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. 

Prevention of Lower Back Pain

1. Maintain Fitness Level

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.

2. Practice Good Posture & Body Mechanics

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:

• Spread Legs Apart Shoulder Width
• Bend at the Knees and Limit Forward Bending the Spine
• Arch Lower Back Slightly
• Get and Maintain a Firm Grip
• Contract and Hold Abdominal (stomach) Muscles
• Lift With Legs (not back)
• Do Not Pivot or Rotate Spine With Load (use feet and step turn)
• Lift Slowly and Carefully (don’t hurry)
• Take Time to Perform Back Extension Stretches After the Lift
• Remember, Pushing is Better Than Pulling a Heavy Load

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!

This column is repeated every year at this time with the intent of raising the level of awareness to prevent death or serious illness from heat stroke in athletes and other active people in hot, humid weather.

It is August and summer is rapidly passing! So, get outdoors and have fun in the sun. However, please be mindful of how your body reacts to high humidity and heat and take appropriate precautions. Athletes are particularly vulnerable this time of year due to daytime practice sessions. (August 7, 2023, first day of acclimatization and August 14, 2023, first day of practice for fall sports according to PIAA). Visit www.piaa.org for more information. Keep in mind, you don’t have to be running a marathon or playing football in full uniform to suffer from heat stroke.

Heat stroke, one of the most serious heat-related illnesses, is the result of long term exposure to the sun to the point which a person cannot sweat enough to lower the body temperature. The elderly and infants are most susceptible and it can be fatal if not managed properly and immediately. Believe it or not, the exact cause of heat stroke is unclear. Prevention is the best treatment because it can strike suddenly and without warning. It can also occur in non athletes at outdoor concerts, outdoor carnivals, or backyard activities.

Hot Temps and Exercise

Some “old school” folks think that wearing extra clothing and “breaking a good sweat” is an optimal goal for exercise. However, it may be potentially very dangerous in hot and humid conditions. When exercising in hot weather, the body is under additional stress.  As the activity and the hot air increases your core temperature your body will to deliver more blood to your skin to cool it down. In doing so, your heart rate is increased and less blood is available for your muscles, which leads to cramping and other more serious problems. In humid conditions, problems are magnified as sweat cannot be evaporated from the skin to assist in cooling the body.

The American Academy of Pediatrics and The American College of Sports Medicine has the following recommendations which are appropriate for both the competitive athlete and weekend warrior:

Treatment of Heat Stroke:

• Heat Exhaustion – can be a precursor to heat stroke
  • Signs: cramps, weakness, fatigue, nausea
  • Treatment: rest in shade, cool down with cool (not cold) towels, and drink plenty of fluids.
• Core Body Temperature above 105 degrees Fahrenheit
• Hot, dry skin – flushed but not sweaty
• Lack of sweating *
  • *NOTE: athletes often have external heat stroke and they can sweat even with an increase core temperature
• Very rapid pulse
• Mental confusion, disorientation or hallucinations
• Physical clumsiness, sluggishness or fatigue
• Seizure
• Dizziness

Treatment of Heat Stroke:

• CALL 911 – Remember this may be life-threatening
• Relocate  – to a cool shady place or air-conditioned indoors and lie down with slight elevation of feet
• Undress – Remove outer garments and roll onto side to expose as much skin as possible to the air
• Cool Down – spray or sponge with cool water (not cold) and fan the skin
• Ice – place ice packs to the groin, neck and armpits to cool down large blood vessels. No ice bath.
• Core Temperature – is the only accurate measurement so medical personnel may take rectal temp if necessary. Must get core temp to 102 degrees Fahrenheit ASAP.
• Begin CPR – if breathing stops
• No Aspirin or Acetaminophen – to decrease temp
• Administer Fluids – if person is alert enough to swallow give 32 to 64 oz over 1-2 hours

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

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

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

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

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

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

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

Visit your doctor regularly and listen to your body.     

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

Contributor: Janet M. Caputo, DPT, OCS

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

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

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

It is time to celebrate the 4^TH 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!

