How to Lower Your Cholesterol

How to Lower Your Cholesterol

by | Nov 18, 2024 | Expert Health Tips

Do you have high cholesterol? Or have you been told to watch your cholesterol level? You might wonder what steps to take. Eat healthier, maybe more veggies? Exercise more? Limit calories? So many questions!

I hope to help provide a little direction to help you.

What Is Cholesterol?

Let’s start with a little bit about cholesterol first. Cholesterol is a molecule made by the liver. It is a part of the lining of each of our cells and helps with hormone and vitamin D metabolism.

Our liver makes all the cholesterol we need so we don’t need to get cholesterol from our diet or the environment. We refer to it as a non-essential dietary nutrient. For this reason, our intake amount is a recommended daily allowance.

What Are Cholesterol Intake Recommendations?

The American Heart Association recommends less than 100 mg of cholesterol per day if your cholesterol levels are normal. If your cholesterol levels are abnormal, the American Heart Association refers you to your doctor. In that situation, our quickest answer is usually to try a medication or to tell you to eat healthier. While there are certain conditions where cholesterol medications are necessary, there are just as many times where modifying your diet is the first recommendation.

Often addressing dietary intake can be a long-term solution to lowering cholesterol. It can also help avoid medications. Even if you and your doctor decide that a medication would be helpful, diet changes to lower your cholesterol intake will also help your condition.

What Are Safe or Normal Cholesterol Levels?

When we talk about cholesterol levels, we measure several different components. The low-density lipoproteins (LDL) are usually what are directly related to cardiovascular risk. For this reason, LDL is sometimes called the ‘bad’ cholesterol. Sometimes we will look at other components of the lipid panel, but overall, getting LDL to the goal level is the focus. This also helps determine dietary recommendations and medication management.

The American Heart Association and the American College of Cardiology help set lipid panel guidelines. A lipid panel is a blood test that measures your cholesterol and triglyceride levels.

Here are the recommended levels for optimal health:

  • Total cholesterol: Less than 200 mg/dL
  • LDL: Less than 70 mg/dL
  • HDL: Greater than 45 mg/dL in women and greater than 50 mg/dL in men
  • Triglycerides: Less than 150 mg/dL

There are a lot of factors that go into your cholesterol levels, but one of the biggest is diet. Cholesterol levels are directly related to how much cholesterol you eat, even if high cholesterol runs in your family genetics.

How Can You Use Your Diet to Lower Cholesterol?

My first recommendation is to pay attention to how much cholesterol you are actually eating. Thankfully, a food’s cholesterol content is listed on the nutrition panel. Simply flip the package over, find the nutrition panel and the cholesterol content is listed there. We care about the milligrams of cholesterol as opposed to the percentage. Please also pay attention to the portion size as this will be how much cholesterol is in a specific portion size of that food. Your cholesterol intake throughout the day should be less than 100 mg.

Which Foods Contain Cholesterol?

Anything that has a liver to produce cholesterol will have cholesterol in it or its products. So, any kind of meat or animal product will have cholesterol in it; how much is entirely dependent on the product. That’s why it is important for you to look at the nutrition panel. Some foods are very high in cholesterol, such as eggs. One egg has anywhere from 220 to 250 mg of cholesterol. That’s over two days’ worth of cholesterol intake! However, other animal products such as skim milk won’t have as much cholesterol.

So, to reduce your cholesterol intake, it is going to mean eating a more plant-based diet. Foods that come from plants do not contain cholesterol because there’s no liver to create the cholesterol. However, it is important to note that we don’t want a highly processed plant-based diet. (Oreos are technically vegan.)

What About Protein in a Plant-Based Diet?

The next question my patients normally ask is, “What am I going to eat for protein?” A well planned, well balanced plant-based diet will get you enough protein. I will talk about protein requirements in a future blog, but just know that you can get plenty of protein through a plant-based diet.

There are a lot of plant-based protein alternatives. The key is to try to make it as unprocessed as possible. That is where your whole grains, legumes, beans, nuts and seeds come in. Meat alternatives (veggie meats) are a good option for those special occasions where we typically eat meat.

Some of the most common and highest protein containing plant products are:

  • Edamame
  • Tofu
  • Lentils (Did you know there are 5 different colors of them?!)
  • Beans
  • Peas
  • Tempeh
  • Seitan
  • Quinoa
  • Millet
  • Hemp

With a little bit of research, these are easy foods to learn how to cook and make tasty. There are tons of recipes online that can help with this.

7 Tips to Lower Your Cholesterol

  1. Pay attention to how much cholesterol you eat each day.
  2. Work on limiting cholesterol intake to less than 100 mg per day; if your cholesterol level is already high, make your intake even lower or eliminate cholesterol.
  3. Follow a more whole food (unprocessed), plant-based diet.
    • Try a meatless Monday. Or a meatless Monday, Wednesday and Friday! Or a meatless week!
  4. Remember, it is not just meat that contains cholesterol, but also animal products like eggs.
  5. Work with your doctor to monitor your cholesterol levels as you make some of these changes so you know how much cholesterol your body can actually handle.
  6. Remember that cholesterol is made by our body and therefore it is not something we are required to eat.
  7. Remember that sometimes cholesterol medications are still recommended for certain conditions even if your cholesterol levels are normal. If your doctor is recommending this, make sure you understand why they want you on a cholesterol medication.
Dr. Crista Few

Dr. Crista Few

Family Physician, Bryan Primary Care

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Breast Cancer & Lymphedema

Breast Cancer & Lymphedema

by | Oct 21, 2024 | Expert Health Tips

Lymphedema is a condition that occurs in one in five breast cancer patients. It might occur right after surgery or radiation therapy, or it might happen months or years later or not at all. If lymphedema is not treated, it can become debilitating and cause an infection known as cellulitis. While there is no cure for lymphedema, there are things you can do to help reduce or relieve the symptoms.

What Is Lymphedema?

Lymphedema is an abnormal swelling that can occur after damage of the lymphatic system or lymph node removal. This might be the result of treatment options such as surgery or radiation therapy. When damage occurs to the lymphatic system, lymphatic fluid can build up. This causes uncomfortable swelling. When identified early, lymphedema symptoms can be treated and relieved.

What Are the Symptoms of Lymphedema?

