Last week we discussed the healthiest New Year’s Resolutions, however, given the fact that 80% of those who made resolutions will have failed by January 19^th, this week I will recommend the use of technology to improve the odds…there is an App for that!

While some apps can be a waste of time, when you find the right app for you most polls show that it can be extremely helpful. They can be used for learning, socializing, calculating, writing, graphing, news, weather, music, school, money AND HELPING YOU KEEP YOUR NEW YEAR’S RESOLUTIONS!

According to “Per Statista,” the most common resolutions are as follows: save money (59%), exercise more (50%), more time with family and friends (40%), lose weight (35%), spend less money (26%), less time on social media (19%), and less job stress.

Apps for Saving Money

Goodbudget, YNAB (You Need A Budget), PocketGuard, and Quapital are some of the better budget Apps. Some of these Apps are free, while others require a nominal fee. In addition to tracking spending and saving, most allow you to set you own parameters and goals. Some helpful features are: moving money from checking into savings every time you buy a coffee.

Apps for Tracking Exercise

In addition to wrist trackers like Fitbit and Smart Watches, there are exercise equipment options with programs and tracking like Peleton, Norditrack and exercise mirrors like Tonal. However,  there are also specific Apps that help you set goals and see your progress. Some of these include: Fitness22, FitNotes, MyFitbnessPal and Strong. Some of these allow you to input your exercises and create graphs showing progress in body weight, fat percentage and more.  These Apps are especially useful for those who dislike going to the gym.

Apps for Prioritizing Time with Family and Friends

While distance-base technology such as Skype, WhatsApp, and Zoom worked well to keep connected during the pandemic and after, there are other Apps that offer more personal ways. Cozi is one of the best as it offers a simple organizer that displays the schedule of the entire family to assist you in planning a get together. Cozi is a great option as a simple organizer that offers a clear visual representation of the entire family’s schedule. It not only shows when people are free but also tracks the amount of time you spend (or don’t spend) with these special people.   

Apps for Losing Weight

There are so many weight loss apps available that it is easy to get confused or overwhelmed. Some of the most popular with the best reviews are: Noom, Reverse Health, Perfect Body, WeightWatchers and MyFitnessPal. MyFitnessPal has the added benefit of tracking exercise and activity with a calorie expenditure report. Simply set a goal, enter food intake and exercise/activity output and the app calculates the rest. A bar-code scanner makes it even easier!

App for Bill-Tracking

Keeping a better eye on finances and expenses is a common resolution, especially as the holiday bills come in. Stax Bill, NetSuite, Paystand and Rocket Money are highly rated. These apps help you budget, save, provide an income analysis and credit scores, and disclose recurring fees.

App for Reducing Stress at Work and Home

Reducing stress is another common resolution and learning stress management techniques and incorporating them into our daily lives is vital. Some of the highly rated apps are: Personal Zen, Sanvello, The Mindfulness App, Headspace and Moodfit. These apps not only give you the tools for managing stress but also provide insights into your mood patterns and stressors. In addition to a “blue mood” you can also track gratitude and other feelings. Also, nutrition, sleep, and medications, which can affect your mood, can also be tracked. Once a pattern is established, tools can be applied to reduce and manage stress.

App for Reducing Time on Social Media

While at first glance it may seem odd that one might use an app to stop using another app but…don’t rule it out! OneSec is an app that creates a 10 second delay after you open an app to allow you time to pause and take a deep breath before you indulge. It will also tell you how many times you have opened the app in the last 24 hours…you might be shocked!

SOURCE: LIFEHACKER

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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: mmptc@msn.com

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

New Year’s Resolutions are very predictable. While most New Year Resolutions are health oriented, I purport that a healthy mind, body and spirit requires a healthy lifestyle. Interestingly, the ten most popular resolutions listed below, all have an impact on a healthy life.  

