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 the end of July and we have managed to survive two “heat waves” in NEPA. While it is important to have fun in the sun, 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 5 & 6, 2024, first day of acclimatization and August 12, 2024, 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 heatstroke 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:

Signs of Heatstroke:

• Heat Exhaustion – can be a precursor to heat stroke
• Signs: cramps, weakness, fatigue, nausa
• 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 heatstroke 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 Heatstroke:

• 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

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!

Introduction

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

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

Tendon Injury and How It Occurs

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

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

Achilles Tendon

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

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

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

Achilles Tendon Rupture Symptoms

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

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

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.

Diagnosis

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

Type 1 Diabetes

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

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

Symptoms 

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

Complications

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

Type 2 Diabetes

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

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

Symptoms

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

Sources: NIH; American Diabetes Association; Harvard Health Publications

Visit your doctor regularly and listen to your body. 

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

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

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

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

3^rd of 3 Columns on Balance Disorders and Falls Prevention

Preventing a fall can not only save your independence but also your life! Preventing injuries from falls reduces the need for nursing home placement. Injuries from falls are the seventh leading cause of death in people over the age of sixty-five.

The following suggestions will assist you in minimizing your risk of a fall:

• Diet & Hydration: Proper nutrition and hydration provides adequate amounts of vitamins and minerals to maintain energy levels and prevent drowsiness. Adequate hydration is also important. Treat dehydration from fever, diarrhea and vomiting by drinking plenty of fluids. You may need IV fluids administered in hospital.
• Exercise: Exercise and activity improves strength, flexibility and balance.
• Medication: Consult a pharmacist or physician regarding medications that can cause: drowsiness, dizziness, lightheadedness, faintness, fatigue, tiredness, unsteadiness, blurred vision, double vision, confusion, or otherwise affect alertness, balance or coordination.
• Positional Changes: Avoid sudden drops in blood pressure by avoid sudden changes in posture and position, standing up slowly, sitting for a few minutes and tapping your toes before getting out of bed and raise head of bed with a wedge pillow.
• Alcohol: Be cautious with alcohol since it interferes with alertness, balance, coordination and reflexes.
• Illness: Treat respiratory infections such as ear infections, colds, flu, sinus congestion to prevent labyrinthitis and Meniere’s disease.
• Frequent Urination: Be cautious with urgency, especially at night.  Consider bedside commode and a grab bar by toilet. Turn lights on and put on eyeglasses to supplement vision. Night lights are recommended. A pendant alarm may be beneficial.
• Vision: Check eyesight and hearing regularly. Poor eyesight makes it difficult to see potential hazards. Update old eyeglasses. Inner ear problems can affect balance. Adequate lighting is paramount. Light switches should be within reach without getting out of bed and on both ends of hallway. Nightlights in bedroom, bathroom and hallway are recommended. Keep a flashlight handy. Turn lights on when entering house and at night.  Use light paint and wallpaper to reflect more light. Use 100 watt bulbs for an adequate amount of light.
• Assistance Devices: Use assistive devices when negotiating uneven terrain or when you feel weak or tired. To avoid falls in the bathroom install grab bars in the shower, tub, and toilet areas. Use bathmats with suction cups or nonslip adhesive strips in tub/shower. Consider a shower stool or bench and an elevated toilet seat.
• Good Footing: Proper footwear with a flat sole, wide base and nonslip grips are important. Footwear should be tied securely and fit snugly. Do not walk in stocking feet
• Remove Hazards: Inspect your floors for hazards! Remove rugs and runners that slip or attach nonslip backing. Tack loose rugs. Glue vinyl flooring. Keep pathways free of electrical/telephone cords. Remove wax from floors. Mops up spills promptly.
• Safety on Stairs: Install secure handrails on both sides. Improve lighting. Ensure carpeting on stairs is firmly attached. Highlight with tape or paint edges of steps especially if narrow or higher/lower than the rest. Paint outdoor steps with a mixture of paint and sand for better traction. If carrying item up or down steps, use handrail.
• Walkways: Sidewalks and walkways should be clear, well lit and free of snow and ice. Salt or sand if slippery. Repair uneven paving.
• Eliminate clutter: Do not store items on steps. Rearrange furniture to move around easier. Watch out for pets. Avoid stepping over pets.
• Store Items Within Reach: Limit reaching by storing frequently used items where they can be reached easily. If reaching is required, use a stepstool with high, sturdy handrails. Repair or discard wobbly stools. Do not use a chair to reach for items.

Following these helpful hints will keep you safe by preventing a loss of balance and a potential fall!

Contributor: Janet M. Caputo, PT, DPT, OCS

Medical Reviewer: Mark Frattali, MD, ENT: Otolaryngology /Head Neck Surgery at Lehigh Valley Health Network

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!

TAKE THE TEST!

Northeastern Pennsylvania is home to a large elderly population and many of the medical problems we expect to see are age related. Dedicated medical practitioners are in constant search for new knowledge and information to prevent or delay many age-related problems. One of the most devastating problems associated with aging is the risk of falling and falling.