Symptoms of lymphedema include a feeling of fullness, heaviness or tightness of the affected area. Lymphedema typically begins slowly. You may notice jewelry or clothing begins to leave an indentation on your skin. Comparing the affected areas (such as an arm, leg, foot or hand) may show differences where one is more swollen than the other.

What Can Be Done to Treat Lymphedema Symptoms?

A trained therapist can provide complete decongestive therapy (CDT) to treat lymphedema. This treatment helps reduce swelling caused by excess fluid in the body.

What Does Complete Decongestive Therapy Include?

CDT includes manual lymph drainage massage, skin care, exercise, use of compression when appropriate and education about how to manage lymphedema symptoms yourself at home.

Manual Lymph Drainage Massage

Manual lymph drainage is a type of massage with specific techniques that can effectively help rid the body of excess fluid and symptoms of swelling. Manual lymph drainage massage uses very light pressure because the lymphatic system is close to the surface of the skin.

Skin Care

Lymphedema can increase the risk of skin infections. For this reason, skin care education is very important. Using products without fragrances or perfumes is recommended as they can irritate the skin. Wound and nail care may also be recommended.

Exercise

Special exercises are used with lymphedema treatment to promote circulation towards the center of the body. Cardiovascular exercise such as walking, jogging, swimming or rebounding promote increased lymphatic circulation in the body. Avoid excessive strain or heavy weightlifting.

Compression Garments

These are usually elastic-type sleeves or stockings that fit closely to the skin. They compress the affected area (usually the arm for breast cancer patients) to promote drainage of lymph fluid. A skilled rehabilitation therapist can recommend various products tailored for each person’s needs. This might include compression wraps, garments, pads and pneumatic compression pumps. At the April Sampson Cancer Center, a team of certified fitters provides measurements to ensure the proper compression and fit for each person.

Additional Services for Breast Cancer Patients

Also at April Sampson Cancer Center are certified mastectomy fitters can help patients with breast prosthetics—whether partial, full, custom or nipple prosthetics—as well as bras.

Tracy Bender

Tracy Bender

Occupational Therapist, Cancer Partners of Nebraska – April Sampson Cancer Center

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Knee Pain & Surgery: How to Avoid It & When to Know It’s Time

Knee Pain & Surgery: How to Avoid It & When to Know It’s Time

by | Sep 16, 2024 | Expert Health Tips

If you’re experiencing knee pain, you might be wondering what you can do to avoid surgery and when surgery might be your best option. Here are answers to these common questions and information to help you determine next steps to resolve your knee pain.

Knee Pain, Why?

There are many reasons why you might develop knee pain. Many patients are happy to hear that often knee pain can be treated and resolved without surgery. However, there are times when surgery is the most reliable solution.

Common Reasons for Knee Pain

Two of the most common causes for knee pain are musculoskeletal strains or an exacerbation of arthritis.

  • A musculoskeletal strain is simply a case of overworking the muscles around your knee joint. Think of this as feeling tired at the end of a long day but specifically related to your knee.
  • Arthritis is a lack of cartilage, which is the shiny, smooth substance that facilitates movement of your joints. When this cartilage wears away, the bone underneath is exposed, which can cause pain. You may have heard of this referred to as “bone on bone.” Your bones are rubbing together without the cartilage between them that makes movement smooth and painless.

Additional Causes of Knee Pain

There are many other conditions that can cause knee pain, such as tendinitis, fractures, or injuries to the meniscus, collateral ligaments or the ACL or PCL. These injuries can be strains of varying severity or complete tears.

Let’s focus more on knee arthritis, which is typically a condition that progresses as you age.

Treatments for Knee Pain due to Arthritis

Conservative treatment (meaning no surgery) offers many different approaches. Treatment options include:

  • Physical therapy
  • Anti-inflammatory pain medications such as ibuprofen
  • Activity modification to avoid activities that have caused knee pain in the past
  • Weight loss
  • Knee injections
  • Bracing

These options might be used on their own at various times or in combination with each other to relieve pain.

Time for Surgery?

Eventually, knee arthritis progresses to a point where it is time to consider surgery. You’ll know you are at this point when your ability to do what you want to do is no longer acceptable to you. You will start to “live your life around your knee,” meaning your knee pain is dictating what activities you are able to do, and negatively impacting your life.

This is when you’ll want to discuss surgery with your orthopedic surgeon. The mainstay of treatment for end-stage arthritis is a total knee replacement. Knee replacement surgery is an elective procedure, and the decision to undergo surgery is a personal one.

Getting the Most out of Life

There are many advances in treatment that can help resolve knee pain, and even delay the need for surgery. When you have persisting knee pain, a referral to an orthopedic surgeon can give you more clarity on the causes, natural history and treatment options for your specific diagnosis.

Nick L. Van Roekel, M.D.

Nick L. Van Roekel, M.D.

Orthopedic Surgeon, Nebraska Orthopaedic Center, PC, South

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Acupuncture: Ancient Medicine with Modern Applications

Acupuncture: Ancient Medicine with Modern Applications

by | Aug 13, 2024 | Expert Health Tips

My interest in acupuncture started while working alongside an acupuncturist in Anchorage, Alaska, at a large medical clinic. I was working as an X-ray technician, massage therapist and laboratory technician. I was also experiencing chronic neck pain due to a waterskiing accident.

After seeing acupuncture treat many patient symptoms and conditions, I decided to give it a try. My pain relief started immediately with my first treatment, and after a series of treatments I was pain free. I thought to myself, “there must be something to this” and started researching the science behind it. This led to acupuncture school in San Diego and a three-year master’s degree.

I’ve been practicing acupuncture for 25 years. During this time, I’ve been fortunate to help people feel better, decrease pain and heal from mental health struggles. I’ve enjoyed seeing acupuncture become more mainstream as more hospitals and the Veterans Administration see the benefits of this type of therapy. I like the diversity of treating patients of all ages with a variety of conditions.

What Is Acupuncture?

Acupuncture is an all-natural therapy that uses very fine needles at strategic points in the body to relieve pain and promote healing. Inserting needles in specific points leads to physiological and/or hormonal changes and helps the body re-balance and stimulate its own natural healing abilities.

How Does Acupuncture Work?

Here are five ways acupuncture works to improve overall health and wellbeing. Acupuncture:

  1. Relaxes muscles
  2. Decreases inflammation
  3. Blocks nerve pain
  4. Increases endorphins
  5. Balances hormones

Acupuncture can be a stand-alone treatment or used alongside conventional medicine.

What Can Acupuncture Treat?

