Gretchen graduated from Philadelphia College of Pharmacy and Science, The University of Scranton, and received a Doctor of Pharmacy degree from Temple University.
Gretchen has been teaching for over 25 years at Rutgers University, Keystone College, Lackawanna College, The University of Scranton, and Marywood University. She has earned certifications in Pilates, yoga, barre and teaches all three locally. She has a Wellness and Lifestyle coaching certification from Harvard University.
Gretchen resides in Scranton with her husband, Timothy Welby, MD, and has three daughters – Casey, Kate, and Caroline.
Lifestyle Medicine, is not just a fad or buzzword that is overused in a plethora of health, fitness and wellness magazines, but is actually a medical specialty. It is the practice of using diet and exercise, along with other lifestyle modifications to prevent and manage disease. Lifestyle Medicine focuses on six pillars: healthy eating, physical activity, restorative sleep, stress management, positive social connections, and avoidance of risky substances.
The American College of Lifestyle Medicine was established in 2004. Since then, its membership and outreach have grown exponentially. Lifestyle medicine is currently the fastest-growing specialty in medicine. Its primary aim is to utilize evidence-based therapeutic lifestyle interventions to prevent/control chronic diseases such as cardiovascular disease, type II diabetes, and obesity. However, new data is emerging which expands the role of Lifestyle Medicine into many other areas, including chronic low back pain, sleep, hormonal disorders, Alzheimer’s Disease, chronic inflammatory conditions, and mental health, to name a few.
Lifestyle Medicine differs from conventional medicine in that its approach is not disease specific. Following the six pillars of Lifestyle medicine improves overall health. Conventional medicine targets and treats a specific disease process with medication or surgical intervention in a reactionary approach. Lifestyle medicine prevents or reverses the disease process through behavioral and dietary changes. In a perfect world, Lifestyle medicine and Conventional medicine can be combined to achieve the best results for some patients.
A JAMA study, published in 1993, linked unhealthy lifestyles with premature death. Since this study was published, the rates of cardiovascular disease and Type II diabetes have continued to climb. Obesity rates are at an epidemic level. 70% of American adults, and 22% of children fall into overweight/obese Body Mass Index (BMI) categories. According to the American Academy of Cardiology, only 6.8% of adult Americans meet the criteria for ideal cardiometabolic health, something the Academy calls a “Population Level Code Blue.”
In 2020, the American Heart Association issued a Presidential Advisory for 2030 Impact Goals. The overall goal is to improve morbidity and mortality through preventative measures. Interventions should be targeted earlier in childhood and young adulthood, where healthy habits can be formed with greater success and maximum outcomes. For example, physical activity is well established for its positive effects on cardiovascular health. Physical activity prevents clot and plaque build-up, is antiarrhythmic, and provides hemodynamic stability. Physical activity has also been shown to have psychological, emotional, and social benefits. The American Heart Association categorizes physical activity as a Level 1 (highest) intervention for primary prevention.
Lifestyle Medicine is rooted in evidence-based findings, and its efficacy is supported in scientific literature. A study published in the New England Journal of Medicine in 2002 examined the prevention of the onset of Type II Diabetes in prediabetic patients. Patients were divided into three groups: a placebo group, a metformin group (a type 2 diabetes medication), and a lifestyle intervention group. The metformin group received daily metformin (medication intervention). The lifestyle intervention group received education and prescriptive interventions/instructions on diet, exercise, and stress reduction. Patients were followed for three years. At the end of the study period, the metformin group saw a 31% incidence reduction of type II diabetes, and the lifestyle intervention group saw a 58% incidence reduction in type II diabetes (almost double that of the medication group).
Many examples abound, highlighting the ability of lifestyle medicine interventions for healthy outcomes. The advantages of lifestyle medicine over conventional medicine interventions are numerous. Medications come with side effects. Medication costs are rising and are often not fully covered by insurance programs. Often, current medications are not completely effective for treating disease. For example, Alzheimer’s Disease treatments are lacking. The Alzheimer’s Association International Conference emphasizes healthy lifestyle interventions. They stress adopting 4 or 5 healthy lifestyle factors to reduce the risk of Alzheimer’s dementia by 60%.
