Wednesday, November 11, 2026 is Veteran’s Day. In 1918, on the 11th hour of the 11th day of the 11th month of the year, an armistice, or temporary cessation of hostilities, was declared between the Allied nations and Germany in World War I. This date became a federal holiday in the United States in 1938, a day set aside to remember with gratitude, those veterans who sacrificed for our freedom.
It is well known that many Veterans have suffered greatly, mentally and physically from their service. Sleep disorders, often associated with other mental and physical problems, are among them. In fact, 2 in 5 (40%) veterans report problems with sleep compared to 30% of adults in the US.
According to recently released CDC data, nearly 13% of American adults used some type of sleep aid most days or every day in the past month. That includes prescription medications, over-the-counter medications and supplements, and marijuana or CBD products.
Despite being completely exhausted, your body hurts, your eyes are heavy, you finally get into bed, and suddenly your brain has decided that now is the appropriate time to think about everything. Tomorrow. Something you forgot to do. Something you said five years ago. The grocery list. That one weird noise in the house. Unfortunately, sleep is not always as simple as being tired.
Sleep is Important
Sleep is important to overall mental and physical health and well-being. While we sleep, the body is still working. Sleep supports memory, immune function, metabolism and recovery. Researchers are also continuing to learn more about how sleep may help the brain clear metabolic waste products. A recent review in Physiology looked at the relationship between sleep and the brain's glymphatic clearance system, which is involved in moving metabolic waste out of brain tissue. Sleep, particularly deeper stages of sleep, appears to play an important role in this process. Your brain does not just shut off for the night. It changes gears.
New research in the area of sleep is encouraging. Dr. Richard Miller is working with veterans and active-duty military personnel practicing Integrative Restoration, or iRest, a modern adaptation of the ancient practice of Yoga Nidra. His work has been studied in military and veterans, including people experiencing symptoms related to post-traumatic stress. In one feasibility study, veterans with combat-related PTSD participated in iRest and described improvements in areas including relaxation and well-being, although larger studies are still needed.
10 Steps of iRest
The beauty of iRest is that it does not ask you to force yourself to sleep. It asks you to lie down and rest. Yoga Nidra is often translated as "yogic sleep," but it is not meant to replace actual sleep. Think of it more as guided deep relaxation which incorporates some of the principles of Progressive Muscle Relaxation (PMR). You lie comfortably, usually with your eyes closed, and listen to someone guide your attention through different areas of your body. 10 steps from the iRest Institute:
Connect to your Heartfelt Desire
Bring to mind your heart’s deepest desire – something that you want more than anything else in life that instills a sense of value, purpose, and meaning. Consider this…how does life want to live through you? Perhaps it is a desire for health, compassion, well-being, or awakening. Feel this heartfelt desire with your entire body while imagining and experiencing it in this moment as if it were true.
Set an Intention
Reflect on your intention for your practice today. It might be to relax and rest, or to inquire into a particular sensation, emotion, or belief. Or you may reflect on intentions that will support living your heartfelt desire in everyday life. Whatever your intention, welcome and affirm it with your entire body and mind.
Find Your Inner Resource
Bring attention to your Inner Resource, a safe haven within your body where you experience a feeling of security, calm and well-being. How and where do you feel this in the body? If helpful, you may imagine a special place, person or experience that helps you feel secure, at ease, and a sense of well-being. Feel into your Inner Resource at any time during your practice or in daily life even when you feel overwhelmed by an emotion, thought or life circumstances and wish to feel secure and at ease.
Feel Your Body
Gradually move attention through your body while welcoming the various sensations that arise.
Become Aware of Your Breath
Sense the body breathing. Observe the natural flow of air in the nostrils, throat, and rib cage as well as the rise and fall of the abdomen with each breath. Imagine each breath as flowing energy coursing throughout your entire body.
Welcome Your Emotions
Without judging or trying to change anything, welcome sensations and emotions that are present in your body and mind. Also, notice opposite feelings and emotions. Sense both opposites simultaneously. Welcome everything just as it is.
Witness Your Thoughts
Notice and welcome thoughts, memories, and images that are present in your mind. Without judging or trying to change them, observe any thought, memory or images and notice corresponding sensations in your body. Welcome your experience just as it is.
Experience Joy
Welcome sensations of joy, well-being, or bliss emanating from your heart or belly and spreading throughout your body and into the space around you. With every exhalation, experience sensations of warmth, joy, and well-being radiating throughout your body.
Find Lasting Peace
Set aside thinking and dissolve into awareness, awake and conscious of the Self.
Reflect on Your Practice
As you complete your practice, reflect on the journey you’ve just taken. Recognize the feeling of peace that is always present. Integrate this into your everyday life, in both pleasant and difficult moments.
SOURCES: National Institutes of Health, National Center for Health Statistics,Transforming trauma: a qualitative feasibility study of integrative restoration (iRest), Yoga Nidra on combat-related post-traumatic stress disorder.