1. More Time With Family And Friends
   • Polls repeatedly show that one of the most consistent resolutions for the New Year is to make more time to spend with family and friends. Moreover, research shows that the comfort and camaraderie of these people whom we love is important to our health and well-being.
2. Begin or Improve a Fitness Program
   • The benefits of regular exercise is no longer anecdotal, it is factual. Daily exercise, even in small doses, has been associated with more health benefits than anything else known to man. Studies clearly demonstrate that it reduces cholesterol and coronary artery disease and the risk of some cancers. Also, it increases longevity, helps achieve and maintain weight loss, enhances mood, lowers blood pressure, and even improves arthritis. In short, exercise keeps you healthy and makes you look and feel better. If done properly, there is no down side. So, make this year the year to do it!
3. Adhere to a Weight Loss Plan
   • Recent studies report that more than 66 percent of adult Americans are considered overweight or obese. As a result, weight loss is one of the most popular New Year's resolutions. However, adhering to a weight loss program is not easy. It requires many things, including, setting reasonable goals and staying focused. Often, professional help is required. While this may be one of the most difficult goals to attain, the ultimate reward and value is well worth the effort.
4. Stop Smoking
   • Second only to losing weight, this resolution, while extremely difficult, is another life-saving goal that must be attempted. Studies report that smokers try and fail four times on average before they are successful. SO, KEEP TRYING! Get help. Talk to your physician about using over-the-counter or prescription nicotine replacement therapy and proven quit-smoking aids. Consider smoking cessation classes, support groups and hotlines in addition to the meds. This is one goal that is worth the effort.
5. Find Your Smile
   • Due in great part to our hectic and stressful work and family demands, the United States is home to millions of people requiring the use of mood elevators and antidepressants. As a result, it is important to learn what really makes you happy in order to FIND YOUR SMILE. It requires the balance of a healthy mind, body and spirit. It might be a walk in the snow, taking dance classes or a trip to the spa. One hint, it is often something simple and inexpensive.
6. Moderate Drinking
   • This is one tip for a healthier New Year that I expect to receive plenty of flack about! But, I would be remise if I did not mention this potentially harmful habit. While many people use the New Year as an incentive to finally stop drinking, most are unable to adhere to such a rigid goal. Studies show that moderate drinking can offer many health benefits such as lowering cholesterol and coronary artery disease but that is defined as one or two 8 ounce drinks per day and red wine is preferred. However, many heavy drinkers would do well to taper off to a moderate level. Consider participating in “Dry January!” For those with a problem and have decided that you want to stop drinking, there is a world of help and support available such as Alcoholics Anonymous. There are also a number of treatment-based programs, as well as support groups for families of alcoholics.
7. Get Finances in Order
   • This is one tip that few consider being health related. However, serious stress from financial problems affects millions of Americans every day. This cumulative stress can be very harmful to your health and can be lessened by initiating a plan. Get professional help and learn how to downsize and reevaluate your real needs…less toys with less stress for a longer life!  
8. Try Something New
   • There may be no one thing more important to gaining a new perspective on life that to have learned something new. It could be as drastic as returning to school to prepare for a career change or as simple as learning to play bridge. Have you vowed to make this year the year to learn something new? Take a course at local college or read a new book. Visit the Everhart Museum or take the free tour of the Scranton Cultural Center. It will enrich your life and make you a more interesting person. Most local colleges and universities offer distance and adult education programs.
9. Service To Others
   • Service to others is service to you! There may not be anything more gratifying than providing a service to others in need. Volunteerism makes you a better and healthier person. It fits into any schedule. Donate clothes, time or resources. Locally, we have many charitable causes in need of help: Be a “Friend of the Poor,” or serve lunch at St. Frances Soup Kitchen.
10. Get Organized
    • The goal of organization, like the goal of financial order, has similar health implications because it eliminates tremendous stress. There are many books and websites that offer suggestions on how to organize just about anything in your life. For this reason, I love my iPhone – there’s an App for that!

SOURCE: A. Powell, About.com Guide

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

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

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

Part II of II  

Introduction:

As most sports enthusiasts know, Aaron Rodgers, former Green Bay Packer quarterback and recent New York Jets QB (for just over a minute and half) suffered a season ending injury when he tore his Achilles tendon in the first game of the 2023/24 NFL season. Since then, I have been answering many questions from patients and sports fans about the nature of the Achilles Tendon rupture injury, recovery, and how to prevent it.

As the days continue to get shorter and temperatures begin a slow steady decline, athletes and exercise enthusiasts will work harder to warm-up and exercise during the winter months. A little caution and preparation are in order to avoid muscle/tendon strain, or worse yet, muscle/tendon tears, especially Achilles Tendon rupture. The Achilles tendon is one of the more common tendons torn.

This is the second of two columns on Achilles tendon rupture. Last week, I discussed the definition, sign and symptoms of the problem. This week will present examination, treatment and outcomes.

Achilles Tendon Rupture Exams and Tests:

A thorough history and physical exam is the first and best method to assess the extent of the injury and determine accurate diagnosis. While a complete tear is relatively easy to determine, a partial or incomplete tear is less clear. Ultrasound and MRI are valuable tests in these cases. X-rays are not usually used and will not show tendon damage.

Achilles Tendon Rupture Treatment:

Initial First Aide Treatment:

• Remember RICE!
  • Rest the involved tendon/ankle/heel. Pain is telling you NOT to move the tendon. Use crutches and limit weight bearing on the involved foot until you are seen by a medical professional.
  • Ice the tendon/ankle/heel. Control the swelling and spasm.
  • Compress the ankle/foot and control the swelling but do not wrap it too tightly.   
  • Elevate the ankle/foot to allow gravity to help control swelling.
• Medication: Depending on your tolerance and previous experience, choose an over-the-counter nonsteroidal anti-inflammatory drug for pain and inflammation such as ibuprofen. Discuss with your primary care physician and pharmacist.
• Note: If symptoms persist, see your primary care physician, podiatrist or orthopedic specialist to determine the extent of your injury. Do not delay too long to seek medical attention because early intervention will produce the best outcomes.

