Should Pregnant Women Get the COVID-19 Vaccine?

Should Pregnant Women Get the COVID-19 Vaccine?

I’m pregnant, should I get the COVID-19 vaccine?

This a good question that many pregnant women or women thinking about becoming pregnant are asking. As a maternal-fetal medicine specialist, I’ll answer this and a few other questions in this blog.

Everything we do or do not recommend comes down to risks vs. benefits. This is true in all aspects of life. Riding in a car carries a small chance of a car accident, but we take that risk frequently. Riding with a 13-year-old driver on the interstate, this is a risk we’re not so willing to take. (Sorry, Zoe. My 13-year-old daughter is very responsible, just not quite ready for the interstate.)

Vaccines & Pregnancy

As a baseline, there are two vaccines we routinely recommend during pregnancy:

  • Flu vaccine
  • TDAP or Pertussis

Why are these vaccines recommended?

Flu vaccine: Pregnant women tend to get sicker or have more pulmonary complications with the flu. When this happens and you have a high fever or low oxygen level, you are at increased risk for preterm labor and other pregnancy complications. So, we don’t want you to get the flu while you’re pregnant, and the best preventative measure is the vaccine. This was especially important with H1N1, as the pulmonary complications were worse than other strands of flu. Increased pulmonary complications are also being seen with COVID-19. The flu vaccine, however, had been around for years. So, there had been exposed pregnancies and it felt safe, though there had been no actual randomized trials.

TDAP/Pertussis: About 15 years ago, we started to see an increase in Pertussis in the U.S., primarily from immigrants that were not routinely immunized in their countries. Since the vaccine doesn’t work until the baby is older, they looked at cord blood levels and found if you gave the mom the vaccine in the third trimester, you would give the baby high levels of antibodies that would protect the baby. It was considered low risk, since there had been lots of inadvertent exposure and no bad outcomes. Again, there was no formal randomized study.

How does this relate to COVID-19 vaccines?

Although the Pfizer and Moderna vaccines are new mRNA (messenger RNA) vaccines and the first of their kind, the technology behind these vaccines has been in place for years. This led to the advantage of being able to develop these vaccines faster than traditional vaccines.

mRNA DOES NOT change your DNA. It is just a recipe that your cells use to make a protein that is found in the COVID-19 virus. Your body recognizes that protein as “foreign” and builds antibodies to destroy it. Traditional vaccines inject the protein(s) itself.

There is no theoretical reason to believe that an mRNA vaccine would be harmful to pregnancy. The people who are immunized and pregnant or become pregnant are being registered to do follow ups to get data to prove this, but for now we have to go with our best theory.

Yes, there are risks of reactions to the components of the vaccine, and because your body is “fighting” the protein, you may feel a little ill, but that’s OK. This also happens with more traditional vaccines like the flu. Overall, the risk is low, but there are some theoretical unknowns, just to be honest. (But there are a lot of low risks we take in life: Did you know you can get listeria from lettuce? – just to be honest.)

What risk does COVID-19 present for pregnant women? I’m weighing the risk vs. the benefit of the vaccine.

With pregnant women, 1-3 per 1,000 with COVID-19 get severe symptoms compared to those who aren’t pregnant. Pregnant women are:

  • Three times more likely to need ICU care
  • Two to three times more likely to need advanced life support and a breathing tube
  • Have a small chance of dying due to COVID-19

New data is also showing pregnant women are at an increased risk for stillbirth and preterm birth.

To summarize: The benefit of the vaccine is that it prevents or lessens the severity of COVID-19. COVID-19 is very contagious. Women who contract COVID-19 while pregnant have higher risk factors than the general population, including the increased need for ICU care, ventilator support, and a probable increased risk of stillbirth/preterm delivery. You DO NOT WANT COVID-19.

Other Common Questions About the COVID-19 Vaccine

Here are a few additional questions people often have about the COVID-19 vaccine.

What about breastfeeding and getting the vaccine?

Vaccination while breastfeeding is currently recommended. The risks are not yet known since like pregnant women, no studies were done on lactating women. However, one great benefit is if mom is vaccinated she will not be exposing her baby inadvertently to COVID-19.

Is there someone who doesn’t need the vaccine?

If someone has allergies to any ingredients in the vaccine or has been otherwise recommended by a physician to not receive the vaccine, then you would not be a candidate.

Is there someone who should get the vaccine?

Although it is still up to each person, health care workers, essential workers, people at high risk for exposure or with other preexisting conditions, including those of Latin and African descent, should strongly consider getting the vaccine.

What if I had COVID-19 already?

Current recommendations are to wait about 90 days after you had COVID-19 to get the vaccine.

Does the COVID-19 vaccine cause infertility?

There’s no reason to believe the vaccine would cause infertility. There has been no evidence of this in prior animal studies.

Medical Resources for Your Review

The Society for Maternal Fetal Medicine has a talking points guide for you to discuss with your health care provider.

I encourage you to View this Guide and talk to your health care provider.

Sean Kenney, MD

Sean Kenney, MD

Maternal-Fetal Medicine Specialist

Dr. Kenney is a Maternal-Fetal Medicine specialist with the Center for Maternal & Fetal Care, part of the Bryan Physician Network.

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COVID-19 Vaccines: Facts, Myths and Hope

COVID-19 Vaccines: Facts, Myths and Hope

The number of COVID-19 cases and deaths continues to climb. As a pharmacist, it’s uplifting to see positive news on the horizon — namely the vaccines. The pharmaceutical industry, the U.S. government, scientists and global health agencies have collaborated to develop these vaccines at an unprecedented, yet safe, speed. This was possible because the technology involved in developing these vaccines has been around for years. This, combined with collaboration, led to the development of COVID-19 vaccines.

Here are answers to some of the most common questions people have about the vaccine, as of December 21, 2020.

How were the vaccines developed?

The Pfizer-BioNTech and Moderna are both mRNA vaccines, which stands for messenger ribonucleic acid. This type of vaccine is manufactured in a cell-free environment. For example, you may have heard that some vaccines, like influenza vaccine, require eggs to develop. mRNA technology does not — it is cell free and allows manufacturers to rapidly produce large quantities of vaccine.

