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

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

Benefits of Exercise for Those with Osteoarthritis:

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

• Pain Control
  • Exercise controls OA pain by releasing natural pain control chemicals in the body called endorphins. It also controls pain by assisting in weight loss and improving range of motion.
• Weight Control
  • We all know how well exercise burns calories and that increased body weight creates increased stress on the joints.
• Prevention of Joint Stiffness
  • Exercise will help maintain joint range of motion. A stiff joint is a painful joint.
• Prevention of Muscle Weakness
  • Exercise will help maintain muscle strength. Weak muscles will allow or increase in joint wear and tear.
• Maintain Lifestyle
  • If a joint is stiff and weak, then they become painful which negatively impacts your lifestyle. Exercise can prevent this problem.  

Tips How To Exercise With Osteoarthritis:

• Start Slowly
  • Wean into exercise because if you advance too quickly, you will flare up the joint and have increased pain. For example, walk for 5-10 minutes the first session. If you do not have pain, add 1-2 minutes each session.
• Lose Weight
  • Every pound lost equates to less stress on your joints. For example, a loss of 5 pounds of body weight translates to 20-30 pounds of stress through the knee, according to David Borenstein, MD, President of the American College of Rheumatology. Also, body weight has a direct impact on daily activities. For example, walking upstairs creates stress through the knee equal to 4 times body weight and seven times body weight going downstairs. Therefore, less body weight equals less stress.
• Low Impact Workouts
  • Low impact exercise creates less stress on the joints while strengthening leg muscles and those who maintain leg muscle strength have less stress on their joints. It is even important not to load your arms with heavy objects when walking or using stairs to limit joint stress.
  • Some examples of low-impact exercises are walking, swimming, elliptical trainer, and biking. Strength training is also low-impact and should be performed with low weight and high repetitions. Water therapy is great for those with OA, especially in a heated pool. It is a great low-impact exercise with less gravity and stress on the joints. Walk, swim and do mild resistance exercises in the water. Use a snorkel and mask for swimming to limit excessive neck turning and back extension.
  • Walking is a great form of exercise; however, walking softly is important for those with OA. Wear good running shoes and orthotics if necessary. Discuss this with your physical therapist or podiatrist. When possible, use soft surfaces like cinder, mulch or rubber. Avoid grass and soft stand due to instability and torsion that may irritate your joints.  
• Warm-Up
  • Warming up your body is critical to prevent injury to the muscles and tendons. This can be done by marching in place or using aerobic equipment such as a bike for 5 to 10 minutes before exercise. Always perform the warm-up activity at ½ your normal pace.
• Balance & Relaxation Techniques
  • Tai Chi and ballroom dancing are two good examples of activities which promote balance and relaxation. Studies showed that those with OA who participated in Tia Chi two times a week for eight weeks reported less pain, increased range of motion and improved daily activities and function. They also noted less low back pain and better sleep.
• Proper Clothing
  • Stay warm in winter and consider wearing compression shorts. Be cool in the summer months with Drytech^R type material.
• Pre/Post Exercise First Aid
  • If you are sore for longer than 12 to 24 hours after exercise, then you overdid it and must adjust next time. Otherwise, use hot packs, bath or shower before you exercise to loosen up and apply ice to your joints after exercise, especially if they are sore.
• Post Exercise Stretch
  • Gentle, active range of motion stretches after exercise is important to maintain mobility. Do not bounce or cause pain. For example: Low Back – knees to chest; Arms – row –the – boat, arms behind head, arms behind back; Legs – wall lean calf stretch, bend and extend knees, open and close hips.

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

Visit your doctor regularly and listen to your body.     

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

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in 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 is hard to believe that August is here but don’t panic, there is plenty of time to get outdoors and enjoy some sunny Vitamin D!

While protection from the sun is very important, too much time indoors playing computer games and watching television can lead to potential problems from lack of exposure to the sun. One must use good judgment and have balance as the potential exists for Vitamin D deficiency due to lack of sun exposure. This problem may be true for individuals who use too much protection or spend most of their day indoors due to occupation or poor health. Therefore, the purpose of this column will be to discuss the importance of Vitamin D for health and wellness.

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

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

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

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

Sources of Vitamin D:

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

Vitamin D deficiency can occur when dietary intake of it is inadequate, when there is limited sunlight exposure, when the kidney cannot convert Vitamin D to its active form or when it is inadequately absorbed from the gastrointestinal tract. Season, geographic location, time of day, cloud cover, air pollution, sunscreens, living indoors and living in cities where tall buildings block adequate sunlight from reaching the ground affect UV ray exposure. Individuals with limited sun exposure are at risk of Vitamin D deficiency.

Homebound individuals, people living in northern latitudes (e.g. New England, Alaska), individuals who cover their bodies for religious reasons and people whose occupations prevent exposure to sunlight may need to supplement with Vitamin D. Sunscreens with a sun protection factor of 8 or greater will block UV rays that produce it. Older adults have a higher risk for deficiency because the skin’s ability to convert Vitamin D to its active form decreases with age and the kidneys, which help convert it to its active form, do not work as well when people age.

Individuals with pancreatic enzyme deficiency, Chron’s disease, cystic fibrosis, sprue, liver disease, surgical removal of part or all of the stomach or small bowel disease may need extra Vitamin D because it is a fat-soluble vitamin and they have reduced ability to absorb dietary fat. Vitamin D supplements are often recommended for exclusively breast-fed infants because human milk may not contain adequate amount. Consult with your pediatrician on this issue.

SOURCES: The National Institutes of Health; CDC

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

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in 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!

Education, Medication, Diet, and Exercise

The list of diseases such as high blood pressure, diabetes, and stroke that can be managed, cured or prevented is endless. Certainly, cholesterol and heart disease are at the top of the list. Studies clearly demonstrate that managing cholesterol through education, medication, diet and exercise can significantly reduce the risk of heart disease.