Guest Columnist: Shelby Yeakel is a Physical Therapist Assistant and Doctor of Physical Therapy Student at Mackarey Physical Therapy. She is a certified yoga instructor and proudly served our country as a United States Marine from 2014 to 2017.
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 has been challenging and disappointing to be an Eagles fan so far this season! Losing two star players to hamstring injuries has not helped! Both Saquon Barkley and DeVonta Smith have been sidelined with hamstring injuries for weeks. 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?
Hamstring Strain
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.
The Most Common Causes of a Hamstring Strain
Overuse – every time the knee is bent the hamstring muscles must contract. If there is not adequate time allowed for rest between workouts or competition, then the muscles may be fatigued and become vulnerable to injury. Also, overuse of the same muscles without rest may make them irritated and inflamed.
Inadequate Warm-up – a warm muscle stretches like a piece of gum warmed up in your mouth. When you pull the warm gum, it stretches. However, if you drink an ice cold drink with gum in your mouth and then stretch the gum, it will tear instead of stretch. A good warm-up will prevent tearing and prepare the nervous system for sudden movements and changes in direction.
Sudden Movement – quick sprint, sudden change in direction, quick turn with an unexpected force or slip.
Muscle Imbalance – when the quadriceps (muscles in the front thigh) are disproportionately stronger than the hamstring muscles (muscles in the back of the thigh)
Poor Body Mechanics – especially when moving or lifting a heavy load away from your center of gravity.
Forceful Contact or Loss of Traction – when a leg is forced away from the body by an outside force (tackle in football) or slip on grass or ice.
Diagnosis
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.
Treatment
There are many conservative options. Your family physician or orthopedic surgeon will help you decide which choices are best.
Anti-inflammatory Medications: such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling.
Orthopedic Physical Therapy: such as heat, cold, ultrasound, electrical stimulation, joint mobilization, massage, range of motion exercises, strengthening exercises, and supportive compression strapping. Once pain free, a preventative training program is essential to prevent reinjury.
Activity Modifications: if it is not the week of the district tournament, rest, avoid running or stretching/stressing of the thigh muscles.
Supportive Devices: such as thigh wraps or sleeves, compression shorts (like those worn under basketball shorts) can provide compression and relief.
Prevention
Recent studies have determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:
High Intensity Training- regardless of the speed of your sport, high intensity, interval anaerobic training is critical. Interval sprints are the best example.
Simulate the Demands of the Sport – when training, simulate the specific demands of your sport… “train the way you play.” For example, in football, the average play lasts 7-10 seconds. Therefore, sprint on a count from the line of scrimmage for 7-10 seconds. First, sprint in a straight line. Then, sprint and cut at 3-5-10 yards. Then, sprint, cut and spin. Then, sprint figure 8’s.
Weight Train for Power and Strength/Weight Train for Speed and Endurance- traditionally, weight training is performed with high weights and low repetitions to increase power and strength and both arms or both legs are used at the same time. However, to prevent hamstring injuries, add a few sets of speed/coordination training by performing lifting with low weights and high reps. Also, alternate right and left legs to simulate normal walking speed.
Weight Training Using Negatives/Eccentrics – weight training with a concentration on lowering the weight against gravity, not raising it.
Exercise All Muscle Groups – of the lower body, not just the quads and hams. Include: Hip flexion, extension, abduction, adduction, internal & external rotation
Knee: flexion, extension
Ankle: flexion, extension, inversion, eversion
Warm -Up: a pregame slow jog or exercise bike and/or massage to the area to warm up the muscles prior to activity.
Stretching: Indian sit stretch, Hurdler stretch, Lying hamstring wall stretch
Strengthening Exercises: weight training for legs, including inside and back leg muscles, use weights or resistance tubing for leg curls and hip extensions.
Agility Drills: figure 8, cross-over, tire or disc running
Compression Shorts: like those worn under basketball shorts
Cool Down: use ice to the effected area after exercise or sport
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!
It seems like every time you scroll through social media wellness or fitness posts, there is a new “fad “or “craze” promising to enhance fitness and weight loss. Weighted vests seem to be the new favorite of social media influencers and fitness fanatics. A weighted vest is a form-fitting garment loaded with extra weight. The vest is worn over the torso during exercise or daily activities to increase resistance. However, like most fads, there is a gap between testimonials and scientific research. But, before you hit the trails with extra weight on your back, know the benefits and risks of using a weighted vest.
Weighted Vests (WV)
According to the American College of Sports Medicine (ACSM), weighted vests are an effective way to increase the calories burned while walking. When tested on untrained subjects, (ages 18-55 years) it was found that walking 2.5 mph while wearing a weighted vest of 15% of their body weight increased energy expenditure approximately 12% as compared to those not wearing a vest. Those subjects wearing 20% of their body weight while walking 3.0 mph expended 13% energy. Please note, however, that the recommended vest weight is 5-10% of body weight.