How will people get the vaccine?

The vaccine requires two doses and is injected into the shoulder muscle just like the influenza vaccine. The Pfizer vaccine doses are to be given 21 days apart; the Moderna 28 days apart.

Could the vaccine give me COVID-19?

No, this vaccine does not contain the live virus. It cannot cause a COVID-19 infection.

Can the vaccine cause side effects?

Side effects are possible. The most common side effects reported are:

  • Pain at the injection site
  • Fatigue
  • Headache
  • Muscle or joint aches
  • Chills
  • Fever

Most of these side effects were mild to moderate and similar to side effects experienced in other FDA-approved vaccines. Side effects usually happen within 24-48 hours of the injection and are short-lived.

How will the vaccines be distributed?

Both the CDC and the state of Nebraska have comprehensive vaccine plans. These plans guide institutions on how to prioritize initial vaccine supplies. Plans are evolving and updated as new information becomes available.

Here is the Federal plan as of December 22, 2020.

Phase 1A – health care workers and long-term care facility residents.

Phase 1B – persons age 75 and older, and frontline essential workers.

Phase 1C – persons age 64-74 years, persons aged 16-64 with high-risk medical conditions, and other essential workers.

Phase 2 is expected to occur later in spring 2021, and will include the general population.

What age groups will be allowed to receive the vaccine?

The FDA Emergency Use Authorization (EUA) for each vaccine determines the ages of children that can be vaccinated. The Pfizer vaccine may be given to patients 16 and older, and the Moderna vaccine may be given to individuals 18 and older.

Will children get the vaccine?

The Pfizer vaccine was studied in children as young as age 12, but it only has EUA for children 16 and older. The Moderna vaccine was only studied in individuals 18 and older. The FDA determines the ages of children that can be vaccinated.

What are the ingredients in the vaccine?

The ingredients in the two mRNA vaccines with Emergency Use Authorization are:

A chart with the ingredients included in the COVID vaccines.

Information via CDC.gov

Do I have to pay for the COVID-19 vaccine?

The government is providing vaccine doses to people across the country at no cost. There may be charges to administer the vaccine.

If I’ve recovered from COVID-19, do I need to be vaccinated? Does immunity after getting COVID-19 last longer than protection from COVID-19 vaccines?

The protection someone gains from having an infection (called natural immunity) varies depending on the disease, and it varies from person to person. Since this virus is new, we don’t know how long natural immunity might last. Early evidence — based on some people — suggests that natural immunity may not last very long, so the vaccine is still needed.

Will the vaccine cause me to have a positive COVID-19 test?

No, but it is possible that a recipient of the vaccine may have positive antibody tests.

Since these vaccines were developed so fast, were any steps in the approval process skipped?

No. mRNA technology is not new — the many years of research allowed the rapid development of the COVID-19 vaccine to occur.

Should pregnant women receive the vaccination? What about those who are breastfeeding?

Pregnant and breastfeeding women were not included in clinical trials, so these risks are not known. Based on current knowledge, scientists believe that mRNA vaccines are unlikely to pose a risk for pregnant women. You should consider your personal risk of contracting COVID-19, the risks of COVID-19 to you and potentially to your fetus, the efficacy of the vaccine, the side effects of the vaccine and the lack of data about the vaccine during pregnancy. The CDC also notes that those who are trying to become pregnant do not need to avoid pregnancy after receiving the Pfizer-BioNTech COVID-19 vaccination.

Can the vaccine impair my fertility?

There is no data showing that the vaccine affects fertility. You may see rumors suggesting this, but it has never been shown. Women who were trying to conceive were excluded from the study. The following statement comes from the CDC: “Those who are trying to become pregnant do not need to avoid pregnancy after Pfizer-BioNTech COVID-19 vaccination.” Please discuss with your health care provider if you have additional concerns.

I’m immunocompromised, should I get the vaccine?

This vaccine does not contain live virus, so it does not pose risk of infectious side effects regardless of immune status. However, the CDC states that persons with immunocompromising conditions might be at increased risk for severe COVID-19. Data is not yet available to establish vaccine safety and efficacy in these groups. You may receive the COVID-19 vaccination if you have no contraindications to vaccination. This is a decision you should make after talking with your health care provider.

How long does immunity last?

It is not yet known how long immunity to COVID-19 lasts, either in a person who recovered from the disease or one who got vaccinated. It is possible that vaccines will require additional booster doses at some point after the first two doses.

What is this idea called herd immunity?

Herd immunity happens when a virus can’t spread because it keeps encountering people who are already protected against infection. Once a large portion of the population is no longer at risk, any new outbreak should halt. Experts estimate that in the U.S., about 70 to 80 percent of the entire population — more than 200 million people — must recover from COVID-19 to stop the pandemic from getting worse. But, that level of infection will lead to large numbers of patients with serious long-term complications and millions of deaths.

This is why the vaccine is so important. Our health care system cannot accommodate that many patients — we are overwhelmed now. When you get the vaccine, you help create herd immunity because the virus can’t spread due to the protection the vaccine provides.

If I get the vaccine, do I still need to wear a mask?

Yes, we all need to continue the same effective practices of wearing a mask, washing our hands and social distancing for the foreseeable future. We are in a long battle with a fierce enemy and we can’t let up, but HOPE is here.

Learn More

Dr. Kevin Reichmuth, pulmonologist with Nebraska Pulmonary Specialties, describes how the vaccine was developed and provides additional information on myths, facts and hope.

Watch Vaccine Development, Facts, Myths & Hope.

Katie Packard, PharmD, Bryan pharmacist, provides information on the vaccine and answers frequently asked questions.

Watch the General Overview and Vaccine Myths & FAQs.

Katie Packard, PharmD

Katie Packard, PharmD

Katie Packard, PharmD, is a clinical pharmacist at Bryan Health.

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The Cycle of Emotions During the Pandemic: What You Can Do

The Cycle of Emotions During the Pandemic: What You Can Do

The world has become a very different place amid the COVID-19 pandemic. It’s only natural to experience different and possibly heightened emotions. According to the Centers for Disease Control (CDC), 40 percent of U.S. adults reported struggling with anxiety, mental health or substance use. The report in June 2020 shows a considerable rise compared to the same time period last year.

