Remember, February is
National Heart Disease Awareness Month
Coordinated The Health Magazine January/February 2012
What’s Inside: ‘Tis the season to be C.O.L.D! Wrestling Your Weight…Safely Sports Vision Training Superbowl Snacks Dry Skin Now is the Best Time to Get Ready for Summer!
“Your Prescription for Better Health” coordinatedhealth. com
And Much More!
#1 in Patient Satisfaction Based on Medicare Data, 2009-2011. Visit hospitalcompare .hhs .gov.
coordinatedhealth.com ALLENTOWN / BETHLEHEM / EASTON / HAZLETON / PHILLIPSBURG BRODHEADSVILLE / E. STROUDSBURG / LEHIGHTON 2
Letter From the Editor
Design and Layout Rick Woods
Contributing Authors Ben Galley Certified Athletic Trainer
Brandon Bushnell Certified Athletic Trainer
Jay D. Rehrig Certified Athletic Trainer
Amy Pucklavage Physician Assistant
Chad Wentz Certified Athletic Trainer
Raymond E. McCarroll Podiatrist
Deb Moyer Licensed Esthetician
Lori Barnett Podiatrist
Amanda Lucik Physician Assistant
The New Year is generally a time when people start looking toward the future and setting new goals to better themselves and improve their health. But, making New Year’s resolutions is the easy part; it’s sticking with them that can be difficult. An estimated 45% of Americans make at least one resolution each year, however; only five to ten percent of those people actually follow through and fulfill their resolution. We’ve got some tips to make sure you follow through with your resolutions. Finding a New Year’s resolution that you can stick with is important. Many people choose a resolution that revolves around improving their health. This can be something as small as resolving to eat less fast food or something on a bigger scale like vowing to lose weight or quit smoking. Regardless of what you choose, make sure it is something you feel you can achieve. Once you decide upon a resolution, create a plan. If you’re like most people, you’ll have a limited amount of time in January to harness your motivation. After that, most people forget about their resolutions. Take the time to write down your resolutions and include specific steps to help meet your goals. It’s also important to think “year round”, not just New Years. Remember the saying; Rome wasn’t built in a day. You aren’t going to achieve your goals immediately, it will take time. Your New Year’s resolution should be nothing more than just a starting point. If you try to make it anything more than that, you may have a difficult time sticking to it. Remaining flexible is also important when it comes to sticking with your New Year’s resolution. Throughout the year, life is likely to throw you a few curveballs. Make sure you can adapt your resolution to the situation. If you hit a setback, don’t give up completely, just make allowances and keep trying. There’s also strength in numbers. If you are trying to lose weight or make a personal change, seek help from friends and family. You’re more likely to achieve your goals if you have a support system in place. It also helps to have someone to bounce ideas off of or just to talk to when times get rough. Remember, New Year’s is just the beginning. You have a whole year to achieve your goals, so take the time that you need. Any progress is better than nothing at all!
Amanda Boyce coordinatedhealth. com
‘Tis the season to be C.O.L.D!
Identifying the signs and symptoms of hypothermia .......................... 6
Wrestling Your Weight…Safely
Rules have changed to make weight loss practices safer for high school wrestlers ........................................................... 8
The Whole Ball of Wax on Ear Wax
Earwax is actually not as bad as we all make it out to be ............... 12
Just because it’s Superbowl Sunday, doesn’t mean you need to blow your diet! ...................................... 14
Xeroderma, meaning “dry skin”, can happen to people of all ages and the severity can range from mild to severe ...................... 16
Weekend Warriors Guide to Achilles Tendon Rupture
How you can prevent achilles tendon rupture ................................. 19
Now is the Best Time to Get Ready for Summer!
Many people don’t realize that the best time to get their bodies ready for summer is actually during the winter ............ 22
My Aching Shoulder
What Is Shoulder Calcific Tendonitis and How Is It Treated? .......... 25
Protecting Your Heart
Featured Physician Coordinated Health Cardiologist David Scoblionko, MD
What our Patients are Saying
Heart disease is the number one cause of death among both women and men and a major cause of disability .................... 29
Stay Independent by Standing on Your Own Two Feet
Each year many older adults have injuries resulting from falls and generally those falls happen in their own home ........ 30
Sports Vision Training
Learn what you can do to “train” your eyes for better performance ..................................................................... 34
Women’s Health Services now at Welcome
Dr. Bruce Viechnicki and
Dr. Deborah Villeneuve Dr. Viechnicki and Dr. Villeneuve are joining Dr. Faust-Rakos in Coordinated Health’s expanding Women’s Health team at our Pond Rd. location and are both Board Certified in Gynecology. Call now to schedule an appointment.