Potential Benefits of Using a WV– according to the current scientific literature
Caloric Expenditure – as stated above, wearing a WV can increase caloric expenditure up to 12-13%.
Bone Mineral Density – wearing a WV can increase mechanical axial load, (increasing the impact of gravity) to signal bone remodeling more than casual walking without a WV. However, those with existing osteopenia/osteoporosis should consult with their physician prior to using a WV.
Cardiovascular Load – wearing a WV while walking or stair climbing has been found to elevate oxygen consumption and heart rate.
Functional Strength – WV use while performing non-impact exercises (pull-ups, push-ups, squats, lunges) can improve functional strength.
Potential Side Effects/Risks of Using a WV
Some of the more obvious side effects of wearing a WV are; blisters, chafing, and muscle soreness and the risks of wearing a WV may require medical clearance from your physician or physical therapist if you have the following conditions:
Chronic neck pain, middle and lower back pain…especially with radiating symptoms into the arms or legs.
Osteopenia/Osteoporosis – bone density problems
Balance or Vestibular Problems
Arthritis – symptomatic arthritis in spine or lower extremities (hips, knees, ankles, feet)
Types of WV’s:
WV’s can be found online or in stores like Dick’s Sporting Goods, Target and Walmart.
Plate Carrier Vest: Holds flat metal plates often preferred by those performing cross-fit or rucking (walking, marching, hiking while using a weighted backpack).
Pocket/Plug Vest: Has small pockets to hold individual sand or iron-filled weights. This type of vest tends to be close-fitting and balanced. It allows for easy changes in the amount of weight.
Fixed-Weight Vest: Offers an inexpensive, easy to use, pre-loaded vest for weighted exercise. However, this vest does not allow for variation in weight.
Choosing the Best WV:
Like most things, there is not one size and style that is best for everyone. WV’s vary in size, cost, durability, flexibility and adjustability.
Start Light: Begin with a vest that allows variation in weight. Start with a light weight which should be approximately 5-10 pounds or 5% of your body weight. Weight can be added gradually over time but should not exceed 10% of your body weight.
Maximum Weight: Although an adjustable WV allows a light start with gradual increases, it is recommended that users keep the amount of weight under 10% of their body weight for safety and the ability to maintain proper alignment and posture.
Adjustable Weight and Straps: WV’s with the ability to adjust the amount of weight and the straps for a proper fit are recommended. A proper fit prevents blisters, chafing and back pain.
How to Begin Using a WV:
Limit Load -start conservatively at 5% to 10% of your total body weight.
Movement Safety – start with non-impact movement and activities such as walking, hiking, lunges, step-ups and avoid running or jumping.
Proper Fit – a snug fit with adjustable weights and straps is best.
Caution for Those with Pre-existing Risks – medical clearance is advised
In Conclusion:
What the Science Says – Using a WV can be an effective way to increase the calories burned while walking or performing other non-impact activities. WV can also improve bone density, cardiovascular fitness, and functional strength. However, for those with the aforementioned risks, medical clearance is advised.
SOURCES: American College of Sports Medicine; NIH; prevention.com
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
Congratulations to more than 1,000 courageous runners who finished the 29th Annual Steamtown Marathon today. Most, if not all of you, will wake up tomorrow morning with a little less jump in your step than you had yesterday as your body begins it's recovery.
As active people by nature, many of you will resist the logic of rest, despite the pain and stiffness in your muscles and joints. Therefore, I would like to offer some words of wisdom. Based on science, to encourage you to adequately rest and allow your body to recover.
GREAT EXAMPLE OF REST AND RECOVERY:
With adequate rest and recovery, an elite runner can quickly regain full form in 3-4 weeks. While an average runner may require 4-6 weeks. Meb Keflezighi, an elite American runner and winner of the 2014 Boston Marathon, is an excellent example of the merits of rest and recovery. However, he discovered it by accident. Following the 2012 New York City Marathon, Meb developed a foot infection which required three weeks rest. With the Olympic Trials just 70 days away, Meb quickly regained his pre-injury fitness level to win the 2012 US Olympic Marathon Trials and join the US Olympic Team in London. It may be that his injury was fortuitous and allowed him adequate recovery time, (that he might not have otherwise allowed), preparing him for intensive training leading up to the trials.
RESPECT THE DAMAGE TO YOUR BODY:
The Effects of Running 26.2 Miles on the Body: (RunNow.com - Jim Peskett)
Muscle-Skeletal System:
One of the most obvious effects of running a marathon is significant muscle and joint pain and stiffness. It will set in after you sit for a while and attempt to get up and move around. For most, it will be more pronounced the day after the marathon, as you get out of bed and limp to the bathroom. Studies show that the leg muscles, (especially the calf muscles) display significant inflammation and necrosis (dead tissue) in the fibers of the muscle. In other words, the trauma to the muscles is so severe that tissue damage causes muscle cells to die. Consequently, studies found that muscle strength, power and endurance is compromised and required significant time to recover… sometimes as long as 4-6 weeks!
