Before you pick up the shovel this winter season, take a few minutes to evaluate not just the outside conditions but the inside conditions, as well. Exposure to cold and the toll of heavy lifting and strenuous activity—as in a shovel full of snow—can be a dangerous combination for some people. If you suffer from any chronic health conditions, take extra precautions as the winter months unfold in Central Pennsylvania. Here are a few things to consider before you grab your shovel and head out into a winter’s day:1) Your regular activity level: If you’re a sedentary person all winter long and then exert yourself in a short period of time, you might be putting yourself at risk. It’s not a bad idea to ask your physician if you’re fit enough for sporadic winter work. 2) Any chronic conditions: Diabetes, hypertension and other chronic health issues can predispose people to cold injuries, particularly hypothermia and frostbite. Prior back problems may be made a lot worse by shoveling. Again, check with your physician to see if there are any special precautions you can take for your own safety. 3) Dress appropriately Layers of clothes work best in cold conditions. And like Mom always said, don’t forget to wear a hat and gloves. Remember, it doesn’t have to be extremely cold for hypothermia or frostbite to set in; children and the elderly are more prone to frostbite and drugs and alcohol can make people more prone to hypothermia. Anyone with peripheral circulation problems should also be especially careful. 4) Know your limits. We see a lot of slips and falls during the winter and we have a lot of icy days here in the Centre Region. If you don’t feel like you are able to clear your walkway or driveway, then hire someone to do it for you or ask a friend or neighbor for help. There’s no shame in knowing your physical limits and asking for help. We see a lot of infectious disease cases in the Emergency Department during the winter as well, from viral infections like influenza to full blown pneumonias. The flu season runs from October through March, so if you haven’t done so already, make time now to get your flu vaccination. (Eating well, getting the appropriate amount of exercise based on your physician’s recommendations and taking time to care for yourself are some of the easiest preventative measures we all can take to stay healthy this winter. Theodore Ziff, MD, is the Medical Director of the Emergency Medicine Services at Mount Nittany Medical Center, State College, PA. More info at www.mountnittany.org.