‘You Have Cancer’: What To Do When You Hear These Words, for Yourself or a Loved One

‘You Have Cancer’: What To Do When You Hear These Words, for Yourself or a Loved One

By Joanna Morgan MSN, RN, OCN & Joselyn Hayes BSW, CSW

For over 35 years, we’ve been helping people and their families through the many emotions and challenges that change their lives after hearing these three words. I’m Joanna Morgan, an oncology nurse navigator and I’m Joselyn Hayes, an oncology social worker, at Bryan Medical Center.

While each person and every situation is different, there are some strategies that seem to help everyone. We hope sharing these will help you – whether you’re the one receiving a cancer diagnosis or it’s a loved one.

What Do You Do When You Hear the Words “You Have Cancer”?

Breathe. Surround yourself with people you love. Allow others to help and support you.

Most people ask, why me? Most people wonder if they have done something to cause the cancer and come up with ideas of why it occurred. If you are having these thoughts you are not alone. Cancer is not a punishment for things you did or didn’t do. Blaming yourself doesn’t help and often makes you feel worse. It’s almost impossible to know exactly what caused the cancer. Instead, focus on taking care of yourself now, both your body and your mind.

Ways You Can Help Someone With a Cancer Diagnosis

When someone we care about is diagnosed with cancer, we want to help but often don’t know what to do or say.

According to the American Cancer Society, people with strong emotional support tend to adjust better to the changes that cancer brings to their lives, have a more positive outlook and report a better quality of life.

Here are some ways you can provide support:

Keep in Touch

  • Write, text, email or call often (try to keep it short) – this lets the person know you are thinking of them.
  • Call at times that work best for your friend.
  • Be available: When your friend calls or texts you, answer right away.

Visit

  • Call before you visit, and be understanding if your friend doesn’t feel well enough to visit.
  • Keep the visit short: understand they may be too tired to actively participate.
  • Don’t be afraid to touch, hug or shake hands.

Know What to Say (And Do)

  • Listen. Allow your friend to honestly share how they are feeling (good, bad or ugly).
  • Give advice only when asked. Don’t urge your friend to fight the cancer if that is not their goal, offer treatment suggestions or share negative stories from your experiences with others who have gone through cancer treatment.
  • Support your loved one’s treatment decisions.
  • Remember the caregiver and seek ways to support and help this person.
  • Stay connected throughout the entire treatment process and beyond – checking in regularly over time is very helpful and meaningful.
  • Let your friend know “we’ll get through this together.”

Know What Not to Say

  • “Everything is going to be fine.” We are often tempted to say it will be fine, but this can make the person with cancer feel like you’re unwilling to talk about the realities and challenges of a cancer diagnosis.
  • “You’ve got the good kind of cancer.” There is no ‘good kind’. Any cancer diagnosis causes fear and changes a person’s life.
  • Nothing at all. Say something, anything. It’s okay to admit you don’t know what to say. What’s most important is starting a conversation.
  • “Let me know how I can help.” People rarely reach out and ask for help. They are exhausted emotionally and physically and don’t have the energy to think about what you can do, and even if they did it’s hard for most people to ask for help. Instead offer concrete ideas of ways you can help, and when your friend takes you up on your offer, make sure you follow through!

How to Help

  • Offer to run errands – get groceries, pick up prescriptions or help transport to and from appointments.
  • Make meals or help coordinate meal drop offs from other friends.
  • Help with tasks – cleaning their house, lawn care, babysitting, pet sitting, walking the dog.

Ways the Bryan Cancer Program Can Help

At Bryan, we have specially trained nurses and social workers to help you and your family through each step of your cancer care. Our oncology certified nurse navigators can help you through all aspects of your cancer care, and especially decisions about treatment.

Oncology social workers have expertise to help you navigate the emotions, financial and insurance concerns, and other areas related to receiving the care you need.

We’re here for you – to support and help you with compassion and expertise, to relieve some of the stress and uncertainty in your life. And to help you determine and navigate your best course of treatment.

You are Not Alone. We’ll Travel This Road Together.

A cancer diagnosis can be overwhelming – the emotions, the unknown, the decisions. At Bryan, our specialty trained nurses and social workers are here to help you and your family through each step of your cancer care.