Education –

Know your numbers. Learn the difference between unsaturated and saturated fats. Make yourself a student of healthy living through diet and exercise. Avoid fads and focus your effort on scientifically proven methods. Many experts feel that those with genetically high cholesterol should use exercise and diet to maintain health but will also need require the addition of a statin drug to manage cholesterol effectively.

Statin Drugs -

There are many methods to lower your LDL (bad cholesterol). However, no method has been proven more successful than statin drugs. Multiple landmark studies confirm that for those individuals needing statin drugs to control their cholesterol, the benefits far outweigh the risks.

By inhibiting an enzyme in the liver, statin drugs limit the liver’s ability to produce cholesterol thereby significantly lowering LDL (bad cholesterol) and triglycerides and modestly increasing HDL (good cholesterol). As a result, their unique benefits include preventing and reducing plaque in arteries, stabilizing existing plaque, reducing inflammation of the arterial wall, and improving overall vascular function. Statin Drugs Include: Lipitor (atorvastatin); Lescol (fluvastatin); Mevacor (lovastatin); Pravachol (pravastatin); Zocor (simvastatin); Crestor (rosuvastatin).

Clinical studies that have shown that statin drugs significantly reduce the risk of heart attack and death in patients with proven coronary artery disease (CAD) and can also reduce cardiac events in patients with high cholesterol levels who are at increased risk for heart disease. And although statins are best known for lowering cholesterol, they may also have several other benefits: they may prevent Alzheimer’s disease, and they may also have a positive impact on diabetes and blood pressure.

Exercise –

Second only to statin drugs, no other method of the prevention of CAD has proven more effective than exercise, specifically aerobic exercise. It is well documented that physically active people have a lower incidence of CAD than sedentary people. For the prevention of CAD, the following exercises are defined as aerobic: High Amount/High Intensity – a caloric equivalent of jogging 20 miles per week at 65 -80 percent intensity, Low Amount/High Intensity – a caloric equivalent of jogging 12 miles per week at 65 to 80 percent intensity, Low Amount/Moderate Intensity – a caloric equivalent of walking 12 miles per week at 40 to 55 percent intensity.

Exercise is a valuable prevention tool on many levels: it reduces weight, LDL, and blood pressure, and it increases HDL. Research has found that the amount of exercise matters more than the intensity. For example, those exercising 5 or more days per week benefited more than those exercising less often. However, it is important to remember that ALL exercise groups showed improvement.

Diet –

Following a Mediterranean diet is one way you can reduce CAD and cut your risks for other diseases. While no Mediterranean diet has more value than another, the following equation highlights the factors that make a Mediterranean diet so valuable. First, eat a variety of fruits, vegetables, whole grains, beans, nuts, and seeds, with olive oil as an important source of fat. Then, add moderate amounts of fish, poultry and fresh dairy. Finally, subtract red meat from your diet, or at least limit your consumption.

The Dietary Approaches to Stop Hypertension (DASH) diet is the American version of the Mediterranean diet and has been found to reduce blood pressure and LDL levels. It is rich in fruits and vegetables, moderate in low-fat dairy, and low in animal protein. It promotes the use of legumes and nuts as plant sources of protein.

Along with increasing your plant-based foods and decreasing your consumption of red meat, you may also want to replace some of the carbohydrates in your diet with proteins or monounsaturated fats. This switch can improve lipid levels.

Fiber, Nuts, Tea, and Alcohol –

Dietary soluble fibers such as pectin, wheat dextrin, and oat products will reduce LDL. Some suggest that a combination of soluble fiber with plant sterols may be beneficial. Walnuts, high in polyunsaturated fatty acids, have been shown to positively impact serum lipid levels. Almonds, pistachios and other nuts have shown similar results. Those consuming nuts more than four times per week showed the most significant improvement. Also, those with moderately high LDL who drank green tea once to twice per day while following a low-fat diet found more improvement in LDL reduction than they did with a placebo. Moderate alcohol consumption (1-2 drinks per day) has been shown to improve HDL levels. Red wine has the added antioxidant benefit even in its non-alcohol form. 

Weight Loss –

Fat cells secrete chemicals that negatively affect lipid metabolism. “Maintaining a body that is slim and trim with consistent exercise and a low-calorie diet limited in saturated fats is the key”

Supplements –

While the internet is littered with information on thousands of supplements claiming to lower cholesterol and provide other life enhancing outcomes, few are proven effective. Of these, only fish oil, taken in concentrated high doses (> 6g/day) has been proven to lower triglycerides and LDL.

Multivitamins, soy proteins, and other grain products, while not cholesterol reducing, are valuable to many. But when it comes to reducing cholesterol, garlic, policosanol, Vitamin E, and isoflavone supplements have failed the scrutiny of scientific research. Plant sterols such as Benecol^R sisosterol and campesterol, found in Promise activ^TM, have been shown to slightly reduce serum cholesterol levels; however, no studies have demonstrated their ability to lower the incidence of CAD. In fact, the Nutrition Committee of the American Heart Association has suggested that the general population not use these products until further studies determine their safety and efficacy, due in part to potential side effects.

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!

Not a "Fad," but an Actual Medical Specialty!

Gretchen graduated from Philadelphia College of Pharmacy and Science, The University of Scranton, and received a Doctor of Pharmacy degree from Temple University.   

Gretchen has been teaching for over 25 years at Rutgers University, Keystone College, Lackawanna College, The University of Scranton, and Marywood University. She has earned certifications in Pilates, yoga, barre and teaches all three locally.  She has a Wellness and Lifestyle coaching certification from Harvard University.

Gretchen resides in Scranton with her husband, Timothy Welby, MD, and has three daughters – Casey, Kate, and Caroline.  