UV rays and Skin Cancer

The majority of skin cancers are caused by harmful ultraviolet (UV) rays from the sun. Two major types are UVA and UVB:

• UVA rays account for the majority of UV rays in sunlight (about 95%) and penetrate deep into the skin causing continual damage throughout our lives – a process called ‘photo-aging’ that results in wrinkles, sunspots, and uneven texture. UVA can also damage skin at a microscopic level, which may contribute to the development of skin cancers.
• UVB rays, while they do not penetrate as deeply, are what cause sunburns when we spend too much time under the sun. UVB rays are primarily responsible for the development of skin cancers.

Aging

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.

Sunscreen Tips & Tricks

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:

• Look for the words “broad spectrum” or “UVA/UVB” on the label – this will ensure you are protecting yourself from all of the sun’s damaging effects
• Chose a product that is water-resistant if you anticipate sweating or swimming.
• Don’t stress over SPF. SPF stands for “sun protection” factor. An SPF 15 sunscreen blocks over 90% of UV rays. What’s more important is re-applying periodically throughout the day.
• Don’t let the cold weather fool you – while they may not feel warm, the suns rays are still penetrating the layers of your skin.
• Wear sunscreen even when it’s cloudy – harmful UV rays are invisible and are able to pass through.
• Don’t forget your ears and lips! Some skin cancers are especially common in these areas.

Sunscreen – Chemical vs. Physical Blockers

Another consideration when choosing a sunscreen is chemical versus physical blockers:

• Chemical sunscreens typically contain a combination of the following ingredients: oxybenzone, avobenzone, octisalate, octpcrylene, homosalate, and octinoxate. These work by absorbing the UV rays and preventing their damaging effects. Make sure to apply at least 30 minutes before heading outside, as these take some time before they begin working effectively.
• Physical, or mineral, sunscreens contain zinc oxide and/or titanium dioxide. These works by creating a layer over the skin that deflects or blocks the UV rays from penetrating. These are a great choice especially if you have sensitive skin.

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!

Part II of II

After a long winter, spring is finally in the air as indicated by the warm (summer-like) temperatures last week. While your mind may be ready to play golf (and other outdoor activities), however, it is important to remember that without proper warmup and preparation, the risk of injury can increase substantially. PGA professionals benefit tremendously from sport science, physical therapy and fitness programs on tour year round. Amateur golfers in northern climates require diligence and planning to prepare for the game after 4-6 months off to avoid injury.  

 Muscle strains, ligament sprains, neck and LBP is prevalent in the early season for golfers, especially for the amateur. The reasons are many: general deconditioning after winter inactivity, poor golf swing mechanics, excessive practice, inadequate warm-up and poor flexibility and conditioning. The very nature of the golf swing can create great stress on the body, especially after time off.

PRESEASON TIPS FOR GOLF

Keep Fit and Trim

• year round with light to moderate weight training, aerobic exercise, stabilization and flexibility exercises and good nutrition.

• Walking – Begin a walking program as the first step to a comprehensive preseason conditioning program for golf. Start 1 mile for a week, then 2 miles for 2 weeks, then 3 miles.

• Walking 18 holes on a golf course is the equivalent of a 5-7 mile walk. It keeps you fit, flexible and avoids the jarring of the bumpy cart. Taking a caddie is optimal. However, carrying your bag requires careful planning. Use a “Sunday bag: or ultra-light bag with a stand and double straps; remove extra balls, unused clubs and umbrellas to lighten the load. Arch your back and extend backwards with the club after every shot. If using a pull cart, push rather than pull, when not walking downhill.

Core Tips- A Strong Core is Critical for a Healthy Golf Swing

• Core Stabilization Golf Exercises – Abdominal/Core Strengthening can be performed sitting on balance ball or standing on discs while doing biceps curls, shrugs, rows, lats, and leg extension. Contract abdominal muscles and keep balance while using arms and legs. (Photo 1)
• Golf Swing on Discs – Backswing
• Tie a light resistance band (red) to a golf club at the top of the grip. Tie the other end to a door knob. Stand with feet shoulder width apart on discs or pillows. Slowly turn into backswing – hold 3-5 seconds- slowly release to starting position. Repeat 5 to 10 times. (Photo 2)
• Golf Swing on Discs – Follow-Through
• Same as above for backswing but perform in follow-through motion.
• Take a Golf Lesson – learn the mechanics of a proper swing for less stress on your body from a PGA golf professional. It can make the difference!
• BE SMART – LISTEN TO YOUR BODY - If the arm, leg, neck or back pain is severe, long lasting or causes radiating pain, tingling or numbness into your legs, consult your family physician to determine the best course of action before you continue playing golf.