Talk to your doctor about a referral to this Bryan oncology nurse navigator and social worker program. This is a free service for our patients.

Joanna Morgan MSN, RN, OCN

Joanna Morgan MSN, RN, OCN

Oncology Nurse Navigator

Joselyn Hayes BSW, CSW

Joselyn Hayes BSW, CSW

Oncology Social Worker

On the Road to a Healthy Heart: Dr. Keith Miller Takes His Own Advice

On the Road to a Healthy Heart: Dr. Keith Miller Takes His Own Advice

I started thinking a lot about my heart health because, at 52 years old (holy crap!), I have come to terms with the reality that I am not immune to the disease that I attempt to PREVENT and TREAT every day as a cardiologist. In short, I have been confronted with my own vulnerability.

So far, thank goodness, I haven’t had any health issues, but I want to be honest with myself and deal with my own future risk of heart attack, stroke and cardiovascular death.

Plus, there are a lot of people like me out there who are getting a little “middle-age-ish,” who may not fully appreciate their risk of cardiovascular disease.

So I thought it would be interesting, educational and perhaps inspirational to share my own personal experience of going through a risk assessment and trying to reduce my risk of heart and vascular disease. I’m focusing on lifestyle changes, but also evaluating whether I am a candidate for prescription medications (such as statins) to reduce my risk.

I had lab work done to find out my cholesterol levels and a coronary calcium scan to help define my risk. And, I have calculated my 10-year risk.

I also signed up for the Good Life Halfsy because I needed a goal to motivate me to exercise!

Identifying Your (and My) Risk for Heart Attack or Stroke

Using only a few, easily obtained pieces of information about your health, you can find out whether you’re on the right track or need some serious lifestyle intervention. You can determine if a little improvement in your diet and exercise program is enough, or whether you may benefit from a medication to lower your blood pressure or your cholesterol level.

If you are in your:

  • 50s or 60s – Age alone becomes a very important risk factor for heart disease. Even if you’re seemingly healthy you may be at risk. Let’s face it, cardiovascular diseases like heart attack, stroke and heart failure are extremely common and we are all at risk to one degree or another.
  • 40s – You aren’t off the hook, and depending on other risk factors, blood pressure or cholesterol lowering medications may help you.

Taking a Dose of My Own Medicine

I recently did my own cardiovascular health assessment.

Here are my stats:

  • 52-year-old white male
  • Total cholesterol – 255 mg/dL
  • HDL cholesterol – 71 mg/dL
  • LDL cholesterol – 168 mg/dL
  • Systolic blood pressure – 110 mmHg
  • Non-smoker
  • Non-diabetic without hypertension

My 10-year risk of having a heart attack or stroke was 3.2%. Not too bad!

I was a little disappointed that my LDL cholesterol was 168 mg/dL, which is definitely higher than I would like. A little improvement in my diet and exercise should do the trick to fix this.

If that 10-year risk number had been 5% or more, with other risk factors like family history, I might have considered going on a cholesterol medicine.

What Can Be Measured Can Be Managed

The point is, heart attack and stroke risk can be measured. And what can be measured can be managed. Lifestyle changes and blood pressure or cholesterol treatment have been shown to reduce the risk of heart attack, stroke and death from cardiovascular disease in people with elevated risk.

The question is, are you one of those people? Don’t wait to find out!

Find Out Your Risk & Take Action if Needed

If you don’t know your cholesterol numbers or you haven’t had your blood pressure checked in a while, talk to your doctor or consider taking part in a health screening offered by Bryan Health.

Find out if you’re at risk with our helpful cardiovascular risk estimator!

The next health screening where you can find out your cholesterol levels, A1c and other important health information is:

Thursday, Nov. 21, 7-9 a.m.

Bryan LifePointe Campus, 7501 S. 27th St.

To learn more and register, click below!

Other Free Risk Assessments

HeartAware

Offered by Bryan Health

Find out your heart age, risk for heart disease and steps you can take to improve your heart health.

If you are at risk, you can choose to have a free consultation with a nurse to discuss ways to improve your heart health.

My Life Check

Offered by the American Heart Association

Get a heart health score with recommendations to make improvements and track your progress.