Lifestyle Medicine, is not just a fad or buzzword that is overused in a plethora of health, fitness and wellness magazines, but is actually a medical specialty. It is the practice of using diet and exercise, along with other lifestyle modifications to prevent and manage disease. Lifestyle Medicine focuses on six pillars: healthy eating, physical activity, restorative sleep, stress management, positive social connections, and avoidance of risky substances.

The American College of Lifestyle Medicine was established in 2004. Since then, its membership and outreach have grown exponentially. Lifestyle medicine is currently the fastest-growing specialty in medicine. Its primary aim is to utilize evidence-based therapeutic lifestyle interventions to prevent/control chronic diseases such as cardiovascular disease, type II diabetes, and obesity. However, new data is emerging which expands the role of Lifestyle Medicine into many other areas, including chronic low back pain, sleep, hormonal disorders, Alzheimer’s Disease, chronic inflammatory conditions, and mental health, to name a few. 

Lifestyle Medicine differs from conventional medicine in that its approach is not disease specific.  Following the six pillars of Lifestyle medicine improves overall health. Conventional medicine targets and treats a specific disease process with medication or surgical intervention in a reactionary approach.  Lifestyle medicine prevents or reverses the disease process through behavioral and dietary changes. In a perfect world, Lifestyle medicine and Conventional medicine can be combined to achieve the best results for some patients.

A JAMA study, published in 1993, linked unhealthy lifestyles with premature death. Since this study was published, the rates of cardiovascular disease and Type II diabetes have continued to climb.  Obesity rates are at an epidemic level. 70% of American adults, and 22% of children fall into overweight/obese Body Mass Index (BMI) categories. According to the American Academy of Cardiology, only 6.8% of adult Americans meet the criteria for ideal cardiometabolic health, something the Academy calls a “Population Level Code Blue.”

In 2020, the American Heart Association issued a Presidential Advisory for 2030 Impact Goals. The overall goal is to improve morbidity and mortality through preventative measures.  Interventions should be targeted earlier in childhood and young adulthood, where healthy habits can be formed with greater success and maximum outcomes. For example, physical activity is well established for its positive effects on cardiovascular health.  Physical activity prevents clot and plaque build-up, is antiarrhythmic, and provides hemodynamic stability.  Physical activity has also been shown to have psychological, emotional, and social benefits.  The American Heart Association categorizes physical activity as a Level 1 (highest) intervention for primary prevention. 

Lifestyle Medicine is rooted in evidence-based findings, and its efficacy is supported in scientific literature. A study published in the New England Journal of Medicine in 2002 examined the prevention of the onset of Type II Diabetes in prediabetic patients.  Patients were divided into three groups: a placebo group, a metformin group (a type 2 diabetes medication), and a lifestyle intervention group.  The metformin group received daily metformin (medication intervention).  The lifestyle intervention group received education and prescriptive interventions/instructions on diet, exercise, and stress reduction.  Patients were followed for three years.  At the end of the study period, the metformin group saw a 31% incidence reduction of type II diabetes, and the lifestyle intervention group saw a 58% incidence reduction in type II diabetes (almost double that of the medication group). 

Many examples abound, highlighting the ability of lifestyle medicine interventions for healthy outcomes. The advantages of lifestyle medicine over conventional medicine interventions are numerous.  Medications come with side effects. Medication costs are rising and are often not fully covered by insurance programs. Often, current medications are not completely effective for treating disease.  For example, Alzheimer’s Disease treatments are lacking.  The Alzheimer’s Association International Conference emphasizes healthy lifestyle interventions.  They stress adopting 4 or 5 healthy lifestyle factors to reduce the risk of Alzheimer’s dementia by 60%.

Healthy eating habits do not lead to serious side effects.   Lifestyle interventions are within the patients’ control and may result in cost savings, potentially lowering food and medical bills. Because lifestyle intervention involves behavioral changes, the process requires time and effort, as well as investment in education and reinforcement to sustain healthy patterns.  Motivating clients to make necessary changes and stick with those changes can be the biggest challenge. A Lifestyle/Wellness Coach may be employed to start the client on their journey.  The coach works with the client to make choices that are adaptable to the client while fitting within the six pillars. The role of the coach is to hold space and provide guidance for the client, but not to “fix”, “rescue,” or “judge”. Coaching sessions last 30-60 minutes. Coaches and clients may meet 10 times over 3-12 months to establish patterns. 

If you, like so many others, have not achieved your health and wellness goals using traditional methods, it may be worth considering Lifestyle Medicine.  Focus on healthy eating (minimizing processed foods and sugar intake), physical activity (minimum 300 minutes per week), restorative sleep (between 7-9 hours per night), stress management (controlling anxiety and depression), positive social connections (consistent interactions with friends) and avoidance of risky substances (alcohol, tobacco/nicotine, illicit drugs) have evidence-based positive outcomes to prevent, manage and reverse chronic diseases. 

Sources: More information about the six pillars of Lifestyle Medicine and specific intervention outcomes can be found @Balanced Living 570 on Facebook and Instagram! 

• Foundations of Lifestyle Medicine and its Evolution - PMC 
• Implications of lifestyle medicine in medical practice - PMC 
• Lifestyle Medicine: An Antidote to Cardiovascular Diseases - PMC 
• Lifestyle Medicine Prescriptions - PMC 
• Lifestyle Medicine: A Critical Key to Restoring Health - PMC 
• McGinnis J.M., Foege W.H. Actual causes of death in the United States. JAMA. 1993;270(18):2207–2212 
• Knowler W.C., Barrett-Connor E., Fowler S.E., et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med.2002;346(6):393–403 
• American College of Lifestyle Medicine

Visit your doctor regularly and listen to your body.  

   

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

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

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

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

Introduction: (Dr. Paul Mackarey)

I have invited Gretchen Welby, PharmD, MHA to present the current wisdom on the very controversial topic of vaccination/immunization to raise awareness and dispel any myths and misunderstandings.