Women’s Health services available at: Lehighton Campus 239 N. First Street Lehighton, PA 18235
Allentown Campus at Pond Rd. 1611 Pond Road, Suite 102 Allentown, PA 18104
(877) 247-8080 | coordinatedhealth.com | (610) 861-8080 coordinatedhealth. com
‘Tis the season to be C.O.L.D! By Ben Galley, MS, ATC, PES
his is the time of year that hunters are hitting the woods, construction workers are working outdoors, the adventuresome are hitting the slopes, and some of the lucky few are still playing football. Whether you are braving the cold temperatures for work or play, you are still putting yourself at risk for hypothermia. Identifying the signs and symptoms of hypothermia, how to treat it, and most importantly how to prevent it will keep you safe and warm these winter months. According to mayoclinic.com, physical symptoms of hypothermia include constant shivering, slurred speech, week pulse, and slow and shallow breathing. Aside from the physical symptoms the mental signs may be the most telling and dangerous aspects of hypothermia. Such signs
include lack of coordination, confusion or difficulty concentrating, poor decision making (such as trying to remove warm clothes), drowsiness or low energy, apathy of one’s condition, and progressive loss of consciousness. If you recognize any of these signs or symptoms in someone you are with, it is a medical emergency and you should seek immediate medical attention. It’s important to identify some do’s and don’ts in hypothermia first aid. Do move or shield the person from the cold and remove any wet clothing. In order to preserve heat, it is important to insulate the person from the cold ground, wrap in blankets, and share body heat via skin-to-skin-contact while wrapping together in blankets, and provide warm drinks if they are able to swallow. Be careful with someone who is hypothermic and do not rub the person in order to try to warm him or her. Believe it or not, vigorous rubbing may trigger cardiac arrest. Also, do not apply direct heat to the person such as hot water or warm lamps, doing so may cause an irregular heart beat and could even cause the heart to stop.
C O L D
COVER (Cover your head and hands.) OVEREXERTION (Sweating due to overexertion can lead to faster loss of body heat.)
LAYER (Layers should be a warm material such as polypropylene or wool close to your skin, and tightly woven water-repellent material on the outer layers to keep you warm and dry.)
DRY (Staying dry is key when it comes to preventing hypothermia.)
Prevention is easy and of course comes nicely wrapped in a clever acronym. (C.O.L.D). ‘C’ stands for Cover. Cover your head and hands, because these are places where heat can easily escape. ‘O’, overexertion. Believe it or not, becoming too warm can be harmful. Sweating, due to overexertion, can lead to a faster loss of body heat. ‘L’, Layer. Layers should be a warm material such as polypropylene or wool close to your skin, and tightly woven water-repellent material on the outer layers to keep you warm and dry. And speaking of dry, our ‘D’ in C.O.L.D., staying dry is key when it comes to preventing hypothermia. Keeping your hands and feet dry will go a long way in keeping you safe and warm. One of the most dangerous things about hypothermia is that you may not be able to recognize the signs and symptoms yourself. Therefore it is important that you watch for these signs and symptoms in others you are with this season. So this winter, remember C.O.L.D. before going out in the cold. Mayo Clinic. (2011, August 2). Hypothermia. Retrieved December 6, 2011, from http://www.mayoclinic.com/ health/hypothermia/DS00333 v
By Jay D. Rehrig, ATC
Wrestling Your Weightâ€Ś Safely H
igh School wrestling is an intense sport whose athletes face many challenges. Some of those challenges include dehydration, fasting, and rapid weight loss. Over recent years high school rules have changed to make weight loss practices safer for wrestlers. The National Federation of State High School Associations (NFHS) implemented new rules for weight loss before the 2006-07 season. These new rules were based on the NCAA weight management program which was adopted for the 1998-99 collegiate season. These rules help high school wrestlers safely establish a minimum wrestling weight (MWW) following the same steps required by collegiate wrestlers. Prior to the first day of practice, wrestlers have their specific gravity of urine tested. It must be equal to or less than 1.025. If the student-athlete does not meet this standard, the test must be repeated no sooner than 24 hours. After the specific gravity test is passed, the wrestler must then be weighed on a certified scale. Next, the wrestler must have his/her percent body fat calculated either through skin fold measurements, hydrostatic weighing, or air displacement
plethysmography (BodPod). These measurements are then entered into the Optimal Performance Calculator (OPC) which determines the athlete’s MWW. This calculation is equated on factors such as percent body fat, fat weight, and fat-free weight. These steps allow wrestlers to drop to 7 percent body fat (males) and 12 percent body fat (females) at a rate of 1.5 percent of their body weight per week throughout the season to reach their MWW more safely. Common practices for losing weight during the wrestling season includes the restriction of fluids/food and exercising more heavily to yield more sweat loss. However, if this is done over a long period of time (entire sports season) detrimental effects to the body will incur. These detrimental changes can include electrolyte imbalances, impaired thermoregulation, glycogen depletion, impaired immune function, fatigue, and loss of lean tissue. Recent research suggests that there is a safer way to lose the weight needed for wrestling. Acute dehydration in the 24 hour period prior to competition followed by aggressive rehydration and refueling is a safer method than larger weight cuts with more severe dehydration and food restriction over a longer period of time. It is important to make large-scale changes to an athlete’s weight during the off-season. If an athlete chooses to move up or down a weight class it should be done as early as possible before the next season. If the athlete waits until pre-season practices to change weight classes it will most likely be too late to do so safely. A wrestler whom chooses to go down a weight class can do so by starting with moderate energy restrictions of 250 to 500 calories per day along with their usual wrestling workouts and additional cardio workouts. The athlete’s goal should be to lose approximately 1 to 2 pounds of body fat per week.