Remember to Exercise!

Staying active is important for all of us, and any amount you do is helpful to your heart health. It doesn’t have to be a half-marathon! If you’re wondering how my training is going, here’s a photo of me after finishing this year’s Good Life Halfsy. I’m getting there!!

dr miller at the good life halfsy finish line

Let’s Improve our Heart Health Together

I hope you’ll join me so we can improve our heart health together. Take the screenings to find out your risk. Look for ways to improve your daily lifestyle. And, if you need help, don’t be afraid to ask for it!

I invite you to follow me and see more videos and blogs to inspire you to better health.

Dr. Keith Miller, MD

Dr. Keith Miller, MD

Health Expert

Dr. Keith Miller, MD, is a cardiologist with Bryan Heart.

The Surprising Risk of Sepsis for Pregnant Women, New Moms and Newborns – What You Need to Know

The Surprising Risk of Sepsis for Pregnant Women, New Moms and Newborns – What You Need to Know

As an infectious disease pharmacist and member of Bryan’s Sepsis Committee, I have seen many cases of infections and sepsis in many different patients. I specialize in getting the right antibiotics to patients with severe infections like sepsis, and work mostly with adult patients.

Now that I’m a father and we are expecting again very soon, I started looking deeper into the risk of sepsis for pregnant women and newborns. And, I was surprised at what I found.

Infections are a Serious Risk for Pregnant Women and Newborns

Thanks to improved prenatal care, most pregnancies and deliveries happen without complications. However, infections are still a serious risk for pregnant women, new moms and newborns. In fact, recent data shows an increase in sepsis-related deaths for pregnant women in the United States.

Newborn sepsis remains a leading cause of death among infants. There are two times sepsis can occur in infants:

  • Before a baby is 72 hours old, called early-onset sepsis. This is usually the result of viruses or microorganisms passed from the mom to the baby in-utero or during delivery. The incidence of this type of sepsis has decreased considerably since the 1990s due to new health screenings for pregnant women
  • After a baby is 72 hours old, called late-onset sepsis. This is usually the result of viruses or microorganisms acquired in the environment or through invasive procedures

What Exactly is Sepsis?

Sepsis is a potentially life-threatening condition caused by the body’s response to an infection. Basically, it’s when your body “over-reacts” to an infection. This can cause your organs (i.e. heart, kidney, liver, lungs, etc.) to fail, and can lead to death. Sepsis can be thought of as the sickest a person can get from an infection. Lots of people get infections, but not everyone develops sepsis. Some people are at a higher risk of developing sepsis than others.

What Can Increase Your Risk of Pregnancy-Related Sepsis?

Many of the risks are associated with the individual person and the type of pregnancy, such as:

  • Have never delivered a baby before (called nulliparity)
  • Currently pregnant with or recently delivered twins, triplets, etc. (called multiple gestations)
  • African American race

Others are associated with the type of delivery or medical therapies, such as:

  • Cesarean-section delivery (i.e., C-section)
  • Assisted reproductive technologies (i.e., artificial insemination, in-vitro fertilization, etc.)

What Can Increase the Risk of Sepsis in Newborns?

Some are associated with mom:

  • A common bacteria called Group B Streptococcus (GBS), most of the time this is not harmful but it can cause a severe infection in some newborns
  • Inflammation of membranes surrounding the baby due to bacterial infection (this is called chorioamnionitis)
  • Currently pregnant with or recently delivered twins, triplets, etc. (called multiple gestations)

Some are associated with the birth:

  • Prelabor rupture of membranes (occurs when the amniotic sac breaks before labor begins)
  • Prolonged rupture of membranes (over 18 hours)
  • Preterm birth (defined as a birth before 37 weeks)
  • Low birth weight

Some are associated with procedures after birth:

  • Invasive procedures such as a cervical stitch
  • Prolonged use of antibiotics
  • Prolonged use of a catheter inside the baby’s body
  • Ventilator associated pneumonia

What are the Warning Signs of Sepsis?

The signs and symptoms are different for moms and babies. It’s important to know the warning signs and seek care immediately. The sooner you or your loved one receives care, the better the chance for a full recovery.