There are a range of conditions acupuncture can improve for people of all ages and all stages of life.

Women’s Health

Women experience many changes from their teenage years to pregnancy, middle age, menopause and beyond. Each woman has a unique journey and different needs at different stages of their lives. Acupuncture can help at each stage. Certain medications, procedures and cancer treatments can cause symptoms resembling menopause, which is also treatable with acupuncture.

Since acupuncture helps balance hormones, it can treat these conditions for women:

  1. Menopause/perimenopause symptoms (including hot flashes)
  2. Endometriosis pain
  3. Menstrual symptoms (irregular or painful periods)
  4. Morning sickness, discomfort with pregnancy and induction of labor
  5. Fertility
  6. Urinary tract infections
  7. Pelvic pain

Men’s Health

Acupuncture can also treat these common issues for men:

  1. Prostate symptoms (pain, frequent urination, hot flashes)
  2. Fertility
  3. Urinary tract infections
  4. Pelvic pain

Cancer Treatment Symptoms

Acupuncture can help with many treatment-related issues for cancer patients:

  1. Chemotherapy-induced nausea/vomiting
  2. Chemotherapy-induced neuropathy
  3. Appetite suppression
  4. Low energy
  5. Pain

General Conditions

Acupuncture can help anyone dealing with these types of conditions:

  1. Pain
  2. Auto-immune disorders
  3. Headaches/migraines
  4. Insomnia
  5. Allergies
  6. Mental health – anxiety, depression and post-traumatic stress disorder (PTSD)
  7. Gastric conditions – irritable bowel syndrome (IBS), reflux (GERD)
  8. Substance abuse (tobacco, drugs and alcohol)

Frequently Asked Questions About Acupuncture

Does Acupuncture Hurt?

No, the needles are not needles in the true sense. They’re thin, sterile wire. Most of my patients don’t feel any of them. It’s a sensation, but it’s definitely not painful. It’s very relaxing and many of my patients actually fall asleep.

Does Insurance Cover Acupuncture?

Many insurance companies cover acupuncture. Definitely check with your insurance company first.

Is Acupuncture Right for Me? How Do I Get an Appointment?

I’m happy to visit with you about any issues you’re facing and see if you may benefit from acupuncture therapy. You can book an appointment now or call 402-481-7973.

Betsy DeGrandi

Betsy DeGrandi

Acupuncturist, Bryan Medical Center – The Spa

DeGrandi has been practicing acupuncture for 25 years and has worked in hospitals, private practice and with veterans. Her passion is empowering her patients and meeting them where they are in their healing journey.

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Preparing for a New Family Member

Preparing for a New Family Member

by | May 20, 2024 | Expert Health Tips

3,591,328—the number of babies born in the U.S. in 2023. Wow! That’s a lot of homes adding a new family member. And what about the 1 in 25 U.S. families who have at least one adopted child? Or the six million U.S. households that have more than three generations living under one roof? How about the 203,770 children that entered foster care in 2021?

Adding a new member to your family can be challenging for everyone. A smooth transition begins with open and honest communication. If you or someone you know is preparing to add a child to their family, here are a few tips to prepare the whole family for the changes.

Tips for Parents & Caregivers

  • Start the conversation early. Be open and honest while being age-appropriate.
  • Spend individual time with each child and try to continue things you did with them before the addition, i.e. watching movies, reading, etc.
    • For older children, consider writing encouraging notes, or getting them a card or a little gift.
  • Model healthy expression of feelings such as, “I’m feeling overwhelmed right now. Let’s take a break.” This normalizes a healthy response and feeling big emotions.
  • Communicate the need for safety (physical and emotional) of the new family member.
  • Teach children that crying is one way babies communicate.
    • Normalize that it may be “annoying” or “loud”, but remind them that we all cried when we were babies too! Or give an example, “Remember when you fell and scraped your knee and cried? What happened? You cried and I came to see if you were okay, and we put a band-aid on it. Your crying got you the help and comfort you needed.”
  • Build on each family member’s strengths. For example, if your youngest daughter is great at organizing, have her help organize things in the home ahead of her sibling’s arrival.
  • Encourage family and friends to give all children equal attention. This will avoid current family members feeling forgotten when the new family member is in the home.

Preparing Young Children

Infancy to Age Two

Young children, infancy to around age two, don’t fully comprehend the addition of a new family member, so simple things may help them adjust.

  • Be positive and talk about the baby or new family member in a positive way.
    • Kids are very smart and will seek to emulate your behavior and attitude. If you’re positive, they will feel positive.
  • Look at and read books about babies or changing family dynamics.
  • Do something special when the baby arrives. I still remember getting a “Big Sister” pin at Bryan when my little brother was born.

Toddlers

The toddler age can be a territorial age for children as they feel strongly connected with caregivers.

  • Relate things to a TV show, movie or book they love.
  • “Practice” for a new baby by getting a doll and showing them how to handle it as if it were a real baby.
  • Involve them in preparing.
    • Work on routines that will help everyone. For example, toilet training, moving from a crib to a bed, reinforcing or making adjustments to sleep schedules.
  • Let them spend “special time” with someone important to them ahead of the new member’s arrival.

School-Age Children

School-age children tend to be a bit easier in preparing for a new family member but still need reassurance and help adjusting. Remember to keep open communication and encourage questions and curiosity.

  • Explain what’s going to happen in a way they understand, including the “good” and “bad”.
  • Let them help prepare for the arrival.
  • Practice with a baby doll, or if you have a close family member/friend with an actual baby.
    • Provide positive reinforcement for them by saying things such as “You’re such a great big brother/sister.” or “I can tell you really care about ______.” or “You’re such a great helper!”
  • Let them come to the hospital as soon as possible after the baby is born so they continue to feel like a part of the growing family.

Managing Regression

Children may experience regression, “childish” behaviors, from time to time during this process of adding a new family member. For example, wanting to drink out of a bottle again, bed wetting or having accidents, or using a “baby” voice. When children regress, remember it’s normal and there’s nothing wrong with your child.

Here are a few facts and helpful tips to manage regression:

  • Children’s brains aren’t fully developed yet, so regression is a way they feel loved and cared for.
    • Attention is ATTENTION to a child’s brain. Even when a child “acts up,” they are getting attention which reinforces the idea that someone cares. They don’t understand the depth of what or why they are acting this way, but this is how they are communicating their need for love, affection and reassurance.
  • Regression typically resolves on its own, but if not, use resources to help.
    • Use books, friends, family, religious or cultural support, medical professionals and counselors.
  • Reinforce the positives. Even the smallest positives help build reassurance that they are loved and their needs will be taken care of.
  • Try to increase individual time with the child that’s struggling or be creative in finding ways to include them.

