Recently, a reader shared with me their concern about the aging process. They were not happy with the changes in their body, despite exercising regularly. New research suggests that there may be some forms of exercise that are better than others to counteract the aging process. With the accumulation of more and more birthdays, I too, am concerned about the changes in my body!

The deterioration and degeneration of the body associated with the aging process is well-documented and the musculoskeletal system is no exception. As we age, weight bearing joints of the lower body (hips and knees) frequently suffer from wear and tear degeneration. Loss of muscle mass and strength is also common with age. Specifically, damage to older muscles has been found to regenerate slowly and incompletely and the problem runs as deep as the cellular level as the mitochondria diminish in quality and quantity. However, there is good news: a recent study published this spring in Cell Metabolism suggests that certain types of exercise can actually regenerate and reverse the aging mitochondria.  

As popular and common as exercise is, little is known about the influence and impact it has on the cellular level. A research team at the Mayo Clinic decided to answer this question and conducted an experiment to determine the cellular effects of different types of exercise on aging muscles.

THE STUDY

The Mayo team chose 72 men and women and separated them into two groups: 30 and under and older than 64. All subjects were healthy but sedentary. Pretest analysis was performed for blood sugar levels, gene activity, muscle cell mitochondrial health, and aerobic fitness level. Subjects from the 30 and under group and the over 64 group were randomly assigned to one of four research groups.

Group One: Vigorous weight training 3-5 times per week, Group Two: Interval aerobic exercise on a stationary bike (pedaling hard and fast for four minutes followed by a recovery at a slow pace for three minutes then repeating the sequence 3 or more times) 3 times per week, Group Three: Moderate aerobic exercise on a stationary bike for 30 minutes 2-3 days per week and light weight lifting on the other 2-3 days, Group Four: Control group who did not exercise. After 12 weeks, lab tests were repeated and data compiled and analyzed.   

THE RESULTS

In the 30 and under group as well as the over 64 group, all three experimental groups improved in fitness level and blood sugar regulation. As expected, Group One, the vigorous weight training group, showed the greatest gains in muscle mass and strength. Also, not surprisingly, Group Two, the interval training group, had the greatest gains in endurance. However, the most unexpected results came when retesting the muscle cells by biopsy. Only group two, the interval aerobic exercise group demonstrated the most significant improvement in the activity levels of their genes in both the young and older groups, when compared to the vigorous weight training and moderate exercise groups.

Moreover, the positive improvements in the genes of the older group far surpassed that found in the younger group. For example, in the younger group, 274 genes improved compared to 170 genes in the moderate exercise group and 74 in the vigorous weight training. In the older group, 400 genes were improved in the interval aerobic group while 33 for weight training and 19 for moderate exercise groups.

CONCLUSION

It is well known that loss of muscle mass and strength is common with age. Specifically, older muscles have been found to regenerate slowly and incompletely, and the problem runs as deep as the cellular level as the mitochondria diminishes in quality and quantity. However, this study suggests that interval aerobic exercise can regenerate and reverse the aging mitochondria. Healthier mitochondria can produce energy for muscle cells to function at a higher level.

TAKE HOME

Interval aerobic exercise can have anti-aging effects. In fact, the older your muscles, the more you will benefit from, not just moderate exercise, but more vigorous interval aerobic exercise. Furthermore, interval training may be applied, not only to aerobic exercise, but to weight training for the upper and lower body. According to the American College of Sports Medicine, high intensity interval training, also called HIIT workouts, involves a repetition of a series of high-intensity exercise (aerobic or weight training) for a specific period of time (3-5 minutes) followed by a specific period of rest or low-intensity exercise (1-3 minutes).

The intensity can be increased by speed or resistance. HIIT workouts have been associated with increased caloric expenditure with less exercise time, as well as improved strength and endurance. Most recently, it has been found to improve cell energy in the aging population. However, do not attempt to increase the intensity of your exercise program without consulting with your physician first. Once medially approved, consult with a Doctor of Physical Therapy to create a program specifically designed for you.    

Therefore, if your gene pool is questionable like most of us, don’t use that as an excuse.  There are things you can do to have a positive impact on your DNA to live longer and healthier…one of them is EXERCISE!

Visit your doctor regularly and listen to your body. Keep moving, eat healthy foods, exercise regularly, and live long and well!

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

NEPA has experienced more than its share of bitter cold temperatures this winter. And, as much as I enjoy skiing, ice skating and snowshoeing, I have noticed a few achy joints when the mercury plummets! 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, the 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 sometimes 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.