Sepsis symptoms in pregnant women or new moms:

  • Shivering, fevers, shakes or very cold
  • Extreme pain or discomfort (feel the “worst you have ever felt”)
  • Pale or discolored, or clammy/sweaty skin
  • Sleepy, difficulty waking up, confused
  • “I feel like I might die”
  • Shortness of breath
  • Decreased urination

Sepsis symptoms in newborns:

  • “Just not looking right”
  • Unusually sleepy, lethargic or difficult to wake up
  • Unusually irritable, inconsolable
  • Not feeding or eating normally, vomiting
  • Less than three wet diapers or stools in a day
  • Fever or hypothermia (low temperature)
  • Shivering, shaking or poor muscle tone
  • Respiratory distress (not breathing right)
  • Abdominal distention or bloating
  • Bulging fontanel (soft spot on a baby’s head)
  • Unexplained jaundice (yellow skin)
  • Blood in stools

Take Action

If you see a combination of the above symptoms and suspect sepsis, or just feel like something isn’t right, call your doctor or go to the emergency room IMMEDIATELY. It’s important to say “I’m concerned about sepsis”. The sooner treatment is started, the better chance you or your loved one has of surviving and making a full recovery.

When caught early, immediate administration of IV antibiotics and fluids can be all you need to make a full recovery. The longer someone delays getting treatment for sepsis, the greater the likelihood that the person will have severe complications such as kidney failure requiring dialysis or problems taking care of themselves (such as walking by yourself, bathing, brushing your teeth, etc.). It can even lead to death.

Be Informed, Tell Others – Let’s Raise Awareness and Save Lives

As an infectious disease pharmacist, treating sepsis and letting others know how to recognize the signs and symptoms of sepsis is my job. As a new father and husband, it’s my passion.

Sepsis is always a serious condition. The sooner signs and symptoms are recognized and treatment is sought, the better chance to save a life. Every patient is somebody’s loved one, and now that I’ve got two little ones depending on me, I feel even more responsibility to make sure people understand how serious and common sepsis actually is.

Prevention of pregnancy-related and newborn sepsis starts with good prenatal care, good hygiene and frequent handwashing. Bacteria and viruses are naturally found on surfaces and easily spread by unwashed hands.

I urge you to tell everyone you know about the signs and symptoms of sepsis as well as the ways to prevent it. With your help, we can increase awareness of sepsis so people will seek treatment sooner, and lives will be saved.

Learn More About Sepsis

To learn more about sepsis, listen to our Bryan Health podcast. Bill Johnson, MD, Nebraska Pulmonary Specialties, tells you how to spot sepsis, and how early diagnosis and treatment can be lifesaving.

Kevin Sponsel

Kevin Sponsel

Infectious Disease Pharmacist

Kevin Sponsel is an infectious disease pharmacist and a member of Bryan Health’s Sepsis Committee.

Developmental Milestones for Your Baby & Toddler: When to Relax and When to Seek Help

Developmental Milestones for Your Baby & Toddler: When to Relax and When to Seek Help

A child’s first words and first steps are memorable events – and most parents want their children to reach these and other developmental milestones ‘on time’ or to achieve them early. So it’s natural to be concerned if your little one isn’t, in your view, keeping up with these milestones. But how do you know if it’s time to truly worry?

Children don’t always meet milestones at the same time or at the age range expected. That’s okay! It’s not a big deal to miss one or two developmental milestones. These milestones should be looked at as a range for developing skills.

Preemies are a special case. Babies who are born prematurely usually will not meet milestones on time. As an example, if your baby was born two months early, he may reach four-month milestones at six months. We generally adjust milestones for premature babies until they reach age two.

That said, when children who are not preemies miss most of the milestones in their age range, it’s worth talking with your child’s doctor.

Here are some milestones and red flags that will help you know if and when to take action.

Two to Four Months Old

Motor Skills: Holding items in the hand. Pushing the upper body with support of the arms when he’s on his tummy. Pushing down on his legs when his feet are on the floor, like when he’s placed in a walker.

Cognitive Skills: Responding to voices. Following movement with his eyes and watching faces. Making some eye contact. He can give a social smile when he interacts with his caregivers.