Scientific progress has rarely advanced by popular vote, and vaccination is no exception. While public sentiment deserves respect and thoughtful engagement, the evidence guiding immunization policy is built on decades of rigorous research, transparent testing and continuous review. These research processes are designed precisely to rise above fear, trend, politics or misinformation. Choosing to prioritize scientific findings over shifting opinion is not an act of dismissal, but of responsibility…it is a commitment to decisions that protect both individual lives and the collective good, even when those decisions challenge what feels comfortable or widely believed.

Vaccination Facts:

2024 marked the 50th anniversary of the World Health Organization’s Expanded Programme on Immunization (EPI).  An initiative to make life-saving vaccines available to all worldwide.  A modeling study done to mark the 50 years of EPI estimated that vaccination averted 154 million deaths, including 146 million deaths among children. Several additional studies on vaccine effectiveness show that vaccines improve infant safety, contribute to a healthy society, and even reduce cancer risk. Vaccines work for an individual and society.  The data show that many vaccines can reduce mortality by 99% or more. Unfortunately, global immunization has been a victim of its own success because people have forgotten how deadly and dangerous the diseases vaccines protect against can be.

Vaccine effectiveness is overshadowed today by misinformation about vaccine safety, changing vaccine administration timelines, and mixed public health messaging. What are the outcomes of the recent relaxed vaccine message? The number of measles cases has jumped.  Fifty-nine cases were reported in 2023.  In 2025, 2242 cases were reported.  For additional perspective, an article published in the 2007 edition of JAMA listed the number of deaths pre-vaccine release and the number of deaths post-vaccine release.  The findings are remarkable.

The recent Centers for Disease Control and Prevention (CDC) change to the childhood vaccine schedule reduces routine protection against 13 childhood diseases to 7, with shared decision-making now required for the remaining 6.  Diphtheria, tetanus, acellular pertussis (DTaP; Tdap), Haemophilus influenzae type b (Hib), Pneumococcal (PCV), Inactivated poliovirus (IPV), Measles, mumps, rubella (MMR), Varicella (VAR), and Human papillomavirus (HPV – changing from 2 doses to 1 dose) are now part of the routine vaccine schedule. 

Rotavirus, COVID-19, Influenza, Hepatitis A, Hepatitis B, Meningococcal ACWY, and Meningococcal B are now grouped in a shared-decision-making model. Traditionally, when changes are made to the vaccine schedule, they are made with much deliberation, study, and expert input from multiple agencies and governing bodies.  However, this recent change, however, did not follow the normal study path.  This is concerning because changes are proposed without proper study of the immediate and long-term consequences.

Vaccines have been shown to be safe, with most patients experiencing very minor side effects. Normal reactions from vaccinations include low-grade fever for 24-48 hours.  A low-grade fever and minor muscle aches signal the body's immune response.  Tenderness and redness at the injection site are other normal reactions from immunization and should last from 24-48 hours.  There is no proof that thimerosal (a preservative historically used in vaccines) causes adverse reactions.  Additionally, thimerosal has been removed from most vaccine preparations used today.  Vaccines do not overwhelm a child’s immune system.  Children are exposed to hundreds of antigens daily.  A WHOLE pediatric vaccination schedule exposes them to around 50 antigens.  There is NO evidence to support altering or delaying the American Academy of Pediatrics vaccination schedule. This does NOT increase safety; it DECREASES protection at a time when infants and children are most vulnerable.

How can consumers of healthcare information, in particular, vaccine information, find reliable, trustworthy, educated guidance? Since the June 2025 changes in CDC personnel have resulted in less qualified members of the Advisory Committee on Immunization Practices (ACIP), it is generally best to rely on non-governmental sources such as the American Academy of Pediatrics, American College of Gynecologists, the Infectious Disease Society of America, and the Vaccine Integrity Project for vaccine advice.  Additionally, discuss vaccine efficacy and safety with your doctor.

For More Information:

Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization - The Lancet

Vaccination greatly reduces disease, disability, death and inequity worldwide - PMC

The New Federal Vaccine Schedule for Children: What Changed and What Are the Implications? | KFF

JAMA 2007; 298:2155-2162 

Visit your doctor regularly and listen to your body.     

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

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

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

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

It’s that time of year…after a long winter of nights that come early and last too long there is LIGHT at the end of the tunnel! In the fall and winter, especially this far north, many people start to feel the gloom of their surroundings creep into their psyche and spring cannot arrive too soon...Is this normal, or a sign of something more serious?

Seasonal affective disorder, or SAD, is at the far end of a spectrum of seasonal mood changes. The mildest of these, “seasonality”, is a normal response to cyclical changes in weather and light exposure. However, when symptoms like depressed mood, lack of motivation, or a shift to more vegetative daily habits become severe and debilitating, SAD may be the cause. In fact, one study found that SAD affects up to 10% of primary-care patients, and that those with a previous diagnosis of depression are even more at risk. Fortunately, though, there are well established therapies that can help those afflicted with SAD to get through the dark winter months.

The American Psychiatric Association defines SAD as a subtype of either Major Depressive Disorder or Bipolar Disorder, depending on the symptoms. It can consist of episodes that onset during either fall/winter or spring/summer, or have symptoms characteristic of either “major depressive” or “manic” episodes. The vast majority of those with SAD, however, experience a persistent overall depressed mood during the shorter days of fall and winter.

Symptoms of SAD:

• Depressed mood
• Lack of interest in previously enjoyable activities
• Decreased energy level, impaired concentration
• Changes in appetite

In more serious cases:

• Excessive feelings of guilt or worthlessness
• Slower or racing thoughts or movements
• Suicidal impulses.