Support Each Other

There are no perfect ways to handle changing family dynamics, but these tips and tricks may make the transition smoother for everyone. Children are innately curious and thrive off love and affection. There is no right or wrong way to adjust your family dynamics as long as supporting each other with open communication and honesty is at the root.

There will be tough times, so give yourself grace. As your family grows, you all may experience some “growing pains”. When you seek to understand and support each other, you’ll all grow together.

Cassie Finkner, MA, LIMHP

Cassie Finkner, MA, LIMHP

Mental Health and Substance Abuse Counselor, Bryan Counseling Center

Cassie provides individual therapy to adolescents and adults. She specializes in trauma, including PTSD, major mental illness, suicidality, substance use, depression and anxiety. Cassie has been specifically trained in Eye Movement Desensitization Reprocessing (EMDR), Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and Motivational Interviewing (MI), however, utilizes a variety of different treatment modalities based upon the individuals needs to meet their treatment goals. Additional experience includes working with people encountering housing instability, poverty and trauma related to military experiences, including deployments and crisis intervention.

Cassie earned her Master of Arts in Counseling at Doane University (CACREP accredited).

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8 Tips to Avoid Injury: Insights from Sports Medicine Trainers

8 Tips to Avoid Injury: Insights from Sports Medicine Trainers

by | Apr 16, 2024 | Expert Health Tips

Whether you’re a weekend warrior, a recreational sports enthusiast or professional athlete, we can all use tips to avoid injury and stay healthy. We asked our athletic trainers to share some of their best tips.

1. Listen to Your Body & Address Pain or Discomfort Early

Grant Rider, athletic trainer at Seward High School

Pain is a message from your body that something is wrong and you should take a break before it worsens. Listening to your body and addressing pain or discomfort early will prevent minor issues from becoming major issues. It’s better to take a short break and avoid a more serious injury than to play through pain and cause a bigger problem later.

2. Stretch Before & After Activities

Terry Adair, athletic trainer at David City Aquinas and David City Public Schools

Stretching is essential to improve your flexibility and reduce your risk of injury. It also helps you warm up before exercise and cool down afterwards. Stretching improves blood flow and reduces muscle stiffness that can lead to injuries. Here are a few tips to get the most benefit from stretching:

  • Relax into your stretches
  • Don’t bounce while stretching
  • Hold each stretch for 30 seconds

3. Add Foam Rolling into Your Daily Routine

Ashley Elwell, athletic trainer at Crete High School

Foam rolling is a self-massage release technique. By using a lightweight cylindrical tube made of dense foam, you can roll over tight spots to help reduce muscle tightness, soreness and inflammation. Foam rolling is an effective tool to add to your warm-up and cool-down routines.

4. Drink Half of Your Body Weight in Water Each Day

Stacy Dahlkoetter, athletic trainer at Lincoln Christian and Parkview Christian Schools

If you participate in exercise or activities where you sweat a lot, your hydration need may be higher, and you will also need to replace electrolytes. Energy drinks do not count as a hydration drink. They actually dehydrate you and you will need to drink more water. To make sure you get enough water, drink half your body weight in water each day. So, if you weigh 120 pounds, you should drink 60 ounces of water a day.

5. What You Put into Your Body Matters

Kyle Younkin, athletic trainer at Lincoln Lutheran and Parkview Christian Schools

Maintaining a healthy diet with a good balance of carbs, proteins, fats, vitamins and minerals will keep you in your best shape. Complex carbohydrates from pasta, whole-grain breads and rice provide energy, fiber, vitamins and minerals without a lot of fat. Choosing lean meats will give you protein without contributing to issues like weight gain or high cholesterol.

6. Sleep Is Important

Choc Bowen, athletic trainer at York High School

Lack of sleep and/or poor sleep quality can impair muscle strength, speed and other aspects of physical performance. Sleep issues can also impair recovery following injury. Aim for 8-10 hours of sleep each night to ensure the proper amount of rest and to allow your muscles to recover.

7. Allow Time for Rest & Recovery

Bethany Dolezal, athletic trainer at Kinetic Sports Complex

Give your body what it needs to recover between training/exercise. Eat well, sleep well, stretch well and take rest days to avoid overdoing it. Don’t feel guilty if you take a day off. It is good for your mental and physical health to take time when you need it. Athletes should also take time between seasons to recover and prevent injuries.

8. Share Any Pain, Discomfort or Injuries with a Health Expert

Cassie Metzner, athletic trainer at Waverly High School

Everyone wants to get back to sports or activities. If injured, seek help from a professional—an athletic trainer, physical therapist or other health expert. Be honest with them about your injury and how you are feeling so that they can best help you recover and return to the activities you love.

Bryan Health/Nebraska Orthopaedic Center

Athletic Trainers

The Bryan Health Center and Nebraska Orthopaedic Center team of certified athletic trainers brings to our region’s youth extensive knowledge, experience and passion for working with young athletes. Learn more about Ashley Elwell, Bethany Dolezal, Cassie Metzner, Choc Bowen, Grant Rider, Kyle Younkin and Terry Adair.

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New Advances in Care: What Do I Need to Know If Someone I Love Is a Past or Current Smoker?

New Advances in Care: What Do I Need to Know If Someone I Love Is a Past or Current Smoker?

by | Mar 18, 2024 | Expert Health Tips

We all know it — smoking is not good for you. Yet for many, it is a reality of our daily lives. Let’s face it, it’s addictive and it’s often not easy to stop. And some people don’t want to quit. Given all of this, what’s a person to do? What steps can you take to make a difference in your life?

Screening & Follow-Up Are Key

There are several ways testing or a screening can help provide early detection. One of the most common is one you may not know about — an incidental finding. A low-dose CT scan is another important screening.

Incidental Findings

An incidental finding happens when you are being treated for one condition and receive an x-ray or CT scan and the doctor notices an abnormal growth in your lung. At Bryan Health, we have a team that follows up on these findings with our patients.