MODELS: Ross Zanghi, Physical Therapy Student; Ashley Ottaviani, Physical Therapist Assistant

Visit your doctor regularly and listen to your body.     

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM

Access all of Dr. Mackarey's articles at our Health and Exercise Forum

Part II of II

According to the American Diabetes Association (ADA), 32.2 million adults and children, 10.5% of the population in the United States, have diabetes. Unfortunately, one-third of these people are not aware that they have the disease. It will be the purpose of this column to raise the level of consciousness through education and offer recommendations for lowering blood sugar levels naturally.  

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

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

10 Tips to Lower Your Blood Sugar Naturally

• Spread Out Your Meals – Spreading out your meals evenly throughout the day is very effective. By keeping the amount of carbohydrates consistent, your body will have enough time to regulate blood sugar levels naturally. Skipping meals, fasting and overeating is counterproductive. 45 grams for women and 60 grams for men is a good carbohydrate amount as a starting point. This is affected by medications and activity/exercise levels and should be discussed with your physician.

• Add Resistant Starch to Your Diet – Resistant starch can bypass the small intestine, get metabolized and acts as dietary fiber in the large intestine and lower your blood sugar level. Resistant starch is found in some potatoes and beans such as black and kidney.

• Beans and More Beans – Studies show that eating 1.5 to 2.5 cups of cooked beans per day improves blood sugar levels, lowers the risk of cardiovascular disease and lowers total cholesterol. Gradually add beans to your diet over time by adding them to soup or salad.

• Cactus – Studies also show that cooked prickly pear cactus slows carbohydrate absorption and lowers blood sugar levels. It is a common treatment for diabetes in Mexico where it is boiled, grilled, fried, mashed and served in soups and stews. While it is available as a dietary supplement, it has not been thoroughly studied in this form.

• Sleep - While being active is important, getting enough sleep is equally essential. Studies show poor sleep habits negatively effects body chemistry and those sleeping 8 hours control blood sugar more effectively. Diabetics with sleep apnea can dramatically improve their blood sugar levels by using continuous positive airway pressure (CPAP).

• Lose Weight – For diabetics every pound counts. Some studies show that losing as little as five pounds can reduce blood sugar levels.

• Manage Stress – While a little stress can be healthy, excessive and prolonged stress causes the body to store glucose and fat as a protective mechanism. If not burned off through activity or exercise, this creates glucose storages and increases blood sugar. Relieve stress through exercise, counseling, meditation, yoga, massage, or spending quality time with family or friends.

• Routine Exercise – Diabetics, especially type 2, benefit greatly from regular exercise through improved insulin resistance to lower blood sugar levels. Additional benefits are: prevention of heart disease, stroke and peripheral neuropathies. Sustained aerobic exercise, 30 to 45 minutes, 3-5 days per week and mild to moderate weight training is recommended, according to your fitness level.

• Constant Movement/Activity – Incorporate activity into your daily life. Use the steps instead of the elevator, park a distance from the store and walk, get up and walk around the house during every television commercial. 

• Eat Breakfast – When waking up in the morning, the body has experienced a fast for 8-12 hours and requires food to balance blood sugar levels, especially when taking insulin. A healthy breakfast should include carbohydrates, proteins and fibers.

**This column is based on information from local physicians Kenneth Rudolph, MD, Gregory Borowski, MD, the American Diabetes Association L (ADA), and Lifescript

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

For all of Dr. Mackarey's articles, visit our Health and Exercise Forum

Exercise is important for prevention!