Early Treatment - Conservative:

• Protection – the torn tendon must be protected from further damage or stretching by using a heel lift to put the tendon on slack. In more involved cases, a removable walking cast/boot may be used for additional protection.
• Physical Therapy -  
  • Controlled Motion – gentle controlled motion to the ankle, foot and toes to control swelling and prevent stiffness is usually encouraged.
  • Modalities – such as ice, compression, ultrasound, massage, electrical stimulation may also be employed for pain and swelling.
  • Gradual Resistance Exercises – in the case of a partial tear, once healing begins, resistance exercises may be introduced gradually. These exercises will require the supervision of a physical therapist to emphasize resistance in a lengthening position (to be described under “prevention” later in this column).

Surgery:

Consultation with an orthopedic or podiatric surgeon will determine the best treatment option for you. When conservative measures fail and for tendons completely torn, surgical intervention is usually considered to be the best option with a lower incidence of re-rupture. Surgery involves reattaching the two torn ends. In some instances, a graft using another tendon is required. A cast or walking boot is used post-operatively for 6-8 weeks followed by physical therapy. 

Outcome:

Most people return to close to normal activity with proper management. In the competitive athlete or very active individual, surgery offers the best outcome for those with significant or complete tears, to withstand the rigors of sports. Also, an aggressive rehabilitation program will expedite the process and improve the outcome. Walking with full weight on the leg after surgery usually begins at 6 -8 weeks and often requires a heel lift to protect the tendon. Advanced exercises often begin at 12 weeks and running and jumping 5-6 months. While a small bump remains on the tendon at the site of surgery, the tendon is well healed at 6 months and re-injury does not usually occur.

Achilles Tendon Rupture Prevention:

Prevention of muscle and tendon tears is critical for healthy longevity in sports and activities. In addition to the Achilles tendon, the tendons of the quadriceps (knee) and rotator cuff (shoulder) are also vulnerable. A comprehensive prevention program includes: gradual introduction to new activities, good overall conditioning, sport specific training, pre-stretch warm-up, stretch, strengthening, proper shoes, clothing, and equipment for the sport and conditions. Also, utilizing interval training, eccentric exercise (lowering body weight slowly against gravity – Photo 1) and proprioceptive and agility drills are essential (Photos 2 & 3). 

In PHOTO 1a & 1b: Eccentric Lowering and Lengthening: for the Achillies tendon during exercise. Beginning on the ball of both feet (1a), bend the strong knee to shift the weight onto the weak leg (1b). Slowly lowering the ankle/heel to the ground over 5-6 seconds. Repeat.

In PHOTO 2: Proprioceptive Training: for the Achillies tendon. Standing on a Bosu Ball while exercising the upper body (for example, biceps curls, shrugs, rows, lats) while maintaining balance on the ball.

PHOTO 3: Agility Drills: for the Achilles tendon involves stepping through a “gait ladder” in various patterns and at various speeds. 

MODEL: Kerry McGrath, student physical therapy aide at Mackarey Physical Therapy

Sources: MayoClinic.com;Christopher C Nannini, MD, Northwest Medical Center;Scott H Plantz, MD, Mount Sinai School of Medicine

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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. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, visit our exercise forum!

Introduction

 As most sports enthusiasts know, Aaron Rodgers, former Green Bay Packer quarterback and recent New York Jets QB (for just over a minute and half) suffered a season ending injury when he tore his Achilles tendon in the first game of the 2023/24 NFL season. Since then, I have been answering many questions from many about the nature of the injury and how to prevent it.

As the days continue to get shorter and temperatures begin a slow steady decline, athletes and exercise enthusiasts will work harder to “fit in” a warm-up before running or other activities during the winter months. But, no matter how limited time is, skipping the warm-up is risky. This time of year, one can expect to feel a little cold and stiff, especially if you are over 40, and therefore a little caution and preparation are in order to avoid muscle/tendon strain, or worse yet, muscle/tendon tears. The more commonly torn tendon is the Achilles tendon . Prevention of muscle tears, including the Achilles tendon includes; gradual introduction to new activities, good overall conditioning, sport specific training, pre-stretch warm-up, stretch, strengthening, proper shoes, clothing, and equipment for the sport and conditions.

Tendon Injury and How It Occurs

A muscle contracts to move bones and joints in the body.  The tendon is the fibrous tissue that attaches muscle to bone. Great force is transmitted across a tendon which, in the lower body, can be more than 5 times your body weight. Often, a tendon can become inflamed, irritated, strained or partially torn from improper mechanics or overuse. Although infrequent, occasionally tendons can also snap or rupture. A tendon is more vulnerable to a rupture for several reasons such as a history of repeated injections of steroids into a tendon and use of medications such as corticosteroids and some antibiotics. Certain diseases such as gout, arthritis, diabetes or hyperparathyroidism can contribute to tendon tears. Also, age, obesity and gender are significant risk factors as middle-aged, overweight males are more susceptible to tendon tears. Poor conditioning, improper warm-up and cold temperatures may also contribute to the problem.  