Over recent years high school rules have changed to make weight loss practices safer for wrestlers.
Another helpful tactic for off-season or pre-season weight loss is learning the athlete’s own sweat rate. Wrestlers who know how much fluid they are losing during practices will be able to better rehydrate during workouts. To determine the wrestler’s sweat rate subtract their post-workout weight from their pre-workout weight, then multiply this number by 16. Add that number to the ounces of fluid the athlete consumed during practice to calculate the total amount of fluids lost (sweat rate). This final number should be divided by the number of hours practiced. For example, a wrestler who weighs 150 pounds before the start of practice and then weighs 145 pounds after practice and consumes 16 ounces of fluid during a two-hour practice would have a sweat rate of 48 ounces per hour. It is recommended that athletes replenish the fluids lost during workouts by way of 16 to 24 fluid ounces per pound lost. Hopefully, these weight management tactics for wrestlers will allow them to more safely meet their body weight goals. v
Coordinted Healthâ€™s New Physical a Located in our Bethlehem Ca
As part of our continuing effort to bring you the best care in the most modern and up to date surroundings we are proud to announce the opening of our new Physical and Occupational Therapy Facility. If you have received therapy at OAB Bethlehem or 2775 Schoenersville Rd., you will now go to our new location. You will still be seen by your current Coordinated Health therapist in our new facility. We look forward to helping you stay healthy now and through out the new year.
HOURS: Mon. - Thurs. 6:00 am - 7:00 pm Friday
6:00 am - 6:00 pm
7:00 am - 3:00 pm
Sunday Closed coordinatedhealth. com
and Occupational Therapy Facility ampus at 2030 Highland Ave.
The Whole Ball of Wax on Ear Wax
By Amy Pucklavage, PAC
As a Physician’s Assistant at the Bethlehem Care on Demand Center, I’ve noticed that a lot of my patients apologize when I examine their ears. They generally think their ears are dirty, but I always surprise them when I say that’s usually good! Funny as that may sound; earwax is actually not as bad as we all make it out to be! Earwax, also know as “cerumen” is a mixture of oil and dead skin. Just like the rest of the skin on the body, the skin in the ear canal grows out and falls off. As it mixes with other naturally secreted oils, earwax is born. Although ear wax may seem gross, it is actually an excellent protective mechanism for the inner ear. Similar to the way nose hair filters air going in and out of the lungs, ear wax acts like a flytrap to collect dust, dirt and debris that may find its way into our ears. The wax itself is slightly acidic, which kills invading bacteria or fungus, preventing infection. It also keeps our ear canals moist, preventing itchiness. Many people think it’s necessary to remove earwax, but you don’t always need to. Our jaw is perfectly positioned under our ear canal. As we talk, chew, bite, or yawn, ear wax is slowly churned outward where it will fall out or be washed out.
The vast majority of the population can maintain good ear hygiene on his or her own with daily showering. Gently tilt your ears toward flowing shower water several times and allow warm water into your ear canals. This will soften and clean out wax. On a monthly or bi-monthly basis, over the counter ear wax softeners or hydrogen peroxide dispensed in the ear can also soften and clean out excess wax. However, different people produce wax at different rates and others may produce a different consistency of wax. Fast producers of soft wax may get blockages, which can affect hearing. This type of wax needs to be professionally cleaned out by a family practice or otolaryngologist (ear, nose, and throat doctor.) Those who routinely wear hearing aids may also need professional ear cleanings. There are several other concepts to keep in mind when cleaning out your ears. Never use q-tips or ear swabs. This has a tendency to push wax further down into the ear canals and can cause a â€œcerumen impactionâ€? with hearing loss and discomfort. When this happens, ears usually need to be flushed out by a medical professional. There is also haphazard trauma that can be done to the ear, such as perforating the ear drum or scratching the external ear canal. v
Superbowl Snacks Dos and Don’ts By Hannah Ropp
Just because it’s Superbowl Sunday, doesn’t mean you need to blow your diet! We’ve got some healthy and delicious alternatives to the traditional game day fare.
Don’t eat hot wings. Most hot wings are
drenched in butter and fried. They are also high in calories and saturated fat. In fact, just six wings can often add up to almost 300 calories.
Do choose chicken tenderloins dipped in
barbecue or hot sauce. This will give you a similar flavor without ruining your diet!
Don’t drink regular soda. Regular soda is loaded
with sugar and caffeine and generally has anywhere from 100 to 140 calories per serving.
Do drink diet soda and juice. Drinking diet soda
will save you several hundred calories. While you may consume extra calories with juice, you will be reaping the benefit of extra vitamins and nutrients.
Don’t snack on chips. Potato chips are high in both fat and sodium and full of empty calories. Do trade in your chips for either pretzels or microwave popcorn. Both of these choices have half the calories and fat.
Don’t use sour cream in your dips. Sour cream is full of calories and can be easily replaced in
recipes with other ingredients.