This statistic is important because it provides a glimpse into what people are feeling related to the pandemic and the changes it has brought to society. Along with depression and anxiety, people are feeling grief. There are different types of grief. The grief we feel when we lose a loved one is what we think of most often, but there’s also grief over how the world and our lives have changed. Another kind of grief, called anticipatory grief, happens when we’re uncertain what the future holds.

What Can You Do?

Understand the Stages of Grief

This will help determine if what we’re feeling is coming from one of these stages. Everyone goes through these stages differently and in no particular order. Kessler and Ross identified five stages of grief. Recently, Kessler added a sixth stage.

Here are some examples of how we might move through these stages related to the pandemic:

  1. Denial – “The pandemic is not going to impact me.”
  2. Anger – “You’re making me stay home. I can’t do the things I want to do.”
  3. Bargaining – “If I stay home for two weeks, all will be fine, right?”
  4. Depression/Sadness – “When will this end? There is no end in sight.”
  5. Acceptance – “This is real and I must accept it and find a way to move forward.”
  6. Finding Meaning – “What can I learn as a result of this?”

Find a Balance in Your Thinking

It’s easy to get pulled into negative thinking which can lead to negative feelings. One thing you can do to take control is actively practice positive thinking and even write positive daily messages in a journal.

Think About What You Can and Cannot Control

You can control the things you do – like following the advice of experts. You can wear a mask, wash your hands and social distance to keep yourself and others safe. You can learn new ways to connect virtually. You can’t control what others are doing. You can only control what you’re doing and lead by example.

Have Empathy

You will encounter people who are irritable and may catch you off guard if you’re used to them being kind. Remember the world we live in right now and show them empathy. They’re going through tough times, too. Offer support and encouragement.

Build Connectedness

This is key. Research shows the more connected we are to family, friends and the community, the less violent we’ll be toward others and ourselves, and the fewer mental health and substance use issues we’ll have.

Understand When to Seek Help

You may just need to reach out and talk to a friend, or you may need to seek help from a professional. Grief can sometimes lead to depression.

Know the symptoms of depression:

  • Persistent sad, anxious or “empty” mood
  • Feelings of hopelessness or pessimism
  • Irritability
  • Feelings of guilt, worthlessness or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering or making decisions
  • Difficulty sleeping, early-morning awakening or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts (call 1-800-273-8255 or go to nearest emergency department if experiencing this symptom)
  • Aches or pains, headaches, cramps or digestive problems without a clear physical cause and/or that do not ease even with treatment

Anyone experiencing symptoms for two or more weeks should seek professional guidance to determine if they’re experiencing depression. Bryan Medical Center offers free confidential online depression screenings.

David Miers, PhD, LIPC

David Miers, PhD, LIPC

Health Expert

Dr. Dave Miers, PhD, is the director of Bryan Behavioral Health Services. This includes mental health treatment and counseling, psychiatric evaluations including medication management, and substance use evaluations and treatment.

Learn More About Our Counseling and Mental Health Services

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FAQs for the Flu Shot in 2020

FAQs for the Flu Shot in 2020

Every year people have questions about the flu vaccine. With the COVID-19 pandemic, it’s more important than ever to be informed and take steps to protect yourself and those you love.

The flu virus can travel up to six feet when someone coughs, sneezes or talks. Droplets can land in the nose or mouth or be inhaled into the lungs. The flu is contagious – this means you should stay away from those who are sick, and if you are sick, you should not be around other people.

The flu shot/vaccine protects you from getting the flu. Here are answers to some of the most common questions about the flu vaccine.

What is a flu shot?

The flu shot is a vaccine given with a needle, usually in the arm. It protects against three to four influenza viruses. It is developed based on research that suggests which virus(es) may be the most common during the upcoming season. A high dose vaccine is available for adults over the age of 65.

Why do I need to get a flu shot every year?

Flu viruses change quickly, so last year’s vaccine may not protect you against this year’s viruses. When you get the vaccine, your immune system produces antibodies to protect you from the viruses. Over time antibody levels will decrease. This is why it’s recommended to receive a vaccine every year.

Why is it so important to get your flu shot this year?

It is very likely flu viruses and the virus that causes COVID-19 will spread together this fall and winter. Flu vaccines are approved by the FDA to prevent influenza. The flu vaccine will not prevent COVID-19. The CDC urges everyone to get their flu shot this year to reduce respiratory illnesses and the burden these illnesses can put on the health care system as we continue to treat COVID-19 patients.

Can I have flu and COVID-19 at the same time?

Yes, that’s another reason why getting the flu shot is so important this year.

Is the flu a serious illness?

Yes, the flu can be serious enough to hospitalize people, and for some, it can be deadly.

Can the flu vaccine give me the flu?

No, the vaccine does not cause the flu.

Do I still need to wear a mask if I get a flu shot?

Yes, wearing a mask is still recommended to protect yourself against other viruses, including COVID-19.

Who should get a flu shot?

Everyone six months of age and older should get a flu shot every year.

When should I get a flu shot? Is it too early to get a flu shot right now?

September and early October are usually the best times to get your flu vaccine. So now is the perfect time, preferably before October 31. You want to get your flu shot before the flu is widespread in the community, so you’ll be protected.

Does the vaccine work right away?

No, it takes about two weeks to build your immunity after getting the flu shot. That’s why it’s important to get your flu shot before the illness is widespread.

How long will the flu shot protect me?

Six months is the amount of time a flu shot is thought to offer protection.

What side effects can happen after a flu shot?

Common side effects include soreness, redness, swelling where the shot was given, nausea, headache, muscle aches and fatigue.

Where can I get a flu vaccine?

You can get your flu vaccine at many places including your doctor’s office, urgent care locations and pharmacies.

Michael Sayers, MD

Michael Sayers, MD

Michael Sayers, MD, is a board certified doctor with Family Medicine of Lincoln, part of the Bryan Physician Network.