In 2000, President Bill Clinton dedicated March as National Colorectal Cancer Awareness Month. The purpose of this designation is to increase public awareness of the facts about colon cancer – a cancer that is preventable, treatable and has a high survival rate. Regular screening tests, expert medical care and a healthy lifestyle, which includes a proper diet and exercise, are essential for prevention. Several studies have demonstrated that exercise can also help prevent colon cancer. 

The American Cancer Society estimates that there will be approximately 107,000 new cases of colorectal cancer in 2023. Of these, 52,550 men and women will succumb to the disease. It is the second-leading cause of U.S. cancer deaths for both men and women combined. The good news is incidence and mortality rates are dropping both nationally as well as in northeast Pennsylvania. The bad news is northeast Pennsylvania still has increased incidence and mortality rates when compared to the national average.

Colon Cancer Facts:

Studies show that prevention of this disease is multifaceted and includes: engaging in daily exercise, eating a low-fat diet with little red meat, avoiding smoking, drinking in moderation and having regular colonoscopy screenings.

Early detection is the key to survival. Death from colorectal cancer can be eliminated if caught at the earliest signs of disease. Colorectal cancer progresses very slowly, usually over years. It often begins as non-cancerous polyps in the lining of the colon. In some cases, these polyps can grow and become cancerous, often without any symptoms. Some symptoms that may develop are: blood in stool, changes in bowel movement, feeling bloated, unexplained weight loss, feeling tired easily, abdominal pain or cramps, and vomiting. Contact your physician if you have any of these symptoms.

The risk of colon cancer increases with age, as 90 percent of those diagnosed are older than age 50. A family history of colon cancer increases risk. Also, those with benign polyps, inflammatory bowel disease, ulcerative colitis or Crohn’s disease are at greater risk and should be screened more frequently.

Prevention of Colon Cancer:

1. Colonoscopy – The colonoscopy is the most accurate screening test for detecting polyps and colorectal cancer. A long, thin, flexible tube with a camera is used to visually examine the lining of the colon. Polyps can be removed at the time of the exam if necessary. Most people should have this test starting at age 50, although high-risk populations (i.e. those with genetic predisposition or inflammatory bowel disease) may begin at age 40 to 45 or even younger.
2. Diet & Nutrition – Diets rich in fiber are generally considered beneficial for overall health, including colorectal health. Limit high-fat foods especially from animal sources. Limit red meat and dairy. A diet consisting of fish, fruit and vegetables is valuable. Some researchers theorize that Brussels sprouts, broccoli and cabbage may trigger a chemical process to turn on a gene to suppress tumors. Sunlight and vitamin D are thought to be important too. 
3. Lifestyle & Personal Habits – Smoking and excessive alcohol use increases risk for colorectal cancer and other forms of cancer. Stress and anxiety can be cancer triggers.
4. Exercise – While there have been many studies about the benefits of exercise for colon cancer, none have been more encouraging than a recent study from the Hutchinson Cancer Institute in Seattle. Patients with abnormal cells on the lining of their colons, as found by colonoscopy, demonstrated positive changes and reversal of these cells after engaging in four hours of exercise per week for one year. Some studies have shown that exercise can reduce the risk of colon cancer by 50 percent.

How Exercise Prevents Colon Cancer:

The intestine works like a sewage plant, recycling the food and liquid needed by your body. However, it also stores waste prior to disposal. The longer the wastes remain idle in your colon or rectum, the more time toxins have to be absorbed from you waste into the surrounding tissues. One method in which exercise may help prevent colon cancer is to get your body moving, including your intestines. Exercise stimulates muscular contraction called peristalsis to promote movement of waste through your colon.

Exercise to prevent colon cancer does not have to be extreme. A simple increase in daily activity for 15 minutes, two times per day or 30 minutes, once per day is adequate to improve the movement of waste through your colon. This can be simply accomplished by walking, swimming, biking or playing golf, tennis or basketball. For those interested in a more traditional exercise regimen, perform aerobic exercise for 30-45 minutes four to five days per week, with additional sports and activities for the remainder of the time. For those in poor physical condition, begin slowly. Start walking for five to 10 minutes, two to three times per day. Then, add one to two minutes each week until you attain a 30-45 minute goal. 

