This column is dedicated to the memory of John R. O’Brien, Esq., who recently passed due to medical complications associated with multiple sclerosis (MS). John was a source of joy and inspiration for those fortunate to have known him. Twenty years ago, John hesitantly agreed to contribute to my column on MS with two requirements: one, if the column would be valuable to those affected by MS and two, he would remain anonymous. When speaking with his dedicated wife, Sally, it became very apparent that any discussion of John’s life would be diminished if it was defined by the disease because he was committed to turning his “DISABILITY INTO AN ABILITY!”
With the help of his loving wife, family, friends, and devices such as an electric scooter and adaptive car, John not only lived but thrived! He was a skilled lawyer, a respected member of the Bar, and an active member of the community. John served on the executive committee of the Lackawanna Bar Association and was recently honored by the Lackawanna Pro Bono. He also taught business law and healthcare law and coached Prep’s mock trial team.
John shared his thoughts with me about the challenges of redefining life… from Golf Club Champion to living with a physically disabling disease. Anyone who knew him would agree that he succeeded in doing so through his keen intellect and sharp wit and humor…his heart and brain overcompensated for his body! In addition to reading books in Latin and Greek, he had his crossword puzzles published in The New York Times and Los Angeles Times. In September 2023, John conducted an interview with presidential historian Doris Kearns Goodwin before a full house at the Scranton Cultural Center. Ms. Goodwin later reported that John was the most knowledgeable, effective and enjoyable interviewer she’s encountered.
John’s absence will be deeply felt and his legacy will continue to shape our community for years to come!
According to the National Multiple Sclerosis Society, Multiple Sclerosis affects approximately 400,000 people in the United States. Multiple Sclerosis is second only to trauma as the most common cause of neurological disability for those in early to middle adulthood. MS is almost three times as common in women. Multiple Sclerosis is very uncommon before adolescence or after 50. However, the risk increases from teen years to age 50.
Multiple sclerosis is considered to be an autoimmune disease. The immune system of the body does not work properly when it fails to attack and protect the body against substances foreign to the body such as bacteria. Instead, the system allows the body to attack normal tissues and create diseases such as MS, rheumatoid arthritis and lupus.
In MS, the immune system attacks the brain and spinal cord of the central nervous system. Each nerve has an outer covering of a fatty material (myelin) for insulation to improve the transmission and conductivity of impulses or messages to and from the brain. The damage to the myelin of the nervous system interrupts the ability of messages to travel to and from the brain, through the spinal cord and to other areas of the body such as the muscles in the arms and legs. Due to this “short circuiting” the brain becomes unable to send or receive messages. In multiple sclerosis, scar tissue or plaques (sclerosis) replaces the fatty myelin in “multiple” areas. This is also called demyelination.
The symptoms associated with MS vary greatly from person to person. The amount, frequency and speed of the demyelination process vary greatly and are directly related to the loss of strength and function in daily activities. Some people are independent and ambulatory with mild and infrequent episodes of weakness and disability and live a relatively normal life. Others suffer from frequent and aggressive episodes that significantly weaken and disable. Some common symptoms in the early stages include: muscle weakness, loss of coordination, blurred vision, pain in the eyes, double vision. Some common symptoms as the disease progresses are: muscle stiffness with muscle spasms, pain, difficulty controlling urination, difficulty thinking clearly.
The diagnosis of MS can be very difficulty in the early stages because the symptoms are often vague and temporary. Also, MS symptoms are very similar to other neurological problems. A neurologist will run several tests to rule out other possible problems. However, an MRI showing demyelination of the nerves is a primary confirmation.
Treatment for MS depends upon many factors and requires consultation with your physician. Some medications can control the frequency and severity of MS symptoms such as pain, weakness, and spasticity. Also, some drugs can slow the progression of certain types of MS. Additional treatments for MS include: diet, exercise, physical therapy, support groups, and counseling for the MS patient and their family. Part II of Multiple Sclerosis will discuss these options in further detail next week.
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 - NEXT WEEK: PART II OF II - MULTIPLE SCLEROSIS
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
January is the time of year that many people set goals and resolve to be their very best. Not surprisingly, weight loss and fitness are the most common resolutions. It is also a time when many residents of NEPA will plan vacations and travel to warmer climates. Well, it may be that you can do both… This year consider visiting a “Fitness Resort.” According to “FitStays,” fitness resorts are rapidly gaining popularity for people of all sizes and shapes. Last week in Part I of “Fitness Resorts” we discussed value of fitness resorts. This week we will present “a typical day, how long you should stay, expected costs, and some recommended resorts.