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Atrial Fibrillation (AFib): A Common, Treatable Heart Condition

Atrial Fibrillation (AFib): A Common, Treatable Heart Condition

If you have atrial fibrillation—also called AFib—you’re not alone. AFib is a common heart rhythm disorder. In the United States, more than 5 million people have atrial fibrillation.

As a cardiologist who specializes in heart rhythm disorders, I am seeing younger, healthier patients with atrial fibrillation than I did five years ago. There are many factors that can contribute to atrial fibrillation including: obesity, alcohol intake, high blood pressure, sleep apnea and genetic factors.

What is Atrial Fibrillation (AFib)?

Atrial fibrillation is a disorganized heart rhythm of the two atria of the heart. The atria are the upper two chambers of the heart that receive blood returning from other areas of the body. These disorganized electrical signals are then filtered to the bottom two pumping chambers of the heart, known as the ventricles. It is the job of the atrioventricular node (AV node) to keep the heart chambers synchronized. But in atrial fibrillation, this area gets bombarded by electrical signals. This leads to an irregular heart rate.

What health conditions should I be concerned about if I have AFib?

As the atrial (upper chambers of the heart) quiver, or fibrillate, the blood tends to move more sluggishly in this area. This sluggish movement allows the blood to clot along the walls of the atrium, which is a part of your heart. The most common areas to find blood clots are in the atrial appendages. As a result, atrial fibrillation contributes to an increased risk of stroke. In fact, the risk of stroke for people with atrial fibrillation is five times that of people who do not have this condition.

When my patients see me for management of atrial fibrillation, our first step is to assess their risk of stroke.

  • The most common way to manage stroke is with anticoagulation or ‘blood thinner’ medication. If the blood is thinned, it has less of a chance to clot and this helps prevent a possible stroke.
  • Another potential safety measure to prevent strokes due to blood clots forming in the atrial appendage area is covering the left atrial appendage with a device called a Watchman, made by Boston Scientific.

Once the assessment of stroke risk is complete, we then assess the heart rates. Generally, we want to keep heart rates between 60-100 beats per minute. People with atrial fibrillation can experience a much faster heart rate. When the atria are quivering, it can fibrillate at rates above 300 beats per minute. This causes the ventricles to move faster and the heart rate to increase.

By controlling heart rate during the atrial fibrillation events, we can help limit the symptoms of the arrhythmia. These symptoms include chest pressure, shortness of breath, inability to exercise, lightheadedness or feeling faint.

How is AFib managed?

No two patients are the same. I have discussions about rhythm control with my patients to discuss their needs and concerns. There are some folks where it is clearly better to try to control atrial fibrillation. There are some folks where stroke prevention and heart rate control are all that they need. Typically, the more symptoms someone has, the more aggressive we are about rhythm control.

The two main ways to control or manage atrial fibrillation are with arrhythmia medications or with ablations.

An ablation is the removal of body tissue. For AFib, this means to neutralize or silence tissue in key areas that trigger and maintain the arrhythmia or irregular heartbeats. This is accomplished by heating or freezing the atrial tissue.

A large part of my practice is doing ablations for atrial fibrillation. I like this approach as it avoids the risk and side effects of rhythm maintaining medication. Ablation has a good success rate in managing irregular heart rhythms, or AFib.

Generally, we are able to minimize atrial fibrillation in 75% of the patients who receive this treatment. This strategy works better when it is combined with lifestyle behaviors to address all factors related to the arrhythmia (or improper beating of the heart). This includes maintaining a healthy weight, regular exercise, minimal alcohol use, and treatment of associated conditions such as high blood pressure or sleep apnea.

Atrial fibrillation can feel scary; however this is a treatable heart rhythm. And, with proper treatment you will feel better and more comfortable doing the activities you enjoy in life.

Matthew Kapalis, DO

Matthew Kapalis, DO

Dr. Matthew Kapalis, DO, is a cardiologist at Bryan Heart.

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Diabetic Foot Wounds: Myths, Care and Healing

Diabetic Foot Wounds: Myths, Care and Healing

In my podiatry practice, it goes without saying, I see a lot of foot issues. But for people with diabetes, foot problems and wounds take on a whole different meaning. Usually they are chronic conditions.

The way you care for your feet can have a big impact on your lifestyle so I thought it might be helpful to share some of the more common misconceptions and myths, as well as good practices, when it comes to foot wound care.

What is the most common foot wound for people with diabetes?

The most common issue I see is the diabetic foot ulcer. This is a break in the skin or a deep sore. Foot ulcers can be caused by minor scrapes, cuts or from the rubbing of shoes that don’t fit properly. It’s important to treat these as soon as you notice them.

Why are people with diabetes at higher risk of foot wounds and wounds that don’t heal?

Most often, people with diabetes are at an increased risk because many suffer from a condition called diabetic peripheral neuropathy. This is when you lose sensation in your feet because of extended periods of elevated blood sugars.

When this happens, you may step on something sharp or on a hot stretch of concrete, or have a rock in your shoe – it could even just be a high pressure point in your shoe. But you won’t notice these things because you can’t feel them. So you’ll continue to walk until the area breaks down and becomes an open sore, or ulcer.

And to make matters worse, having elevated blood sugar levels impede healing. So, it’s an added layer of complication, and that’s why it’s so important to stay on top of foot wounds if you have diabetes.

What are some common myths about wounds and healing?

MYTH #1. Use alcohol or hydrogen peroxide.
While these are good first aid tools for one-time use to disinfect a wound on a skinned knee, they don’t help with long-term wound care or wound healing. In fact, prolonged use of either of these is actually cytotoxic, meaning it kills both unhealthy cells and healthy cells, and slows wound healing.

MYTH #2: Soak a wound.
Soaking an open wound predisposes it to bacteria. On the other hand, showering is great for wounds; it rinses bacteria off and makes it tough for bacteria to stick to the wound.

MYTH #3: Wounds need air to heal.
I think we’ve been told this from our grandparents for generations! What studies actually show is that a moist wound will heal up to five times faster than a dry wound. To provide moisture apply a topical medication then keep it covered with a Band Aid or dressing 24 hours a day.