This can be life-changing and life-saving. Here’s a perfect example of the power this has on a life. ‘Suzie’ is a smoker, but she doesn’t have any symptoms of lung cancer. While being seen in the ER, a chest x-ray is done and an abnormal growth is found. She does the follow-up testing and finds out she has very early-stage lung cancer. Because the follow-up testing is done with an advanced robotic procedure and it’s found so early, we can move quickly through staging and resect (remove) the tumor early. The cancer doesn’t grow or metastasize (spread), and further treatment is not needed.

Low-Dose CT Scan

This is a test specifically designed for early detection of lung cancer. Current guidelines for who should receive this screening are:

  1. A daily smoker within the last 15 years
  2. Age 50-80
  3. Smokes at least one pack a day for 20 years or two packs a day for 10 years

A low-dose CT scan is recommended yearly unless it has been more than 15 years since the person has used tobacco. If you qualify for this screening, talk to your doctor about ordering this test.

3 Reasons People Avoid Screening & 6 Reasons to Get Screened

If you or a loved one have any of these thoughts, consider the following.

Reason One: I Know Smoking is Bad For Me. I’m Not Going to Quit/I Already Quit So Why Get Screened?

  1. Getting screened for lung cancer is about life — your life. And, using the latest technology can catch cancer early, so you can go on enjoying life.
  2. If you no longer smoke, that’s great. But you are still at risk and should be screened. Think of it as an extension of your healthy habits.

Reason Two: I Don’t Have Any Symptoms

That’s exactly when you should be screened for two reasons:

  1. You could find out you don’t have cancer and your lungs are fine.
  2. You could find cancer before any symptoms occur, when it can be treated quickly and easily.

Reason Three: I Don’t Want to Know. What If They Find Something?

  1. If something is found that requires a biopsy (further testing), 95% of the time it is not cancer.
  2. If it is cancer and it’s found early, the five-year survival rate is 92%.

New Advances in Diagnosing & Treating Lung Cancer

When it comes to diagnostics (biopsy) to determine if a nodule (growth) is cancer, there are three options.

  1. A biopsy with Interventional Radiology (IR) — This is the most common and is usually a same-day procedure.
  2. Surgical resection is also an option, though it is much more invasive and requires a hospital stay.
  3. A new advancement in bronchoscopy (a way to look at the lungs with a small camera) — This has been a significant enhancement in care and is generally a same-day procedure.

IR Biopsy

A typical IR biopsy identifies just the lesion (growth) in question. Then a separate procedure is needed to determine the stage of cancer (i.e., no cancer or how much cancer there is and if it has spread) followed by surgery, if needed.

Bronchoscopy Advancement

This advancement is robotics, and the platform we use at Bryan Medical Center is Ion. The benefit of this type of procedure is in its completeness. With robotic-assisted bronchoscopy and the Ion platform, we are able to reach nearly anywhere in the lung for the nodule, although there are some limitations.

Where Ion and bronchoscopy really shine is not just in the identification of the nodule, or spot, on the lung. In the same procedure, we do a staging — determining if the cancer has spread — for all patients with biopsy of the lymph nodes in the chest. This reduces the need for staging after the initial diagnosis. As a combined procedure with Ion, we can reduce the time from nodule-to-knife (diagnosis of the lesion to when it can be surgically removed).

Take Advantage of Advances in Care

There are exciting advances in medicine that allow us to diagnose and treat lung cancer to make a significant difference in a patient’s life. The key is early diagnosis.

Ryan Martin, MD

Ryan Martin, MD

Pulmonologist

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How to Avoid Burnout in Work & Life

How to Avoid Burnout in Work & Life

by | Feb 1, 2024 | Expert Health Tips

Do you feel sluggish and exhausted? Can simple tasks seem overwhelming to complete? Have you found yourself so stressed out that you quickly become angry or frustrated? If you’ve noticed feeling this way, you might be experiencing burnout.

Burnout can be difficult to describe to others. According to the American Psychological Association, burnout is defined as “physical, emotional, or mental exhaustion, accompanied by decreased motivation, lowered performance and negative attitudes towards oneself and others.”

Burnout Can Be Caused by More Than Your Work

Most people associate burnout with a stressful job. However, burnout can affect many aspects of your life, from being a parent to your relationship with your significant other or even being a caregiver for an elderly parent. Understanding the symptoms of burnout and what you can do about it can improve your mental health and quality of life.

Over the last few years, burnout has been developing more and more as work-life balance gets out of sync. This is because of the increase in remote work and technology that does not let us “turn off” and reset from our workday or slow down and manage our personal lives along with our work demands.

Signs You May Be Experiencing Burnout

There are many physical, emotional and behavioral signs that could mean you are experiencing burnout.

Physical Signs:

  • Feeling tired all the time
  • Frequent headaches
  • Changes in appetite or sleep habits

Emotional Signs:

  • A sense of failure and self-doubt
  • Detachment and feeling alone
  • Feeling trapped or defeated
  • Loss of motivation
  • Decrease of satisfaction and sense of accomplishment

Behavioral Signs:

  • Withdrawing from responsibilities
  • Isolating from others
  • Procrastinating to get things done
  • Taking frustrations out on others
  • Skipping work or coming in late and leaving early

Although many of these symptoms may line up with depression, causes of depression tend to be broader whereas burnout symptoms can be pinpointed to specific reasons or triggers in a person’s life.

Burnout Happens When Work-Life Balance Is Out of Sync

This may be due to:

  • Working too much without enough time to socialize or relax
  • Lack of close, supportive relationships and not reaching out to others for help
  • Not getting enough rest to recharge
  • Taking on too many responsibilities at work and home

Ways You Can Manage Burnout

Here are ways you can deal with burnout and perhaps prevent it in the future.

Recognize the Warning Signs

If you are feeling that there are no boundaries between your personal and work life or if you sense that you have been going 100 miles per hour and it would be impossible to slow down to even 85 miles per hour, this might be a sign that you are depleting your physical and emotional reserves and need to reach out for some support.

Reach Out for Support

Focusing on day-to-day activities might give you clues on what you need to work on to make substantial changes in your life. Sometimes talking to a friend about how you are feeling can really improve your outlook. There are other times when it is important to reach out for professional help from a therapist. The nice thing about therapy is that you have a safe place to talk with someone who is not a family member, friend or coworker.

Improve Your Self-Care

One of the best starting points is building personal check-ins into your schedule. Taking a step away from the computer or whatever your source of stress is and asking yourself daily, “How am I doing emotionally? How am I doing physically?” is a perfect first step.