Loss of balance causes falls. Falls are a leading cause of injury and death. Thirty percent of women and thirteen percent of men over the age of sixty-five will fall. Twenty to thirty percent of these individuals suffer moderate to severe injuries. Preventing falls is not an easy task. A good understanding of the causes of loss of balance and knowledge of a few fall prevention suggestions can enhance your balance and reduce your risk of a fall.

The Falls Risk Self-Assessment below allows and individual to determine their risk of falling to take the appropriate steps for prevention and treatment. The next three weeks will be dedicated to this topic to educate and inform readers and their families to make good decisions.

The Falls Risk Assessment is from the Centers for Disease Control (CDC).

WHAT IS YOUR RISK OF FALLING?

SCORE YOUR RISK OF FALLING.

Add up the number of points for each YES answer. If you have scored 4 or more points you may be at risk for falling.

Accordingly, 0-1 = Low Risk; 1-2 = Moderate Risk; 3-4 =  At Risk; 4-5 = High Risk; 5-6 = Urgent; > 6 = Severe

Low    Moderate     At Risk     High Risk   Urgent   Severe

0          1          2          3          4          5          6          7          8         

Listen to your body and talk to your doctor.

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

Next Monday Part II of III on Balance Disorders and Falls Prevention

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 clinical professor of medicine at GCSOM.

For all of Dr. Paul's articles, check out our exercise forum!

Part II of II

It is difficult to take care of a senior with many needs. The demands of care-giving can create situations in which abuse is more likely to occur. Even though many non-professional care-givers consider their role to be satisfying and enriching, the responsibilities can be extremely stressful. This stress can escalate, especially as the elder’s condition deteriorates, and can lead to mental and physical health problems causing caregivers to burn out, become impatient, and unable to restrain their frustration.

Among caregivers, significant risk factors for elder abuse are:

• Inability to cope with stress (lack of resilience)
• Depression, which is common among caregivers
• Lack of support from other potential caregivers
• The caregiver’s perception that taking care of the elder is burdensome and without psychological reward
• Substance abuse

Even caregivers in institutional settings can experience stress at levels that can lead to elder abuse. Nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities, are unsuited for care-giving, or work under poor conditions.

Several factors concerning the elders themselves, while they do not excuse abuse, influence whether they are at greater risk for abuse:

• The intensity of an elder’s illness or dementia
• Social isolation: the elder and caregiver are alone together almost all of the time
• The elder’s role, at an earlier time, as an abusive parent or spouse
• A history of domestic violence in the home
• The elder’s own tendency toward verbal or physical aggression

In many cases, elder abuse, though real, is unintentional. Caregivers may be pushed beyond their capabilities or psychological resources.

You can protect yourself from elder abuse by:

• Make sure your financial and legal affairs are in order. Obtain legal advice concerning arrangements for future disability (e.g. power of attorney).
• Review your will periodically.
• Arrange to have your social security check or pension check deposited directly into your bank account. 
• Avoid becoming isolated. Keep in touch with family and friends. Participate in social and community activities.
• Do not live with someone who has a history of violent behavior or substance abuse.
• Do not sign a document unless someone you trust has reviewed it.
• If you are unhappy with the care you are receiving, at home or in a facility, tell someone you trust.

Caregivers can prevent from becoming elder abusers by following some simple suggestions:

• Request help from friends, relatives, or local respite agencies so you can take a break.
• Find an adult day care program.
• Stay healthy and get medical care for yourself when necessary.
• Do not ignore your limitations and overextend yourself.
• Adopt stress reduction practices.
• Seek counseling for depression.
• Find a support group for caregivers of the elderly.
• If you are having problems with drug or alcohol abuse, get help.
• Do not offer personal home care unless you thoroughly understand the demands and can meet the responsibility and costs involved.

Elder abuse help-lines offer help for caregivers as well. Call a helpline if you think there is a possibility that you might cross the line into elder abuse. (REPORT ELDER ABUSE: PA Dept of Aging 24 Hotline 1-800-490-8505)

If you suspect elder abuse, report it. Look at the elder’s medications to see if the amount left in the bottle is consistent with the dosing schedule and date of the prescription. Watch for possible financial abuse by asking the elder if you may scan financial documents for unauthorized transactions. Call and visit the elderly person as often as you can. Offer to stay with the elder so that the caregiver can have a break.  

Many seniors do not report abuse. Many are ashamed, feel responsible or fear retaliation from the abuser. Others believe that if they turn on their abusers, no one else will take care of them. If you are an elder who is being abused, neglected, or exploited, tell at least one person: your doctor, a friend, or a family member whom you can trust. Every state has at least one toll-free elder abuse hotline or helpline for reporting elder abuse in the home, in the community, or in nursing homes and other long term care facilities. You can also call Eldercare Locator at 1-800-677-1116. For those over the age of 60, help is available through local Area Agencies on Aging (AAA).