Do use yogurt for your fruit and veggie dips. Don’t drench your nachos in cheese and beef. Cheese has many health benefits, but
only if eaten in moderation. Ground beef is often high in saturated fat, which can increase your cholesterol.
Do choose a reduced fat cheese for your nachos and use ground turkey instead of ground beef. Also, consider adding some guacamole to your nachos. Avocados have vitamin E and healthy fats. v
Dry Skin? By Brandon Bushnell MS, ATC
As the temperatures begin to drop and the air becomes more dry, we find ourselves running inside to stay warm. We also find ourselves becoming more susceptible of accumulating the effects of dry skin. Xeroderma, meaning â€œdry skinâ€?, can happen to people of all ages and the severity can range from mild to severe. The most common areas of xeroderma are the knuckles of the hands, forearms, elbows, abdomen, knees and lower legs. Generally flaking of the skin is commonly seen to those areas and is treated with topical creams and moisturizers. One common cause of xeroderma is the falling temperatures outside combined with the warm dry atmosphere in our homes. The low temperatures and the low humidity can take a toll on your skin causing it to dry out. Another cause is using harsh soaps. There are several soaps available that can actually over clean the skin and cause it to crack and dry itself out. Such soaps include Ivory, Irish spring, Lever 2000 etc. Hot showers can cause dry skin as well. The combination of hot showers and the use of harsh soaps can easily clean off the skins natural oils. The final outcome would produce dry, tight skin that could possibly start flaking.
The daily use moisturizers such as lotions or creams can help stop the cracking and flaking of the damaged skin.
Typically the signs of xeroderma are red patches on the skin and signs of white flaking over the area. As mentioned above, xeroderma usually occurs over the areas of the knuckles, elbows and lower legs. Other signs and symptoms include skin that is rough to the touch along with irritating itching. coordinatedhealth. com
There are several easy and inexpensive treatments available if you are suffering from a mild case of dry skin. The daily use moisturizers such as lotions or creams can help stop the cracking and flaking of the damaged skin. The goal of the moisturizers is to keep the bodyâ€™s natural oils on the surface of the skin and keep it hydrated. For more severe cases, petroleum jelly works great on cracking and bleeding skin. Petroleum jelly works well when it is applied to the knuckles and then covered by gloves. The best treatment for xeroderma is prevention. When taking a shower, be sure to avoid hot water. The hot water can wash off all the bodyâ€™s natural oils predisposing the body to dry skin. The best time to apply moisturizers and creams is immediately after taking a shower. Avoiding harsh soaps can help prevent dry skin. Using moisturizing soaps and body washes can help prevent dry skin. Avoiding products that contain alcohol will help in the prevention of xeroderma. As the winter season approaches, the skin is very susceptible to cracking, flaking and over drying. The best line of defense is prevention and the use of moisturizers. The skin is the largest organ in the human body. It is the first line of defense against external harms, so make sure it is protected. v
Choose a Location Near You: 2310 Highland Ave. Bethlehem, PA 18020 877-247-8080 Hours: Monday-Friday 7am-11pm Saturday/Sunday 8am-8pm
1503 N. Cedar Crest Blvd. Allentown, PA 18104 877-247-8080 Hours: Monday-Friday 8am-5pm
511 VNA Rd. 239 N. First St. East Stroudsburg, PA 18301 Lehighton, PA 18239 877-247-8080 877-247-8080 Hours: Hours: Monday-Friday 7am-11pm Monday-Friday 8am-4:30pm Saturday/Sunday 8am-8pm
Weekend Warriors Guide to Achilles Tendon Rupture By Raymond McCarroll, DPM “I was just running and heard a pop”, “I think I tore my Achilles tendon, but I was just climbing a ladder to clean out the gutters”, these are common statements from the weekend warrior with a torn Achilles tendon. Who is the weekend warrior? The weekend warrior is generally a male between the ages of 30 and 50 years old who balances work with personal physical fitness. Men tend to be naturally tighter or have poor range of motion or flexibility than their age related female counterparts. When it comes to the Achilles, that tightness leads to more stress on the tendon, and every step of every day that tendon takes up that added stress. The stress is caused by an increased time that the heel is off the ground, when the Achilles is loaded through the walking cycle. Yes, these microseconds of added stress accumulate and develop into tendonitis, degradation and even rupture. This accumulative trauma can be more devastating than the 1 1/2 to 4 times body weight the foot usually takes with sports.