Adding some physical exercise into your routine can definitely improve your outlook. “Regular exercise can reduce stress, anxiety, and depression” according to the American Psychological Association. Exercise is also an essential part of a wellness journey. There are many ways to be physically active—from walking your dog to walking with a work friend at lunch to release some excess stress.

Establishing a healthy daily routine for sleep, diet, movement and non-work time is crucial for your well-being. It is critical to tell yourself, “I have worked hard today, now I need to stop, change gears and attend to the social and personal aspects of my life. I need to do things that are fun and relaxing.”

We’re Here for You

If you think you might be experiencing burnout or would like to explore talking to a therapist about symptoms you are having, please reach out to Bryan Counseling Center at 402-481-5991. You can also take a free mental health screening on our website.

Stacy Waldron, PhD

Stacy Waldron, PhD

Dr. Stacy Waldron provides treatment for individuals of all ages across the lifespan and specializes with adolescents and adults. She offers individual and family therapy to help clients with stress , anxiety, mood disorders, life transitions and chronic pain. This includes helping individuals with stress management, assertiveness training, communication and problem solving skills as well as relaxation training. She also provides psychological assessments that include bariatric surgery evaluations, spine surgery, and spinal cord stimulator evaluations.

Waldron earned a doctorate in counseling psychology from the University of Southern California in Los Angeles. She serves on the Board of Psychology for the State of Nebraska, the Board of Directors for the Midwest Pain Society, and the Association of State and Provincial Psychology Boards.

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Let’s Talk Osteoporosis: How to Keep Your Bones Strong

Let’s Talk Osteoporosis: How to Keep Your Bones Strong

by | Jan 22, 2024 | Expert Health Tips

It might seem hard to believe but we reach our peak bone mass in our late 20s or early 30s. From there, men and women start to lose some amount of bone density throughout their lifetime. The loss in bone density causes an abnormal structure and ultimately weakens our bones, increasing the chance of osteoporosis and a bone fracture.

What Is Osteoporosis?

Osteoporosis is the loss of density or mass within our bones.

To illustrate, picture a healthy bone as a honeycomb and then put a bone with osteoporosis next to it. The bone with osteoporosis will have much larger holes than the healthy bone.

Osteoporosis affects all of our bones. But the ones most likely to fracture due to osteoporosis are in your spine, wrist, shoulder and hips.

Most Common Osteoporosis Risk Factors

There are many risk factors that can lead to osteoporosis.

  • More common in women
  • 50+ years old
  • Post-menopausal
  • Caucasian
  • Low body weight
  • Undergoing chemotherapy for cancer treatment
  • Certain diabetes and seizure medications, and some medications that cause immunosuppression
  • Current or previous use of tobacco/nicotine products

Ways You Can Slow Bone Density Loss

Here are some ways you can help your bones stay strong and slow bone loss.

  • Avoid drinking alcohol/drink alcohol in moderation
    • Alcohol affects your nutrition level, which can mean your bones don’t get the adequate nutrients to stay strong
  • Avoid smoking
  • Make sure you get the right amount of vitamin D and calcium
  • Stay active
    • Weight-bearing and strengthening exercises at least three to four times a week

Screenings to Diagnose Osteoporosis

Screenings for osteoporosis risks include a FRAX score and DEXA scan.

FRAX Score

This screening should be done when you reach menopause. It involves reviewing risk factors and answering a series of questions with your provider. With this information, your provider can determine your FRAX score. This will help to understand your chance of having a fracture within the next 10 years.

DEXA Scan

This screening typically begins at age 65, unless your FRAX score is higher than the recommended level. A DEXA scan tells us the quantity or amount of bone. It’s a bone mineral density test. The DEXA scan looks at the bone density of your lumbar spine, and then usually at a hip or wrist or forearm. It’s noninvasive, similar to having an x-ray.

Possible DEXA scan results:

  • Normal, meaning you don’t have osteoporosis.
  • Osteopenia, meaning your bone density is in between normal and osteoporosis.
  • Osteoporosis, meaning your bone density has reached the level to be diagnosed with osteoporosis.

Based on the results, DEXA scans may be repeated every couple of years to monitor your bone density.

Treatment & Prevention of Osteoporosis

Medication to Treat

Medications typically are not started until you are diagnosed with osteoporosis. The exception to this would be if you have osteopenia and have a fragility fracture. A fragility fracture is a fracture from a fall at standing height or less. It can be both a sign and a symptom of osteoporosis.

Diet & Exercise to Prevent & Treat

It’s really important to make sure you have a well-balanced healthy diet and are getting enough protein, calcium and vitamin D. Most of our vitamin D comes from the sun, so in the fall and winter months, a vitamin D supplement may be beneficial. It is possible to get too much of these vitamins, so it is important to talk to your health care provider to make sure you’re taking the correct amount.

Staying active is also important. Exercise, walking and generally taking care of our bodies helps not only to slow our bone loss down, but also helps us to prevent falls.

Megan Simpson, APRN-NP

Megan Simpson, APRN-NP

Bryan Primary Care

I believe in a collaborative approach to care, and want to create a partnership with my patients. It’s important to me to provide each patient with the knowledge they need to make decisions that are best for them and their health.

I’m here for my patients – to listen to you and your concerns and answer questions you have at the office or after you go home.

Care for:

  • Toddlers age 2 and older
  • Children, teens and adults of all ages
  • Preventative care, wellness checks and screenings
  • Chronic conditions like high blood pressure and diabetes

It’s a privilege for me to help people of all ages live their best lives.

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Multiple Sclerosis and Dietary Changes

Multiple Sclerosis and Dietary Changes

by | Dec 18, 2023 | Expert Health Tips

As a neurologist and subspecialist in multiple sclerosis, I am dedicated to helping patients with MS live their best lives. Many patients have questions about how dietary changes can impact their life. You will find that a well-balanced diet fuels your body and becomes a trusted companion in navigating the challenges posed by MS. It’s a flavorful quest where each meal becomes a small victory, a step towards a healthier, more vibrant life.

Dietary considerations are very important in most chronic medical conditions. From a nutritional perspective, what we expose our system to can have an important impact on our symptoms and sometimes in the course of the chronic medical condition. Multiple sclerosis is no different.

Here are answers to common questions about diet and MS.

Should I Be Supplementing My Diet with Vitamins and Other Supplements?