Additionally, many runners report severe bone and joint pain following the race. Some studies report findings of microfractures or bone bruising from the repeated and prolonged pounding of the marathon. It is purported that the stress on the joints may be related to: weight and body type, running shoes, running style and mechanics. While not dangerous, again, it is important to respect the stress placed on the body and allow adequate healing…LISTEN TO YOUR BODY!
Cellular Damage:
Creatine kinase is an enzyme found in the brain, skeletal muscles and heart. It is found in elevated levels in the presence of cellular damage to these tissues, for example, following a heart attack. Similarly, significantly elevated creatine kinase levels are found in the blood of runners up to 4 days post marathon, demonstrating extensive tissue damage at the cellular level. It is important to note, that these enzyme markers are present, even if a runner does not experience muscle soreness. So, adequate rest for healing and recovery is required, regardless of soreness.
Immune System:
It is not a coincidence that the runners are more likely to contract colds and flu after intensive training or running 26.2 miles. The immune system is severely compromised after a marathon and without adequate recovery; a runner can become ill and ultimately lose more training time or will underperform.
3 MYTHS THAT PREVENT REST AND RECOVERY IN RUNNERS:
If I don’t have pain, then I did not damage my body.I can run again soon after the marathon.
FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.
Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.
FALSE: In addition to rest, drink, drink, drink - 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.
If I don’t run, I will lose all of my conditioning in one week.
FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker. Remember Meb Keflezighi!
Expedite Your Recovery:
Rest – Take it easy for a few days. Let you muscles/body heal. Take short walks.
Elevate – Elevating your legs to allow blood/fluid in you muscles to return to the heart without using gravity.
Massage – This can be an effective method of relaxing muscle spasms, cramps and mobilizing fluids from your muscles to your heart after the marathon. It should be very comfortable. You may find even more benefit from massage 24-48 hours after the race to assist in the recovery of delayed onset muscle soreness from lactic acid build-up in your muscles.
Slowly Reintroduce Exercise and Running – Gradually introduce longer walks and slow jogging after a few weeks. Cross-training is good for less joint compression and allows the use of other muscles. (Elliptical, bike, swim)
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!
Provisional Bag/First Aide Kit
It is one week away from the 29th Steamtown Marathon. This column is dedicated to all the runners preparing for the big day. One small piece of advice; start slowly, avoid the first mile adrenaline sprint downhill, and enjoy the journey! Remember, only one Olympic marathon winner (Juan Zabala, Argentina, 1932) was in the lead at the 5 mile mark. Lesson: The last miles matter more than the first!
Today, I hope to address some common questions for the novice marathon runner or for those coming from other locations to run in the race. What should you pack? How should I dress? What supplies will I need?
Elite runners are so experienced that they know exactly what to pack in preparation for the big day. However, those, running in marathon for the first or second time usually have lots of questions. First, what you need and what you can bring will depend on your support team. If you are running alone and will not have family or friends meeting you along the way, then you are limited to a fanny pack and a few supplies. If you have a support team, then they can carry a bag with supplies, meet you along the course and you can have a sense of security.
Remember; do not do anything different on race day. Try out special clothing, water with supplements and snacks on a practice run. Also, experiment with your best pre-race meal. You will be getting up at 5-6:00am to catch the bus from Scranton to Forest City. You may want to pack breakfast to eat in the high school gym such as; bagel, peanut butter, jelly, banana and coffee or Gatorade. Moving your bowels before the race is a must.
Marathon Musts:
Dress:
Columbus Day Weekend in NEPA could bring 30 to 40 degree temperatures when you catch the bus in Scranton and at the 8:00 am race starting time in Forest City.
Clothing:
Hat and Gloves: Wearing a hat, light gloves can be a good idea. DryTech materials are best to prevent retention of sweat.
Long Sleeve Shirt and Light Jacket may be necessary. Wearing old items are best so they can be discarded along the way once you are warmed up.
Remember, any extra items can be placed in a labeled bag at the starting line and will be transported to the finish line for your convenience. So, if it’s a cold morning, wear a jacket and warm up pants on the bus to the starting line and “bag it!”
Accessories:
Sunglasses and Sunscreen: If sun and warm temps are forecasted, sunglasses are best placed on top of your hat until needed and sunscreen applied before the race.
Skin Lubrication: Lubricate your skin with petroleum jelly in areas of potential friction such as arm pits, nipples, thighs and feet.
Dry Tech Clothing: Wear dry tech protects, including shirt, underwear and socks, to prevent excessive moisture and friction.