Fortunately, under normal conditions the body repairs degeneration and microtrauma while at rest. It is when this balance is not kept (i.e. poor training habits, tightness, etc.) that there can be a problem. If the weekend warrior continues to ignore the pain or inflammation of the tendon, small microscopic tears develop. The body responds to these micro tears by laying down scar tissue to heal them. This will result in a thickening of the tendon focally and inflammation or edema within the tendon. This can often be felt as a knot within the tendon, as the scar tissue accumulates. These micro tears, if they accumulate enough, can result in an Achilles rupture as easily as an outright rupture from a major single traumatic force. Other factors come into play as well. Men generally have a lower blood supply to the Achilles tendon than women, which may slow healing. The protective effects of estrogen that delay heart disease and other microcirculatory Continued on next page
processes in women also afford them some protection until after menopause. It is interesting to note that women usually rupture their Achilles tendon later in life than men. As people get older and less active, women may skip the “window of opportunity” for the Achilles to rupture. However, there may be a more balanced male to female ratio with Achilles ruptures because we are all more active in our 5th and 6th decade of life than any other generation. So how do we prevent Achilles ruptures in our weekend warriors? First, check your ego at the door. Do not expect to start running five miles a day when you haven’t run five miles in a year. You have to increase activity slowly and build
strength, gain flexibility and allow for an adequate recovery or rest time to afford healing. You may not have the natural flexibility that you remember from your younger days. Remember, “I walk 5-10 miles a day at work”, may build some muscle but it does nothing to add flexibility. If the last Achilles stretching you did was in high school, a 2-4 week stretching program may be beneficial before you even start a new exercise program. A trip to your local podiatrist, orthopedic surgeon, trainer or therapist would also be helpful. This would be money well spent given the 6-12 week recovery time after an Achilles rupture. If suspect that an Achilles rupture may be developing or has developed, seek medical attention immediately. Given the economy and the tough job market, more people with Achilles ruptures are waiting 4-12 weeks old before seeking treatment. Yes, although unusual, you can walk on a complete Achilles tendon rupture with mild to moderate pain. This can have a negative impact on your post surgical result and make it harder to obtain restoration of normal strength and function. It also will dramatically lengthen your time of recovery. v
________________________________________________________________________________________________ ____________________________________________________________________________________ ____________ A note from Dr. DiIorio, ________________________________________________________________________________________________ I am writing to you today to let you know of an exciting change in my practice beginning this year. ________________________________________________________________________ ________________________ After much consideration I have decided to sub-specialize exclusively in the treatment of the shoulder. ________________________________________________________________________________________________ The intricacies and complexities of the shoulder’s anatomy, mechanics, and pathology have become my ____________________________________________________________ ____________________________________ greatest love in orthopedics. ________________________________________________________________________________________________ If you are currently in active treatment with me for non-shoulder problems, I will continue to see you ________________________________________________ _______________________________________________ through the duration of your treatment. I will maintain office hours in most of the Coordinated Health ________________________________________________________________________________________________ campuses at: _____________________________________ ___________________________________________________________ Easton at Emrick Bivd. Bethlehem at Schoenersville Rd. ________________________________________________________________________________________________ Allentown East Stroudsburg Lehighton Brodheadsville _________________________ _______________________________________________________________________ Hazleton ________________________________________________________________________________________________ Thank you___________________________________________________________________________________ for your continued confidence. _____________ Sincerely, ________________________________________________________________________________________________ _ _______________________________________________________________________________________________ ________________________________________________________________________________________________ Emil J. DiIorio, M.D.
Put your Heart
Na Re t m Awion emb ar al H er, F en e eb es art rua s D ry M is is on ea th se
in our Hands Now Accepting New Patients
To schedule an appointment visit coordinatedhealth.com or call (610) 861-8080 coordinatedhealth. com
Itâ€™s a New Year! Now is the Best Time to Get Ready for Summer! By Deb Moyer
It may be too cold to wear your favorite summer outfit, but that doesn’t mean you shouldn’t be getting your body ready for it. Many people don’t realize that the best time to get their bodies ready for summer is actually during the winter! And while diet and exercise should always be used to maintain a healthy lifestyle, there are also some great cosmetic procedures available to help keep you looking and feeling your best.
associated with heavy breasts. Better yet, a breast reduction surgery is often covered by insurance! If having small breasts is your concern, a breast augmentation procedure is an exciting way of increasing breast size. Women who have very small breasts may not feel that they fit into clothing nicely and may lack self-confidence. Breast augmentation is one of the most sought after cosmetic surgeries preformed every year. Plastic surgeons have been using breast implants to increase breast tissue and reconstruct breasts for over 50 years.
It may be too cold to wear
As a new year begins, we are all reminded of the passage of time. We know that as we age our body changes, but that doesn’t make dealing with those changes any easier. Many times, signs of aging can only be addressed with cosmetic procedures. Some of the most exciting procedures you can have include tummy tucks, breast surgery, or facial procedures.
your favorite summer outfit, but that doesn’t mean you shouldn’t be getting your
If you are over the age of 40 and notice that you have developed droopy eyelids, jaw line, or neck, a facial procedure is something you may want to consider. Having eyelid surgery can make you look more awake and take years off of your face! An upper eyelid surgery typically takes only a week of healing time and is very popular with men and women alike!
body ready for it.