As a rule of thumb, I do not recommend multivitamins to all my patients with multiple sclerosis. I tend to screen for specific vitamin deficiencies. If a patient has one or more vitamin deficiencies, I recommend direct supplementation of that vitamin. I recheck the vitamin level in the future to adjust the dose.

What about Vitamin D? Which Vitamin D and How Much Should I Take?

Most patients with multiple sclerosis will be deficient or relatively deficient in vitamin D. I tend to recommend vitamin supplements with vitamin D3, which can be obtained over the counter. The goal is to have a vitamin D3 level from 60-80 ng/mL. To reach this goal, patients may need to take 2000-5000 international units of vitamin D3, particularly if they live in Nebraska or the Midwest.

Can I Take Too Much Vitamin D3?

Yes, and many of the symptoms of vitamin D3 toxicity may mimic chronic symptoms of multiple sclerosis, such as muscle aches, fatigue and even weakness.

Can Diet Decrease Inflammatory Activity and Relapses?

So far, there is no good evidence that dietary changes alone can directly modify the course of the disease and prevent inflammation and relapses (flares). However, maintaining a healthy body weight has been shown to decrease the risk of MS-related disability. A good diet and healthy body weight decreases the risk of other serious conditions such as cardiovascular and cerebrovascular conditions. This leads to improved overall health and decreased disability.

What Else Can Diet Do for Me and My Multiple Sclerosis?

Dietary changes have been shown to improve the overall quality of life and fatigue and, in some instances, hand dexterity. More than 50% of patients with multiple sclerosis suffer from MS-related fatigue. Unfortunately, the medications we use to treat fatigue in multiple sclerosis do not have great evidence backing their efficacy. Therefore, dietary changes have an important place in treating MS-related fatigue.

What Is the Best Diet for Multiple Sclerosis?

I always say that there is no one-size-fits-all when it comes to MS drugs/treatment, and I also apply this to diet. I recommend that my patients select one diet they can adhere to and follow long-term. Very restrictive diets and strict products may not be easy to obtain or even affordable.

Diets like the Mediterranean diet are easier to follow because they do not require complex planning and are more intuitive to follow. Other diets may also benefit multiple sclerosis, such as paleolithic, low-fat and intermittent fasting.

Where Can I Learn More About Diet and Multiple Sclerosis?

A good place to start is the National Multiple Sclerosis Society. The diet and nutrition section on this website has plenty of written information and pre-recorded webinars about diet and multiple sclerosis.

Daniel Crespo Artunduaga, MD

Daniel Crespo Artunduaga, MD

Neurologist, Bryan Neurology

Dr. Daniel Crespo Artunduaga is fellowship-trained in Neuroimmunology/Multiple Sclerosis and a neurologist at Bryan Neurology.

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Six Common Ways We Struggle During Holidays

Six Common Ways We Struggle During Holidays

by | Nov 20, 2023 | Expert Health Tips

Elvis once sang about feeling blue at Christmas time, and I’m here to tell you: It’s perfectly normal to feel that way.

There are many reasons why your days may not be merry and bright around the holiday season. Jam-packed social calendars, deadlines at work, loss of a loved one, sunless, dark winter days, financial pressures surrounding gift giving
sound familiar?

Still, you can prepare and hopefully deflect some of the increased stress of the season. It’s important to realize that you have more control than you think. Here are six common issues that come up this time of year, followed by ways to address them.

1. You’re Lacking the “Holiday Spirit”

Being surrounded by cheeriness can be difficult when you don’t feel the same level of enthusiasm as others. The pressure to be social, happy and present can make it hard to speak up if you feel otherwise.

  • Recognize that you don’t need to force yourself to be happy and that it’s good to acknowledge feelings that aren’t joyful; remember that you are not alone in feeling this way.
  • Trying to numb or avoid feelings by using alcohol or other substances just worsens anxiety and depression.
  • If possible, surround yourself with people who feel similarly; celebrate your traditions or create new ones.

2. You’re Overwhelmed by Grief and Loss

If you are living with grief, loss, trauma or loneliness, it can be easy to compare your situation to others’, and this can increase feelings of loneliness or sadness. Check in with yourself so that you’ll have realistic expectations for how the holiday season will be. Gently remind yourself that as circumstances change, traditions will change as well.

  • If holiday observances seem inauthentic right now, you do not need to force yourself to celebrate.
  • Perhaps connect with a support group, therapist, faith community or friends who understand.
  • Let your loved ones know how they can support you, whether it’s helping you with shopping or meeting up for a regular walk. Often, people want to help, but don’t know what to say or where to start.

3. You’re Feeling Pressured to Participate in Activities You’d Rather Not

We all have our own personal history with holidays. We have visions about the ways the holidays are “supposed” to be, which can be a distorted perspective.

  • Recognize that most people feel at least a little stressed during the season.
  • Prioritize the most important activities, or schedule get-togethers for after the holidays, and learn to say no if you need to.
  • Make a schedule of when you will do your shopping, baking and cleaning—and be sure to include time to take care of yourself.
  • Instead of spending the holidays the way you think you “should,” opt for an activity you actually feel like doing, whether it’s making a favorite dish or having a Netflix marathon.
  • Regardless of your plans, try to make your intentions known to friends and family early in the holiday season so everyone knows what to expect.

4. You’re Stressed About Giving Gifts

It’s so common to get caught up in the commercialization of the holidays. We can feel stressed about spending on a strained budget or trying to find just the right gift. Advertisers take advantage of our susceptibility and make us feel as if we need to buy more than we can. But giving to others is not about spending money. We need to remind ourselves that we are the ones creating that anxiety, and we can reduce it by setting realistic expectations.

  • Consider how much money you can comfortably spend and stick to the amount.
  • If purchasing gifts for everyone is difficult, consider having a secret Santa or white elephant exchange to reduce the number of items everyone needs to buy.
  • Simply let people know you are unable to give gifts this year.
  • Sometimes personal gifts—like a poem, short story or framed photo—are the best ones. How about the gift of helping a neighbor, a friend, a family member or a stranger? It’s the act of giving that is more important than a present. Our generosity can be a gift to ourselves, because when we focus on others and less on ourselves, we tend to reduce our anxiety.

5. There’s Not Much Sunlight, and It’s Affecting Your Mood

In the northern hemisphere, the holidays coincide with winter’s lack of available sunlight. Less exposure to natural light can lead to new or increased symptoms of depression.