Tendon rupture is very painful and debilitating and must not be left untreated. While conservative management is preferred, surgical management is usually required for complete tears. The purpose of this column is to present the signs, symptoms and management of Achilles tendon ruptures.

Achilles Tendon

The Achilles tendon (also called the calcaneal tendon), is a large, strong cordlike band of fibrous tissue in the back of the ankle. The tendon (also called the heel cord) connects the powerful calf muscle to the heel bone (also called the calcaneus). When the calf muscle contracts, (as when you walk on the ball of your foot), the Achilles tendon is tightened, tension is created at the heel and the foot points down like pushing a gas pedal or walking on tip of your toes. This motion is essential for activities such as walking, running, and jumping. A partial tear of the tendon would make these activities weak and painful, while a full tear through the tendon would render these activities impossible.      

With age, the Achilles tendon (and other tendons) gets weak, thin, and dehydrated, thus making it prone to inflammation, degeneration, partial tear or rupture. The middle-aged weekend warrior is at greatest risk. A full or complete tear (Achilles tendon rupture) usually occurs about 2 inches above the heel bone and is associated with a sudden burst of activity followed by a quick stop or a quick start or change in direction, as in tennis, racquet ball, and basketball.

In some instances, the tendon can be injured by a violent contraction of calf when you push off forcefully at the same time the knee is locked straight as in a sudden sprint. Other times, the tendon is injured when a sudden and unexpected force occurs as in a trip off a curb or sudden step into a hole or a quick attempt to break a fall.

Achilles Tendon Rupture Symptoms

• Pain – sudden and severe pain in the back of the ankle or calf that feels like being hit by a rock or gun shot.
• Pop – sometimes it is reported that a loud pop or snap is heard when the tendon tears.
• Divot Deformity – sometimes a depression or indentation in the tendon is seen or felt with a bulbous area above or below the tear.
• Black and Blue – it is common to have bleeding after tearing the muscle or tendon with black and blue color and bruising the night or day after the injury.
• Swelling – in addition to swelling in the tendon area of the tear, sometimes swelling will be prominent in the ankle and foot.
• Stiffness – loss of movement due to swelling and weakness.
• Weakness – inability to “push off” on the injured foot when walking or climbing steps.
• Loss of Function – difficulty with daily activities that require walking, ascending inclines, climbing stairs, or jumping.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog Next Week: Achilles tendon Part II of II.

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

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

Diabetes Part II of II: Management and Lifestyle

According to the American Diabetes Association (ADA) and the Centers for Disease Control (CDC), 11.3% of the population in the United States or almost 37.3 million adults and children has diabetes. Unfortunately, the number keeps rising and one-third of these people are not aware that they have the disease. It will be the purpose of this column to raise the level of consciousness through education and offer recommendations for lowering blood sugar levels naturally.  

Perhaps no goal is more important to a person with diabetes than maintaining a healthy blood sugar level. When managed over time, healthy blood sugar levels can slow the onset of complications associated with the disease. According to the ADA, pre-diabetes, or impaired glucose tolerance, occurs when blood glucose levels are higher than normal (110 to 125mg/dl) but below type 2 diabetes levels (126mg/dl). 54 million Americans have pre-diabetes in addition to the 20.8 million with diabetes.

While medications are effective in maintaining blood sugar levels, for those who are borderline, there are effective ways to lower your blood sugar naturally. Your physician will determine which treatment is most appropriate for your problem. Also, maintaining your ideal body weight is always important.

10 Tips to Lower Your Blood Sugar Naturally

• Spread Out Your Meals – Spreading out your meals evenly throughout the day is very effective. By keeping the amount of carbohydrates consistent, your body will have enough time to regulate blood sugar levels naturally. Skipping meals, fasting and overeating is counterproductive. 45 grams for women and 60 grams for men is a good carbohydrate amount as a starting point. This is affected by medications and activity/exercise levels and should be discussed with your physician.
• Add Resistant Starch to Your Diet – Resistant starch can bypass the small intestine, get metabolized and acts as dietary fiber in the large intestine and lower your blood sugar level. Resistant starch is found in some potatoes and beans such as black and kidney.
• Beans and More Beans – Studies show that eating 1.5 to 2.5 cups of cooked beans per day improves blood sugar levels, lowers the risk of cardiovascular disease and lowers total cholesterol. Gradually add beans to your diet over time by adding them to soup or salad.
• Cactus – Studies also show that cooked prickly pear cactus slows carbohydrate absorption and lowers blood sugar levels. It is a common treatment for diabetes in Mexico where it is boiled, grilled, fried, mashed and served in soups and stews. While it is available as a dietary supplement, it has not been thoroughly studied in this form.
• Sleep - While being active is important, getting enough sleep is equally essential. Studies show poor sleep habits negatively effects body chemistry and those sleeping 8 hours control blood sugar more effectively. Diabetics with sleep apnea can dramatically improve their blood sugar levels by using continuous positive airway pressure (CPAP).
• Lose Weight – For diabetics every pound counts. Some studies show that losing as little as five pounds can reduce blood sugar levels.
• Manage Stress – While a little stress can be healthy, excessive and prolonged stress causes the body to store glucose and fat as a protective mechanism. If not burned off through activity or exercise, this creates glucose storages and increases blood sugar. Relieve stress through exercise, counseling, meditation, yoga, massage, or spending quality time with family or friends.
• Routine Exercise – Diabetics, especially type 2, benefit greatly from regular exercise through improved insulin resistance to lower blood sugar levels. In addition, some benefits include prevention of heart disease, stroke and peripheral neuropathies. Sustained aerobic exercise, 30 to 45 minutes, 3-5 days per week and mild to moderate weight training is recommended, according to your fitness level.
• Constant Movement/Activity – Incorporate activity into your daily life. Use the steps instead of the elevator, park a distance from the store and walk, get up and walk around the house during every television commercial. 
• Eat Breakfast – When waking up in the morning, the body has experienced a fast for 8-12 hours and requires food to balance blood sugar levels, especially when taking insulin. A healthy breakfast should include carbohydrates, proteins and fibers.