MYTH #4: Foot wounds need an antibiotic.
The Infectious Disease Society of America recommends that if there is no infection, we don’t need to treat it with antibiotics. Patients with diabetes are already at increased risk of developing antibiotic resistance. So, we only use them if the wound becomes infected.

What about socks and footwear?

If you have a wound on your foot, it is best not to wear shoes. For the wound to heal, you’ll need to remove any pressure to the wound. This may mean using crutches, a wheel chair or a walking boot for a bit. Once healed, it’s critical to be very careful with the shoes and inserts you wear, so there aren’t any pressure areas that may cause the wound to return.

With socks, you should avoid those with seams, because they can rub on your feet or toes and cause issues, too. Your socks also should be made with a breathable fabric that won’t cause excess sweating.

Is it important to examine my feet, and if so how often should I do this?

The American Diabetic Association recommends people with diabetes have their feet checked at least annually by a doctor. If you have diabetic neuropathy, you should check your feet daily.

What are some tips for checking my feet?

It can be hard to see the bottom of our feet, and if you have neuropathy it’s especially difficult to know if anything is wrong because you don’t have feeling in your feet. Here are a couple of ways to check your feet:

  1. Apply lotion to your feet after bathing or showering. When you run your hands over your feet, you can feel with your hands if there is something new happening with your feet.
  2. Take a handheld mirror (like you use when you’re checking the back of your hair) and set it on the floor in your bathroom or bedroom. Then hold up your foot so that you can see it in the mirror. This way you can see the bottom of your foot and look for problem areas.

If you see or feel something abnormal with your feet—whether it’s a blister, a cut, a wound or bleeding—call your doctor as soon as possible. This is especially true for those with diabetes and neuropathy.

Jeffrey Wienke, DPM

Jeffrey Wienke, DPM

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5 Ways to Keep Cool & Safe When Exercising Outside

5 Ways to Keep Cool & Safe When Exercising Outside

It’s hot out there, but summer weather shouldn’t stop you from exercising, gardening or enjoying other activities outside – in fact, getting out in nature helps with stress levels! But it’s important to be prepared and proactive to avoid heat-related problems.

The more physically fit you are, the better you’ll be able to adapt. If you have medical conditions, please check with your health care provider before you begin exercising in the heat. Then, use these guidelines to help ensure that when you do go out, you’re being smart and safe.

Hot Weather Guidelines

Take It Easy at First

If you’re used to working out at the gym or are not used to hot temps, decrease your usual intensity, frequency and/or duration to allow yourself to acclimate. Monitor your heart rate and your feeling of exertion. For example, if you normally walk for 60 minutes, start with 30 minutes, at a slower pace than you’re used to. It can take up to two weeks of repeated activity in the heat to acclimate.

I know, it’s hard! I have known many athletes over the years and even those who are quite fit are surprised at what heat will do to a workout! Be aware of the “feels like” temperature as opposed to the actual temperature; humidity levels also make a difference.

Drink Plenty of Fluids, Preferably Water

At a minimum, drink 12 ounces before exercise, 12 ounces every 30 minutes during exercise, and 12-16 ounces after exercise. Drink more if you feel that you have lost a lot of fluid due to sweating during your exercise. It’s also helpful to monitor your urine output. If it’s dark yellow and/or low in volume you need to rehydrate.

But Don’t Drink Too Much!

Drinking too much water, called over-hydration, can lead to low blood sodium. To stay hydrated but not overly so, here is a general rule: Drink before, during and after exercise and other physical activities. At other times of the day, drink when thirsty.

Wear Loose, Light Clothing in Fabrics That Evaporate and Wick Sweat Away

Try clothes such as DryMax, CoolMax and others. Avoid dark colors, because they absorb heat (darker colors also attract mosquitoes). Wear a light-colored hat to help limit direct sun exposure.

Use Sunscreen, and Try To Reapply at Two-Hour Intervals Even if the Labels Have Sweatproof and Waterproof Claims

Sunburn increases the risk of premature skin aging and skin cancer. Another good way to decrease sun exposure is to a wear wide-brimmed hat, avoid the midday sun and heat (10 a.m.-2 p.m.), rise early, or make sure your route/trail for exercise is shaded. Or, consider a swim!

What If You Start to Feel Sick?

Pay attention to the heat. Listen to your body. If you start to feel faint and/or sick, stop immediately. Sit down in the shade and drink water. If possible, it’s also a good idea to have a healthy, hydrating snack, such as fruit. Energy bars or crackers are not ideal as they slow hydration.

Here are some of the most common heat-related illnesses and how to handle them:

Cramps

If you get heat cramps, usually occurring in your legs, stop the activity, move to a cool spot, place a chilled cloth around your neck, and sip water or a sports drink – water is usually better. Since sweat helps your body cool itself, if possible sit in a breeze or in front of a fan.

Heat Exhaustion

Signs include heavy sweating, weakness, dizziness, nausea, a fast and weak pulse and possibly fainting. Seek medical help if symptoms are extreme or if they last longer than an hour.

Heat Stroke

This is the most serious, potentially fatal, heat-related condition. Symptoms include high body temperature (104 F or higher), absence of sweating with hot, flushed or red/dry skin, rapid pulse, difficulty breathing, hallucinations, confusion, agitation, seizure, coma, and if untreated, death.

Sometimes these things come on quickly with little warning. If you suspect that you or others are suffering heat stroke, call 911 immediately. If possible, move to a shady area, drink and spray cool water on the person, avoid alcohol or caffeine (in tea and soft drinks), apply ice packs under the armpits and groin, and fan until help arrives.

Any Amount of Exercise You Get Has Health Benefits

Having said all of this, always remember that even a 20-minute workout has positive health benefits! Don’t sweat it (no pun intended!) when the weather is not giving you your best day out. It’s the number of days you exercise that matters most, not the length of time of any given exercise session.

Cindy Kugler, MS, Bryan LifePointe

Cindy Kugler, MS, Bryan LifePointe

Cindy is a certified exercise physiologist and certified strength and conditioning coach.