• Parafin Bath and Hot Packs: A paraffin bath is one of the best methods to apply heat to your hand and feet joints 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.   
• 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)

• 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, to name a few. Additionally, it can be helpful for those having joint pain with daily activities such as grocery shopping or housework. 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)
• 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.
• Hot Tub: It seems obvious how and why hot water and massaging water jets can soothe sore joints and muscles. To ensure additional pain and stress relief, add a candle, soft music and a cocktail!

• Low Impact Exercise for Legs/ Low Impact Exercise for Arms: 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. 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.  
• Heat Vest or Jacket: As many of you know, I love outdoor activities year-round. However, with age I have become a little more sensitive to the cold…which can be a problem when you are skiing, skating, snowshoeing, or hiking. Fortunately, technology has made it possible to be “warm in the cold!” I love my heated vest because it not only keeps me warm, but I require less layers and less bulk to be toasty. These products come with a rechargeable battery. Heated gloves are also available. Vests and jackets range in price from $60.00 to $200.00 but you don’t have to by the most expensive to get a good result. Visit www.ororowwear.com; www.ihoodwarm.com; www.amazon.com
• 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. A topical NSAID, Voltaren, is also available over-the-counter. 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.

• 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 relief 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 after using these products and before using heat, cold or electric stimulation.
• 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

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

According to American Association of Retired Persons (AARP), those 50 years old and older are seniors! By this definition, as hard as it is to admit, I am well into senior status and as one, I offer holiday health tips for seniors.

Overindulgence during the holidays causes many seniors to make New Year's resolutions related to diet and exercise. But, this year, I propose that seniors incorporate healthy habits during the holiday season, and you may find that your resolutions are not as hard to keep.

1. Exercise every day. - Every evening, get out of the house for a walk to view the Christmas lights. Dress for the weather, walk with a companion, and take along a flashlight to illuminate your path. Use caution to avoid falls on slippery sidewalks.
2. Combine shopping and walking. - In inclement weather, combine holiday shopping with your daily dose of exercise. Indoor malls are great places to walk. Inquire with the mall management about walking clubs. Plan to shop early or late to avoid crowds. If you are planning on shopping in a particular store, park at the opposite end of the mall -- even if time is short, you will still get some exercise.
3. Remember to take your medications. - Routines are disrupted during the holidays, and you may forget important medications. Make a special reminder to take your medications or order re-fills. If you are traveling, be sure to take enough medications with you in case of delays and have a copy of your prescriptions in case of loss. Be sure to bring a phone number for your doctor along with your health insurance cards, in case of emergency. Carry your medications in your carry-on luggage if you are flying.
4. Eat your vegetables and salad first. - Beginning your meal with healthy vegetables and salads will fill you up and reduce the temptation to over-indulge in high-fat, high-calorie foods. Taste your holiday favorites in small amounts to satisfy your palate.
5. Be aware of drug interactions. - According to Dr. Amy Anderson, internal medicine physician on the medical staff at Baylor University Medical Center," says holiday spices like cloves, thyme and sage can interfere by as much as 50 percent with the body's natural ability to utilize common drugs." Talk with your doctor or pharmacist about your medications and find out if there are any foods you should avoid while taking them. Also, be aware that alcohol should be avoided when taking many drugs.  
6. Know your food ingredients. - If you have food allergies, ask about ingredients before you indulge. Be especially careful of home-baked goods if you have an allergy to tree nuts or peanuts. Those ingredients can be deadly if you are affected by these types of allergies.
7. Practice allergy-free decorating. - If you suffer from allergic rhinitis, holiday decorations stored in the attic and basement can build up a coating of dust and mold that can trigger allergies. Some people may also need to rethink Christmas tradition and substitute with an artificial tree.
8. Get vaccinated for covid, flu and RSV. - The holiday season includes plenty of kissing and handshaking. Getting yearly vaccinations and frequent hand washing are your best defense for avoiding the covid, flu and RSV. If you are sick with a cold or flu, limit contact with others until you are symptom free, so you don’t infect others.
9. Get a good night's sleep. - Holiday preparations and helping Santa means less sleep. Do your best to get to sleep 6-7 hours every night and avoid heavy foods and alcoholic beverages before bedtime. If you need to recharge, take a nap during the day.
10. Spend Time With Loved One’s - The holiday season and throughout the year, be proactive and participate in outings with family and friends. Make a call and invite a loved one over for coffee and eagerly accept invitations. Studies show those who are social and interactive are mentally and physically healthier.