Language Skills: He should gurgle and coo. There may be some different inflection in his vocalizations.

Red Flags: Not responding to loud noises, interacting with caregivers or visually following movement.

Six to Eight Months Old

Motor Skills: Sitting unsupported for short periods of time. Passing objects from one hand to another. Grasping at things with her whole hand. She can probably roll over.

Cognitive Skills: She has gotten better at watching things. Her eyes track side-to-side, up and down, and in circular motions. Reaching for things that are in her field of vision.

Language Skills: Responding to sounds by “talking” back. Turning toward sound sources. She may repeat syllables, like “ma-ma,” “da-da” or “ba-ba”. She’s interested in social play—a fan of peek-a-boo or pat-a-cake.

Red Flags: Stiff or tight muscles. Sloppy or ragdoll-like movement patterns. Showing no affection for caregivers. Eyes turning inward or outward. Not responding to sounds.

One Year Old

Motor Skills: Crawling. Pulling himself up to standing with the support of furniture. Taking steps with help or support. Ability to grasp finger foods. Using both hands together to pick things up. Pinching things, poking things. Shaking, banging, throwing and dropping toys. Waving and clapping.

Cognitive Skills: Imitates gestures. More engagement in social play. Extending an arm or leg to help get dressed. May show some anxiety with strangers.

Language Skills: Speaking more. Maybe using noises as names, like “mama” or “dada”. Responding to “no”. Understanding simple verbal requests

Red Flags: Dragging one side of the body while crawling. Inability to stand with support. No words. Not seeking out a caregiver when upset.

Toddlers

Motor Skills: Younger toddlers should be mobile and walking, perhaps pulling toys along. Fine motor skills like scribbling and stacking blocks.

Cognitive Skills: Identifying body parts. Pretending. Starting to categorize things.

Language Skills: Using pronouns (I, me, he, she, for example.) Naming colors and objects. Listening to short stories. Creating simple sentences.

Red Flags: Extreme clumsiness. Inability to sit still for long periods of time. Not walking yet. Oversensitivity to light, sound or movement.

Tracking Milestones and Treatment

  • Many milestone checklists are available with a simple online search
  • Make note as your child attains new skills
  • Talk to your child’s doctor if multiple milestones are missed or you notice developmental red flags

If your child is missing milestones, your child’s doctor can evaluate his or her development and guide treatment as needed. Physical therapy can help with muscle tone, while occupational therapy can help your child develop fine motor skills. Speech therapy treats language development. If you are concerned about your child’s development, talk to your child’s doctor about potential needs for a therapy specialist.

More on Child Development

Want to learn more? Listen to a 10-minute podcast with Stacey Anderson, a pediatric occupational therapist at Bryan Health:

Stacey Anderson

Stacey Anderson

Pediatric Occupational Therapist

Stacey Anderson is a Pediatric Occupational Therapist with Bryan Health!

Hugh Jackman, #WearSunscreen & Your Family: What Do You Need to Know?

Hugh Jackman, #WearSunscreen & Your Family: What Do You Need to Know?

My husband and I have four children, all ages six and younger (that’s what happens when you go to medical school). Right now, their favorite movie is “The Greatest Showman” starring Hugh Jackman. He is famous in the entertainment industry for his singing, dancing and acting abilities, along with his devilishly handsome good looks.

However, he’s also famous in the dermatology world as he has publicly battled basal cell carcinoma not once, but five times in the past including a recurrent basal cell carcinoma on his nose. Hugh posted pictures on Instagram with the hashtag #wearsunscreen to help raise public awareness and encourage good sun protection behavior.

Most Common Type of Skin Cancer

Basal cell carcinoma is the most common form of skin cancer. In fact, it’s the most common cancer overall. It develops after repeated sun damage over time. You might notice it as a pink scaly patch. Or, it might be a raised pearly bump, almost pimple-like that never seems to go away. Sometimes basal cell carcinoma will bleed after minor trauma or for no reason at all.