SOURCES: The American Diabetes Association (ADA), CDC, NIH, and Lifescript

Visit your doctor reguLlarly and listen to your body.

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

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

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

November is National Diabetes Awareness Month. This column will present information regarding type 1 and type 2 diabetes and the diagnosis and symptoms of the disease. Next week, Part II will present the role of exercise in the management of the disease. 

What is it?

            Diabetes is a disease where the hormone insulin is not adequately produced or used by the body. Insulin is needed for cells to take up glucose after it is broken down from sugars, starches and other food that we eat. When working properly, this provides the fuel necessary for activities of daily living. While the exact cause is not completely understood, genetics is known to play a big role. However, environmental factors such as obesity and inactivity have also been found to play a large role.

            According to the American Diabetes Association (ADA) and the Centers for Disease Control (CDC), 11.3% of the population in the United States or almost 37.3 million adults and children has diabetes. Unfortunately, the number keeps rising and one-third of these people are not aware that they have the disease.

Diagnosis

A Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT) can be used to screen a person for diabetes or pre-diabetes. Due to the fact that it is easier, quicker and cheaper, the FPG is the recommended test by the ADA. A FPG test results between 110 and 125 mg/dl indicates pre-diabetes. A FPG of 126 mg/dl or higher indicates diabetes.

Type 1 Diabetes

Type 1 diabetes occurs when the islet cells of the pancreas are destroyed and unable to produce insulin. Without insulin, the cells of the body are unable to allow glucose (sugar) to enter the cells of the body and fuel them. Without the hormone insulin, the body is unable to convert glucose into energy needed for activities of daily living. According to the ADA, 5-10% of Americans diagnosed with diabetes has type 1. It is usually diagnosed in children and young adults.

While type 1 diabetes is serious, each year more and more people are living long, healthy and happy lives. Some conditions associated with type 1 diabetes are: hyperglycemia, ketoacidosis and celiac disease. Some things you will have to know: information about different types of insulin, different types of blood glucose meters, different types of diagnostic tests, managing your blood glucose, regular eye examinations, and tests to monitor your kidney function, regular vascular and foot exams.

Symptoms 

While symptoms may vary for each patient, people with type 1diabetes often have increased thirst and urination, constant hunger, weight loss and extreme tiredness.

Complications

Type 1 diabetes increases your risk for other serious problems. Some examples are: heart disease, blindness, nerve damage, amputations and kidney damage. The best way to minimize your risk of complications from type 1diabetes is to take good care of your body. Get regular checkups from your eye doctor for early vision problems, dentist, for early dental problems, podiatrist to prevent foot wounds and ulcers. Exercise regularly, keep your weight down. Do not smoke or drink excessively.

Type 2 Diabetes

Type 2 is the most common type of diabetes as most Americans are diagnosed with type 2 diabetes. It occurs when the body fails to use insulin properly and eventually it fails to produce an adequate amount of insulin. When sugar, the primary source of energy in the body, is not able to be broken down and transported in the cells for energy, it builds up in the blood. There it can immediately starve cells of energy and cause weakness.

Also, over time it can damage eyes, kidneys, nerves or heart from abnormalities in cholesterol, blood pressure and an increase in clotting of blood vessels. Like type 1, even though the problems with type 2 are scary, most people with type 2 diabetes live long, healthy, and happy lives. While people of all ages and races can get diabetes, some groups are at higher risk for type 2. For example, African Americans, Latinos, Native Americans and Asian Americans/Pacific Islanders and the aged are at greater risk. Conditions and complications are the same as those for type 1 diabetes.

Symptoms

People with type 2 diabetes experience symptoms that are more vague and gradual in onset than with type 1 diabetes. Type 2 symptoms include feeling tired or ill, increased thirst and urination, weight loss, poor vision, frequent infections and slow wound healing.