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ATVs – Before You Ride, Make Sure You Have Safety on Your Side

ATVs – Before You Ride, Make Sure You Have Safety on Your Side

Summer and the sun is finally here. Many are taking this opportunity to get outside and enjoy outdoor activities. One activity that is growing in popularity is the use of All-Terrain Vehicles (ATVs).

It has become very popular with agriculture, farming and recreational activities, and sure can be fun and enjoyable going on a relaxing ride.

However, many do not realize the dangers of this high-risk activity. In my role working to prevent injuries, I am passionate about getting the word out on how important it is take safety into account when you’re out having fun on an ATV. Last year, Bryan Trauma treated nearly 55 people who had life-threatening ATV-related injuries. And, in the first five months of 2020 we’ve already cared for 32 patients with life-threatening injuries due to ATVs.

We want you to have all the fun, and none of the injuries. Here are some tips to keep you and others safe when you’re out on an ATV.

ATV Do’s and Don’ts

Do:

  • Ride an ATV that’s right for your age – this is especially important for youth.
  • Wear a DOT-compliant helmet, goggles, long sleeves, long pants, over-the-ankle boots and gloves.
  • Ride only on designated trails and at a safe speed.
  • Scan the path ahead and identify potential hazards such as rocks, stumps, low or fallen branches, fences, guy wires, and rough or unstable path surfaces.
  • Be careful when driving with added ATV attachments. These affect the machine’s stability, braking and operation.
  • Tell someone where you are going and when you will return.

Don’t:

  • Allow children to operate ATVs without training.
  • Operate the ATV on streets, highways or paved roads, except to cross at safe, designated intersections.
  • Ride under the influence of alcohol or other drugs.
  • Carry passengers.
  • Operate an ATV at excessive speeds. Go at speeds right for the terrain, visibility conditions and your experience level.

UNL Videos to Help You Prepare

To help prepare yourself and those you care about for safe ATV outings, the UNL Nebraska Extension Office offers free educational videos developed for the Bryan Trauma Center. We encourage you to take advantage of this to learn more.

Other ATV Resources for You

Want to learn more? Check out this free ATV online safety course.

The ATV Safety Institute (ASI) offers three e-learning courses to address basic ATV safety for:

  • Adults and teens
  • Youngsters
  • Adults who will be helping youngsters on ATVs

The courses includes videos, pictures and interactive lessons to make them fun and effective learning experiences. After completing a course, you can receive a certificate of completion.

Interested in Nebraska laws for ATVs? Get that information now.

Have Fun and Be Safe!

I hope you’ll take advantage of this information to enjoy outings on ATVs. We all know how much fun this can be, and while the Bryan Trauma Center offers expert treatment, we don’t want you to be sidelined from the fun while you recover from an injury.

Joni Folkerts RN, MSN

Joni Folkerts RN, MSN

Trauma Outreach & Injury Prevention Coordinator

Joni Folkerts, RN, MSN, is the trauma outreach & injury prevention coordinator the Bryan Trauma Center.

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Your Ankle Pain: Could It Be Arthritis?

Your Ankle Pain: Could It Be Arthritis?

How many times have you stepped off the curb or out of your car the wrong way, and twisted your ankle? Probably more than you’d like to admit! Ankle injuries are pretty common. It’s easy to make a misstep and give yourself a strain or sprain. But as an ankle surgeon, many of my patients are surprised when they learn that arthritis can also be the source of their ankle pain.

So What Causes Arthritis in Our Ankles?

The most common form of ankle arthritis is actually caused by a previous trauma or injury. Perhaps you were in a car accident, or had a sports injury and had surgery for it. Then this injury, in a way “re-awakens.” This is different than when you get arthritis in your hip or knee, as these cases are usually caused by overuse or general wear and tear over time. With trauma, we can see deformities of the ankle caused by the injury.

Symptoms of Ankle Arthritis

There are several grades of arthritis, and your symptoms and treatment largely depend on these.

Grade 1

This is a very mild form of arthritis. You may only feel pain when you exercise or perform certain work duties or chores. Your pain might be in a specific area of your ankle joint. Pain will come and go; you’ll have good days and bad days.

Grade 2

This is a more moderate form where a significant portion of your cartilage may be lost. You’ll have more pain, and more limited range of motion and function. You might feel the changes in weather because your ankle might swell and be painful.

Grade 3

This is what we often consider end-stage arthritis, where we see bone-on-bone in the joint. This means the two bones now grind together because there is no cartilage to provide a nice gliding surface and lubricating joint fluid. Think of an engine trying to run without motor oil. This friction causes inflammation, and the ankle further deteriorates and starts to deform. When you reach this stage, ligaments and tendons can become compromised as your ankles are now weakened and unstable. At this stage, your pain is persistent.

Treatments for Aching Ankles

For those with milder symptoms, there are several things we recommend. Anti-inflammatory medications, using a brace or wrap, and shoe modifications such as orthotics are great first steps. As podiatrists we may recommend specific types of rocker bottom shoes or modifying certain activities. We also prescribe physical therapy to strengthen muscles around the ankle. There are also some injections that may help.

Some patients benefit from minor arthroscopic procedures that enable us to go in and clean up scar tissue or remove bone or cartilage fragments that may be the cause of pain. These are the types of treatments we consider for those with both grades 1 and 2. Again, frequency and intensity of these treatments depend on the each person’s case. If you’re at grade 3, surgery may benefit you. Two types of surgery are ankle replacement and ankle fusion.

Who Needs Surgery and What Kind of Surgery?

Ankle fusion

This is the tried and true method of treating end-stage ankle arthritis. It’s been described in the medical literature since the 1850s believe it or not! This is where arthritic bone is removed, the joints are “welded” shut, and held in place at a 90 degree angle with plates and screws. This eliminates grinding and eases inflammation and pain. It does a great job of relieving pain, but the ankle does become quite stiff. This is good for those who perform high-impact activities or whose job entails heavy labor, because it’s sturdier than ankle replacement.

Ankle replacement

With ankle replacement, we take out the arthritic joint and replace it with two metal surfaces with a plastic liner in the middle. This allows patients to have some flexibility and range of motion. The goal is to ease or eliminate pain while preserving range of motion as much as possible. You will have a more normal walk compared to joint fusion, but not as complete as before surgery. This is a great option if you prefer low-impact activities, such as walking, playing golf, swimming, etc. It’s also a very good option if you are in your 50s or older.

