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Guest Author: Gretchen Welby, PharmD, MHA

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

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

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

Introduction: (Dr. Paul Mackarey)

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

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

Vaccination Facts:

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

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

  • Peak year pre-vaccine deaths (year)
    Diphtheria 3065 (1936)
    Measles 554 (1958)
    Mumps 50 (1964)
    Pertussis 7518 (1934)
    Rubella 24 (1968)
    Smallpox 2510 (1902)
    Tetanus 601 (1947)
  • 2004 deaths
    0
    0
    0
    27
    0
    0
    4

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

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

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

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

For More Information:

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

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

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

JAMA 2007; 298:2155-2162 

Visit your doctor regularly and listen to your body.     

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

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

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

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

NEPA has experienced more than its share of bitter cold temperatures this winter. And, as much as I enjoy skiing, ice skating and snowshoeing, I have noticed a few achy joints when the mercury plummets! Osteoarthritis, the most common type of arthritis, is often considered to be a normal part of aging. Usually by the age of forty our joints, especially those which are weight bearing (lower spine, hips, knees, ankles, feet) begin to show signs of wear and tear. The cartilage begins to thin, the joint surfaces are not as smooth, and fluid which lubricates the joint becomes diluted, dehydrated and less protective.

Consequently, these aging joints become stiff, sore, weak, and sometimes swollen. Most people with osteoarthritis report additional pain and stiffness in the winter and early spring due to cold, damp weather and NEPA has plenty of it! The cold, for example, restricts the flow of blood to the joints, leading to more pain and stiffness. While moving to a warmer and less humid climate is one solution, it is not practical for most. But all is not lost because there are other alternatives to protect and keep your joints healthier this winter and early spring.

SOURCES: www.apta.org; www.webmd.com

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

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

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

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

Guest Columnist: Paul Mackarey, Jr. DPT

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

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

10 Ways to Prevent the Cold and Flu:

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

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

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

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

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

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

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

Part II of II

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

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

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

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

SOURCES: WebMD, University of Pennsylvania

Visit your family doctor regularly and listen to your body.

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

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

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

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

Part I of II

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

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

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

SOURCES: WebMD, University of Pennsylvania,

Visit your family doctor regularly and listen to your body.     

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

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

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

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

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

NEW YEAR’S RESOLUTION: GET A “RUNNER’S HIGH” ON LIFE!

The number one New Year’s Resolution in the United States is to lose weight. A close second is to gain control over one’s life. One of the best ways to lose weight is thought diet and exercise. It can also be a very effective method to begin taking control of one’s life. This is especially true for those suffering from stress, anxiety and depression. This year make your New Year’s Resolution to “Get a Runner’s High on Life!”        

Specifically, aerobic exercise (exercise that increases your heart rate for 30 minutes or more) such as walking, biking, running, swimming, hiking, elliptical & stepper machines to name a few, is the secret to “runner’s high.” This exercise euphoria is not limited to runners alone, but all who engage in aerobic exercise are more likely to experience high energy, positive attitude, and mental wellness – not to mention burn calories.

Physical activity, specifically aerobic exercise, while well known for its importance to one’s physical well-being has also been scientifically proven valuable for preventing and easing stress, anxiety and depression. Studies have found improvement in mental health for groups that engaged in aerobic running, jogging or walking programs, 30-45 minutes 3-5 days per week for 10-12 weeks when compared to a control group and a group in counseling.

EXERCISE FOR PHYSICAL HEALTH:

EXERCISE FOR MENTAL HEALTH:

HOW TO BEGIN EXERCISE TO GET THE “RUNNER’S HIGH” ON LIFE:

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

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

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

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

Happy Holidays Seniors! My gift to readers this holiday season is to offer some health tips for seniors. However, before I get accused of being a “Scrooge” about enjoying the food and drink associated with the season, please know that I was raised in an Italian kitchen. As such, it is fair to say that I have and will eat my fair share of the Italian Christmas Eve food celebration consisting of, but not limited to: Chianti wine, seafood antipasti, calamari, baccala, smelts, pasta with anchovies, seafood ravioli, cannoli, Italian cheesecake and Baci Perugina Dark Chocolate Hazelnut candy, cappuccino, espresso, sambuca and limoncello.

Overindulgence during the holidays causes many, including seniors, to make New Year's resolutions related to diet and exercise. But, this year, I propose that you incorporate healthy habits during the holiday season, and you may find that your resolutions are not as hard to keep. According to American Association of Retired Persons (AARP), seniors are considered those 50 years old and older. I will never forget how humbled I felt when I received my application to join AARP a few years ago. With this in mind, this year I offer healthy holiday tips for seniors, who are especially vulnerable to unhealthy holiday habits.