Healthy eating habits do not lead to serious side effects. Lifestyle interventions are within the patients’ control and may result in cost savings, potentially lowering food and medical bills. Because lifestyle intervention involves behavioral changes, the process requires time and effort, as well as investment in education and reinforcement to sustain healthy patterns. Motivating clients to make necessary changes and stick with those changes can be the biggest challenge. A Lifestyle/Wellness Coach may be employed to start the client on their journey. The coach works with the client to make choices that are adaptable to the client while fitting within the six pillars. The role of the coach is to hold space and provide guidance for the client, but not to “fix”, “rescue,” or “judge”. Coaching sessions last 30-60 minutes. Coaches and clients may meet 10 times over 3-12 months to establish patterns.
If you, like so many others, have not achieved your health and wellness goals using traditional methods, it may be worth considering Lifestyle Medicine. Focus on healthy eating (minimizing processed foods and sugar intake), physical activity (minimum 300 minutes per week), restorative sleep (between 7-9 hours per night), stress management (controlling anxiety and depression), positive social connections (consistent interactions with friends) and avoidance of risky substances (alcohol, tobacco/nicotine, illicit drugs) have evidence-based positive outcomes to prevent, manage and reverse chronic diseases.
Sources: More information about the six pillars of Lifestyle Medicine and specific intervention outcomes can be found @Balanced Living 570 on Facebook and Instagram!
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!
Allergies affect 30 % of adults and 40% of children in the United States. Avoiding the outdoors is often not an option…especially if you enjoy outdoor activities and sports. Not long ago, it was unthinkable that an athlete with serious allergies could compete at a high level, such as the Olympics. Now, in great part due to advanced research, medications and proper management, an Olympic gold medal for those suffering from allergies is a reality. Recently, the National Institute of Allergy and Infectious Disease at the National Institutes of Health have published research on this topic to provide a better understanding and make recommendations.
The most common allergic reactions which athletes suffer from are sneezing, itchy and watery eyes, runny nose and coughing. Moreover, 67% of those with these symptoms also suffer from asthma. The athlete in NEPA is particularly vulnerable when the pollen count is high during spring and fall for several reasons. One, after being indoors all winter, one might develop a heightened sensitivity to allergens. Also, increased rapid and deep breathing during exercise makes athletes more susceptible to significant symptoms when exposed to allergens such as tree, grass and weed pollens.
Sources: American College of Allergy, Asthma, and Immunology. National Athletic Trainers Association.
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!
Guest Author: Andrea Molitoris Kozlowski, PT, DPT - Andrea is a doctor of physical therapy and an associate at Mackarey Physical Therapy in Scranton and Clarks Summit.
May is national pet month! As we take a moment to celebrate our pets it is important to acknowledge the many contributions having a pet brings to our lives, not the least of which is improving our health and wellness. Pets have a long history of helping humans navigate daily life. In fact, the oldest record of having a pet date back 15,800 years ago in Turkey where archaeologists found dog remains buried with humans.
Pets come in many different shapes, sizes, and species. Whether you are a cat/dog person, a reptilian lover, or marine life enthusiast, having a pet that is right for you can enrich you life in many ways. If you have never had a pet before or might be thinking about adopting a new addition to the house, it is important to research first and know the right ways to care for your new friend in the best way possible. Being a responsible pet owner will help to flourish your relationship with your pet and make the time and bond you share a stronger and more positive experience.
Making an informed and thoughtful decision about getting a pet is important. Don’t be afraid to ask questions, do some research, or simply take some time to figure out the logistics of how adding a pet can influence your life. From personal experience, I could not imagine my life without my four-legged friends by my side to share, enjoy, and enrich my every day. Having a pet can be one of the best parts of life. Remember, although having a pet can be a small part of your life; to them, you are their whole life, so make sure it can be the best life possible. Together, you will form of a bond that in enhances you life in many ways, including your health and wellness!
Sources: https://newsinhealth.nih.gov/2018/02/power-pets
Visit your doctor regularly and listen to your body. Keep moving, eat healthy foods, and exercise regularly.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
May is National Bike Month! For those who have a bike, now might be a good time to dust it off and enjoy the many beautiful and well-maintained trails that are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority. For those who don’t have a bike, it might be a good time to get one!