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

While I normally do not address the topic of shoveling snow until January, considering recent weather events, I thought it might be valuable to present it sooner. Much has been written about the dangers of snow shoveling for your heart. However, while not fatal, low back pain is the most common injury sustained while shoveling snow. Heart attacks are also more common following wet and heavy snow.

Snow shoveling can place excessive stress on the structures of the spine. When overloaded and overstressed, these structures fail to support the spine properly. The lower back is at great risk of injury when bending forward, twisting, lifting a load, and lifting a load with a long lever. When all these factors are combined simultaneously, as in snow shoveling, the lower back is destined to fail. Low back pain from muscle strain or a herniated disc is very common following excessive snow shoveling.

Snow Shoveling as a Form of Exercise:

• GOOD - For the Young and Healthy – studies show that snow shoveling for 15 minutes is considered moderate physical activity and extreme and vigorous physical activity when performed more than 15 minutes even for young healthy college students.
• BAD – For the Older and Unfit – research clearly shows that there is a significant increase in heart attacks among snow shovelers. If you have any risk factors or medical condition and do not exercise regularly consult your physician.
• Cold Weather – makes this activity even more difficult and physically stressful. Cold air makes breathing more labored and difficult and cold temps create added strain on the body.

People at High Risk of Illness Due to Snow Shoveling:

• History of Heart Attack
• History of Heart Disease
• History of High Blood Pressure or High Cholesterol
• Smokers
• Inactive & Sedentary Lifestyle
• Overweight
• Elderly

10 TIPS FOR SAFE SNOW SHOVELING:

1. MEDICAL CLEARANCE: If you have any medical condition or risk factors consult your physician.
2. PAIN: Stop immediately if you experience any pain. Especially in the chest, left arm, jaw, face, neck, or lower back.
3. ERGONOMICS: Choose a snow shovel that is right for you:
   1. An ergonomic shovel with a curved handle allows you to keep your back straighter or arched when shoveling
   1. An ergonomic shovel with a shorter or adjustable handle length allows you to keep your back straighter and knees bent when shoveling. The right handle length allows you to arch your back 10 degrees with your knees slightly bent when the shovel is on the ground.
   1. A plastic shovel blade is lighter than a metal one and will be better for your spine.
   1. A smaller blade is better than a larger blade. It may take longer but will stress your back less.
4. PUSH: When possible, push the snow. Do not lift it. Lifting is much more stressful on the spine. You can find shovels that are ergonomically designed just for pushing snow.
5. WARM – UP: Be sure your muscles are warm before you start to shovel. Cold and tight muscles are more likely to strain than warm, relaxed muscles. Layer and consider compression shirts or tights can help prevent cold and tight muscles.
6. LEVERAGE: When you grip your shovel, spread your hands at least 12 inches apart. This will improve your leverage and reduce strain on your lower back.
7. TECHNIQUE: Shoveling technique is very important. The American Academy of Orthopaedic Surgeons recommends:
   • Squat with your legs apart, knees bent and back straight.
   • Lift with your legs. Do not bend at the waist.
   • Scoop small amounts of snow into the shovel and walk when you want to dump it.
   • Do not hold the filled shovel with outstretched arms.
   • If snow is deep, remove in piecemeal, a few inches at a time.
   • Rest and repeat as necessary.
   • Move your feet and do not twist your back as you shovel or dump. Never throw snow over your shoulder
8. CAUTION: Be cautious shoveling wet snow. One full shovel can weigh 25 pounds.
   • Shovel wet snow slowly in piecemeal.
9. PACE YOURSELF: Take frequent breaks and stretch your back in the opposite direction of shoveling. For example: 1. Lean backwards and extend your lower back. 2. Pinch your shoulder blades together.
10. TECHNOLOGY:
    • Snow Blower - Use a self-propelled snow blower. It will put much less stress on your lower back than shoveling snow if used correctly. For example, push the blower with your legs and keep your back straight or arched and knees bent.
    • Ergonomic Shovels:
    • 2 Handle Shovels: ErgieShovel or Snow Joe Shovelution
      • Push Shovels: Garant Yukon or Garant Sleigh Shovel
    • Snow Melting Alternatives:
    • www.warmlyyours.com - WarmlyYours - HeatTrak® portable snowmelting system for roofs, gutters, driveways, sidewalks, stairs and handicapped ramps uses electric mats or runners for home or office which can be customized.

Sources: The Colorado Comprehensive Spine Institute; American Academy of Orthopaedic Surgeons 

Visit your doctor regularly and listen to your body.     