If enough of these symptoms are present for a long enough time and onset in a seasonal pattern, that can mean Seasonal Affective Disorder. Most people with the disorder find themselves sleeping more and eating more (especially carbs), and report that their symptoms can even resolve with relocation to a sunnier environment. Along the spectrum of disease is a less severe form called “subsyndromal” SAD, which can still be effectively treated. Periods of SAD tend to resolve with the coming of spring, but they can be immensely distressing and always deserve medical intervention.

No one knows exactly why Seasonal Affective Disorder happens, but it appears to be associated with decreased exposure to natural light during the fall and winter months. One possible explanation is the “phase-shift” hypothesis. It states that your body’s circadian rhythms, which are regulated by hormones and the brain, become out-of-step with environmental sleep/wake cues as the days shorten. In other words, the light levels around you and your body’s internal clock are telling you two different things about when to sleep. This disruption of circadian rhythms, or “phase-delay”, likely contributes to the symptoms of SAD, although precisely how it induces changes in mood remains unclear.

Another hypothesis for the mechanism underlying SAD involves abnormalities in the activity of serotonin, a neurotransmitter in the brain. Normally, serotonin regulates mood and attention. However, studies have found that people with SAD clear serotonin out of their brains faster, giving the hormone less of a chance to provide a boost in mood.

Treatment for SAD:

Current medical treatment of SAD targets the changes in both circadian rhythms and serotonin metabolism. This can be accomplished with light therapy, antidepressant medications or a combination of both.

• Light Therapy - works by correcting the miscommunication between the body’s internal clock and its surroundings. It is administered as either “bright-light therapy” or “dawn stimulation.” Bright-light therapy involves the patient sitting or going about their activities while exposed to a very bright light for a certain amount of time every day. Dawn stimulation, on the other hand, gradually exposes the patient to more light as they wake up in the morning. In this way, dawn stimulation simulates a pattern of morning light-exposure more akin to what we experience in the summer.
• Antidepressant Medications - most of the time, doctors begin with a “selective serotonin reuptake inhibitor” (SSRI), which remedies the dysregulation of serotonin signaling observed in patients with SAD. SSRIs block serotonin from being recycled in the brain, thus giving it more time to work.

• Lifestyle Changes - behavioral and lifestyle changes can be instrumental in fending off seasonal depression. Below are some easy changes you can make that are proven to help with seasonal mood changes--whether it be the “winter blues”, subsyndromal SAD, Major depression with seasonal pattern...or just plain “seasonality”:
  • Maximize your sleep hygiene:
    • Go to bed and wake up at the same time every day.
    • Try not to let your bedtime or wake time vary by more than an hour from day to day.
    • Have a regular, relaxing bedtime routine.
    • Doing the same thing every night, including taking time to just wind down, will help you sleep and optimize your circadian clock.
    • Create a comfortable sleeping environment.
    • Make sure your bedroom is quiet, dark, and not too warm.
    • Avoid using TV, computers, phones and other electronics before bed. Bright blue light from screens can interfere with circadian rhythms.
    • If possible, try to minimize exposure to bright light from any source for 2 hours before bed.
    • Limit caffeine intake later in the day. 4 to 6 hours after you have a cup of coffee, half of the caffeine from it is still in your body--keeping you awake! Be sure to check labels: coffee, soda, iced tea and dark chocolate are not the only things that contain caffeine.

• • Maximize Outdoor Activities:
    • Get Outside! Take daily walks outside. Some experts believe that natural light can alleviate the symptoms of seasonal depression in exactly the same way as bright light therapy. Don’t stay in, even if it’s overcast. Even on a cloudy day, the outdoor light intensity is up to half that of prescription bright-light lamps. And on a bright day, the midday sun can be up to ten times their intensity!  
    • Exercise! Engage in aerobic exercise like biking, running, or walking Regular exercise can improve the symptoms of seasonal depression, even in the absence of other lifestyle changes. If you can exercise outside when it’s sunny, you’ll be killing two birds with one stone. Early morning and late afternoon are the best times to exercise. Try to avoid strenuous activity right before bed.
    • Stay Positive! Always remember that spring sunshine is never all that far away!

Medical Contributor:

Brendan Bormes, MD, GCSM 2019: This column was previously featured in “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

Visit your doctor regularly and listen to your body.

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

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

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

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

Guest Columnist: Paul Mackarey, Jr. DPT

According to the Centers for Disease Control and Prevention (CDC), the 2025/26 flu season has been exceptional. Normally, elderly adults have the largest number of flu related hospitalizations while young children are second. This year, however, baby boomers between 50 and 64 years of age are the second most vulnerable. And, as of January 2026, the US flu season has resulted in an estimated 19 million illnesses, 250,000 hospitalizations, and 10,000 deaths. At the risk of creating an overreaction and promoting “germaphobic” behavior, if there is one time of year that diligent hygiene has merit, it is now…during flu season.

Contracting the cold or flu can make you feel run-down and under the weather for weeks. Unfortunately, your daily activities and responsibilities cannot take a sick day. The common cold and flu is most prevalent during late fall, winter and early spring. According to flufacts.com, “The influenza virus, more commonly known as the flu, is defined as a contagious respiratory infection that infects the nose, throat, and lungs. Thankfully, there are several easy and effective preventive measures that can reduce the probability of contracting the cold and flu.  These preventive measures are designed to help keep your immune system strong and healthy. A healthy immune system fights against pathogens, such as the cold and flu virus. This article will focus on the ten best ways to prevent the flu and cold this season.  

10 Ways to Prevent the Cold and Flu:

• Get Vaccinated
  • The vaccine produces antibodies that protect against the cold and flu virus within two weeks after vaccination. There are currently two different types of vaccines; an “intramuscular shot,” meaning it is injected into the muscle and a nasal-spray vaccination is available for people two to 29 years of age. The traditional intramuscular vaccine has been used for decades and has been approved for use in people six months of age and older. Recently, two new intramuscular vaccines are available. A hi-dose vaccine was designed for people 65 years and older and a vaccine designed for people 18 to 64 years of age is also available.
• Wash Hands Regularly
  • The most common way to spread the cold and flu virus is by direct contact. The virus can live on surfaces for hours and even days eagerly waiting to get picked up by the next individual.
•  Do Not Cover Sneezes With Your Hands
  • Germs attach onto your hands and can be passed onto other public surfaces. The most effective ways to cover a sneeze are to use a tissue or your sleeve.