However, whether you head out for 5 or 50 miles, ensuring a proper bike fit should be on your checklist. Riding a bicycle that is properly fit for your style and body will not only help to prevent injury but allow for a more comfortable riding experience. There are many things to take into consideration when checking your bike fit. First and foremost, you must choose a bike that fits your style of riding.
For the sake of simplicity 3 basic styles of bikes include Road bikes, Hybrid bikes and Mountain bikes. Road bikes are designed for long distance riders, hybrid bicycles can be used for longer distance riders, but usually accommodate a recreational cyclist, and mountain bikes are designed for dirt or gravel and technical trails. The next component of ensuring a proper bike fit is making sure that you have a good foundation by choosing the right sized frame. To find the right sized frame you can use the following guidelines as a way to start or simply ask the local bike shop or bike fit consultant of your choice for help.
Now that you have right size for your bike you should adjust the components of the bike to allow for a more comfortable riding experience. Please use the diagram as a point of reference for the following tips. Also be sure to re-examine your bike fit after any bad falls. Keep in mind these measurements are meant to be used as a simple guideline and if you have any preexisting injuries or concerns please be sure to consult your local Physical Therapist or bike fit consultant.
The knee to pedal measurement should be taken with the knee in the most extended position. There should be about a 25-35° angle at the knee (See “C” on diagram)
The ball of your foot should be over the pedal spindle (See “D” on diagram). This will allow for the best leverage, comfort and efficiency. Using a stiff soled shoe is recommended.
If you are a recreational cyclist, it’s a good idea to take all the proper steps in preventing injury. This article can be used as a reference point to help to prevent common cycling injuries, enhance your comfort and improve your riding efficiency. If you have any further questions about enhancing your bike fit, please contact your local physical therapist or bike fit consultant.
Sources: REI.com, APTA.org
Contributions & Illustrations: Sarah Singer, BFA, PTA
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
Spring sports and outdoor activities are here…tennis, pickleball, baseball, soccer, running, walking, hiking, golfing, etc. One of the most common injuries associated with physical activity, especially after a sedentary winter or change in temperature is a “pulled hamstring.” This painful injury is not only for the weekend warrior. Well-trained, healthy and fit professional athletes often have their season interrupted for weeks and months due to a hamstring injury. What is the hamstring? How is it injured? What is the best treatment?
A hamstring strain is a tear of the muscle fibers of the muscle group in the back of the thigh called the hamstring. The hamstring muscle is a group of three muscles that run from the back of the hip (lower pelvis), crossing the back of the knee and attaches to the knee bone (tibia). The hamstring muscles work to extend the hip and bend the knee during running and walking activities. They are very active when an athlete changes direction, especially forwards and backwards or decelerating. This injury, like others muscle strains, varies in intensity.
Severe hamstring strain occurs when many muscle fibers are torn. The athlete may experience a sudden onset of severe pain in the back of the thigh and occasionally report a popping sensation. Pain, swelling and black and blue skin from tissue damage and bleeding is often reported. Also, pain is reproduced when attempting to bend the knee. In very severe cases, the boney attachment can be pulled so strongly that a small fracture can occur. Healing time can be as short as a few days or as long as weeks or even months.
Your family physician will examine the back of your leg to determine if you have hamstring strain. Sometimes, pain in the buttocks and back of the leg can be referred from your lower back if the sciatic nerve is inflamed. In more advanced cases, you may be referred to an orthopedic surgeon for further examination and treatment. An X-ray, MRI or bone scan will show the extent of the tear and if the bone is involved. The diagnosis will determine if your problem is minor, moderate or severe.
There are many conservative options. Your family physician or orthopedic surgeon will help you decide which choices are best.
Recent studies have determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:
SOURCES: Journal of Physical Medicine & Rehabilitation and 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!