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Part II of II

November is National Hospice Month! During this time, we celebrate the tireless work of the hospice professionals who assist patients and their families during the weeks and months that they journey with a serious or terminal illness.

However, in addition to the service of providing pain and symptom management, assisting with personal care, providing volunteer, counseling and social work services, there may be many other services that your local hospice program may be able to offer to patients, families and caregivers alike.

Please keep in mind that each hospice agency provides unique services to the community. Before you decide, it is important to reach out and ask which agency offers services that best meet your needs.

Some community support programs that are offered by hospice agencies that are routinely available include: 

Bereavement Support ---Dealing with the death of a loved one can be a difficult and often lonely endeavor. All hospice agencies offer bereavement services to families of patients that have died. In addition, many hospices offer community support programming to help those who have suffered a loss. Some support programs are in groups, but often individualized help is available. Most times the bereavement services for the community are without charge.

Pet Bereavement Support---The death of a pet can often be quite traumatizing, especially when the pet has been a long-standing member of the family. Hospice agencies are offering bereavement counseling for those who suffered the loss of a pet. Call and reach out if you have suffered a loss and require support.

Dementia Support Groups--- Nancy Reagan always referred to the diagnosis of President Reagan as the ‘long goodbye’. Dealing with a loved one suffering with dementia is difficult---but you do not have to deal with this alone. Many hospices have dementia support groups that educate, support and guide.

Supporting Children through a Loss---Often it is difficult for children to understand or process the death of a parent, sibling, and grandparent or loved one. There are specialized programs for children to understand and live with the loss----developing a new normal. These programs are usually done in a series of 5 sessions so that proper education and guidance can be accomplished.

Community Education Series--- Not only are your local hospices taking the lead to advance end of life care, but many are helping to educate the professional and lay community alike. Ask about monthly seminars, educational programs and other topics of interest to you and your family/co-workers.

Memorial Services--- Hospice agencies routinely celebrate the lives of those patients who have died within the last 6 months or a year. Surrounding yourself with others who have suffered a loss can often be healing and certainly supportive. Call and ask your local hospice about planned memorial services that honor lives well lived through prayer and testimonials.

Volunteer opportunities---There can be no better way to give back to your community than through volunteering opportunities. Hospice offers a wide array of ways to volunteer ranging from direct patient contact to more administrative tasks. Whatever the job, the act of volunteering is what makes hospice care so special.

Mentoring Programs--- As hospice programs are traditionally interdisciplinary in approach; students working with hospice programs are provided an optimal environment to learn not only hospice care, but also the ever-important concept of team. Many hospice agencies work with students regularly from nursing schools, universities and our local medical college.

Transitions Program--- Often patients are referred for hospice services, but do not meet eligibility requirements for this level of care. However, many hospice agencies offer a transitions program, which is a volunteer supported program to monitor the frail elderly in the community and reporting changes back to the physician for advice and guidance. These programs are free of charge, volunteer supported and a valuable asset for the independent senior who may need that extra set of eyes and ears of a skilled volunteer.

So, in honor of National Hospice Month, we say, thank you to all the hospice professionals, volunteers and families who work so diligently to care for those in our community with a serious or terminal illness. But remember too, that your local hospice agency can be a wonderful resource for education, mentoring, dementia support and grief counseling. Ask questions, attend a seminar, inquire about memorial services or look for support when caring for a loved one with dementia. Help, support, guidance and education are available----just make the call to your local hospice agency.

To find out which hospices serve your community, call NHPCO’s HelpLine at 1-800-658-8898 or visit www.caringinfo.org/findahospice.

Medical Contributor: Ralph DeMario, MD, Former CMO, Hospice of the Sacred Heart

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Part I of II

November is National Hospice Month! Each November, the community of hospice and palliative care professionals celebrates National Hospice Month. Although, at first glance, spotlighting the concept of death and dying may seem a bit gloomy. It’s actually the concept of quality of life and the focus on living that is truly being celebrated.

It is true that hospice serves those patients and their families who are on the journey of a serious or terminal illness. But as any hospice professional from the nurse to the social worker to the volunteer to the pastoral counselor will attest------our focus is ALWAYS on the value of life being maintained and the quality of living for each and every one of our patients.