Having a tummy tuck dramatically changes how you look and feel in your clothing or bathing suit. Tummy tucks address any loose skin or excess “pouching” in your lower abdomen by tightening the skin and muscle. After the healing process, exercise and diet only help enhance your appearance. Some individuals have excess breast tissue while others don’t feel they have enough. Individuals who have too much breast tissue can benefit by having a reduction surgery. This surgery has a huge satisfaction rate! It leaves you with more youthful appearing breasts and alleviates back pain
Dr. Manny Iyer, our plastic and cosmetic surgeon will take his time in addressing the issues that concern you most. He will explain procedures in detail and educate you so that whatever procedure you are considering, you will feel knowledgable and confortable making the decision that is right for you. v
Physician Getting to the Heart of the Matter with
Cardiologist Dr. David Skoblionko Meet this month’s featured physician, Coordinated Health Cardiologist Dr. David Skoblionko. Dr. Skoblionko has been practicing cardiology in the Lehigh Valley for over 25 years and is currently the lead cardiologist for Coordinated Health’s Cardiology Department. While he treats a wide range of cardiovascular conditions as well as hypertension, he also specializes in the prevention of cardiovascular diseases. “We try to identify people who have a number of risk factors for cardiovascular disease and do a preemptive strike through modification and lifestyle changes,” says Dr. Skoblionko. And while many people may not think they need to see a cardiologist if they don’t have an existing heart condition, Dr. Skoblionko says the best time to see a cardiologist is actually before you have a problem. He says this is especially true for people with risk factors for cardiovascular disease. Risk factors include having immediate family members with cardiovascular conditions that presented before they were 65, people with high cholesterol, those with high blood pressure and those who have diabetes or who smoke. Dr. Skoblionko always begins his exams by going through his patient’s medical history thoroughly. He says it’s important to be honest regarding your health, even if that means admitting to some less than healthy habits like smoking or eating fast food frequently. Depending on your medical history the next step would be some non-invasive tests like an EKG or stress test for more information. Your blood pressure and cholesterol will also be tested.
you get at your doctor’s office. He says the most accurate blood pressure readings are probably those done in the comfort of your own home and often advises people to get their own at home blood pressure kits. How often you have your cholesterol checked depends on several variables. Everyone over the age of 20 should have a blood cholesterol test every five years. If you have been diagnosed with high cholesterol, but are controlling it through diet, you may need to have it tested every year. If you are using medication to control your cholesterol, you may need to have a blood test twice a year. Dr. Skoblionko believes that keeping your heart healthy means taking accountability. “It’s important to identify your cardiovascular risks and seek help from your physician and specialist when appropriate. Give up smoking, watch your cholesterol and your diet. You can prevent certain heart conditions,” he says. Regardless of whether you have a pre-existing heart condition or just want to assess your heart health, Dr. Skoblionko believes the cardiology team at Coordinated Health’s can help everyone. “We are developing a world class cardiovascular clinical and diagnostics team that is comprehensive and offers a wide range of services.” The Coordinated Health cardiology clinical team also includes CRNP’s Joyce Dobish and Carolyn Phillipi. Both Nurse Practitioners bring many years of cardiac experience in the Lehigh Valley to Coordinated Health and are accepting new patients. Our cardiac diagnostic imaging services include Echo’s, Stress Echo’s, Nuclear Medicine, Vascular Duplex imaging, EKG’s, Device Monitoring, and many other services.
Since blood pressure is often tested at routine doctor appointments, many people think they know their blood pressure. But, Dr. Scoblionko says beware of basing your blood pressure solely off of the reading
to schedule an appointment
What is Shoulder Calcific Tendonitis and How is it Treated? By Amanda Lucik PA-C
Calcific tendonitis or calcium deposits, is a very common condition that usually affects individuals over the age of 40 and is commonly found in people who are diabetic. 65% of calcium deposits, ranging in size from 5-15mm, are found in the rotator cuff in the shoulder. When you have calcium deposits you may experience severe pain that occurs suddenly without any injury to your shoulder. This pain may happen while youâ€™re at rest, but is often made worse by exercise or movement of the shoulder and lifting your arm. You may also experience shoulder stiffness, swelling and sensitivity to the touch. In some rare cases, calcific tendonitis does not cause any pain. The cause of this condition is unknown, but some theories as to why it occurs have been suggested. The most commonly supported theory is that there is a lack of blood supply due to the pinching of the rotator cuff tendon by the large bone spurs in the shoulder. There are three stages involved in this theory: the precalcific stage, the calcific stage, and the postcalcific stage.
â€˘ Precalcific stage: This is a non-painful stage in which the site of the rotator cuff that will be the home of the calcium deposits undergoes a change caused by decreased blood and oxygen supply.
Continued on next page
• Calcific stage: During this stage, new blood vessels are formed. During the entire calcific stage the new blood vessels restore the blood and oxygen supply to the tendon and start to remove the calcium. This is when the pain begins!
• Postcalcific stage: During this non-painful stage, the site where the calcium deposit had been is replaced by normal appearing rotator cuff tendon.