Second Most Common Skin Cancer

Are there other types of skin cancer? You bet! The second most common form of skin cancer is squamous cell carcinoma. This type of skin cancer may appear as a growing lump, often with a rough surface. But, it also could be a flat, reddish patch that grows slowly and may be tender. Sometimes these grow quickly on the skin in a volcano-like fashion. Squamous cell carcinoma can be serious in some cases and spread beyond the skin to lymph nodes if not treated properly or within a reasonable amount of time.

Most Well-Known Skin Cancer

Finally, the skin cancer with which most people are familiar, is melanoma. Melanoma can be a life-threatening skin cancer, especially if not caught early. The warning signs for melanoma are summed up in the “ABCDE” algorithm.

  • A = asymmetry (one half doesn’t look like the other)
  • B = border (irregular, ill-defined or funny-looking shape)
  • C = color (one spot that has multiple colors within it, such as different shades of brown or black. Red, white or blue colors are occasionally seen in melanoma)
  • D = diameter (a majority of melanomas are greater than 6mm when diagnosed, which is the size of a pencil eraser; however this doesn’t mean that smaller spots aren’t worrisome)
  • E = evolving (a mole that is changing in size, shape or color)

Ways to Protect Yourself and Your Family

So, what can you do to reduce your risk for skin cancer? Protect yourself! Make sun protection a priority, not only for yourself but for your family. If you have children, make it your goal to not let them burn. Like never. Never ever.

Here are some tips I use with my own family:

  • Everyone needs sunscreen when outside. This includes just playing outside, going to the pool, going on walks, whatever it may be. The two types of sunscreen available are:
    • Chemical sunscreens: (the active ingredients are long words that are hard to pronounce, such as oxybenzone)
    • Physical sunscreens: (the active ingredients are zinc and/or titanium, easy to pronounce)

I prefer zinc/titanium-based sunscreens because they stay on better, cause less skin sensitivity issues and are better at preventing sunburn in my opinion. Examples of this type of sunscreen include Neutrogena Sheer Zinc SPF 50 or CeraVe Hydrating Sunscreen SPF 50. Overall, any sunscreen is better than none. And don’t forget, it needs to be reapplied every 2-3 hours.

  • Make hats your friend. Put them by the door you use most often to go outside. Put one in your car. I don’t know HOW many times a patient has told me, “I didn’t plan on being outside that long!” Never travel without a hat!
  • Buy rash guard swim shirts or other sun protective clothing for yourself and your family. Yep, I make my kids wear long-sleeve swim shirts to the pool. Sorry kids, but you’ll thank me later. SPF 50+ clothing is available for swimmers, golfers, fishermen, etc., at local stores such as Scheels but also on well-known websites such as www.coolibar.com. Trust me, it’s worth the money to invest in good sun-protective clothing.
  • Put on a layer of sunscreen to your face and neck every morning. Use it before applying makeup. There are some really nice, light sunscreens available over the counter. My most recent favorites for this purpose are Neutrogena Sensitive Skin Face Liquid Sunscreen SPF 50 or La Roche-Posay Anthelios Ultra-Light Tinted Mineral Sunscreen SPF 50.
  • Finally, come see me! If you are worried, questioning a spot on your skin or just want a once-over, you should visit me at South Lincoln Dermatology or see a board-certified dermatologist in your area.
Gina Weir, MD

Gina Weir, MD

Dr. Weir is a dermatologist with South Lincoln Dermatology.

2625 Stockwell
Lincoln, NE 68502

402-421-3335

Healthy Teeth for Your Baby and Toddler: When to See the Dentist, How to Prevent Cavities, & Other Dental Issues

Healthy Teeth for Your Baby and Toddler: When to See the Dentist, How to Prevent Cavities, & Other Dental Issues

If you’re the parent of a baby or toddler, you may think you have plenty of time before making her a dental appointment. After all, if she doesn’t have any teeth coming in, what’s the point? But that’s not necessarily the case. In fact, it’s never too early to get a good start on healthy teeth.

How Soon Should My Baby or Toddler See the Dentist?

As a pediatric dentist, I recommend getting kids in for their first dental checkup before their first birthday. This way we can make sure we’re preventing cavities before they occur. And for the teeth that are already in, we get a chance to see what the enamel looks like. At this age we also can determine if there is a higher risk of your child getting cavities. If we see issues that could lead to cavities we will visit with you about your child’s diet and oral hygiene, because these are important for developing healthy teeth.