Placing the focal point of hospice care on living, instead of dying, enables the patient and family to focus on:

• maintaining/expanding personal relationships
• reasonable exercise program
• continuing religious and/or spiritual traditions
• quality time with friends and family members
• hobbies
• completion of photo albums, scrapbooks, diaries, legacies

Remember that your hospice team will make suggestions to improve your pain and symptoms, all with the ultimate goal of allowing you to live your life as fully and functionally as possible. Pain alleviation will allow for improved activities, help with personal care will conserve energy for visiting with family and friends, and allowing a volunteer into your home will give caregivers much needed time for rest and relaxation.

Hospice Myths:

There are a number of myths surrounding hospice care----and this is good a time as ever to help dispel them…

Myth #1--- Hospice is for patients in the last days of their lives.

Actually, hospice care was designed to care for patients and their families for the last 6 months of their lives----the longer patients are under the care of hospice professionals, the better their symptoms are controlled and the better their quality of living.

Myth #2--- Pain medications are given in large doses to sedate the patient and hasten death…..

Pain medications are used in small of doses as required to control pain, and to maintain patients’ alertness, always focusing on living life to the fullest. Medications are never given to hasten death, only to control pain and maintain quality of life.

Myth #3--- Once patients start hospice services, death will come soon….

The statistics on this issue are interesting. In a major study, patients who received hospice care for congestive heart failure actually lived 29 days longer!!! Also, on average 15% of patients are actually discharged from hospice services because of significant improvement in symptoms.

Myth #4--- Patients receiving hospice services cannot leave the home or travel….

 The truth is that patients receiving hospice care can drive, travel as able, go to bingo/hairdresser/casino----actually come and go as they are able. So the goal is to improve symptoms so that patients can enjoy their lives as fully as possible while on the journey of a serious illness.

Although the topic of death and dying has been rather taboo in the US, hospice professionals celebrate the living potential that their patients still have. The focus is on quality of relationships, maintaining a functional lifestyle and living the life they were meant to live. Hospice professionals also celebrate the many lives they have improved, all the lives they have touched and the fact that they were chosen to dedicate their professional lives to helping others live more fully……

To find out which hospices serve your community, call NHPCO’s HelpLine at 1-800-658-8898 or visit www.caringinfo.org/findahospice 

Medical Contributor: Ralph DeMario, MD, Former CMO, Hospice of the Sacred Heart

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.comPaul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Age-related changes to your body are normal and expected. For example, loss of muscle tone, stiffness in joints, and loss of balance. With effort, some of these changes can be retarded and managed with stretching, strengthening and balance exercises. The brain is no different…it can slow down and lead to memory lapses. However, for most of us, it too can be managed and with a little effort, be kept sharp and clear.

• 1. Exercise Your Body

Many experts feel that exercise is the best method to maintain not only physical health but mental health. Regular exercise can prevent the things that contribute to memory loss with age such as; diabetes, high blood pressure, high cholesterol, obesity and stroke.

Specifically, aerobic exercise may be most beneficial. Aerobic exercise is any type of sustained exercise that strengthens the heart and lungs to improve the body’s use of oxygen. This may include running/jogging, brisk walking, cycling, swimming, rowing, and the use of a treadmill, elliptical, stepper or similar device, at light to moderate intensity which requires the use of oxygen to adequately meet the oxygen demands of the body for an extended period of time. The generally accepted time and frequency is at least 30 minute sessions performed three or more times per week. Two 15 minute or three 10 minute sessions are also valuable. For those with back, hip, knee and other lower body pain, consider low-impact or partial weight-bearing activities such as a recumbent bike or stepper or upright bike instead of a treadmill.  

• 2. Healthy Diet

The benefits of a healthy diet are well-documented. Specifically, a Mediterranean-style diet comes highly recommended. It focuses on plenty of fruits and vegetables with fish instead of red meat and olive oil instead of butter.  Researchers found people who closely adhered to a Mediterranean diet were nearly 20% less likely to have thinking and memory problems.

• 3. Exercise Your Brain

Exercise your brain just as you do your body. Make time each day to challenge your brain. Learn something new to keep your mind sharp. Play cards, read a book, do crossword puzzles or other word games, take a class or learn play a musical instrument.

• 4. Maintain Social Activities

Human beings are social animals and in the right setting, we stimulate and challenge each other. Join a book club, fitness center, or a community center. Consider volunteering, taking an art or photography class. Social interaction can prevent isolation which can lead to depression and depression is associated with dementia.

• 5. Sleep Better

Without adequate sleep, attention and concentration is compromised. Studies show that those who have normal restful sleep outperform those who are restless and sleep deprived. Some tips for better sleep are: avoid big meals before bed, keep a consistent sleep and wake up time, avoid nicotine, caffeine and alcohol close to bedtime. “

Consider an afternoon “power nap!” Recent studies show that an afternoon nap was rejuvenating to the mind and body. Participants improved on mental skills such as memory, calculation, orientation and attention.