It’s important to remember that this condition has nothing to do with diet and the amount of calcium you eat. The calcium in your blood is typically normal. The best way to diagnose calcific tendonitis is by getting an x-ray. The calcium deposits appear as white dots above the shoulder bones on an x-ray. Your doctor may also order an MRI to examine the rotator cuff and to rule out any tears. In most cases calcific tendonitis goes away by itself and does not require medical treatment, unless the pain is affecting your daily activities or sleep. The calcium deposits are typically reabsorbed into the body within 1-4 weeks, causing pain to disappear. If treatment is required, you can take a traditional NSAID, such as ibuprofen, as an anti-inflammatory agent and for pain control. The next step to decrease the inflammation in your shoulder and rotator cuff tendon is with a cortisone injection. Cortisone injections are very predictable in decreasing the pain associated with calcific tendonitis. If you are experiencing loss of motion of your shoulder, physical therapy is needed to increase range of motion. If the previously mentioned treatment options fail or a rotator cuff tear is identified on MRI, arthroscopic shoulder surgery can treat the condition successfully. Once calcific tendonitis is treated it does not usually reoccur. v
OPEN Coordinated Health East Stroudsburg Campus
Ambulatory Surgery Center • Now open 5 days a week for out-patient surgeries and procedures • Ask your physician about having your procedure performed close to home at our new E. Stroudsburg ASC. • Brand new OR’s and equipment • Comfortable and relaxing surroundings • Supported by the CH Hospital Network and our Care on Demand walk-in medical and injury care facility • Specialties performing surgeries and procedures include: Orthopedics, Podiatrists, Physical Medicine and Rehab, and more
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February is National Heart Disease Awareness Month
Protecting Your Heart By Hannah Ropp Many people associate the month of February with love, the color red and of course anything heart shaped because of Valentine’s Day. Therefore, it only seems appropriate that February has been deemed national heart month, a time when many organizations do their best to spread awareness about the importance of heart health. Heart disease is the number one cause of death among both women and men and a major cause of disability. However, there are things you can do to reduce your risk of heart disease. For example, high cholesterol, high blood pressure, obesity, tobacco use, unhealthy diet and physical inactivity will make you more susceptible to heart disease; however, all of these issues can be addressed and corrected. Everyone over the age of 20 should have their cholesterol tested every five years. If your cholesterol is high, it can be treated through a modification of diet and medication. High blood pressure can also be reduced through lifestyle changes and medication. Another important weapon against heart disease is maintaining a healthy diet and lifestyle. Choose foods that are low in Trans fats and cholesterol and look for lean meats and poultry that don’t have the skin. While dairy products are an essential part of your diet, make sure they are all either fat-free, 1% or low fat. Also, cut back on foods and drinks with added sugar or partially hydrogenated vegetable oil and include more fruit and vegetables in your diet. All of these changes will also help you fight obesity.
other chronic illnesses. The CDC recommends that healthy adults aim to get at least two hours and thirty minutes of exercise every week. While that may seem overwhelming, remember that exercise should be broken up. Try to start with ten minutes at a time. Go for a few brisk walks each day or take the stairs instead of the elevator. Knowing the signs and symptoms of a heart attack can mean the difference between life and death, however, it’s important to realize that they symptoms may vary from men to women. Many men report a sensation of pressure or fullness in their chest, chest discomfort, dizziness, fainting, shortness of breath and nausea. Women, on the other hand, may feel milder chest discomfort, therefore it’s important to take any chest pain seriously. Women are also more likely to have atypical symptoms like nausea, vomiting and indigestion. Other atypical symptoms that both men and women should be aware of are discomfort in other areas of the upper body, like the jaw, arms back, neck or stomach. Remember, while heart disease is a serious condition, it is one that is easily prevented. Take the time to care for your heart and the rest of your body by maintaining a healthy lifestyle and scheduling regular wellness exams. v
Including regular physical activity in your lifestyle will help reduce your risk of heart disease and coordinatedhealth. com
Stay Independent by Standing on Your Own Two Feet By Dr. Lori Barnett Each year many older adults have injuries resulting from falls and generally those falls happen in their own home. Unfortunately, a good number of people lose their independence and notice their health deteriorate after a fall. Why do falls happen and why are they worse for older adults? Aging causes a variety of conditions, such as spinal stenosis, which can lead to balance issues; arthritis, which may case difficulties in movement, and osteopenia or osteoporosis, which can lead to bones that break easily. All of these conditions have their effect on your lifestyle and home-style. You may need to do things differently to make it easier to get around your house and neighborhood. There are ways to prevent this tragedy from becoming a reality. First, de- clutter your home. Loose rugs and throws can be dangerous. You can slip on rugs and a blanket can make a surface slippery if you’re trying to use a couch to support yourself. Loose cushions on chairs can slip. Avoid step stools and ladders; keep items you use frequently within arm’s length. It’s also important to wear a supportive shoe with a broad base of support like a walking shoe. Socks and slippers can acquire a sheen on the sole and can slide easily.
Do exercises to strengthen legs and feet. They are very easy and can be done while sitting in a chair. For example, sit on the edge of a chair and raise your thigh up and hold for 20 seconds then repeat for the opposite side. Repeat for three sets of ten. To make it more difficult, place a weight on your leg. You may have to hold it in place on your thigh. Work on your abdominal muscles and shoulder muscles to keep your head and back strong. Walk daily.
Take calcium, vitamin D and Magnesium daily to fight osteoporosis and get a Dexa scan to evaluate your risk.
Improve your balance with toe raises. Support yourself against a counter and raise your heels off the ground to stand on your toes, repeat 10-30 times. Try to balance on your left and then your right so eventually you can balance on one foot and do a toe raise.
