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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!

Studies have shown a recent escalation of joint replacements in a much younger and more active group than previously noted…the baby boomer! While the end result is mostly physical, the cause is often psychological. We all know the personality type: type A, hyperactive, goal-oriented, driven, possessed and highly organized – almost at all costs! Many of you have seen fitness enthusiasts running through the streets at 5:30 AM for 5-10-15 miles each day. Moreover, many of these runners have more activities planned later in the day: golf, tennis, ski, swim, play sports with their kids. Well, after 20 years of this behavior, many of these enthusiasts are now suffering the effects of long term multiple micro traumas. They are suffering from what orthopedic surgeons at the University of Pennsylvania call “Boomeritis! Boomeritis is inflammation of the baby boomer from overuse. Lower back pain, hip, groin, and knee pain is almost a daily event.

As baby boomers continue to enjoy sports with the same vigor and intensity as when they were younger, they are finding that their older bodies just can’t keep up. While these individuals often succeed in finding the balance of fitness and craziness, they have had times when they took it too far. Furthermore, nearly all compulsive exercisers suffer from over training syndrome. When take too far compulsive behavior is rationalized by insisting that if they didn’t work to extreme then their performance would suffer.

10 Warning Signs of a Compulsive Exerciser (E. Quinn):

• You force yourself to exercise even if you don’t feel well
• You almost never exercise for fun
• Every time you exercise, you go as fast & hard as you can
• You experience severe stress & anxiety if you miss a workout
• You miss family obligations because you have to exercise
• You calculate how much to exercise based on how much you eat
• You would rather exercise than get together with friends
• You can’t relax because you think you are not burning calories
• You worry that you’ll gain weight if you skip exercising for one day
• Rain, sleet, or hail would not prevent you from exercising

*Each sign is worth 1 point:

• 1-3 Points    = Normal compliance & disciplined behavior
• 3-5 Points     = Caution but OK
• 5-7 Points     = Reexamine goals
• 7-10 Points   = Get Help

10 Warning Signs of Overtraining (E. Quinn):

• Mild leg soreness & general achiness
• Pain in muscles & joints
• Washed-out feeling, tired, drained & lack of energy
• Sudden drop in ability to run “normal” distance or times
• Insomnia
• Headaches
• Inability relax, twitchy, fidgety
• Insatiable thirst, dehydration
• Lower resistance to common illnesses: colds, sore throat etc.
• Exercise starts to feel like a job

Managing Overtraining

If you have two or more of the warning sings, consult your family physician to rule out potentially serious problems.

• Stop and rest. Taking several days off is the best treatment.
  • 3-5 days off if overtraining for 3-4 weeks and 3-5 weeks if severe and prolonged overtraining.
• Drink plenty of fluids.
• Alter you diet by eating health carbs (fruit, veggies, pasta)
• Alternate your routine to prevent stagnation. Cross training will use different muscles (lift: arms Mon & Wed, legs Tues & Thur, Aerobic: run Mon & Wed and bike Tues & Thur).
• Try a massage to mobilize built up lactic acid in your muscles.
• Use RICE (rest, ice, compression elevation) for acute injuries (strains, muscle/tendon soreness) associated with exercise.
• Have Fun! Mix in fun sports and activities to break the monotony by adding fun activities such as golf (walk 5-7 miles and carry a light bag), swim, bike, ski, hike and play tennis. Remember, overtraining problems occur in single sport athletes.
• Limit Intensity – only work out intensely 2-3 times out of 5 days per week.

TIPS TO AVOID EARLY JOINT DEGENERATION

Avoid weight bearing exercises two days in a row. Run one day, walk, swim or bike the next.

Use the elliptical instead of the treadmill.    

Avoid squatting…deep squatting is bad for your hips and knees. Even when gardening, use a kneeling pad instead of bending down and squatting.

Visit your family doctor regularly and listen to your body.     

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

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

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

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

For all of Dr. Mackarey's articles, visit our exercise forum!

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!