Sources: NIH; American Diabetes Association; Harvard Health Publications

Visit your doctor regularly and listen to your body. 

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

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

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

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

Ankle swelling is a common symptom that occurs when your body retains fluid in the lower legs, ankles and feet. Most people have experienced it at some point in their lives and it often resolves on its own with elevation and muscle movement. While it is usually benign and occurs on both sides of the body, in some instances immediate medical attention is required. The most common causes of ankle swelling are:

Prolonged Positions – you have probably noticed swelling in your ankles and feet after a long trip by plane or car. Some may also experience symptoms after a long day at work sitting or standing in one position for an extended period of time. It may be the most common cause of lower leg swelling and easiest to resolve.

Diet- excessive salt in your diet is associated with swelling in the lower legs, especially when associated with other risk factors for swelling such as organ function or obesity.

Varicose Veins – when the valves in the blood vessels which carry blood from the legs back to the heart are damaged, blood and fluid can collect in the lower legs. Prolonged standing or sitting without intermittent movement with worsen the condition.

Pregnancy – during pregnancy, the body retains more fluids than usual and most women experience some form of swelling in the lower legs, ankles and feet.

Medications – certain drugs can cause fluid retention in the lower legs such as: anti-inflammatory medications, steroids, diabetes medications, antidepressants and cardiac medications.

Blood Clots – blockages in the blood vessels of the lower leg can limit the movement of fluid from the legs back to the heart. It is often present in only one leg and associated with warmth, pain, and cramping. It is a serious condition and requires immediate medical attention.

Trauma/Infection – after a trauma or injury such as an ankle sprain, bruise or fracture, the damaged tissue leaks fluid surrounding the affected area. Also, when specific area of the lower leg can becomes infected, as in the case of a cut or splinter in the ankle or foot that has not healed properly, swelling occurs in the surrounding tissues. These situations are often associated with warmth, pain and limited to the side of the injury. Treatment to injured tissues and the infection is required.

Lymphedema – swelling in the lower leg can occur when there is a blockage in the lymphatic system is blocked or when lymph nodes are removed in surgery for cancer. Medications, massage, compression garments, and elevation, can address the symptoms.

Obesity – due to the excessive weight placed on the tissues of the legs, ankle and feet and adipose tissue in the abdomen compressing blood vessels, obesity is one of the most common causes of lower leg swelling. It also complicates all of the above conditions associated with swelling in the legs.

Diseases – such as those of the kidney, heart, and liver are associated with swelling in the lower legs.

Tips to Control Swelling in the Ankles and Feet

Change Positions – on a long plane ride or sitting all day at school or work – get up and walk around every 30-45 minutes. Set a timer on your phone to remind you.

Exercise – regular exercises keeps the muscles and blood vessels in you lower extremities healthier. Also, intermittent movement of the leg muscles throughout the day, even when sitting, serve to prevent swelling. Try ankle pumps and toe curls.

Elevation – when sitting or lying down, try elevating your ankles and feet on a pillow to allow gravity to assist fluid movement in your legs.

Low-Sodium Diet – read the labels on your food and you will be shocked by how much sodium is in most foods, especially canned soups and vegetables. But, there are low-sodium options and don’t add more salt to your food.

Weight Loss – maintaining a healthy BMI is the single best thing you can do, not only for lower leg swelling, but for your overall health and wellness.

Compression Socks – for most people, over-the-counter compression socks will adequately prevent fluid retention in the lower legs. For comfort, begin with the lightest compression possible. 12-15 or 15-20 mm of mercury is a good start and put them on as soon as you get up in the morning, before swelling begins.

When to See Your Physician about Lower Leg Swelling –

• If you have a history of kidney, liver or heart disease and notice an increase of leg swelling
• If the swelling in your leg or legs are associated with warmth, redness and pain
• If you are have increased swelling in your lower legs and are running a temperature
• If you are pregnant and have sudden or severe onset of swelling
• If you tried conservative management (elevation, frequent positional changes) without success
• If the swelling in you lower legs continues to get worse
• If you have lower leg swelling and notice shortness of breath

Visit your doctor regularly and listen to your body.

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

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

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

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

Part II of II

According to the National Institutes of Health, an estimated 19.1% of U.S. adults 18 and older had an anxiety disorder in the past year. Anxiety disorders were higher for females (23.4%) than for males (14.3%). An estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives.

There are a wide variety of anxiety disorders and will vary by the objects or situations that induce them. However, the features of excessive anxiety and related behavioral disturbances are similar. Anxiety disorders can interfere with daily activities such as job performance, school work, and relationships. Symptoms include: distress, nausea, shortness of breath, bowel pattern changes, excessive perspiration, frequent laughing or crying, restlessness, and is often associated with depression. While there are many types and degrees of anxiety and there is no substitute for medical and psychological care, there are some simple and basic tools to help manage the problem…daily exercise is one easy, affordable and accessible suggestion for most. Multiple studies have discussed the incidence of unhealthy self management of anxiety, including the use of alcohol and recreational drugs.