Favorite Water Source and Snack: Water and light snacks will be provided every 2 miles but sometimes it is good to have your own favorites, especially in the high school gym before the race.
FANNY PACK – Especially for those running without a support team
If you don’t mind the little pack on your butt, a fanny pack can be valuable. In it, you will want supplies such as: small bandages, small roll of medical tape, ibuprofen, antacid tablets, small tube of lubricant, favorite running snack, and extra shoe laces. One might also consider packing a little money, credit card, ID, emergency contact numbers and medical insurance cards. A cell phone is optional.
SUPPLY BAG – For those with support team
Have your support team meet you at prearrange locations along the race route and bring your supply bag. In the bag, you might consider all of the above fanny pack items and: A change of clothes such as: extra running shoes, socks, shorts, shirt, water proof wind breaker, according to the weather, especially if rain is predicted. Towels, ace bandages, gauze pads and wrap, antibiotic cream, mole skin, sunscreen, petroleum jelly, safety pins, extra water and favorite sport drink, favorite sport snacks, extra ibuprofen, antacid, anti diarrhea medicine, chemical ice pack, mobile phone, money, credit cards, ID, medical insurance cards.
For those with allergic reactions, remember to pack: epinephrine, antihistamine, and other important medications.
Don’t Forget: Map and directions to the bus or starting line, course map, race number, and get your timing chip.
Enjoy! Enjoy! Smell the roses, take in the fall foliage and chat with a fellow racer. Savor the marathon moment and enjoy the day…you are doing something very special!
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!
Weight Training and Aerobic Exercise for GLP-1 Users
The popularity of glucagon-like peptide-1 (GLP-1) medications, such as semaglutide (Ozempic, Wegovy, Mounjaro) for weight loss, have increased exponentially over the past few years. Many medical experts predict that it is only the beginning. Medicare recently announced that it will begin a pilot program for those who qualify for GLP-1. If approved and covered by Medicare, GLP-1 use will become widespread. While the potential benefits of these weight-loss drugs exceed the risk for those suffering from obesity, it is not without some risk and side effects such as gastrointestinal problems and loss of muscle mass. Following a healthy diet and engaging in an exercise program to maximize the benefits and minimize the side effects from GLP-1 medications is necessary.
GLP-1
Glucagon-like peptide-1 (GLP-1) medications, when used for weight loss, reduce food cravings, increase fullness, slow digestion and control blood glucose. However, gastrointestinal (GI) side effects and maintaining muscle mass and energy levels are common concerns. These medications are designed to mimic the action of a natural hormone GLP-1, which is produced in the intestines after eating. This hormone regulates appetite, blood sugar levels and digestion. Ultimately, by slowing digestion, GLP-1 users feel fuller for longer periods of time.
A recent study published in Journal of the American Medical Association (JAMA) strongly recommends that people using GLP-1 medications eat more protein, consume smaller meals and snacks, avoid certain foods to reduce constipation, nausea and heartburn, stay hydrated, and engage in regular exercise including aerobic exercise and strength training to minimize muscle and bone loss.
Benefits of a Well-Designed Weight Training Program for GLP Users
Increased Strength
Prevent Loss of Muscle Mass & Bone Density
Improved Performance in daily tasks and activities
Improved Endurance
Improved Injury Prevention
Improved Mental Health
Improved Overall Health & Wellness
Risks From Poorly Designed or Unsupervised Program
Risk level increases if the program is not developed or supervised by a qualified professional for technique, safety, intensity and frequency
Lower Back Pain – from poor technique and overload
Muscle/Tendon Strain – from overuse and overload
Tendonitis – from overuse and overload
How to Begin A Weight Training Program for GLP Users
Primary Care/Family Physician – get medical clearance to make sure that you are not at risk, especially if you have medical issues such as heart disease, hypertension, diabetes.
Orthopedic Physical Therapist – your doctor may think you would benefit from a few visits with an orthopedic PT to make sure your program is well-designed for your specific goals and your specific needs or activities (gardening, walking, golf, tennis)
Avoid Getting Competitive – it sets you up for injury! No Clean-Jerk, Overhead Press, Full Squats. Don’t compete to lift to your maximum. Make Exercise FUN!
Technique
Slowly lift and lower weight 4 seconds up, 4 seconds down
Breath – inhale lifting weight up and exhale down
Never hold breath!
