music and a cocktail!
6.Low Impact Exercise for Legs:
If you suffer from osteoarthritis to the joints of your lower body, you would be well-advised to limit impact activities such as running and basketball. Instead, walk, swim, use the elliptical and bike to protect your joints.
7.Low Impact Exercise for Arms:
As above, if you have arthritis in the joints of the upper body, use low weights, avoid push-ups and dips, which transfer your body weight through the arms.
8.Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
These over-the-counter, non prescription drugs include aspirin and ibuprofen (Advil, Motrin) which are very effective in the treatment of the pain and inflammation associated with arthritis. However, like all drugs, they are not without their risks so one must consult with their primary care physician and pharmacist before using them. For example, NSAIDs can thin the blood, irritate the stomach and may interact with other medications.
9.Topical Creams: Lidocane, Capsacian
Topical analgesics or pain relievers can be rubbed into or sprayed on the skin over the affected area. Some products are counterirritants using menthol, methylsalicylate and camphor which provide a sensation on the skin other than pain. Salicylate based products can work like aspirin to provide relieve from mild pain and inflammation. Capsaicin based products can also provide temporary relief due to the counter stimulation of warmth and tingling. A few things to keep in mind when using these products: one, discuss it with your physician or pharmacist. Two, topical agents are more effective in superficial joints such as the fingers, toes, wrist, elbow, knee and shoulder than in the deep tissues of the hip, buttocks, or lower back. Three, wash your skin thoroughly ater using these products and before using heat, cold or electric stimulation.
10.Massage: The therapeutic benefits of massage are well documented. However, like most treatments, it is important to find a qualified professional that meets your needs. Licensed physical therapists, physical therapist assistants and massage therapists are the best choice. Benefits include; relief from pain, headaches, muscle spasm, and stress, improved relaxation, posture, and breathing.
SOURCES: www.apta.org; www.webmd.com

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
For all of Dr. Mackarey's Articles visit 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.
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.
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.
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 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.
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.
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.
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 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.
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.
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!
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.

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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
FACT 1: In 2019 over 225,000 people in the United States were newly diagnosed with lung cancer (615 people/day).
FACT 2: 90% of individuals who have lung cancer will eventually die of the disease, making lung cancer the deadliest cancer in the United States for both men and women (19% 5-year survival rate).
FACTS 3: 85% of all lung cancers are caused by smoking.
FACT 4: According to the Pennsylvania Department of Health, 22% of people aged 18 years and older residing in Northeastern, PA smoke.
FACT 5: The best prevention measures are not smoking or using tobacco products and avoid second-hand smoke or high air pollution environments.
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.
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.
Patients who fit all of the below criteria:
*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/
💥💥This week in “Health & Exercise Forum “Lower Blood Pressure with Tia Chi!” by Dr. Paul Mackarey in “The Scranton Times Tribune”💥💥
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“For those with prehypertension or hypertension and are unable to tolerate the repetitive and prolonged weight bearing stresses of running, walking or cycling, these results have tremendous implications. The slow, gentle and controlled movements and positions of Tai Chi coupled with controlled breathing and meditation may be a valuable alternative.”
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✨✨For full article visit mackareyphysicaltherapy.com or click the link in the bio✨✨
#physio #physiotherapy #physicaltherapy #rehab #exercise #getPTfirst #exercisescience #manualtherapy #kinesiology #dptstudent #fitness #injuryprevention #move #movement #movementmedicine #scranton #electriccity #nepa #orthopedic #scrantontimes #timestribune
Apr 15
💥💥This week in “Health & Exercise Forum “Cycling: Prevent Exercise Ruts: PART 2!” by Dr. Paul Mackarey in “The Times Tribune”💥💥
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It is essential to reassess and update your program to prevent stagnation.
Make sure the routine has all three fundamental components of a well-balanced exercise program; cardiovascular, strength and flexibility training. Moreover, to be truly healthy, one must work toward a “Healthy Mind, Body, and Spirit. Therefore, in addition to traditional exercise one must incorporate the following: nutrition; meditation, relaxation techniques, yoga, core fitness; functional/sports specific training; leisure sports and activities
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✨✨For full article visit mackareyphysicaltherapy.com or click the link in the bio✨✨
#physio #physiotherapy #physicaltherapy #rehab #exercise #getPTfirst #exercisescience #manualtherapy #kinesiology #dptstudent #fitness #injuryprevention #move #movement #movementmedicine #scranton #electriccity #nepa #orthopedic #scrantontimes #timestribune
Mar 11
💥💥This week in “Health & Exercise Forum “How to Prevent Exercise Ruts!” by Dr. Paul Mackarey in “The Times Tribune”💥💥
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The purpose of this column will be to offer suggestions on how to improve or get more out of a “stale” exercise program. Step one is to build an exercise program that is grounded in the basics. Step two, which begins after the basics have been mastered, includes the components necessary for a healthy mind, body and spirit connection and translates into functional activities of daily living including work and leisure sports.
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✨✨For full article visit mackareyphysicaltherapy.com or click the link in the bio✨✨
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#physio #physiotherapy #physicaltherapy #rehab #exercise #getPTfirst #exercisescience #manualtherapy #kinesiology #dptstudent #fitness #injuryprevention #move #movement #movementmedicine #scranton #electriccity #nepa #orthopedic #scrantontimes #timestribune
Mar 8
💥💥This week in “Health & Exercise Forum “Cycling: Tips For Cancer Prevention!” by Dr. Paul Mackarey in “The Times Tribune”💥💥
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February is National Cancer Prevention Month and March is Colorectal Cancer Awareness Month. Unfortunately, according to a study conducted by Northeast Regional Cancer Institute (NRCI), our area has a higher rate of cancer compared to the rest of the United States. Residents of NEPA must be vigilant!
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✨✨For full article visit mackareyphysicaltherapy.com or click the link in the bio✨✨
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#physio #physiotherapy #physicaltherapy #rehab #exercise #getPTfirst #exercisescience #manualtherapy #kinesiology #dptstudent #fitness #injuryprevention #move #movement #movementmedicine #scranton #electriccity #nepa #orthopedic #scrantontimes #timestribune #cancer
Feb 26
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.
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:

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.