• 6. Stress Less

Cortisol is the hormone associated with stress. Recent studies have found that elevated cortisol levels were associated with poorer overall cognitive functioning, including memory, language, and processing speed.

Try yoga, massage, breathing techniques to relax. Progressive muscle relaxation (PMR) techniques can be very effective…try it on YouTube!

• 7. Don’t Smoke

Smoking is clearly one of the worst things you can do to your body AND MIND! Smoking can lead to early memory lose in part due to small strokes in the brain. Do whatever it takes to quit; nicotine replacement, medication, or counseling.

• 8. Regular Medical Check-ups

There are many medical conditions and medications associated with memory loss. Regular medical check-ups can prevent, diagnose and treat some of these conditions such as; depression, diabetes, thyroid disease, vitamin deficiencies, and drug interactions or side effects. For example, sleep aid and anxiety drugs associate with memory loss.

• 9. Use Technology

In addition to common tricks such as word association, sticky notes, use your smart phone for appointments and reminders. If you don’t know how to use a smart phone, it is time to learn something new…and that is a healthy brain activity!

SOURCES: WebMD; Harvard Health

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what type of exercise is best for those suffering from osteoarthritis (OA). Osteoarthritis is also known as degenerative arthritis. It is the most common form of arthritis in the knee. It is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle. It causes gradual onset of pain, swelling and stiffness in the involved joint, especially after increased activity and weakness with loss of function due to disuse.

However, OA is not an excuse to avoid exercise but it is important to be smart about it. Regular exercise is essential to maintain a normal lifestyle for those with OA. However, if you do the wrong exercise, use poor technique, or are too aggressive, you could flare-up your joints and do more harm than good.

Benefits of Exercise for Those with OA:

When performed correctly, exercise for those with OA has many benefits:

Pain Control

Exercise controls OA pain by releasing natural pain control chemicals in the body called endorphins. It also controls pain by assisting in weight loss and improving range of motion.

Weight Control

We all know how well exercise burns calories and that increased body weight creates increase stress on the joints.

Prevention of Joint Stiffness

Exercise will help maintain joint range of motion. A stiff joint is a painful joint.

Prevention of Muscle Weakness

Exercise will help maintain muscle strength. Weak muscles will allow or increase in joint wear and tear.

Maintain Lifestyle

If a joint is stiff and weak, then they become painful which negatively impacts your lifestyle. Exercise can prevent this problem.  

Tips How To Exercise With Osteoarthritis:

Start Slowly

Wean into exercise because if you advance too quickly, you will flare up the joint and have increased pain. For example, walk for 5-10 minutes the first session. If you do not have pain, add 1-2 minutes each session.

Lose Weight

Every pound lost equates to less stress on your joints. For example, a loss of 5 pounds of body weight translates to 20-30 pounds of stress through the knee, according to David Borenstein, MD, President of the American College of Rheumatology. Also, body weight has a direct impact on daily activities. For example, walking upstairs creates stress through the knee equal to 4 times body weight and seven times body weight going downstairs. Therefore, less body weight equals less stress.

Low Impact Workouts

Low impact exercise creates less stress on the joints while strengthening leg muscles and those who those who maintain leg muscle strength have less stress on their joints. It is even important not to load your arms with heavy objects when walking or using stairs to limit joint stress.

Some examples of low-impact exercises are: walking, swimming, elliptical trainer, and biking. Strength training is also low-impact and should be performed with low weight and high repetitions. Water therapy is great for those with OA, especially in a heated pool. It is a great low-impact exercise with less gravity and stress on the joints. Walk, swim and do mild resistance exercises in the water. Use a snorkel and mask for swimming to limit excessive neck turning and back extension.

Walking is a great form of exercise; however, walking softly is important for those with OA. Wear good running shoes and orthotics if necessary. Discuss this with your physical therapist or podiatrist. When possible, use soft surfaces like cinder, mulch or rubber. Avoid grass and soft stand due to instability and torsion that may irritate your joints.  

Warm-Up

Warming up your body is critical to prevent injury to the muscles and tendons. This can be done by marching in place or using aerobic equipment such as a bike for 5 to 10 minutes before exercise. Always perform the warm-up activity at ½ your normal pace.