• Exercise Regularly
  • Exercising regularly causes an increase in your heart rate. Therefore, the heart can pump more oxygen rich blood throughout the body. Increased blood flow to the body has been proven to increase the body’s immune system and help to prevent illness.
• Eat Well
  • Eating nutrient rich foods is the best way to keep your immune system strong.  Phytochemicals are natural immune boosting chemicals found in plants, fruits and vegetables, specifically, dark green, red, and yellow vegetables and fruits. Yogurt is also an effective way to prevent illness. Studies have shown that eating low fat yogurt regularly can reduce susceptibility to colds by 25 percent. Research also suggests that the natural bacteria found in yogurt stimulates and strengthens the immune system.

• Stay Hydrated
  • Staying hydrated is important. Water flushes your system by filtering out poisons as it replenishes your body. Dehydrated individuals feel tired and unfocused. A healthy adult requires eight 8-ounce glasses of fluid a day. The easiest way to determine if you are dehydrated is by the color of your urine. If it is dark yellow your body may require fluids.
• Get Plenty of Sleep
  • Doctors recommend a full eight hours of sleep a night. The demands of your busy life sometimes make that difficult. However, during the cold and flu season, it is particularly important. If you are not well rested, your body becomes tired and “run-down,” leading to a weakened immune system and leaves you more susceptible to illness.  
• Do Not Smoke
  • Statistics show that smokers are at a higher risk of contracting more frequent and severe cold and flu symptoms. This is because the toxic chemicals in smoke are seen as pathogens or foreign contaminants in the body. As a result, your immune system is working overtime. Also, smoking is proven to paralyze cilia that line your nose and lungs. The cilia, or delicate hairs, are designed to remove cold and flu viruses out of your nasal passageway before they can infect the body. Smoking a single cigarette can paralyze the cilia for up to 40 minutes.

•  Drink Less Alcohol
  • Heavy alcohol consumption negatively affects the body and its immune system in several ways. Heavy drinkers are more prone to cold and flu illnesses because alcohol suppresses the immune system and significantly dehydrates the body.
•  Most Importantly Relax
  • It is important to relax and “unwind” at the end of a busy day. Relaxing lowers cortizol levels in the blood. Cortizol is a hormone released into the body’s blood stream when a person is feeling stressed or pressured. Over time, this hormone weakens the immune system. Relaxing causes interleukins, the main components of your immune system that fights against the cold and flu virus, to increase in your bloodstream. It is recommended that one makes time for at least 30 minutes of relaxation each day.  

THE 10 MOST GERM-FILLED ITEMS YOU USE DAILY   (webMD)

• CELLPHONE – it is with us at ALL times; kitchen, bedroom, bathroom, office car. Bacteria loves its warm dirty surface and has been found to be 10 times dirtier than a toilet seat as E.coli, a harmful and potentially deadly bacterium has been found on it. Wash your hands often and swipe the surface with antibacterial swipes frequently.
• TV REMOTE CONTROL – stuck between the dark and warm pillows and sofa cushions, bacteria flourish on the surface of this device which has been touched by every family member and their runny-nosed friends.
• COMPUTER KEYBOARD – like the phone and remote, it is the most touched and dirty places in your daily routine. Wash hands and swipe surface.
• DISH SPONGE – considered the dirtiest item in your home or office. Ring it out after each use, soak in bleach, clean in dishwasher and replace often.

• TOOTH BRUSH HOLDER – the germs from your mouth drip from the brush onto the holder two or three times a day. Overtime, a buildup of germs becomes overwhelming and dangerous as those with illnesses share the holder with others. Dry the brush after each use and clean the holder often. During an illness, do not share the holder and start a new toothbrush after an illness.
• MONEY - as much as we love the feel of money in our hands, studies show that the average dollar bill has 3,000 bacteria. Wash your hands after handling money.
• OFFICE KITCHEN – not everyone in your office practices good hygiene. The sink, sponge, towels, cups, silverware, and dishes in your office area potential Petri dishes. While it is good to use reusable products, take care to clean them carefully and use wash, dry, bleach, and replace.
• LAUNDRY – some studies show that dangerous viruses found in undergarments are able to survive the spin cycle and dryer. For those items, hot water, bleach, and long hot drying cycles are recommended.
• PURSES/BRIEFCASES – money, food, tissues, and hundreds of hands. It goes wherever you go…bathroom, countertop, bank, and office. Clean and empty regularly.
• ATM – countless strangers touch the ATM keypad in a public area where dirty money is handled regularly. Use antibacterial swipes and wash hands.        

Sources: www.flufacts.com; www.webmd.com; www.lifescript.com; www.cdc.gov

Guest Contributor: Paul Mackarey, Jr. DPT, is a Doctor of Physical Therapy and partner at Mackarey & Mackarey Physical Therapy Consultants, LLC in Scranton and Clarks Summit.

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

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

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

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

Part II of II

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what they should avoid, how to prevent and what is recommended to prevent or limit the progression of arthritis. Osteoarthritis (OA) is also known as degenerative arthritis. It is the most common form of arthritis in the knee. OA is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the joint which eventually wears down to the bony joint surface.

It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle. It causes gradual onset of pain, swelling and stiffness in the joint involved, especially after increased activity. While diet and exercise help, some people are more likely to develop OA based on previous trauma or injury, labor intensive occupations and genetics. Either way, we all get OA to some degree but there are a few things you can do to limit wear and tear to your joints.