Exercise Major Muscle Groups
Upper body: shrugs, rows, lats, biceps, triceps, chest press, wrist curls – all with light dumbbells and bands to start
Lower Body: hip hike, leg extension, ham curl, step ups, 45 degree squat, calf raise – all light with sandbags and dumbbells to start
Lift 3 times per week on alternating days – 30 to 45 minute sessions
Warm up
Cool down
Work upper body/lower body
Can alternate days for upper body and lower body
INCLUDE AEROBIC EXERCISE:
Can alternate days for weight lifting with aerobic exercise (elliptical, swim, walk, run, bike)
Concentrate on low weights (5-10#)/high repetitions(10-15 times)
Once you master the technique add 1-2 # and 3-5 reps
Never advance weight or reps if you overstrain and compromise technique
**STOP:
If you have pain
If you get lightheaded or dizzy
If you experience lower back pain or joint pain
If you have muscle or joint pain that lasts more than 2 days
SOURCES: Journal of the American Medical Association, Trimrx.com, National Institutes of 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!
Part 1 of 2
The popularity of glucagon-like peptide-1 (GLP-1) medications, such as semaglutide (Ozempic, Wegovy, Mounjaro) for weight loss, have increased exponentially over the past few years. Many medical experts predict that it is only the beginning. Medicare recently announced that it will begin a pilot program for those who qualify for GLP-1. If approved and covered by Medicare, GLP-1 use will become widespread. While the potential benefits of these weight-loss drugs exceed the risk for those suffering from obesity, it is not without some risk and side effects such as gastrointestinal problems and loss of muscle mass. Following a healthy diet and engaging in an exercise program to maximize the benefits and minimize the side effects from GLP-1 medications is necessary.
GLP-1
Glucagon-like peptide-1 (GLP-1) medications, when used for weight loss, reduce food cravings, increase fullness, slow digestion and control blood glucose. However, gastrointestinal (GI) side effects and maintaining muscle mass and energy levels are common concerns. These medications are designed to mimic the action of a natural hormone GLP-1, which is produced in the intestines after eating. This hormone regulates appetite, blood sugar levels and digestion. Ultimately, by slowing digestion, GLP-1 users feel fuller for longer periods of time. A recent study published in Journal of the American Medical Association (JAMA) strongly recommends that people using GLP-1 medications eat more protein, consume smaller meals and snacks, avoid certain foods to reduce constipation, nausea and heartburn, stay hydrated, and engage in regular exercise including aerobic exercise and strength training to minimize muscle and bone loss.
Diet and Nutrition Considerations for GLP-1 Users
FOOD TO AVOID
High-Fat Foods
High-fat foods can increase nausea and bloating.
Fried foods: French fries, fried chicken, and doughnuts.
Fatty Meats: Bacon, sausage and fatty meats
Creamy Sauces and Dressings
Sugary Foods and Beverages
Foods with high sugar content can spike blood sugar levels which counteracts the benefits of GLP-1 medications without significant nutritional value. Some include candy, sweets, pastries, desserts, sodas, sweet teas, fruit juices which can also contribute to GI issues.
Starchy Vegetables and Fruits
Some starchy vegetables and fruits have a high glycemic index which causes spikes in blood sugar. However, due to the nutritional value that this food group provides, moderation, not elimination, is the best approach when eating potatoes, corn, and peas. High sugar fruits such as very ripe bananas, mangos, and grapes must be consumed prudently.
Highly Processed Foods
Highly processed foods are never a healthy choice and more so for GLP-1’s. They often contain unhealthy fats, sugars and preservatives that can contribute to side effects. Some examples are; fast foods, prepackaged snacks (chips, cookies), and instant meals.
Alcohol
Overuse of alcohol can contribute to GLP-1 side effects…so drink in moderation and discuss it further with your physician.
Alternative Food Choices for GLP-1 Users
While it is important to eliminate unhealthy foods from your diet as previously discussed, it is equally important to include a diet rich in nutritious and wholesome foods to prevent the loss of muscle mass associated with GLP-1 use.
Lean Proteins
Chicken, fish, and plant-based proteins such as lentils, chickpeas, and tofu.
Non-Starchy Vegetables (low in carbohydrates and calories)
Be Mindful - Listen to your body - stay focused and listen to your body…don’t eat if you’re not hungry. GLP-1’s will make you feel full if you are paying attention.
Regular Meal Times – try to eat meals at consistent times to avoid blood sugar spikes.
Consult with a Dietitian – get professional advice from a registered dietitian to tailor a plan for your specific needs.
SOURCES: Journal of the American Medical Association, Trimrx.com, National Institutes of 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
NEXT WEEK: Part II of II “Diet & Exercise Considerations for GLP-1 Users”
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 III OF III
This is the third of three columns dedicated to healthcare for college students. Please find these “10 Tips to Keep Yourself Healthy in College” helpful. However, no discussion regarding the health and wellness of college students would be complete and thorough without addressing what health care and university experts consider the two most dangerous behaviors on college campuses across the nation: binge drinking and unprotected sexual activity.
While it is not my intent to offend the religious and moral values of any reader, it is my purpose to provoke direct and meaningful conversation between parents, religious leaders and students. To prevent serious health problems in college, parents must share their experience and discuss their values regarding sexual activity and alcohol consumption with children before they leave home to live independently in college. If you are unable to have a direct conversation about these issues, consider doing what several readers have done; mail a copy of this column to your child!