Medical Contributor: Christopher A. Peters, M.D

Dr. Christopher Peters is a partner of Radiation Medicine Associates of Scranton (RAMAS) and serves as medical director of Northeast Radiation Oncology Centers (NROC). He is an associate professor of clinical medicine at GCSOM. Sources: American Cancer Society/Northeast Regional Cancer Institute, and CA Cancer J Clin.

EVERY MONDAY - Read Dr. Paul J. Mackarey "Health & Exercise Forum!"

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

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

October is National Breast Cancer Awareness Month. Due in great part to improved awareness and advances in treatment and early diagnosis, the survival rate continues to improve. The American Cancer Society relies on information from the Surveillance, Epidemiology and End Results (SEER) database to provide survival statistics for different forms of cancer.

While the overall 5-year survival rate for breast cancer is 90% and the 10-year survival rate is 84%, the survival rate for those fortunate to have early detection and treatment is even more encouraging. For example, when breast cancer is determined to be “localized” (no sign that the cancer has spread outside of the breast), the 5-year survival rate improves to 99%! AWARENESS AND EARLY DETECTION ARE CRITICAL!

BREAST CANCER PREVENTION TIPS

Maintain Healthy Body Mass Index (BMI) – studies repeatedly show that obesity increases the risk of breast cancer. A healthy BMI for women falls between 18.5 and 24.9. To find out your BMI visit: www.calculator.net

Maintain a Healthy Diet – the Mediterranean Diet emphasizes plant-based foods such as vegetables, beans, whole grain, fruits, nuts and seeds, and plant-based oils, especially olive oil. Avoid sugared drinks, refined carbs and fatty foods and eat fish or chicken instead of red meat. 

Limit Alcohol Consumption – While no alcohol consumption may be optimal, up to one drink a day for women is acceptable.

Avoid or Limit Hormone Replacement Therapy – Studies show that menopausal hormone therapy increases the risk of breast cancer. For those who must take hormones to manage menopausal symptoms, limit the time period to less than three years and avoid progesterone.

Consider Estrogen-Blocking Drugs – For women with a family history of breast cancer or those over 60, consulting your physician about the pros and cons of these drugs.

Do Not Smoke – Studies show that smoking increases the risk of breast cancer.  Visit: smokefree.gov for help with smoking cessation.

Breast Feed – According to the scientific literature, women who breast feed for at least a year in total have less risk of developing breast cancer. So, breast feed as long as possible.

Participate in Research – What can you do to help? Participate in clinical trials studying new and more effective ways to detect and treat breast cancer. Visit the National Cancer Institute

Limit - Manage Stress - According to a recent long-term study, both men and women have a higher incidence of cancer in those who did not manage chronic stress well. Life is full of potential stress and it cannot be avoided. But, you can learn to handle stress better. Exercise, meditation, and counseling are some options to explore. Try Progressive Muscle Relaxation (PMR) videos.

Exercise – A recent study in the Journal of the American Medical Association from Harvard has found that regular exercise can improve the survival of patients with breast cancer.

Benefits of exercise in women with breast cancer:

• May increase survival
• Lessen risk of endometrial cancer
• Improved C-reactive protein levels
• Improve autoimmune function
• Control Depression
• Psycho-Social Value:
  • builds confidence, fosters control, develops new skills
  • promotes health, mind, body, & spirit

Current research supports the fact that exercise may not only prevent, but also improve breast cancer survival.  The following guidelines are proposed:

• Medical Clearance
  • Talk to your physician to get clearance for exercise
  • Remember, each patient must be individually evaluated by their physician to determine the extent of their problem and the appropriateness for exercise. Once medically cleared, seek the advice of a physical therapist to assess your needs and specifically design a program for you.

• Aerobic Exercise
  • 3-5 days per week
  • Moderate intensity
  • 20 to 60 minutes

• Strength Training
  • 2-3 days per week
  • Light to moderate weight
  • Wear a compression sleeve if you have lymphedema (swelling in the affected arm) during exercise

Source: Hutchinson Cancer Research Center

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

For all of Dr. Mackarey's articles visit our Health and Wellness Page!