What to Expect After Ankle Replacement Surgery

After your ankle replacement surgery, you probably won’t do any weight bearing activities for 2-6 weeks. This timeframe really depends on your surgeon and your situation. When your surgeon thinks it’s appropriate, you’ll ease into exercises for range of motion, strength and balance. After that, you can expect several months of physical therapy. You’ll likely stay in touch with your surgeon periodically for months or even years to ensure your joint is still in its proper place and your pain is still relieved.

In the final analysis, we want to make sure that you get the right treatment for your lifestyle and life stage so that you can live as pain-free as possible.

Dr. Eric So

Dr. Eric So

DPM

Dr. Eric So, DPM, is a fellowship-trained foot and ankle surgeon with Capital Foot and Ankle, in Lincoln, Nebraska.

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COVID-19: Coping with Stress, Social Distancing and the New Normal

COVID-19: Coping with Stress, Social Distancing and the New Normal

We certainly live in stressful, uncertain times right now. Events, schools, jobs, services and life’s milestones, are all coming to a standstill.

As someone who has worked in mental health for 23 years, I want to assure you that some level of anxiety and stress is normal. In fact, some stress is good because it alerts us to threats and motivates us to take care of ourselves.

And, I urge you not to neglect your emotional well-being and self-care during these times. If gatherings, support groups, exercise classes or other outlets you usually rely on are off limits, try phone calls, social media and texting to stay in touch with those you care about.

Here are some other strategies to help while we are safely social distancing:

Strategies for Adults

  1. Practice relaxing and breathing. Take breaks during the day, practice relaxation skills and take deep breaths. As the old Johnny Mercer song goes, accentuate the positive!
  2. Stay positive. Start a journal and write about positive things going on in your life.
  3. Stay Connected. Check in with people through text, phone, email or social media.
  4. Keep in touch, especially with those you trust with your feelings, and share with them your thoughts, concerns and needs.
  5. Have some fun! Watch a movie, go for a walk, play games.
  6. Avoid too much exposure to news and information. You can watch a bit of news each day to stay informed, but don’t get absorbed by it. It can weigh you down.
  7. Take care of yourself physically. Exercise, eat healthy foods and get plenty of sleep.

Strategies to Help Young People in Your Life

  1. Talk and answer questions. Have daily discussions and ask your children if they have questions or concerns. Go over the facts with them.
  2. Reassure children that they are safe. Our community is taking extra care to ensure that we are practicing social distancing and taking other precautions to prevent the spread of this virus.
  3. Be a good role model. Practice good coping skills such as those above. Share the healthy ways you deal with stress.
  4. Limit media exposure.
  5. Keep structure in their lives. Work with your child to set a daily routine.

We’re in this Together

Try to remember: We’re all in this together, and hopefully soon, the “old normal” will return. Perhaps, we will even see our lives with new clarity and hope for a better future.

You can find more information in my podcast “Staying Sane During Social Distancing”.

If you find yourself anxious or if life seems overwhelming and this it’s impactive your daily life, or if you think you are having symptoms of depression, please take our free, online mental health screening.

Additionally, the Bryan Medical Center Bryan West Campus mental health emergency room is available 24/7 to determine if hospitalization is appropriate.

David Miers, PhD, LIPC

David Miers, PhD, LIPC

Health Expert

Dr. Dave Miers, PhD, is the director of Bryan Behavioral Health Services. This includes mental health treatment and counseling, psychiatric evaluations including medication management, and substance use evaluations and treatment.

Learn More About Our Counseling and Mental Health Services

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Understanding Kidney Stones: What are They & How do They Form?

Understanding Kidney Stones: What are They & How do They Form?

If you’ve ever suffered from kidney stones, you don’t need to be told how painful they are. They’re also very common, as more than half a million people visit emergency rooms each year for kidney stones. As a nephrologist, I see a lot of kidney stone cases. They are most common in warm, humid times of the year; when people sweat, they get dehydrated, which isn’t good for the kidneys.

We tend to see more men with kidney stones than women; about 1 in 7 men will have a stone in their lifetime. Females experience about half of that. Although interestingly, in the last 10 to 20 years or so, kidney stones in females has been on the rise.

How Do Kidney Stones Form?

Calcium or Uric Acid Build Up

The most common reason is a build up of too much calcium in the urine. About 8 out of 10 types of stones that are formed are calcium stones, and a smaller percentage are what we call uric acid or gout stones.

Chronic Infection

Some kidneys stones are caused by chronic infections, but these are much less common

Other Contributors to Kidney Stones

  • Age: As we get older, we’re more prone to get kidney stones. Caucasians have the highest incidence of kidney stone disease of any ethnicity.
  • Family history: If someone in your family has or had kidney disease or stones, you’re more likely to develop them.
  • Obesity: People who are obese and people who lose weight after bariatric or weight reduction surgery, have a higher incidence of kidney stone disease.
  • High-salt diet: When you have too much calcium in your urine it is usually a result of too much sodium in your diet.

Kidney Stone Symptoms

Pain

The most common symptom of kidney stones is abrupt, severe pain. It’s usually felt in your back, or what we call the flanks, although the pain can be felt in a number of different areas, starting from your back, rotating around to the side, going into your groin, and in some cases it actually goes into your genital area. Note again that this pain would be abrupt, severe and may or may not include some blood in the urine.

What to Do if You Think You Have Kidney Stones

If you’re having severe pain, go to either an urgent care or an emergency room to be checked. Providers will likely need to do an X-ray (there are several types of X-rays or scans to diagnose kidney stones) or ultrasound, as well as a urine analysis. A physical exam also provides clues, because you may have a pelvic or bladder infection; or even appendicitis or gallbladder attack that can mimic kidney stones. It’s important to have a good handle on your medical history.

Treating Kidney Stones

Treatment depends on the size of the stone.