10 Tips to Keep Yourself Healthy in College: (American Academy of Pediatrics)
Sleep – somehow, despite a busy academic and social schedule, you MUST get enough rest. Lack of sleep may be the single unhealthiest habit of a college student. It can lead to many negative consequences such as lack of concentration, poor emotional stability, and vulnerability to germs and disease. While one may get by on 3-4 hours sleep for short periods of time, eventually, your body will take control and shut down. Do your best to develop a regular sleep pattern and factor in short naps to catch up on needed rest if necessary.
Diet – the “freshman fifteen” is no joke, it is the real thing. Skipping breakfast, “pigging out” on junk food, late night eating, and drinking high calorie soda and beer all factor into weight gain and poor dietary habits. Make time to eat breakfast, snack on yogurt, fruit and nuts. Fill up on a healthy salad. Avoid a constant diet of fried foods and sweets.
Water – even adults forget to drink plenty of water throughout the day. Carry a water bottle and skip the soda.
Get regular check-ups – see your doctor when home on semester break for an annual check-up or more often if needed. Many college health centers offer this service. Many serious problems can be avoided with early detection.
Get a flu shot, vaccines and mask up – remember, college campuses breed germs and most schools offer inexpensive flu shots and Covid vaccines.
Exercise – make time to exercise regularly (30-45 minutes 3-5 days per week). Walk, run, bike, lift weights, play tennis, racquetball or swim. Colleges have the best facilities for sports and exercise. Just DO SOMETHING! It will help you sleep, relax and feel better.
Relax – make time to relax. Read a book, go for a run, meditate, do yoga, or walk and have good conversations with friends. Mental health is important on a stressful college campus.
Emotional Health – is a vital component of a healthy person. College life can be very stressful. Depression, anxiety, addiction, eating disorders, and homesickness are some examples of emotional problems common among college students. If you feel emotionally unhealthy, get professional help. All colleges have trained counselors equipped to assist you.
Drink Sensibly – binge drinking might be one of the most dangerous behaviors on a college campus. Studies show 44% of U.S. College students engage in binge drinking uniformly among freshman through seniors. Of these, 50% binged 3-4 times in a two-week period. Binge drinking is defined as 5 drinks in a row for men and 4 for women. Binge drinkers are more likely to be victims of poor academic performance, addiction, trauma, auto accidents, assault, unprotected sex, sexual assault, and death. Some of the most common reasons reported for binging are: to get drunk, status, campus culture, peer pressure, academic stress. TALK TO YOUR CHILDREN!
Safe Sex – promiscuous sex is physically and emotionally unhealthy. Unprotected sex can be LIFE ALTERING! Studies by the Center for Disease Control found that almost 80% of college students 18 to 24 years old had sexual intercourse at least one time during college. 73% reported having unprotected sex and 68% of this group did not believe that they were at risk of contracting a sexually transmitted disease. TALK TO YOUR CHILDREN! GET THE HPV VACCINE!
SOURCES: American Academy of Pediatrics
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
PART II OF III
This is the second of three columns dedicated to healthcare for college students. As part of the preparation, think about a first aid kit, health care history, and insurance file. For parents without other children at home, once you finish with these preparations and your child departs for college away from home, plan to take dance, art history and conversational Italian classes to occupy your time without children. Resist the temptation to be a helicopter parent…life goes on!
Remember, living in a large community and sharing close quarters makes the development and spread of disease a natural progression. College life can be very unhealthy for many reasons: lack of sleep, poor eating habits, poor hygiene and stress.
10 Symptoms College Students Should Not Ignore: (American Academy of Pediatrics)
Last week we discussed common illnesses among college students, how to manage and when to seek professional help. Below you will find a list of symptoms that should never be ignored. The college health services department should be contacted if you have any of the following symptoms:
Fever – 102 degrees F or higher
Headache – if accompanied by a stiff neck
Pain with urination
Unusual discharge from penis or vagina
Change in menstrual cycle
Abdominal pain – that will not go away
Persistent cough
Persistent chest pain
Persistent difficulty breathing
Persistent pain or any other symptoms that last longer than you think it should
10 Must-Have Health Care Items For College: (American Academy of Pediatrics)
Get a small/medium plastic storage box and use it to keep all the following health care items together in one place.
Health Care Record – keep a copy of the required health care record required by the school in your health box. You may need it for the health services department or for an unexpected visit to the hospital.
Medication List – with names and dosages
Allergy List – with medication used for each allergy. For example, bee sting kit.
Past Medical History List – write down previous surgeries (appendectomy), diseases (Mono) and dates
Special Needs List – for example breathing inhaler for sudden asthma
Mental Health Problem List – problem and dates
Immunization Record – list shots/vaccines you have had and dates. For example, meningococcal disease vaccine.