A fitness resort is a vacation destination where travelers go to exercise and lose weight. Sometimes called a “weight loss resort”, “fitness retreat”, “wellness resort”, “weight loss boot camp”, or “adult fat camp”, fitness resorts around the United States cater to people of all shapes and sizes.
Most fitness resorts consist of pre-determined, calorie-limited menus to help travelers in their weight loss journey. Some resorts promote menus of 1,000 to 1,500 calories-per-day, which is fewer than most people burn naturally via their resting metabolic rate (RMR).
In addition to net-negative calories through nutrition, fitness resorts and retreats typically have an extensive workout plan as part of their standard program. Many resorts and retreats offer daily hiking, in addition to strength classes, cardio, sports, and other physical activities.
The combination of healthy nutrition and active exercise means that most visitors can expect to lose weight at a fitness resort. Specific weight loss goals are determined by which fitness resort you pick, how long you stay, and how strenuously you want to stick to the program.
Fitness resorts (fitness retreats) are not your average “Reality TV Fat Camp.” In fact, your do not have to be excessively overweight to attend as people of all shapes and sizes benefit and enjoy the experience. Thousands of people chose to visit fitness resorts and fitness retreats every year because they are looking for a healthy alternative to a typical vacation. Instead, many want to “kick-start” a healthy lifestyle in a controlled environment. The basic concept of combining a limited-calorie diet with daily exercise, most people will have net-negative calories every day, lose weight, and gain strength and endurance at a fitness resort—provided they stick to the program.
Typically, fitness resorts offer one week programs but multiple weeks with a variety of options are available. However, for the best outcomes and carryover, experts recommend 2-3 weeks for your first visit to a fitness resort.
Fitness resorts, like everything else, vary in cost. According to FitStay, programs cost as little as $1,500 per week (all-inclusive), while some are more than $7,000 per week.
To choose the best fit for you, your budget, and goals, visit fitstay.com. Remember, most fitness resorts are all-inclusive, meaning that you won’t need to budget any extra for food. The program includes meals. Also, when choosing a fitness resort consider: location (where would you like to travel?); cost (how much can you afford to spend?); how long can you stay (one, two or three weeks?)
NOTE: One of these includes a fitness retreat in our very own Pocono Mountains!

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
January is the time of year that many people set goals and resolve to be their very best. Not surprisingly, weight loss and fitness are the most common resolutions. It is also a time when many residents of NEPA will plan vacations and travel to warmer climates. Well, it may be that you can do both…this year consider visiting a “Fitness Resort!” According to “FitStays,” fitness resorts are rapidly gaining popularity for people of all sizes and shapes.
A fitness resort is a vacation destination where travelers go to exercise and lose weight. Sometimes called a “weight loss resort”, “fitness retreat”, “wellness resort”, “weight loss boot camp”, or “adult fat camp”, fitness resorts around the United States cater to people of all shapes and sizes.
Most fitness resorts consist of pre-determined, calorie-limited menus to help travelers in their weight loss journey. Some resorts promote menus of 1,000 to 1,500 calories-per-day, which is fewer than most people burn naturally via their resting metabolic rate (RMR).
In addition to net-negative calories through nutrition, fitness resorts and fitness retreats typically have an extensive workout plan as part of their standard program. Many resorts and retreats offer daily hiking, in addition to cardio and strength classes and assorted sports and other physical activities.
The combination of healthy nutrition and active exercise means that most visitors can expect to lose weight at a fitness resort. Specific weight loss goals will be determined by which fitness resort you pick, how long you stay, and how strenuously you want to stick to the program.
Fitness resorts (fitness retreats) are not your average “Reality TV Fat Camp.” In fact, you do not have to be excessively overweight to attend as people of all shapes and sizes benefit and enjoy the experience. Thousands of people chose to visit fitness resorts and fitness retreats every year because they are looking for a healthy alternative to a typical vacation. Instead, many want to “kick-start” a healthy lifestyle in a controlled environment.
Fitness resorts have been found to be effective for most attendees. The basic concept of combining a limited-calorie diet with daily exercise, most people will have net-negative calories every day, lose weight, and gain strength and endurance at a fitness resort—provided they stick to the program.