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

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

HOW EXERCISE REDUCES ANXIETY AND DEPRESSION:

According to research reported in sports medicine journals, exercise reduces anxiety and depression in two ways, psychologically (mentally) and physiological (physically). 

Psychological or Mental Benefits of Exercise on Anxiety and Depression:

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

Physiological or Physical Benefits of Exercise on Anxiety and Depression:

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

HOW TO BEGIN EXERCISE FOR ANXIETY AND DEPRESSION:

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

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

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

Visit your doctor regularly and listen to your body.     

SOURCES: University of Pittsburgh Medical Center (UPMC); National Institutes of Health (NIH); The American Journal of Sports Medicine

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Paul's articles, check out our exercise forum!

Part I of II

According to the National Institutes of Health, an estimated 19.1% of U.S. adults 18 and older had an anxiety disorder in the past year. Anxiety disorders were higher for females (23.4%) than for males (14.3%). An estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives.

There are a wide variety of anxiety disorders and will vary by the objects or situations that induce them. However, the features of excessive anxiety and related behavioral disturbances are similar. Anxiety disorders can interfere with daily activities such as job performance, school work, and relationships. Symptoms include: distress, nausea, shortness of breath, bowel pattern changes, excessive perspiration, frequent laughing or crying, restlessness, and is often associated with depression. While there are many types and degrees of anxiety and there is no substitute for medical and psychological care, there are some simple and basic tools to help manage the problem…daily exercise is one easy, affordable and accessible suggestion for most. 

Multiple studies have discussed the incidence of unhealthy self management of anxiety, including the use of alcohol and recreational drugs. The University of Pittsburgh Medical Center (UPMC) recommends the following healthy tips for coping with anxiety:

Healthy Coping Tips

1. Get Enough Sleep 
Adequate sleep is critical for mental health. Unfortunately, anxiety can lead to sleeping problems and, according to the Anxiety and Depression Association of America (ADAA) inadequate sleep can worsen anxiety.

Seven to nine hours of sleep each night is recommended for most adults. The National Sleep Foundation recommends maintaining a regular schedule that includes going to bed at the same time each night and waking up at the same time each morning.

2. Practice Mindfulness Meditation 
Incorporating meditation into your life can help you cope with anxiety, according to the National Center for Complementary and Integrative Health.

Research shows mindfulness meditation programs are effective in reducing anxiety and depression. UPMC offers a Mindfulness-Based Stress Reduction Course and a Beginners Guide to Meditation that have been proven to be very effective. Another option for reduction of anxiety and stress is Progressive Muscle Relaxation. This mind-body technique can be found in 5, 10, 15 or 20 minute videos.

3. Spend Time in Nature 
How you deal with anxiety should include a walk in the forest or even a tree-lined park. In NEPA we are very fortunate to have access to beautiful walking and biking trails and state parks. Make time to enjoy them.

Research shows that “forest bathing,” long, slow walks in nature for health purposes, can lower blood pressure and relieve anxiety. A review of clinical trials published in the International Journal of Biometeorology found that salivary cortisol levels, biomarkers for stress, were significantly lower in groups who participated in forest bathing versus the control group.

4. Take up Yoga or Tai Chi 
Yoga does more than increase your flexibility. It incorporates exercise, deep breathing, and meditation. Yoga is an all-in-one anti-anxiety activity, as shown in a review of body-centered interventions published in Frontiers in Psychology. Tai chi, a mix of meditation and martial arts, works much the same way.

5. Dance Therapy 
That same research found that dance therapy, also known as movement therapy, reduces anxiety by engaging the body’s nervous system, which regulates how the body reacts to stress. In addition, dance/movement therapy increases production of serotonin, a chemical produced by the cells that’s responsible for mood.

6. Breathe Through It 
When you begin to feel anxiety or a panic attack with symptoms such as: sweating, trembling, dizziness, rapid heartbeat and nausea, start to come on, “take a deep breath.” Research shows that slow deep breaths can calm you down and lower your heart rate while quick, shallow breaths  can induce or worsen anxiety.

One breathing technique shown to reduce anxiety is diaphragmatic breathing. Using your diaphragm for deep breathing requires you to fill your lungs to capacity.

Breathe in slowly through your nose so that your stomach rises. Then, tighten the stomach muscles and exhale slowly through pursed lips. Repeat several times.

7. Limit Caffeine and Alcohol 
Too much caffeine restricts blood vessels, which can increase blood pressure and contribute to anxiety. Coping with anxiety also doesn’t mean masking it with alcohol. Studies show that there is a complex relationship between alcohol and anxiety. While some may use alcohol and recreational drugs to mask the symptoms of anxiety (often leading to substance abuse disorder), some studies show that alcohol can interfere with the neurotransmitters that manage anxiety and prevent you from getting a good night’s sleep. Drinking to cope creates a sort of feedback loop, which makes the anxiety worse and can lead to alcohol dependence.