Remember prevention is the key and making choices throughout your day can help keep you upright and safe. v
Assistive devices like canes and walkers can help aid independence and help foster confidence, especially when walking on unfamiliar surfaces. They are not an indication of weakness, but prevention against accidents.
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i n g a b o u t o u r p h ys i c i a n s Dr. Nicole Chiappetta is my favorite Coordina ted Health Physician for so many reasons. She has helped me regain my life! She is kind, caring and liste ns to her patients. As a onco logy nurse in the Lehigh Valley for over 30 years expe rience, she exemplifies the qualities we all want in a provider.I was diagnos ed woth rheumatoid arthrit is in 7/10 my physician left the area in Oct.201 0. I saw two different rheumatologist and was not getting any relief of my symptoms. As a nu rse using my hands and being on my feet all da Dr. Mary Loftus, she’s about how much longeryI Iwwas increasingly worried ould be able to work. I d an te na sio as comp have a son in college an d I’m D r . d an le ab W ge led ow eiss kn determined a knee re . He performed to help him placemen always listens to my recen t s urgery tly. His financially untill c a I . r nts lai e mp a co , t t the offi foo the staf he graduates. f ce and th w e a s hospita so muc couldn’t ask for With Dr. ever ima h better than I l Chiapetta’s help gi anything more. this surg ned. I had put I now feel so er taking dr y off for 5 year Janis M. much better, s, u shots ev gs, having cortiso er I can work, n and worr y three months e sleep and enjoy yi operatio ng about it. The n was ex activities I am He . i r p l a a a n i n g d e e t d l h fully e ta accustomed to Dr. Me formed 3 or was deta ke home paperwo ile rk doing. Thank you understa d but easy to has per dures on me for employing her. nd. I ha e n c e v o e e t h r s b r e p e n s e of my f t 4 Michelle S. riends s alway h
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Sports Vision Training By Chad Wentz, ATC There are approximately 640 muscles in the human body. And, as athletes, we are always looking to improve strength, endurance, and speed in as many of them as possible so that we can gain an advantage over the competition. We stretch our joints and muscles to improve flexibility and range of motion. We strengthen the core, develop muscles patterns, and increase speed and explosiveness. We do all of this to gain an edge on the competition and they in turn do the same to gain an edge on us. So, is there anything we can do that the competition has not already tried? The United States Air Force Academy believes they may have found an unexplored edge in nine muscles not commonly associated in strength training.
to limit the amount of light allowed through the lens during exposure in bright light), and the radial muscle of the iris (which dilates the pupil to allow more light through the lens during low light situations). Because we are dealing with muscles, we can use many of the same principles and concepts used to enhance muscles elsewhere in the body. We can do multiple repetitions to improve endurance and conditioning. We can work on improving the speed and accuracy in moving the eye to a specific spot or our speed in focusing as an object moves from near to far (or as we move closer to or further from an object). We can also improve the communication between the eyes and the brain to help with depth perception, visual memory, and the use of peripheral vision (seeing things that are the edges of our visual image).
Because we are dealing with muscles, we can use many of the same principles and concepts used to enhance muscles elsewhere in the body.
There are six occulomotor muscles, which are extrinsic or “outside” of the eyes, and the three intrinsic muscles, which are within the eye. The occulomotor muscles help to move the eyeball within the eye socket. The intrinsic muscles are the ciliary muscle (pulls the edges of the lens to focus the image seen), the circular muscle (which constricts the pupil
Sports vision training consists of several exercises that we can perform. First, to improve eye endurance and prevent “tired eyes”, we can perform saccadic (back-and-forth) eye movements, going back and forth between two eye charts spaced several feet to
several yards apart. To improve eye speed and hand coordination, we can use a SVT board which is very similar to a whack-a-mole game except that it consists of illuminated discs and is hung on a wall. We can also use the SVT board to improve peripheral vision by staring at the center of the board and reacting to the lit discs. To prevent diplopia (double-vision) and to improve depth perception we can use a Brock String. The Brock String is a 20 foot long string with beads spaced five feet apart. One end of the string is held up to the athlete’s nose and the other affixed to a wall. By looking down the string at one of the balls, you can adjust your depth perception and coordinate the two pictures presented by the eyes. There are many other exercises that can be performed specific to the sport you are preparing for. As for the results, they pretty much speak for themselves. In the first year that the USAFA implemented their Sports Vision Training Program to all of its sports teams, their baseball team led the NCAA in Batting Average and Slugging Percentage. This past year, they also had their first tennis player to be ranked nationally (Tahlia Smoke) since they made the move to NCAA Division I. One year, the USAFA had ten cadets who failed the depth perception portion of the flight qualifying test. After participating in the Sports Vision Training Program, all ten were able to pass the test and were cleared to fly.
In recent years, sports vision training has begun to grow. Training centers are popping up all over the country, especially in regions dominated by hockey. Some training centers are even located within hockey arenas and cater primarily to goalies, who rely heavily on many of the skills taught in sports vision training programs. Another interesting part of sports vision training is that it can be adapted to help with nearly any sport. For more information on Sports Vision Training or to find a Training Center near you, contact your school’s Athletic Trainer or your family optometrist. v
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