Health Insurance Card – keep a photo copy of your health insurance card in your wallet and another in this college health care box
Hand Sanitizer
First Aid Kit
Bandages to dress wounds
Gauze and adhesive tape to dress wounds
Elastic bandage to support and compress sprains
Antibacterial towel packets
Antibacterial/antibiotic ointment
Digital thermometer
Chemical ice pack/Microwave heating pack for sprains/strains
Acetaminophen and ibuprofen for aches/pains/fever
Other prescribed medications
Vitamins
SOURCES: American Academy of Pediatrics
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy. Next Week: “Health Tips for College Students – Part III of III”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
PART I OF III
It is hard to believe it is that time of year when parents and students are preparing to return to school. Many will leave home for the first time as college freshmen. Over the past month I have received several requests for a copy of my three-part series of columns on health tips for college students. In view of this, I thought other parents preparing to send a child off to college this fall might also find this information valuable.
To fully appreciate the importance of this topic, one must keep in mind that living in a large community and sharing close quarters is the first ingredient in the development and spread of disease. College life can be very unhealthy for many reasons. Lack of sleep, poor eating habits and stress add spice to the recipe for disease. Lastly, poor hygiene added to the equation will really get the Petri dish cooking up some nasty germs.
Common Health Problems for College Students (American Academy of Pediatrics)
Colds, Flu, Covid - These are caused by viruses. While both are similar, flu symptoms are typically more severe.
Flu Symptoms: high fever (above 102 degrees), body aches, dry cough, upset stomach or vomiting
Covid Symptoms: can appear 2-14 days after exposure and can vary from
Mild to severe; fever, chills, cough, shortness of breath, fatigue,
Muscle or body aches, headache, loss of taste or smell, sore
Throat, congestion or runny nose, nausea or vomiting, diarrhea
Treatment: rest, plenty of fluids, and treat symptoms. Consult your physician or college health services for the best medicines to control your symptoms. Caution should be used when taking excessive flu meds containing aspirin because an increase in complications (Reye Syndrome) are associated with the flu in college students.
Covid-19: get tested and isolate if positive. Contact the college health services to discuss isolation and treatment protocols. If you have mild to moderate symptoms an antiviral may be recommended. Otherwise, over-the-counter nonsteroidal anti-inflammatory drugs may be adequate with rest and fluids.
Prevention: While it is not possible to prevent getting a cold or flu, you can take precautions, such as washing your hands and getting a flu shot. Get full vaccinated for Covid-19. And, depending on school protocols and infection rates, MASK UP!
Strep Throat, Sinus Infections, Ear Infections - caused by bacteria
Symptoms: very sore throat, pain in the ears or sinuses, persistent fever
Treatment: These symptoms require a visit to the college health services department. You may need to take antibiotics. If so, take as directed and take all of them or you may have a relapse.
Prevention: Avoid close contact with infected people – no kissing, sharing drinks or eating utensils. Wash your hands, get plenty of rest.
Meningococcal Disease the brain, spinal cord and/or blood
Symptoms: high fever, stiff neck, severe headache, a flat, pink or purple rash, nausea and vomiting, as well as sensitivity to light
Treatment: Immediate medical treatment is required. This disease is serious. It can be fatal or cause permanent brain damage.
Prevention: It is strongly recommended that all teens, especially incoming freshman college students, receive a vaccine to prevent the infection of most, but not all, strains of bacteria that cause this disease.
Mononucleosis (Mono) - It is very common among college students.
Symptoms: fever, sore throat, headache, swollen lymph nodes (glands) in the neck, extreme fatique.
Treatment: If a sore throat or flu symptoms do not resolve in 7- 10 days, see your doctor for a blood test called the “monospot.” While there is no specific treatment, plenty of rest and a healthy diet are essential. Medication to control symptoms can also be used.
Prevention: Plenty of rest, healthy diet, good hygiene
Bruises, Sprains and Strains - These are very common in healthy, active college students and are rarely serious.
Symptoms: Bruises: a bump or bruise can cause the skin to turn purple, brown or red in color.
Strains: are injuries to muscles or tendons from overuse or sudden overstretching.
Sprains: are injuries to the ligaments which connect the bones. It can be caused by a twist or fall or awkward sudden movement.
Ice – use ice or cold gel packs on the injury for 20-30 minutes several times per day
Compression – to the area with an elastic bandage
Elevation – elevate the injury on pillows, etc to limit swelling. If the pain or swelling is not improved in 1-2 days, or if you cannot bear weight on the extremity, visit the college health services dept.
Prevention: While it is important to be physically active, one must do so intelligently:
Use Proper Equipment – eye protection, helmets, mouth guard, etc
Warm up/Cool Down – take time to warm up, stretch and cool down
Take Breaks – ease into activity and rest when necessary.
SOURCES: American Academy of Pediatrics
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