A health column about sugar for Easter??? Well, maybe this information will be more appropriate next week! For those trying to lose weight or “get in shape” for the “bathing suit season,” a better understanding of the role sugar plays in your diet and overall health may be valuable. You have probably noticed a lot of attention being paid to sugar lately. Many television stars and other celebrities have shared their experiences using a “sugar cleanse” when they need to lose a few pounds and get healthier.
I have had several patients and friends tell me the same thing. For 4-6 weeks these people decide to avoid all refined sugars with the goal of losing weight and improving their health and wellness. Well, what is all the fuss about? Terms like simple sugars and simple carbs, which are purported to be bad, and complex carbs, suggested to be good, are being used ad nauseam. While medical research does not support the value of a short term “sugar cleanse,” it may have value for another reason. For example, it would be very beneficial if one engages in a “sugar cleanse” for the purpose of changing their palate with the hope of developing long term healthy eating habits, especially for those with diabetes…to be implemented AFTER the Easter candy has been consumed!
So, with this in mind, I decided to find the answers to some simple questions about the fuss over sugar. What is a simple sugar? What is a complex sugar? Which sugars are good for you?
Sugars, along with starches and fibers, are one of three types of carbohydrates (also referred to as a carb). A carb is “simple” or “complex,” based on its chemical composition and how it is processed in the body. It gets a little complicated because some foods have both simple and complex carbs. Typically, simple carbs are chemically more “simple” and basic, and therefore they are broken down more easily and serve as a quick source of energy. Some of these carbs are naturally simple (like fruit and milk) while others are processed or refined sugars such as those used in candy, soda and baked goods.
To determine if a food product has good or bad simple sugar, you must also know how much fiber, vitamins and minerals are in the food. A food with a higher sugar content combined with a low fiber, vitamin or mineral content will be worse than a food with the same sugar content but high fiber and vitamins or minerals. For example: a candy bar, which is high in sugar without fiber or vitamins or minerals, is not as healthy as a fresh orange, which contains fiber, vitamins and minerals along with its simple sugar (fructose).
Complex carbs have a more complicated chemical makeup and take more time for the body to break down for use as energy. Therefore, these are considered “good” carbs because they provide a more even distribution of energy for the body to use during activity. They cause a more consistent and gradual release of sugar into the blood stream (as opposed to peaks and valleys caused by simple carbs) and provide energy to function throughout the day. Additionally, “good” carbs have the added benefit of providing vitamins, fiber, and minerals that are missing from simple carbs.
Remember that carbohydrates fuel the body and are an important source of energy, especially for active and athletic people. However, carefully selecting the type of carb you eat is critical to peak function and performance.
Simple carbs taste great (according to our modern brain raised on simple sugars) and are easy to break down into a quick source of energy. However, the sensation of hunger is quick to return because the sugar is released and used up in the body quickly, giving the sensation of needing more.
Simple carbs are often “refined” and therefore stripped of their fiber, vitamins and minerals, which is why they are often referred to as “empty” calories.
Simple carbs lead to rapid spikes in blood sugar and insulin levels after meals. When these levels are not controlled over time, it can lead to obesity, which is ultimately related to adult-onset diabetes and high blood pressure.
Sources: www.everydayhealth.com; www.yourdictionary.com; Mayo Clinic
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!
Guest Author: Gretchen Welby, PharmD, MHA
Gretchen graduated from Philadelphia College of Pharmacy and Science, The University of Scranton, and received a Doctor of Pharmacy degree from Temple University.
Gretchen has been teaching for over 25 years at Rutgers University, Keystone College, Lackawanna College, The University of Scranton, and Marywood University. She has earned certifications in Pilates, yoga, barre and teaches all three locally. She has a Wellness and Lifestyle coaching certification from Harvard University.
Gretchen resides in Scranton with her husband, Timothy Welby, MD, and has three daughters – Casey, Kate, and Caroline.
I have invited Gretchen Welby, PharmD, MHA to present the current wisdom on the very controversial topic of vaccination/immunization to raise awareness and dispel any myths and misunderstandings.