And once children begin going to the dentist, I urge parents to bring them in every six months. If we identify that a child has cavities starting to form, we can catch them early.

 

Ways You Can Help Prevent Cavities and Other Dental Issues for Your Infant or Toddler

Diet

  • Reduce or eliminate sugar from their diet. You might be surprised to learn that some things that seem healthy really aren’t, because they contain a lot of sugar. This is especially true with juice and chocolate milk. My recommendation is not to give kids juice. If I give my little three year-old a small glass of juice, she’ll drink it and want more before you know it! It’s too much sugar.
  • Get them started on water. It’s a healthy habit for all of us. Having your child drink water at an early age builds healthy habits for life, plus it helps their body function properly.
  • Mind the temptations. Once kids move to solid foods, temptations are everywhere. Whether it’s coming from grandparents or parents, we like to spoil our kids. So it’s tough to want to spoil them, but then also be mindful of the sugar they’re taking in. I urge parents to be mindful of candy, cookies and chips – all of the processed treats. That includes gummies and fruit roll ups! They sounds healthy, but I call them the ‘dreaded fruit snacks’ because they create a lot of cavities. As a parent, I get it. They’re easy. But please, try to avoid purchasing those fruit snacks!

Dental Hygiene

  • Brush those teeth twice a day as soon as they come through the gum tissue, using a soft toothbrush. Your child’s age doesn’t matter. Once they get teeth, we’ve got to take care of them.
  • When you brush your child’s teeth, just gently massage the teeth. At this point you’re getting rid of plaque and keeping everything clean and healthy.
  • Use a very small amount of fluoride toothpaste. For your infant, who is not able to spit out the toothpaste, just a tiny bit of fluoride toothpaste, the amount of a grain of rice, is plenty. This is enough to help prevent decay.
  • Use whichever flavor your child likes or will tolerate. My daughter says our mint toothpaste is too spicy! She likes the fruity flavored toothpastes and those are just fine.

 

A Word About Pacifiers and Thumb Sucking

Parents often ask me about these behaviors and how they affect dental development. The question I get most often from parents is: Will this cause their teeth to grow in out of line? Unfortunately, it can. When a thumb or pacifier is in your child’s mouth, it pushes on structures in the mouth, whether it’s the teeth or bone structures, and moves them. Timely intervention is really important here.

  • Pacifier – Try to wean your child from this early on. At around a year or 18 months old, I like children to be done with the pacifier. It could be molding the upper arch and changing the shape of your child’s palate.
  • Thumb Sucking – The longer your child sucks his thumb or fingers, the higher the risk of changing the shape of his arch or palate. I recommend parents work on this habit and get it conquered by age three.

Start Early for Your Child’s Good Dental Health and Habits

I hope these tips are helpful for you. Taking your kids to the dentist early on gives them a good start on great dental health and habits, and helps get them comfortable with the environment of a dentist’s office. This also helps them have great dental experiences when they come to their dental home.

Want more dental care tips for your infant or toddler?

Get even more information from our ten minute podcast!

Marty Killeen, DDS

Marty Killeen, DDS

Marty is a pediatric dentist with Wilderness Station Pediatric Dentistry.

8 Ways You Can Prevent & Manage Diabetes

8 Ways You Can Prevent & Manage Diabetes

Diabetes is a silent disease affecting the lives of millions each year. Chances are you know someone with diabetes—a friend, family member or maybe even you. I am one of the millions living with diabetes. As a certified diabetes educator, I work to educate myself and others about how to prevent diabetes from impacting your life and how you can take care of yourself and improve your health if you have diabetes.

What Is Diabetes?

Diabetes happens when your body does not properly use the sugar in your body. The different types of diabetes are related to the reasons the body is not using the sugar. This excess sugar causes clogs in the blood stream, leading to complications.

Type 2 diabetes is the most common. With type 2 diabetes, the body either doesn’t produce enough insulin, or it resists insulin. Insulin helps keep your blood sugar level from getting too high.

Symptoms of Type 2 Diabetes

  • Increased thirst
  • Frequent urination
  • Hunger
  • Fatigue
  • Blurred vision

However, in some cases, there may be no symptoms.