PREVENTION OF RUNNING INJURIES

It is two months away from the 25^th Steamtown Marathon. This column is dedicated to those dedicated runners preparing for the big day, Sunday, October 9, 2022.

Congratulations and thank you to Bill King, founder and race director, and his band of brothers, for their tireless efforts organizing and sustaining a great race that instills pride for all people of NEPA. It has inspired many people, including me, to transfer the discipline and determination required to complete a marathon by overcoming challenges one mile at a time.

Now, a little marathon history: In 490 B.C. Phedippides, ran 25 miles from Marathon to Athens to deliver an important military message and died immediately. Ironically, the first marathon of the modern Olympic Games in 1896 in Athens was won by Spiridon Louis, a humble Greek peasant, who stopped along the way for a glass of wine and told the owner of the tavern that he would win the race. He was determined to pace himself properly, as he knew the dusty, hilly path better than anyone in the field. He was greeted with jubilation and become a hero and legend.

HOW TO PREVENT RUNNING INJURIES

Avoid the “terrible too’s”

• Avoid overtraining: number one cause of injury
  • Too much intensity
  • Too many miles
  • Too soon
  • Follow the 10% rule
    • Do not increase weekly mileage by > 10% each week

Only run miles needed to meet your goals

• Following the mantra that more must be better will lead to injury
• Accumulating “junk miles” causes the body to break down

Avoid inconsistent training

• Occurs when you have missed several sessions and you attempt to “catch up” by adding additional miles

Avoid repeating hard workouts without any easy workouts in between

• Do not run two hard workouts on consecutive days
  • Long runs
  • Hill repeats
  • Races
  • Speedwork
  • Allow for recovery, re-building and reduction of injury risk
    • Day of rest
    • Cross training

Consider cross training to avoid overtraining without compromising fitness level

• Reduces chance of injury
  • Balances muscle groups
    • Strengthens non-running muscles and rests the running muscles(Quadriceps and adductors)
  • Develops body parts that running neglects
  • Reduces stress on joints
    • Low-impact
    • Swimming
    • Water running
    • Cycling
    • Cross country skiing
    • Stair climbers
  • Maintain/improve cardiovascular fitness
    • Increases aerobic capacity
    • Burns additional calories
  • Avoids  boredom of running
    • Provides mental break from sport to avoid burn-out
      • Especially for the long distance events (marathons)
      • Try hiking!
  • Allows  continued training despite injury
    • Maintain fitness level while recovering from injury
    • Reduces frustration of inability to run

Treat your feet right

• Avoid worn out shoes
  • Most common cause of injury
  • Reduced shock absorption, cushioning and stability
    • Increases stress and impact
    • Muscle fatigue, shin splints and joint pain (especially knees) may be a signal
  • Replace every 300-400 miles
    • Dependent on running style, body weight and running surface
      • Smaller/lighter runners closer to 400
      • Heavier runners closer to 300
      • Running on hard surfaces
        • Replace shoes sooner than if running on treadmill
  • Record new shoe purchase
    • Calendar
    • Training log
    • Inside shoe
  • Purchase a second pair halfway through the life of the initial pair
    • Rotate shoes
      • Running in different shoes on alternating days provides even stress distribution on feet
    • Extends shoe life
    • Having a fresh pair as a reference
      • Will recognize when old ones need to be replaced
  • Shoe type
    • Most important piece of equipment
    •  Appropriate for foot type and weight
      • Flat foot: motion control
      • High arch: cushioning
    • Specialty running store
      • Scranton Running Co
    • Tennis shoes not appropriate
  • Biomechanical problem
    • Heel lifts or orthotics

Visit your doctor regularly and listen to your body. 

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

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

For all of Dr. Mackarey's articles visit: www.mackareyphysicaltherapy.com/forum

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.

Part 2 of 2

I have a vested interest in this column…I just had a big birthday! It is a BIG birthday because it is the one before I get health care insurance from Uncle Sam! Consequently, the “aging process” is very much on my mind!