Balance & Relaxation Techniques

Tai Chi and ballroom dancing are two good examples of activities which promote balance and relaxation. Studies showed that those with OA who participated in Tia Chi two times a week for eight weeks reported less pain, increased range of motion and improved daily activities and function. They also noted less low back pain and better sleeping.

Proper Clothing

Stay warm in winter and consider wearing compression shorts. Be cool in the summer months with Drytech^R type material.

Pre/Post Exercise First Aid

If you are sore for longer than 12 to 24 hours after exercise, then you overdid it and must make adjustments next time. Otherwise, use hot packs, bath or shower before you exercise to loosen up and apply ice to your joints after exercise, especially if they are sore.

Post Exercise Stretch

Gentle, active range of motion stretches after exercise is important to maintain mobility. Do not bounce or cause pain. For example: Low Back – knees to chest; Arms – row –the – boat, arms behind head, arms behind back; Legs – wall lean calf stretch, bend and extend knees, open and close hips.

SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons; www.lifescript.com

Visit your doctor regularly and listen to your body.     

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

There are Many Positives About Aging!

Ageism is prejudice or discrimination on the grounds of a person’s age…

While I hesitate to discuss politics, as an aging physical therapist, I feel that it is incumbent upon me to speak out against ageism, especially with so much attention being paid to the age of the candidates in the upcoming US presidential election. Interestingly enough, age seems to be of more concern for President Biden (age 81), than his opponent, former President Trump (age 78), even though there is only 4 years between them. By the way, “Corporate Sages,” Warren Buffett, CEO of Berkshire Hathaway is 93 years old and Rupert Murdock, CEO of News Corp is 86 years old and their stock holders seem very satisfied! Two local examples of aging with an “A Game” are my 92 year old mentor, Dr. Gino Mori, founder of Delta Medix, who took college classes for enrichment until the age of 90 and Fr. Bernard Mcllhenny, SJ, retired dean of admissions at the University of Scranton, who plays golf (competitively) at least once a week at the age of 98.

It is low hanging fruit to list all the problems associated with age; muscle and bone loss, balance deficits, delayed mental processing, and memory loss to name a few. However, the purpose of this column is to present the positive qualities of the “golden years!”

Wisdom, Wisdom, Wisdom

There are no shortcuts for the assimilation and accumulation of knowledge and wisdom that one acquires over a lifetime and it cannot be taught…only experienced! Not only do older adults know what they know, more importantly, they know what they DON’T know! Moreover, they know how to use this knowledge efficiently and effectively. This is referred to as “crystallized intelligence” and it keeps improving with age…even at 65-75 and more.

Steady Eddie

While the term “Grumpy Old Men/Women” makes for good TV, the reality is that most of us get more agreeable, likable and consistent with age. Older people are less volatile, control their emotions and tend to focus more on the important things in life.

Collegiality

With age, people tend to be less egocentric and more in tune with the feelings and emotions of others. Using this acquired insight, one can foster a more cooperative and productive solution to problems with friends, family and coworkers.

Improved Sex Life

Quality over quantity with age! Studies show that women over 40 and much older have improved sexual satisfaction when compared to their youth. Moreover, women over 80 were more satisfied with sex than those between 55 and 75! Go figure!

Enjoy the Sunrise

Whether you like it or not, there is a good chance that you will become a “morning person” with age. As sleeping patterns change, including sleep interruptions, we tend to go to bed earlier and rise and shine with the sun. The good news is that you can start your day early to “suck the marrow” out of the day.

Headaches Are Over

Most migraine sufferers report little to no headaches after age 70. And, for older adults who experience headaches, they tend to be less painful and debilitating.

Have a Purpose

Studies show that early retirement may not be good for your health. The Longevity Project that people who continue to be productive, have purpose, and enjoy their work, live the longest. So maybe, Biden and Trump want the POTUS job in order to stay healthy!

Fear Not

While older adults may fear falling and breaking a bone, they don’t have the same fears and concerns that distract many younger people. With age, self-esteem and confidence improves and with wealth, education, good health and a sense of purpose, these qualities increase exponentially. According to the American Psychological Association, while more young people report high stress levels, older Americans report less. And, even when encountering a stressful situation, older people have learned coping methods to manage it better than younger people. 

Productivity

We can waste our time debating the potential problems with an aging POTUS, however, we must decide between two candidates that will be octogenarians while in office. With that in mind, we must focus on the potential for solid, honest, dedicated, effective and productive leadership to guide us through the next four years. Research has shown that the workforce is aging worldwide and older workers are a critical component to overall productivity in an age of worker shortages. A thorough assessment of the literature related to the productivity of an aging workforce shows that older workers are at least as productive and in some cases (that does not require heavy labor), are more productive than their younger coworkers. In great part, this is attributed to the aforementioned positive aspects of aging such as “crystallized intelligence”. In view of this, ageism has no place in the workplace because older workers can and do keep up.