8. Check Your Medicine 
Certain medicines, such as corticosteroids, asthma drugs, and others, can cause anxiety. Ask your doctor if any medicines you take may be a contributing factor.

9. Eat Healthy Foods 
Keeping the body nourished is essential for all functions of life. New research shows that a healthy diet may affect more than just weight and energy levels. One example is a Mediterranean Diet, with lots of vegetables, fruits, beans, lentils, nuts, whole grains, extra virgin olive oil and a moderate amount of fish (especially those rich in omega-3 fatty acids), with limited use of red meat.

10. Keep a Journal 
Keeping a journal can be a great way to keep track of your progress with anxiety and how your body responds to such situations. Tracing the triggers of anxiety can help you develop the skills to properly respond when put in anxious conditions.

11. Exercise Regularly 
Exercise promotes the release of endorphins. These brain chemicals reduce the body’s reaction to pain and stress. They also produce a feeling of euphoria, or happiness, that’s comparable to morphine. Just five minutes of aerobic exercise can kick start these anti-anxiety effects, according to some studies.  Next week in “Health & Exercise Forum” specific details about exercise for anxiety will be presented.

Talk to a Mental Health Professional

Chronic anxiety also can point to an underlying mental health issue. When your anxiety causes extreme distress or interrupts your ability to function on a daily basis, or when panic attacks are frequent and debilitating, it’s important to talk to your physician and ask for a referral to a mental health professional. They can provide a treatment plan, which may include specialized anti-anxiety medicine, psychotherapy, or both.

Visit your doctor regularly and listen to your body.     

SOURCES: University of Pittsburgh Medical Center (UPMC); National Institutes of Health (NIH);

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next week: Coping with Anxiety Part II This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Paul's articles, check out our exercise forum!

Last week in Health & Exercise Forum, we discussed dehydration as a potentially life-threatening problem, especially in those over 60. Summer heat and humidity are here and the risk of heat related illnesses are greater than normal. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year round. Furthermore, age related changes in 50-60 year olds can also make one vulnerable to dehydration, especially if they are active and exercise in the heat.

It is widely accepted that the best treatment for dehydration is prevention.  One must take a proactive approach to ensure and/or encourage adequate fluid intake, especially with age and in high temperatures. Consider some of the following practical tips to promote optimal hydration.

• Medications: Review your medications and note if any have the potential to reduce your body fluid levels or alter your electrolyte balance. Diuretics, hypnotics, and laxatives are some examples of medications that have the potential to contribute to dehydration.
• Fluids that can dehydrate: Avoid beverages that contain caffeine or alcohol since both have dehydrating properties.
• Check on your urine: As a general guide to hydration, urine should be plentiful, pale in color, and odorless. Dark, scanty, and strong-smelling urine may be the signal of dehydration.
• Early morning or late day exercise or activities: Avoid the hottest part of the day. Remember that simply breathing in and out uses more than a pint of water a day. Drink slowly and frequently when exercising. On an average day, try to drink about two liters of water and with activity you can double or triple that amount and consider sports drinks with electrolytes if you are engaging in activities longer than 45 minutes.
• Extra caution to hydrate if you are ill: You will need to hydrate more of you are experiencing vomiting, diarrhea, or an infection that causes fever.
• Make a hydration plan: Some elderly individuals fear frequent nightly urination. To prevent this occurrence, begin your fluid consumption early and not later then 6 o’clock at night. Eliminate the need to “think” about drinking more fluids. Carry a water bottle around with you or at least keep a glass filled with your favorite, healthy beverage within your reach or at least within your view! Having fluids nearby and easily accessible will help to remind you to drink!
• Be creative: Plan and provide “opportunities to drink”. to schedule a happy hour before your evening meal and serve liquid appetizers (e.g. tomato juice, orange juice, V-8 juice) or non-alcoholic drinks such as a virgin Bloody Mary.Fluids with appealing colors (e.g. pink lemonade) served in attractive bottles, glasses, or stemware are more alluring to the senses and more likely to be sampled. Use a blender to mix cocktail combinations: kiwi-strawberry, vanilla and root beer soda, ginger ale and cranberry juice, and orange and pineapple juice. Garnishing a simple glass of water with a wedge of lemon or a frozen strawberry may be the stimulus that some people need to take their first taste. Adding sprigs of fresh mint or lemon verbena can make a fresh-tasting drink with an appetizing aroma. If texture is an important factor, create frozen liquids such as lemon ice, popsicles, gelatin desserts, Italian ices, and snow cones. Consider fresh fruit such as watermelon and pineapple. Fruits and vegetables are great examples because they contain 80% to 90% water. 

Remember, knowledge and awareness of the symptoms of and the prevention of dehydration can reduce unnecessary hospitalizations and maximize health and well-being for the elderly and not-so-elderly individual. 

Visit your doctor regularly and listen to your body.     

 Keep moving, eat healthy foods, exercise regularly, and live long and well!

Contributor: Janet M. Caputo, DPT, OCS

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, check out our exercise forum!