While some people report losing 1-3 pounds-per-week at a fitness resort, others experience much more success. Exactly how much you will lose will be dependent on a wide variety of factors, including the duration and intensity of your exercise and activities and the calories you consume. Inherently, men tend to lose weight more easily than women, and younger people typically have an easier time shedding pounds than older people.
Ideally, for long term success, a fitness resort program should be a part of a healthy lifestyle, rather than an absolute weight loss goal. Be aware that many “spas and wellness centers” entice people with lavish facilities in a beautiful environment but mostly offer passive modalities such as massage, meditation, acupuncture, manicures, pedicures and facials. While these modalities have value, if your goal is jump start on weight loss and physical fitness, a fitness resort may be a better option.
Most fitness resorts are not “diet retreats” or painful “boot camps.” With a little effort, you can easily find the right fit for you. You will not starve! While you need to limit caloric intake, you also need enough energy for the 3-6 hours of exercise and activities (swimming, biking, hiking, Zumba, Yoga) offered. There is no need to be intimidated as most attendees are like-minded people with the same goals and needs. A good resort will not only provide the right amount of calories and exercise for your goals but also educate you how to prepare meals and engage in proper exercise once you return home.
According to FitStays, most fitness resorts offer a set schedule and a camp-like experience for adults with three meals every day, usually prepared by expert nutrition staff and/or dietitians, designed around healthy foods. A typical morning begins with extended cardio exercises, such as a run, bike or hike. The afternoon may have more intense exercise classes such as strength training classes as well as more fun activities such as sports and games. Educational classes are offered throughout the day, so you can carryover the lessons from your fitness resort experience when you return home. Evenings are usually lighter to allow for leisure, rest, or spa services, which are also offered at many resorts.

NEXT WEEK: FITNESS RESORTS - PART II – A typical day at a fitness resort, recommended length stay, cost and top 20 recommended resorts.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, please check out 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.
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!
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.
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
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!
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.
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 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.
While symptoms may vary for each patient, people with type 1diabetes often have increased thirst and urination, constant hunger, weight loss and extreme tiredness.
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 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.
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!
Studies have shown a recent escalation of joint replacements in a much younger and more active group than previously noted…the baby boomer! While the end result is mostly physical, the cause is often psychological. We all know the personality type: type A, hyperactive, goal-oriented, driven, possessed and highly organized – almost at all costs! Many of you have seen fitness enthusiasts running through the streets at 5:30 AM for 5-10-15 miles each day. Moreover, many of these runners have more activities planned later in the day: golf, tennis, ski, swim, play sports with their kids. Well, after 20 years of this behavior, many of these enthusiasts are now suffering the effects of long term multiple micro traumas. They are suffering from what orthopedic surgeons at the University of Pennsylvania call “Boomeritis! Boomeritis is inflammation of the baby boomer from overuse. Lower back pain, hip, groin, and knee pain is almost a daily event.
As baby boomers continue to enjoy sports with the same vigor and intensity as when they were younger, they are finding that their older bodies just can’t keep up. While these individuals often succeed in finding the balance of fitness and craziness, they have had times when they took it too far. Furthermore, nearly all compulsive exercisers suffer from over training syndrome. When take too far compulsive behavior is rationalized by insisting that if they didn’t work to extreme then their performance would suffer.
*Each sign is worth 1 point:
If you have two or more of the warning sings, consult your family physician to rule out potentially serious problems.
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.
Avoid squatting…deep squatting is bad for your hips and knees. Even when gardening, use a kneeling pad instead of bending down and squatting.
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 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.
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.
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!
There is little doubt that the workplace has been redefined since the pandemic as many employees continue to work from home. Sitting for many hours at a workstation that may not be optimal has also changed the way we define workplace health and safety. It may be more important than ever to pay close attention to designing an ergonomic workstation, changing position, and stretching regularly to prevent injury.
Since 1894 Labor Day has been designated as the national holiday that pays tribute to the contributions and achievements of American workers. Research supports the notion that healthier employees are happier and more productive. When employers encourage healthy behavior and safety at work, they benefit in many ways. For example, in addition to improving job satisfaction and productivity, healthy employees save money by using less sick time, worker’s compensation benefits and health benefits. For example, according to the Centers for Disease Control and Prevention, approximately 75 percent of employers” health care costs are related to chronic medical problems such as obesity, diabetes, high blood pressure, and high cholesterol. De-conditioned, overweight employees are more likely to suffer from these preventable conditions and are at greater risk for injury. Employers, please consider using this holiday as an opportunity to start a health promotion program at your workplace…have a health fair, offer healthy snacks, encourage walking, smoking cessation, exercising at lunch, and offer fitness club stipends.