Water and Pain Meds for Smaller Stones

Drinking a lot of water and easing the pain are the best ways to deal with smaller stones. If the stone is less than about 5 mm, which is small, it most likely will pass through with urination, along with pain meds and hydration. Hydration will be either orally or through an IV, depending on the severity of dehydration. Finally, on rare occasions we might need to use other meds, like alpha blockers, to help pass those stones.

Surgery May be Needed for Larger Stones

If the stone is greater than about 10 mm, it likely won’t pass on its own, so surgery is the best option. Surgeries include:

  • Lithotripsy, where sound waves are used to break up the stones
  • Cystoscopy, which goes through the bladder with a small ‘basket’ to break up stones
  • Major surgery, where the kidney stone has to be cut out or directly visualized by the surgeon

Home or Hospitalization?

Whether you are treated at home or in the hospital really depends on your degree of pain. If you can drink water and take your pain meds without nausea or vomiting, you can wait it out at home – again, taking your meds and drinking a lot of water.

But if you are vomiting or having severe nausea, which can be very common with stone disease, then you’ll likely be hospitalized.

Preventing Kidney Stones

Hydrate

I tell my patients to think about it like this: Say you’re putting sugar into iced tea. If you use too much sugar, it all falls to the bottom and the only way to get it back is to put in more tea. Well that’s what happens with urine. You get too much unwanted stuff in the urine and it falls to the bottom, and forms crystals and stones.

How much water? We want people to hydrate to the point where their urine is pale yellow. The exact amount of water is individual; we can’t tell someone how much water to drink, exactly. But seeing pale yellow urine is a good goal. If you are someone with a lot of kidney stones, you may even have to get up in the middle of the night to drink water, because during the night is the longest time you go without liquid, and that’s when your urine becomes most concentrated and can potentially form a stone.

Eat Less Salt

As I mentioned earlier, excessive salt intake is the most common reason why people get stones. Salt affects other components of urine, like uric acid and other minerals, causing crystals and stones to form. I’m a very strong proponent of the D-A-S-H (Dietary Approaches to Stop Hypertension) diet, which has been shown to decrease the incidence of stone disease as well as reduce blood pressure. The National Institutes of Health did studies on this diet dating back to the 1990s; it’s been very good for lowering blood pressure as well as preventing kidney stones.

Dr. Leslie Spry, MD FACP FASN FNKF

Dr. Leslie Spry, MD FACP FASN FNKF

Dr. Leslie Spry is a Nephrologist with Lincoln Nephrology and Hypertension.

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The ‘Pet Effect’ and Its Impact on Your Mental Health

The ‘Pet Effect’ and Its Impact on Your Mental Health

If you’re on the fence about adding a pet to your family, here is something in the ‘plus’ category: Pets can be very good for your mental health and well-being. As a mental health professional for more than 27 years, I’ve seen in my practice as well as my own life, how pets can truly make a difference. Whether it’s a dog, cat, bird or fish, many studies prove the benefits of sharing your home with a pet.

Our little “shorkipoo,” Ollie, has been with our family for three years now. He was a gift to our youngest daughter, but this little guy with a big voice has brought a lot of joy and happiness to our family as well as to friends and our neighborhood. (I think more people know where “Ollie” lives than where we live!)

Pets Improve Our Well Being

Just ask nearly any pet owner and you’ll hear how spending time with an animal helps them relax and alleviate stress. While the phrase “emotional support animal” has become commonplace, the science behind the “pet effect” is beginning to back up the claim that pets improve our well-being.

So how about those studies? For starters, they’ve found that:

  • Service dogs aid treatment for military members and veterans struggling with PTSD
  • Pet ownership benefits those experiencing mental health problems
  • Therapy dogs reduce stress and increase feelings of well-being in college students

A lot of research is also being done on how animals can help children who have conditions like autism spectrum disorder, ADHD and others, be more comfortable and present in the classroom.

According to the Mental Health Foundation of the United Kingdom, “a pet can be a great source of comfort, companionship and motivation for their owners. In many ways, pets can help us to live mentally healthier lives.” I’ve seen this in my own life. My father lights up when we bring Ollie over for a visit. And when my late mother was ill with cancer, Ollie always put a smile on her face.

So What Is It about Pets that Makes Such a Difference?

Pet ownership creates a sense of responsibility. In turn, that sense of responsibility promotes many positive behaviors with benefits for both our behavioral and physical health. Regular exercise, for example, helps improve mood and well-being. When you take a nice long walk with your dog, you get a physical workout as well as the emotional satisfaction of bonding with and caring for your pet. I walk Ollie at least a couple of times a day, rain or shine, and have him to thank for sticking with my exercise routine!

Pet ownership has social benefits. Walking a pet gets you out of the house and into your community, where you can greet old friends, meet new people and interact with other pet owners. In our case, a walk around the block that should take three minutes can take 30 because every little kid wants to pick up Ollie or pet him.

Caring for a pet requires following a routine and building some structure into your day. While the schedule you follow actually may be one you set up for your pet, just having a regular routine in the first place can be an important accomplishment for many struggling with their mental health.

Stroking a dog, cat or other animal helps reduce stress. In fact, even just the companionship of having a pet around can be a source of comfort and relaxation. When my daughter comes home from school, Ollie is first on the scene, showering her with unconditional love and affection. What better way to decompress from the day?! Pet ownership can also counteract feelings of loneliness and help ward off anxiety, and can establish a sense of pride or achievement. This benefits all of us and can be very important to someone with depression or anxiety.

Volunteer or Visit

If you’re unable to have a pet, consider volunteering at a local animal shelter or visiting a friend with a pet. Many of the benefits of time spent with animals can be realized after even a short time spent together (though the effects tend to be strongest between a pet and its owner). If larger pets are out of the question, think about a guinea pig or fish. Even these more “low-maintenance” pets can help you de-stress and build resiliency.

David Miers, PhD, LIPC

David Miers, PhD, LIPC

Health Expert

Dr. Dave Miers, PhD, is the director of Bryan Behavioral Health Services. This includes mental health treatment and counseling, psychiatric evaluations including medication management, and substance use evaluations and treatment.

Learn More About Our Counseling and Mental Health Services

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