  1. Exercise every day.
    • Every day, get out of the house for a walk to view the outdoor Christmas lights and decorations. Dress for the weather, walk with a companion, and take along a flashlight if necessary to illuminate your path and use caution to avoid falls on slippery sidewalks.
  2. Remember to take your medications.
    • Routines are disrupted during the holidays and you may forget important medications. Make a special reminder to take your medications or order re-fills. If you are traveling, be sure to take enough medications with you in case of delays and have a copy of your prescriptions in case of loss. Be sure to bring a phone number for your doctor along with your health insurance cards, in case of emergency. Carry your medications in your carry-on luggage if you are flying.
  3. Eat your vegetables and salad first.
    • Beginning your meal with healthy vegetables and salads will fill you up and reduce the temptation to over-indulge on high-fat, high-calorie foods. Taste your holiday favorites in small amounts to satisfy your palate.
  4. Be aware of drug interactions.
    • According to Dr. Amy Anderson, internal medicine physician on the medical staff at Baylor University Medical Center," says holiday spices like cloves, thyme and sage can interfere by as much as 50 percent with the body's natural ability to utilize common drugs." Talk with your doctor or pharmacist about your medications and find out if there are any foods you should avoid while taking them.
  5. Know your food ingredients.
    • If you have food allergies, ask about ingredients before you indulge. Be especially careful of home-baked goods if you have an allergy to tree nuts or peanuts. Those ingredients can be deadly if you are affected by these types of allergies.
  6. Practice allergy-free decorating.
    • If you suffer from allergic rhinitis, holiday decorations stored in the attic and basement can build up a coating of dust and mold that can trigger allergies. Some people may also need to rethink Christmas tradition and substitute an artificial tree.
  7. Get a flu shot.
    • The holiday season includes plenty of kissing and hand shaking. Getting a yearly flu shot and frequent hand washing are your best defense for avoiding the flu. If you are sick with a cold or flu, limit contact with others until you are well so you don’t infect others.
  8. Get a good night's sleep.
    • Holiday preparations and helping Santa means less sleep. Do your best to get to get at least 6-7 hours of sleep every night and avoid heavy foods, chocolate, caffeine and alcoholic beverages before bedtime. If you need to recharge, take a nap during the day.

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

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

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

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

More than 65 million people, almost 30% of the population in the United States, are actively involved in providing 20 or more hours of care for a chronically ill, disabled, or aged family member or friend each week. As our population continues to age, this number is expected to grow rapidly.

The role of a caregiver is multifaceted and often involves tasks and skills beyond the education or comfort level of most providers. Some examples include; managing money, paying bills, shopping, cleaning, maintaining and repairing a home, dispensing and injecting medications, cleaning wounds, changing dressings, catheter management, bed baths, assisting in position changes, transferring from the bed to the chair, ambulation, stair climbing, bathroom assistance for toileting and showering and many other responsibilities. Consequently, a caregiver is often at risk for mental, spiritual and physical fatigue or breakdown. It is no surprise that depression, illness and injury often plague a caregiver and eventually, the caregiver is in need of a caregiver. One of the most common injuries suffered by a caregiver is back pain.    

Lower back pain (LBP) is one of the most common problems in our society. Over 90% of all Americans will suffer from it at least once in their lives. It is generally agreed that prevention is the best treatment for LBP.

TIPS FOR THE PREVENTION OF BACK PAIN FOR THE CAREGIVER:

MODELS: Andrea Molitoris Kozlowski, PT, DPT, Associate Mackarey Physical Therapy, Doris Koloski, Scranton

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

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

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

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

What is an Ice Bath?

Ice baths have become a new trend or fad in health and fitness, especially among elite athletes and some celebrities. In fact, it is impossible to scroll through social media without encountering someone “taking the frigid plunge!” However, it is far from a new treatment modality. The Ancient Greeks employed cold-water immersion for fever, pain relief, relaxation and socialization. In fact, Hippocrates documented the use of cold for medicinal purposes for its analgesic benefits. 

Ice baths, a type of cryotherapy, is also referred to as cold water immersion (CWI) or cold-water therapy, involves immersing your body in ice water for approximately 5-15 minutes from the neck down at a temperature of 50-59 degrees. The ice baths are commonly used for pain, delayed-onset muscle soreness (DOMS), and inflammation and mood elevation. 

In theory, the cold water lowers the temperature of your skin and body by vasoconstriction (narrow) of the blood vessels. When you get out of the cold water the vasodilatation (widen) of the blood vessels immediately brings fresh oxygen and nutrient-rich blood back to the tissues to warm the body and in the process, reduce pain, inflammation and promote healing.