Scientific progress has rarely advanced by popular vote, and vaccination is no exception. While public sentiment deserves respect and thoughtful engagement, the evidence guiding immunization policy is built on decades of rigorous research, transparent testing and continuous review. These research processes are designed precisely to rise above fear, trend, politics or misinformation. Choosing to prioritize scientific findings over shifting opinion is not an act of dismissal, but of responsibility…it is a commitment to decisions that protect both individual lives and the collective good, even when those decisions challenge what feels comfortable or widely believed.
2024 marked the 50th anniversary of the World Health Organization’s Expanded Programme on Immunization (EPI). An initiative to make life-saving vaccines available to all worldwide. A modeling study done to mark the 50 years of EPI estimated that vaccination averted 154 million deaths, including 146 million deaths among children. Several additional studies on vaccine effectiveness show that vaccines improve infant safety, contribute to a healthy society, and even reduce cancer risk. Vaccines work for an individual and society. The data show that many vaccines can reduce mortality by 99% or more. Unfortunately, global immunization has been a victim of its own success because people have forgotten how deadly and dangerous the diseases vaccines protect against can be.
Vaccine effectiveness is overshadowed today by misinformation about vaccine safety, changing vaccine administration timelines, and mixed public health messaging. What are the outcomes of the recent relaxed vaccine message? The number of measles cases has jumped. Fifty-nine cases were reported in 2023. In 2025, 2242 cases were reported. For additional perspective, an article published in the 2007 edition of JAMA listed the number of deaths pre-vaccine release and the number of deaths post-vaccine release. The findings are remarkable.
The recent Centers for Disease Control and Prevention (CDC) change to the childhood vaccine schedule reduces routine protection against 13 childhood diseases to 7, with shared decision-making now required for the remaining 6. Diphtheria, tetanus, acellular pertussis (DTaP; Tdap), Haemophilus influenzae type b (Hib), Pneumococcal (PCV), Inactivated poliovirus (IPV), Measles, mumps, rubella (MMR), Varicella (VAR), and Human papillomavirus (HPV – changing from 2 doses to 1 dose) are now part of the routine vaccine schedule.
Rotavirus, COVID-19, Influenza, Hepatitis A, Hepatitis B, Meningococcal ACWY, and Meningococcal B are now grouped in a shared-decision-making model. Traditionally, when changes are made to the vaccine schedule, they are made with much deliberation, study, and expert input from multiple agencies and governing bodies. However, this recent change, however, did not follow the normal study path. This is concerning because changes are proposed without proper study of the immediate and long-term consequences.
Vaccines have been shown to be safe, with most patients experiencing very minor side effects. Normal reactions from vaccinations include low-grade fever for 24-48 hours. A low-grade fever and minor muscle aches signal the body's immune response. Tenderness and redness at the injection site are other normal reactions from immunization and should last from 24-48 hours. There is no proof that thimerosal (a preservative historically used in vaccines) causes adverse reactions. Additionally, thimerosal has been removed from most vaccine preparations used today. Vaccines do not overwhelm a child’s immune system. Children are exposed to hundreds of antigens daily. A WHOLE pediatric vaccination schedule exposes them to around 50 antigens. There is NO evidence to support altering or delaying the American Academy of Pediatrics vaccination schedule. This does NOT increase safety; it DECREASES protection at a time when infants and children are most vulnerable.
How can consumers of healthcare information, in particular, vaccine information, find reliable, trustworthy, educated guidance? Since the June 2025 changes in CDC personnel have resulted in less qualified members of the Advisory Committee on Immunization Practices (ACIP), it is generally best to rely on non-governmental sources such as the American Academy of Pediatrics, American College of Gynecologists, the Infectious Disease Society of America, and the Vaccine Integrity Project for vaccine advice. Additionally, discuss vaccine efficacy and safety with your doctor.
For More Information:
Vaccination greatly reduces disease, disability, death and inequity worldwide - PMC
The New Federal Vaccine Schedule for Children: What Changed and What Are the Implications? | KFF
JAMA 2007; 298:2155-2162
Visit your doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
It’s that time of year…after a long winter of nights that come early and last too long there is LIGHT at the end of the tunnel! In the fall and winter, especially this far north, many people start to feel the gloom of their surroundings creep into their psyche and spring cannot arrive too soon...Is this normal, or a sign of something more serious?