SOURCES: National Institutes of Health; Mayo Clinic, WebMD

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Most would agree that this spring has a little cloudy, rainy and cool in NEPA. However, warm sunny days are soon to come. While protection from the sun is very important, too much time indoors playing computer games and watching television, can lead to potential problems from lack of exposure to the sun. One must use good judgment and have balance as the potential exists for Vitamin D deficiency due to lack of sun exposure. This problem may be true for individuals who use too much protection or spend most of their day indoors due to occupation or poor health. Therefore, it will be the purpose of this column to discuss the importance of Vitamin D for health and wellness.

Vitamin D, a fat soluble vitamin, is found in food and can be made by your body after exposure to ultraviolet (UV) rays from the sun. The liver and kidney help convert it to its active form. Therefore, vitamin D assists calcium absorption, which is essential for normal development and in forming and maintaining strong bones and teeth. Without it, bones can become thin, brittle and soft. The classic Vitamin D deficiency diseases are rickets in children and osteomalacia in adults. Rickets results in skeletal deformities. Osteomalacia is the softening of bones. Therefore, it is essential for normal bone health and may diminish or prevent the onset of osteoporosis in the elderly.

The requirement for Vitamin D is dependent on age, sex, degree of sun exposure and the amount of pigmentation in the skin. Since it can be produced by the body and retained for long periods of time by the body’s tissues, the precise daily requirement has been difficult to determine. Instead, an Adequate Intake (AI) level has been established. AI is a level of intake sufficient to maintain healthy blood levels of an active form of Vitamin D.

AIs are similar for males and females but increase with age:

• Ages 19-50: 200 International Units (IU)
• Ages 51-69: 400 IU
• Age 70 and older: 600 IU

Sources of Vitamin D:

• Food Sources
  • Fortified foods are a major dietary source:
    • One cup of Vitamin D fortified milk: 98 IU
    • Dairy products (e.g. cheese, yogurt, ice cream) are generally not fortified
    • Orange juice, cereals, pastries, breads, crackers, cereal grain bars may be fortified; read the nutrition label for more information.
  • Only a few foods naturally contain significant amounts:
    • Salmon, cooked, 3 ½ oz: 360 IU
    • Mackerel, cooked, 3 ½ oz: 345 IU
    • Sardines, canned in oil, drained, 3 ½ oz: 270 IU
    • Liver, beef, cooked, 3 ½ oz: 30 IU
    • Egg yolk, one: 25 IU
• Exposure to sunlight:
  • Regular ultraviolet exposure stimulates the skin to produce Vitamin D.
  • Exposure to ultraviolet light or ambient sunlight
  • Exposing the face and hands for 20 minutes, 3 times a week can be sufficient
  • Exposing the hands, legs and arms for 5 to 10 minutes, 2 to 3 times a week, is more than adequate to satisfy requirements.

Vitamin D Deficiency:

Vitamin D deficiency can occur when dietary intake is inadequate, when there is limited sunlight exposure, when the kidney cannot convert Vitamin D to its active form or when Vitamin D is inadequately absorbed from the gastrointestinal tract. Season, geographic location, time of day, cloud cover, air pollution, sunscreens, living indoors and living in cities where tall buildings block adequate sunlight from reaching the ground affect UV ray exposure. Therefore, individuals with limited sun exposure are at risk of this deficiency. Homebound individuals, people living in northern latitudes (e.g. New England, Alaska), individuals who cover their bodies for religious reasons and people whose occupations prevent exposure to sunlight may need to supplement in other forms.

Sunscreens with a sun protection factor of 8 or greater will block UV rays that produce Vitamin D. Older adults have a higher risk for this deficiency because the skin’s ability to convert Vitamin D to its active form decreases with age and the kidneys, which help convert Vitamin D to its active form, do not work as well when people age. Individuals with pancreatic enzyme deficiency, Chron’s disease, cystic fibrosis, sprue, liver disease, surgical removal of part or all of the stomach or small bowel disease may need extra intake because Vitamin D is a fat soluble and they have reduced ability to absorb dietary fat. Supplements are often recommended for exclusively breast-fed infants because human milk may not contain adequate Vitamin D. Consult with your pediatrician on this issue.

SOURCES: The National Institutes of Health; CDC

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

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!