Types of Cold Water Therapy:

Purported Ice Bath Benefits:

Potential Side Effects of Ice Baths:

Ice baths are not without risk and not everyone reacts the same way to ice immersion. It is recommended that one engages in ice exposure gradually, for short periods and in a controlled setting like a home shower. Furthermore, one must be mindful of age, general health, time of exposure, and water temperature. Remember, body temperature is 98.6 and water temperature of 65-70 degrees will feel very cold so 50-59 degrees can create problems such as:

Potential Risks of Ice Baths:

If you have the following health conditions, ice baths may not be the best therapeutic modality for you. Before you consider trying an ice bath, consult with your physician to avoid potentially serious problems:

In Conclusion:

What the Science Says –

While some studies have shown that subjects report less muscle soreness following CWI when compared to rest, most studies suggest that the reported effects are placebo. Also, reports of improved circulation, reduced inflammation and improved recovery or performance has not been scientifically validated. In view of this, it is recommended that those considering the use of CWI for pain and inflammation management, reduced muscle soreness, and mood elevation, should consult their physician to determine if the potential risks are worth the purported benefits.

SOURCES: nih; health.com; health.clevelandclinic.org; prevention.com

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

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

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

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

Congratulations to more than 1,000 courageous runners who finished the 28th Annual Steamtown Marathon today. Most, if not all of you, will wake up tomorrow morning with a little less jump in your step than you had yesterday to begin your recovery.

As active people by nature, many of you will resist the logic of rest, despite the pain and stiffness in your muscles and joints. Therefore, I would like to offer some words of wisdom, based on science, to encourage you to adequately rest and allow your body to recover.

GREAT EXAMPLE OF REST AND RECOVERY:

With adequate rest and recovery, an elite runner can quickly regain full form in 3-4 weeks, while an average runner may require 4-6 weeks. Meb Keflezighi, an elite American runner and winner of the 2014 Boston Marathon, is an excellent example of the merits of rest and recovery. However, he discovered it by accident…following the 2012 New York City Marathon, Meb developed a foot infection which required three weeks rest. With the Olympic Trials just 70 days away, Meb quickly regained his pre-injury fitness level to win the 2012 US Olympic Marathon Trials and join the US Olympic Team in London. It may be that his injury was fortuitous and allowed him adequate recovery time, (that he might not have otherwise allowed), preparing him for intensive training leading up to the trials.

RESPECT THE DAMAGE TO YOUR BODY:

The Effects of Running 26.2 Miles on the Body: (RunNow.com - Jim Peskett)

Muscle-Skeletal System:

One of the most obvious effects of running a marathon is significant muscle and joint pain and stiffness. It will set in after you sit for a while and attempt to get up and move around. For most, it will be more pronounced the day after the marathon, as you get out of bed and limp to the bathroom. Studies show that the leg muscles, (especially the calf muscles) display significant inflammation and necrosis (dead tissue) in the fibers of the muscle. In other words, the trauma to the muscles is so severe that tissue damage causes muscle cells to die. Consequently, studies found that muscle strength, power and endurance is compromised and required significant time to recover… sometimes as long as 4-6 weeks!

Additionally, many runners report severe bone and joint pain following the race. Some studies report findings of microfractures or bone bruising from the repeated and prolonged pounding of the marathon. It is purported that the stress on the joints may be related to: weight and body type, running shoes, running style and mechanics. While not dangerous, again, it is important to respect the stress placed on the body and allow adequate healing…LISTEN TO YOUR BODY!  

Cellular Damage:

Creatine kinase is an enzyme found in the brain, skeletal muscles and heart. It is found in elevated levels in the presence of cellular damage to these tissues, for example, following a heart attack. Similarly, significantly elevated creatine kinase levels are found in the blood of runners up to 4 days post marathon, demonstrating extensive tissue damage at the cellular level. It is important to note, that these enzyme markers are present, even if a runner does not experience muscle soreness. So, adequate rest for healing and recovery is required, regardless of soreness. 

Immune System:

It is not a coincidence that the runners are more likely to contract colds and flu after intensive training or running 26.2 miles. The immune system is severely compromised after a marathon and without adequate recovery; a runner can become ill and ultimately lose more training time or will underperform.

3 MYTHS THAT PREVENT REST AND RECOVERY IN RUNNERS:

  1. If I don’t have pain, then I did not damage my body and I can run again soon after the marathon.
    • FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.
  2. Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.
    • FALSE: In addition to rest, drink, drink, drink - 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.
  3. If I don’t run, I will lose all of my conditioning in one week.
    • FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker. Remember Meb Keflezighi! 

Expedite Your Recovery:

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy 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!