Seasonal affective disorder, or SAD, is at the far end of a spectrum of seasonal mood changes. The mildest of these, “seasonality”, is a normal response to cyclical changes in weather and light exposure. However, when symptoms like depressed mood, lack of motivation, or a shift to more vegetative daily habits become severe and debilitating, SAD may be the cause. In fact, one study found that SAD affects up to 10% of primary-care patients, and that those with a previous diagnosis of depression are even more at risk. Fortunately, though, there are well established therapies that can help those afflicted with SAD to get through the dark winter months.
The American Psychiatric Association defines SAD as a subtype of either Major Depressive Disorder or Bipolar Disorder, depending on the symptoms. It can consist of episodes that onset during either fall/winter or spring/summer, or have symptoms characteristic of either “major depressive” or “manic” episodes. The vast majority of those with SAD, however, experience a persistent overall depressed mood during the shorter days of fall and winter.
In more serious cases:
If enough of these symptoms are present for a long enough time and onset in a seasonal pattern, that can mean Seasonal Affective Disorder. Most people with the disorder find themselves sleeping more and eating more (especially carbs), and report that their symptoms can even resolve with relocation to a sunnier environment. Along the spectrum of disease is a less severe form called “subsyndromal” SAD, which can still be effectively treated. Periods of SAD tend to resolve with the coming of spring, but they can be immensely distressing and always deserve medical intervention.
No one knows exactly why Seasonal Affective Disorder happens, but it appears to be associated with decreased exposure to natural light during the fall and winter months. One possible explanation is the “phase-shift” hypothesis. It states that your body’s circadian rhythms, which are regulated by hormones and the brain, become out-of-step with environmental sleep/wake cues as the days shorten. In other words, the light levels around you and your body’s internal clock are telling you two different things about when to sleep. This disruption of circadian rhythms, or “phase-delay”, likely contributes to the symptoms of SAD, although precisely how it induces changes in mood remains unclear.
Another hypothesis for the mechanism underlying SAD involves abnormalities in the activity of serotonin, a neurotransmitter in the brain. Normally, serotonin regulates mood and attention. However, studies have found that people with SAD clear serotonin out of their brains faster, giving the hormone less of a chance to provide a boost in mood.
Current medical treatment of SAD targets the changes in both circadian rhythms and serotonin metabolism. This can be accomplished with light therapy, antidepressant medications or a combination of both.
Medical Contributor:
Brendan Bormes, MD, GCSM 2019: This column was previously featured in “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
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!
According to the Centers for Disease Control and Prevention (CDC), the 2025/26 flu season has been exceptional. Normally, elderly adults have the largest number of flu related hospitalizations while young children are second. This year, however, baby boomers between 50 and 64 years of age are the second most vulnerable. And, as of January 2026, the US flu season has resulted in an estimated 19 million illnesses, 250,000 hospitalizations, and 10,000 deaths. At the risk of creating an overreaction and promoting “germaphobic” behavior, if there is one time of year that diligent hygiene has merit, it is now…during flu season.
Contracting the cold or flu can make you feel run-down and under the weather for weeks. Unfortunately, your daily activities and responsibilities cannot take a sick day. The common cold and flu is most prevalent during late fall, winter and early spring. According to flufacts.com, “The influenza virus, more commonly known as the flu, is defined as a contagious respiratory infection that infects the nose, throat, and lungs. Thankfully, there are several easy and effective preventive measures that can reduce the probability of contracting the cold and flu. These preventive measures are designed to help keep your immune system strong and healthy. A healthy immune system fights against pathogens, such as the cold and flu virus. This article will focus on the ten best ways to prevent the flu and cold this season.
Sources: www.flufacts.com; www.webmd.com; www.lifescript.com; www.cdc.gov
Guest Contributor: Paul Mackarey, Jr. DPT, is a Doctor of Physical Therapy and partner at Mackarey & Mackarey Physical Therapy Consultants, LLC in Scranton and Clarks Summit.
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 had its share or snow this winter…and the recent storm added plenty of the pretty white stuff for work and play. 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.
Sources: The Colorado Comprehensive Spine Institute; American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.
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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 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!