  • Try to get as much sunlight as possible.
  • To boost your mood and regulate sleep, schedule outdoor exercise in the middle of the day when the sun is brightest. If you can, work near a window throughout the day. Even outfitting your home with warm, bright lighting can help improve your mood.
  • If you feel the need to slow your pace and stay home this time of year, consider reframing the winter months as an opportunity to work on “quieter” projects and activities suited for the indoors, such as writing, knitting or taking online courses.
  • Seasonal affective disorder (SAD) is a more severe form of the winter blues. If you feel hopeless, have suicidal thoughts, or changes in appetite and sleep patterns, talk to your doctor. Effective treatments for SAD include light therapy, talk therapy and medication.

6. You’re Alone or Feeling Isolated

While it’s true that many of us have friends and family to connect with during the holiday season, we can still have feelings of isolation. If you have a predisposition to depression or anxiety, it can be hard to reach out to others.

  • Remind yourself of the people, places and things that make you happy. Consider scheduling a call or video chat with friends or loved ones on a weekly or biweekly basis so you don’t have to think twice about making the effort.
  • Take advantage of other ways to connect, including sending out holiday cards and communicating with family and friends by phone, text, email and social media.
  • Calming activities, such as reading, meditating and gratitude journaling, can be positive ways to spend time if you are alone or don’t feel comfortable in social situations.
  • Remember self-care! We hear about the importance of a balanced diet, moderate exercise and plenty of sleep, but because there are so many distractions and stressors this time of year, we lose sight of some of these basic necessities. We need to take care of ourselves in order to navigate the holiday season.

Don’t be afraid to ask for help. You are not alone, even though it may feel like it. If you have been feeling anxious or depressed for more than two weeks, or if the holidays are long gone and you are still feeling stressed, anxious or depressed, please take one of our free, confidential online screenings, or talk to your primary care or mental health care provider.

Stacy Waldron, PhD, LP

Psychologist, Bryan Counseling Center

Stacy Waldron, PhD, is a licensed psychologist at Bryan Counseling Center. She provides treatment for individuals of all ages and specializes in working with adolescents and adults.

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Straight Talk on Mammograms and Breast Cancer

Straight Talk on Mammograms and Breast Cancer

by | Oct 18, 2023 | Expert Health Tips

The primary focus of most women is not themselves. Women for the most part are focused on taking care of their family and put themselves at the bottom of the list. It is time to change this way of thinking and put you and your priorities at the top of your list! You must take care of yourself. No one is going to do it for you!

Why Should You Get Your Mammogram?

  • Mammograms detect breast cancer before it can be felt
  • Early stage breast cancer has a great prognosis (outcome)
  • The earlier breast cancer is identified the less invasive the surgery can be
  • Early stage breast cancer may be less likely to require chemotherapy

When Should I Start Getting My Mammograms?

  • Start getting your mammogram at age 40 and have them every year
  • You may need to start having your annual mammograms earlier than 40 if you have a family history of breast cancer
  • Start your monthly self breast exams in your 20s

What Factors Increase My Risk for Breast Cancer?

  • Family history of breast cancer
  • Alcohol intake
  • Smoking tobacco
  • Not having children
  • Prior chest radiation
  • Starting your menstrual cycle before age 12
  • Starting menopause after age 55 (longer exposure to estrogen in your life)
  • Taking hormone replacement therapy
  • A sedentary lifestyle
  • Having a breast cancer gene mutation such as BRCA

How Can I Decrease My Risk for Breast Cancer?

  • No tobacco
  • Minimal alcohol
    • Women who have three alcoholic drinks per week have a 15% higher risk of breast cancer
  • Four to seven hours of exercise per week can lower your risk of breast cancer by 20 to 30%
  • Weight management. Overweight women—defined as having a BMI (body mass index) over 25—have a higher risk of being diagnosed with breast cancer compared to women who maintain a healthy weight, especially after menopause
  • Breastfeeding can lower breast cancer risk, especially if a woman breastfeeds for longer than one year

What Are the Surgical Options for Breast Cancer Treatment?

  • Lumpectomy
  • Mastectomy without reconstruction (removal of all of the breast tissue)
  • Mastectomy with reconstruction (removal of all of the breast tissue and rebuilding of the breast)
  • Oncoplastic reduction (bilateral breast reduction and lift at the same time as the lumpectomy)

What Is Involved with a Lumpectomy?

  • Removal of the breast cancer and a small amount of surrounding tissue
  • Removal of a few axillary (underarm area) lymph nodes
  • Usually followed by radiation therapy
  • There is a 20% chance the cancer will reoccur after a lumpectomy alone
  • Radiation therapy can reduce the recurrence risk to 7-10%

What Is Involved with a Mastectomy?

  • Removal of the breast
  • Removal of a few axillary (underarm areas) lymph nodes
  • You can have reconstruction at the same time

There is no difference in survival rates or prognosis (outcome) with a lumpectomy and radiation versus a mastectomy. The surgical choice comes down to patient preference and breast size in relation to tumor size. You have to do what is best for you and no one else in that moment.

Take Care of You

I encourage all women now to take care of themselves. We are often focused on taking care of others, but to take care of others and be there for them, you have to take care of yourself! Take that step now and schedule your mammogram.

If you’re curious or nervous about a mammogram, here’s what to expect and how to prepare.

Dr. Rachel Jendro, DO, FACOS

Dr. Rachel Jendro, DO, FACOS

Bryan Breast Surgical Specialists

Dr. Rachel Jendro, DO, FACOS is proud to be the first fellowship trained Breast Surgical Oncologist to serve the community of Lincoln and greater Nebraska. Her motivation for serving the women of Nebraska is due to her lifelong mission to provide evidence-based medicine to enhance the standard of care through surgical expertise, compassion for women’s health, and emotional support. As an osteopathic surgeon, Dr. Jendro brings enhanced surgical training and vast experience from accredited medical institutions, and is committed to her patients through their entire journey.

As a native of Kentucky, Dr. Jendro attended the University of Kentucky. She graduated magna cum laude with a Bachelor of Science in Biology. Dr. Jendro received her medical degree from the Kentucky College of Osteopathic Medicine. Her general surgery internship and residency were completed at Grandview Medical Center in Dayton, Ohio. Dr. Jendro was selected as chief resident in her general surgery residency program at Grandview Medical Center. Dr. Jendro is board certified by the American College of Osteopathic Surgeons.

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