Lower back pain, one of the costliest illnesses to employers, is one example of a problem which can be prevented with a good health and safety program. It is widely accepted in the medical community that the best treatment for lower back pain (LBP) is prevention. Keeping fit, (flexible and strong), practicing good posture, and using proper body mechanics are essential in the prevention of LBP. At our clinic, significant time and effort is spent emphasizing the importance of these concepts to our patients, employees, and the businesses we work with through industrial medicine programs. A comprehensive approach can produce significant reductions in LBP injuries through an onsite safety program which promotes education, wellness, body mechanics, lifting techniques, postural and stretching exercises and ergonomics.
As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well, exercise regularly and don’t smoke. Smokers have a much higher incidence of LBP and failure from lower back surgery.
Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back. Also, consider sitting on a physio ball, which promotes proper posture for part of the day.


Perform postural exercises throughout the day. Most of the day we sit, stand, and reaching forward and bend our spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.
Chin Tuck: Tuck your chin back to bring your head over shoulders.
Shoulder Blade Pinch: Pinch your shoulder blades together.
Standing Extension: While standing, put your hands behind back and extend lower back 10-20 degrees.
Good Body Mechanics and ergonomics are also important in the prevention of LBP. When lifting, think twice. Think about the weight, shape and size of the object. Think about where the object is going and the surface resistance of the floor. Does it require two people to lift? Can I safely lift that high or bend that low?
When bending to lift an object think about safety:
Proper Lifting Technique:
Visit your doctor regularly and listen to your body.
Model: Lexi DiGregorio, PTA

NEXT SUNDAY IN THE PAPER AND EVERY MONDAY'S BLOG – 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!
It is time to celebrate the 4TH of July with some fun in the sun…but don’t forget to protect your skin! A little awareness and some precautions can go a long way to make this holiday weekend safer!
Despite the fact that we have limited exposure to sunny days in NEPA (50%), skin cancer still exists in large numbers. Skin cancer is the most common cause of cancer in the United States. While there are several types of skin cancer and not necessarily all are deadly, procedures to remove these skin cancers are both costly and frequently result in unsightly scars. The most dangerous type of skin cancer, called melanoma, results in an estimated 10,000 deaths per year. The good news? Nearly all skin cancers are preventable!
The majority of skin cancers are caused by harmful ultraviolet (UV) rays from the sun. Two major types are UVA and UVB:
In the field of anti-aging, advertisers make lofty promises for many products that claim to contain or boost collagen. Whether or not these work is a whole other discussion, but what is collagen and what does it have to do with wrinkles?
Collagen is the most abundant protein in the human body. It is found in nearly all tissues and organs, and plays a crucial role in maintaining structural integrity. Unfortunately, collagen production naturally decreases with age. This causes many of the findings we associate with older age, such as sagging skin and wrinkles, as well as joint pain. Collagen also works together with another important protein called elastin, which helps to maintain elasticity – a feature commonly associated with youthful skin.
When exposed to UV rays, these proteins can become damaged. For instance, studies have shown that skin exposed to UV rays increases the expression of proteins called matrix metalloproteinases, or MMPs. You can think of these MMPs as collagen’s enemy, as they cause their degradation. This results in a decrease in collagen’s structural function leading to loose and wrinkled skin. UV rays can also stimulate the production of reactive oxygen species. These are substances such as hydrogen peroxide and bleach, which further cause destruction of skin’s microscopic structure.
So, you’re convinced and have decided to keep your skin healthy and youthful – what next? With so many different products on the market, choosing a daily sunscreen can become a difficult task. Here are a few pointers:
Another consideration when choosing a sunscreen is chemical versus physical blockers:
If preventing skin cancer isn’t incentive enough to wear sunscreen daily and avoid excessive sun exposure (and indoor tanning booths!), then consider the rapid effects on aging the sun’s rays can have. While a tan may look good for a week, avoiding exposure to UV rays will both delay and prevent aging for years.
For more information on skin cancer and prevention, please visit the Center for Disease Control’s website (https://www.cdc.gov/cancer/skin/) and contact your physician for specific concerns regarding spots on your skin.
Guest Contributor: Eduardo Ortiz, MD, Geisinger Commonwealth School of Medicine 2018

NEXT WEEK! Read Dr. Mackarey’s Health & Exercise Forum – every Monday. 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 Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's Articles. check out our exercise forum!