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

1. Don’t Burn the Candle at Both Ends
   • Poor sleep can affect your joints. One study found that people with arthritis felt more pain after restless nights. One theory is that when you don’t sleep well, it triggers inflammation in your body, which may lead toOA over time.
2. Don’t Slouch and Slump
   • Posture matters. Sit up straight. When you slump in your chair, it puts more stress on your muscles and joints and tires them out. Two good posture stretches are making a double chin by bringing your head over your shoulders and the second is pinching your shoulder blades together.
3. Don’t Ignore Pain
   • The exercise mantra “no pain, no gain” may be appropriate for a young healthy athlete, however, it may prove counterproductive for most of us. It’s true that some muscle soreness is OK, but not if it lasts for days or if your muscles are swollen or too sore to move or to touch. Joint pain isn’t normal, so pay attention to it. If you think you overdid it, ease up on your exercises. If the pain won’t go away, check with your doctor.
4. Don’t Overdo Computer Time
   • It can literally be a pain in your neck -- and your elbows, wrists, back, and shoulders. The problem isn’t just bad posture, but that you hold it for too long. That overworks your muscles. It also puts pressure on the discs in your back. Set up an ergonomic workstation. If you’re in a soft chair, prop up your arms with cushions to take the load off your shoulders and your neck. Be sure to get up and move every hour.
5. Don’t Get Rigid and Repetitive in Your Exercise Routine
   • If you perform the same exercise, sport or activity every day, you use the same muscles and joints repeatedly. Remember, overtraining problems commonly occur in single sport athletes. Mix in fun sports and activities to break the monotony by adding fun activities such as golf, swimming, biking, skiing, hiking or playing tennis. Avoid weight bearing exercises two days in a row. Run one day, walk, swim or bike the next. Use the elliptical instead of the treadmill on various days. Limit intensity – only work out intensely 2-3 times out of 5 days per week.
6. Don’t Squat
   • Avoid squatting…deep squatting is bad for your hips and knees. Even when gardening, use a kneeling pad instead of bending down and squatting.
7. Don’t Smoke and Chew Tobacco
   • Nicotine from cigarettes and chewing tobacco cuts down on blood flow to your bones and to the cushioning discs in your back. It limits how much bone-building calcium your body can take in. It also breaks down estrogen, a hormone you need for bone health. And it slows new growth that thickens bones…which can lead to OA and osteoporosis.

SOURCES: WebMD, University of Pennsylvania

Visit your family doctor regularly and listen to your body.

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

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

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

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

Part I of II

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what they should avoid, how to prevent and what is recommended to prevent or limit the progression of arthritis. Osteoarthritis (OA) is also known as degenerative arthritis. It is the most common form of arthritis in the knee. OA is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the joint which eventually wears down to the bony joint surface.

It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle. It causes gradual onset of pain, swelling and stiffness in the involved joint, especially after increased activity. While diet and exercise help, some people are more likely to develop OA based on previous trauma or injury, labor intensive occupations and genetics. Either way, we all get OA to some degree but there are a few things you can do to limit wear and tear to your joints.

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

1. Don’t Carry Extra Weight
   • Your joints, which link your bones together, are sensitive to heavy loads. Every pound on your frame puts 4 pounds of stress on your knees. It also strains your back, hips, and feet.
   • That causes wear and tear that can lead to damage, aches, and pain. A poor diet, which can lead to being overweight, can also be the source of inflammation. That can make all your joints, including in your hands, stiff, painful, and swollen.
2. Don’t Text Too Much
   • “Texting thumb” is a real thing. Your tendons can get irritated and lock your thumb in a curled position. All that looking down at your phone is just as bad for your neck and shoulders, too. Every inch your head drops forward raises the load on your muscles.
3. Don’t Wear High Heels Too Often
   • While they might look styl”n, the higher the heel, the more your weight tips forward. Your leg muscles have to work harder to keep your balance and alignment, which can cause pain. When heels go up, so does the twisting force in your knees. If you wear them every day, you increase your odds of developing OA.
4. Don’t Wear the Wrong Shoes
   • Old, worn-out shoes will not adequately support your feet and ankles. That’ll throw your knees, hips, and back out of whack. Also, make sure your sneakers are right for your sport. High tops for basketball, for example, can protect your ankles from sprains and flip flops or summer beach shoes are not meant for long distances…especially if you are over 50.
5. Don’t Crack Your Knuckles
   • That satisfying pop comes from tiny bubbles bursting in the fluid around your joints, or from the ligaments snapping against the bone. While it might not cause OA directly, one study showed that this habit may cause your hands to swell and weaken your grip.
6. Don’t Carry a Heavy Bag
   • Whether it’s a purse, backpack, or messenger bag, packing too much can cause neck, back and shoulder pain. Heavy weight on one shoulder throws off your balance and your walk. If you tend to carry things only on one side, the constant pull overstretches your muscles and tires out your joints.
7. Don’t Use Wrong Muscles for the Job
   • When you put too much load on little muscles, your joints pay the price. If you need to open a heavy door, for example, push with your shoulder instead of your fingers. When you lift something off the floor, bend at your knees and push up with your strong leg muscles, instead of your arms.
8. Don’t Sleep on Your Stomach
   • While it might help with snoring, it may not be best for the rest of your body. Lying on your belly pushes your head back, which compresses your spine. Your head also will face in one direction for longer stretches than if you sleep on your back.
9. Don’t Skip Stretching
   • Gentle, comfortable, active stretching on a regular basis can help strengthen your muscles and tendons. It also can make them more flexible. That allows your joints to move more easily and helps the muscles around them work better.
10. Don’t Skip Strength Training
    • Once you turn 40, your bones start to get a little thinner and more likely to break. If you build muscle with strength training, it slows bone loss and triggers new growth. So, you not only get stronger muscles, but denser bones, too. Together, they stabilize your joints so you’re less likely to get hurt. In fact, studies show that the stronger your leg muscles, the less stress on your knees.