In the book, “Being Mortal,” Atul Gawande discusses the role of medical care placing emphasis on “well-being” rather than survival, especially as it relates to end-of-life care. It is a “must read” for health care providers as well as the general public. The book also describes, in great detail, the process of aging; the physiology of bone and muscle mass loss, factors affecting balance and coordination, changes in mental acuity, memory, and mood. As depressing as it sounds (many of the changes begin as early as mid to late thirties), it is also a “call to arms!”

To prepare for the inevitable aging process one must be proactive, not reactive. From an early age, challenge yourself mentally by taking classes and learning things for which you may not have an interest. Try new physical activities and sports even if you feel unable to excel. Find balance in your diet by trying to eat fruits and vegetables that you don’t find appealing. Engage in daily exercise and physical activities even if you would rather be indoors playing video games. Lastly, get professional advice on matters beyond your scope. See your physician regularly for routine care and diagnostic tests, find a mental health professional if you are not at peace, consult with a physical therapist to help you design an exercise routine appropriate for your individual needs.

While it is never too late, remember, slowing down the aging process should not begin at 60, it begins at 30!

Memory Loss

Minor word or memory loss is a normal part of aging as the brain changes and affects how you remember things. Don’t hesitate to use technology or other tricks to assist you. For example, consider using alerts, reminders and lists on your smart phone. Also, you may want to organize certain items in a set location, use post it notes or a white board. However, these reminders are not a substitute for keeping your mind sharp. Studies show that being social, exercising regularly, eating well and learning a new skill can go a long way to maintain a healthy brain.

Weight Gain

According to several studies on aging, unfortunately, most people gain 1-2 pounds per year (10 to 20 pounds over 10 years). The aging body does not burn calories like you used to. But there are some simple steps you can implement to offset this pattern of weight gain. Obviously, eat less (less calories) and exercise more (stimulate your metabolism). Consider fruits, vegetables, and leaner protein instead of foods high in sugar/carbs and saturated fats and don’t forget portion control. Be active and take the stairs instead of the elevator.

Sexual Performance Challenges

Aging can also affect sexual performance. According to the Mayo Clinic, lower testosterone levels in men can lead to erectile dysfunction and hormonal changes in women can cause vaginal dryness. Stiff and painful joints add to the challenge. However, with a little effort, most healthy people can continue to be sexually active well into their 70’s and 80’s. Communication with your partner is important. Try new positions. Discuss hormone supplements and ED medications with your doctor. Try over-the-counter lubricants. Remember, exercise improves blood flow and stimulates sex hormones!

Urinary Frequency

Like the other muscles in your body, pelvic and bladder muscles also weaken with age. This problem can be worsened for men by an enlarged prostate and for women following multiple births. However, the muscles can be strengthened by performing specific exercises that target the area called Kegel exercises. These exercises involve squeezing the muscles that control urine flow. For example, while urinating try to stop midstream and hold your urine flow for a few seconds. Repeat 10 times and do this 3-5 times a day.  Other recommendations include eating foods high in fiber, avoiding carbonated drinks and limiting caffeine.

Boredom

People often fall into a rigid routine with age. While this predictable pattern often provides comfort, it can also lead to boredom. Try changing your routine or schedule. Learn a new skill (baking, painting, golf) or visit a new place (museums, libraries, community centers). Getting a part-time job or volunteering can be rewarding and stimulating.

Loneliness and Isolation

There are a number of reasons for one to feel lonely with age…children relocate, loss of a spouse, divorce. Experts say that it is important to take control by initiating contact with others. Call upon neighbors, friends, relatives, and former coworkers to chat or get together. Volunteer for a charity; join a book club or fitness group. Take classes at a local college and consider getting a pet.

Take Care of Your Health

Most health problems associated with aging can be treated. Regular checkups and routine diagnostic tests (blood work, colonoscopy, cardiac tests) will assure that health issues do not get out of control. Be sure to organize your medications and take them as directed. Keep a health journal or use and app on your phone to list meds, allergies and record tests and doctor visits.

SOURCES: National Institutes of Health; Mayo Clinic, WebMD

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician.

For further inquires related to this topic email: drpmackarey@msn.com

For all of Dr. Mackarey's articles visit: www.mackareyphysicaltherapy.com/forum

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.