SOURCES: WebMD, University of Pennsylvania,

Visit your family doctor regularly and listen to your body.     

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

Next Week: Part II of II “Save Your Joints”

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 is no surprise that the most common New Year Resolution is to be healthier…eat less, exercise more, etc. However, health is multidimensional! To be truly healthy, one must have a healthy mind, body and spirit! It is well documented and established that exercise and diet contribute to your physical health, and mentally, the brain is healthier by avoiding toxins such as tobacco, drugs and alcohol, while the spirit is healthier by being mindful, spiritual and meditative. Unfortunately, less attention is paid to other critically important aspects of health: the unhealthy impact of negative visceral emotions such as hate, jealousy, and anger.

Considering our present divisive social and political climate in the United States and globally, I find myself in constant search to understand the pervasive hate and division which seems to be, not only prevalent, but acceptable. I have attempted to read books such as “The Science of Hate,” by Matthew Williams,  about the science of hate and survival, “Demon Copperhead,” by Barbara Kingsolver, about those marginalized and left behind, ”The Demon of Unrest,” by Erik Larson, about the history of our national political division preceding the Civil War and its relevance in the present, and watch TED Talks podcasts and television specials such as those presented by WVIA Public Media in a special series “We Stand Against Hate.”

All of this, to no avail! I failed in my effort to understand the unthinkable: We hate individuals whom we have NEVER even met. We hate groups of people through unfounded generalizations. We hate because of color, creed, stature, rank?!?! At the end of the day, I just don’t get it! Fortunately, I was not born with the “hate gene” and may never fully understand. But what I do understand is that HATE IS UNHEALTHY! So, if you want to be truly and completely healthy this new year, work on your hate!

What Is Hate? (Everydayhealth.com Laura Williams)

The word “hate” is thrown around more often than the actual emotion is felt. The statement “I hate broccoli” is rarely accompanied by the strong negative emotion of true hatred. Even strong feelings of anger or disgust are not the same as hate. According to Laura Williams, clinical psychologist “Hate is a profoundly intense and enduring dislike for someone or something. Hate can be tenacious, and often has roots in mistrust, fear, or (lack of) individual power, and vulnerability.”

It can be hard to distinguish hate from other powerful negative emotions that you may be feeling at the same time. Some psychologists say what makes hate different is that it’s directed toward who or what someone or something is, rather than what they’ve done.

The negative physiological, physical health, mental and emotional effects of hate are well documented by many sources including the National Institutes of Health.

Physiological Effects of Hate:

• Hormonal Surge: Hate activates your stress response, releasing cortisol and adrenaline, which raise heart rate, blood pressure and blood sugar.
• Increased Inflammation: Chronic stress from hate causes widespread inflammation, damaging tissues and organs over time.
• Nervous System Overload: Hate overstimulates the nervous system, leading to restlessness and heightened states of alertness.

Physical Health Effects of Hate:

• Cardiovascular Problems: Higher blood pressure and chronic stress increase the risk of heart attacks and stroke.
• Digestive Issues: Inflammation and stress can lead to stomach pain, irritable bowel syndrome and other gut problems.
• Weakened Immune System: A suppressed immune system makes you more susceptible to infections and illnesses.
• Physical Tension: Involuntary clenching of the jaw, grinding teeth and tense muscles are common.

Mental & Emotional Effects of Hate:

• Anxiety & Depression: Hate is often rooted in fear and helplessness, which can fuel anxiety, depression and obsessive thoughts.
• Exhaustion/Fatigue: Maintaining hate is mentally taxing, draining energy and leading to a constant state of agitation.
• Behavioral Changes: Hate can manifest in angry outbursts, violence, or social withdrawal, which can negatively affect relationships.

Ultimately, hate creates an internal state of emergency which demands significant physical and mental resources and leads to wear-and-tear on your entire system. Letting go of hate is a form of self-care that promotes relaxation and long-term well-being.

Tips to Deal With Hatred: (PsychMatters, Joanna Kleovoulou, Clinical Psychologist)

• Acknowledge that you are full of hatred. Examine your prejudices. If you can admit that you are feeling hateful, then you can begin to deal with this emotion and find a solution to the problem.
• Understand why you are feeling hate. Look within yourself and ask why you are upset. Hatred usually comes from a place of fear, insecurity or mistrust.
• Try to catch yourself in your hatred. The mind in its ego state, will perpetuate it by saying confirming labelling statements such as “She’s really such a @*&?*.”
• Stop yourself - When you catch yourself in these phrases, words or actions, stop yourself, recognize that it just feeds your hatred and builds up more anger.
• Take a step back. In the heat of the moment, it can be hard to make wise decisions. Take a break, go for a walk or practice meditation until you have calmed down. Take deep breaths and allow yourself to relax. Once your mind is calm, you can and will be able to control your emotions in a more efficient manner, bringing perspective to your thoughts and feelings.

• Build connections with people outside your normal social group. Volunteer at a local soup kitchen or food bank.
• Deal with it. Instead of ignoring the issue, try to find a solution to the problem. If the situation is beyond your control, try to resolve it in your head by shifting your mindset. You may not be able to change a particular person or situation, but you can change how you think about them. Join “Emotions Anonymous” a 12-step recovery program. 
• Support victims of hate. Speak out within your personal network and through social media against acts of hate. Join support groups. VictimConnect Resource Center 1-855-4VICTIM; National Advocacy Groups such as Southern Poverty Law Center.
• Talk to someone you trust as talking to a close friend, family member or a psychologist about something painful can help to alleviate the negative feelings you are having. They can often offer valuable advice or guidance.

2026 is a great opportunity to be truly healthy…eat well, exercise more and rid yourself of hate!

Visit your family 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!