Risk Factors for Developing Type 2 Diabetes

  • Having prediabetes
  • Being overweight
  • Being 45 years or older
  • Having a parent, brother or sister with type 2 diabetes
  • Being physically active less than three times a week
  • Previous gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than nine pounds
  • Being African-American, Hispanic/Latino-American, American Indian or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)

How Do I Manage Diabetes?

We must help our bodies use the sugar. When I think about how best to care for diabetes I think about BALANCE. It’s all about eating healthier, exercising more and taking better care of ourselves.

Balance in diabetes can mean a lot of things – both in terms of preventing diabetes and taking care of yourself if you have diabetes. We all know if we don’t care for ourselves, then we can’t care for others.

8 Ways to Take Care of Yourself

Here are eight areas that I focus on and share with others to take care of yourself.

1. Eat Mindfully

  • Don’t eat in front of the TV
  • Take small bites
  • Taste your food
  • Add protein and fiber to feel full

2. Take Time to Exercise & Be Active

  • Park farther away
  • Stand during commercials
  • At a minimum, commit to five minutes of exercise…it’s better than zero

3. Be Consistent When Taking Medicine

  • Place your medicine where you will see it
  • Use an alarm to remind yourself when to take your medicine
  • Mark your calendar so you know you took your medicine
  • Follow your doctor’s advice

4. Find Ways to Decrease Stress

  • Take ten deep breaths
  • Get five minutes of quiet – put yourself in timeout if you have to! (your kids will find this intriguing)

5. Add Vegetables so Meals Aren’t Meat or Carbohydrate-Heavy

  • Add lots of color
  • Make a meal plan
  • Don’t fight it…just get creative!

6. Find Ways to Keep Your Whole Family Active

  • Go swimming together
  • Go to the zoo
  • Take the kids shopping
  • Use active video games like Wii or YouTube

7. Find Ways to Eat at Home, Even When You Don’t Want to Cook

  • Cook freezer or microwaveable meals
  • Cook in the crockpot
  • Plan ahead and prepare the day or weekend before

8. Eat More Fruits & Vegetables

  • Look for sales (canned and frozen often are on sale)
  • Take vegetables from neighbors or coworkers who grow them
  • Grow your own garden
  • Buy what’s in season

Taking a Goal & Making It SMART

Much of what I do in my job is help people figure out how to achieve their goals. For instance, I would love to lose ten pounds. How can I do that? I can exercise more and eat less. However, these plans are vague. When making goals, we have to make the goal SMART.

S – Specific: I will increase my exercise by five minutes each day.
M – Measurable: I will exercise an extra 25 minutes per week.
A – Achievable: I can add five extra minutes of exercise per day while watching TV.
R – Realistic: I can add five minutes in the evening and increase my exercise. I don’t have time to increase my exercise by 30 minutes a day, but I can add five minutes a day.
T – Time-bound: I will increase my exercise and reevaluate by the end of the month. If no improvement is seen, I will change my goal strategy.

Get the Help You Need to Prevent or Manage Diabetes

If you’re concerned about developing diabetes or struggling with your diabetes or weight management (which could lead to diabetes), there is help waiting for you. Bryan Diabetes Center has nurses who are certified diabetes educators and licensed medical nutrition therapists/registered dietitians who also serve as diabetes educators. Insurance often covers this kind of education.

Bryan Health Diabetes Center

Learn more about how diabetes impacts the lives of millions every single day, get management tips, and easily schedule an appointment to speak with a diabetes expert at Bryan Health today!

We’re here to help you manage your diabetes or get on track to prevent getting diabetes in the future.

Ask your provider for a referral to Bryan Diabetes Center today! We have three locations:

  • Bryan Medical Plaza, 1600 S. 48th St.
  • Bryan LifePointe Campus, 7501 S. 27th St.
  • NorthPointe Family Medicine, 5901 N. 27th St., Suite 102

Check out these resources:

Samantha Beckler

Samantha Beckler

Health Expert

Samantha Beckler is a Certified Diabetes Educator with Bryan Diabetes Center.

Relieving Lower Back Pain

Relieving Lower Back Pain

As an interventional radiologist, I see many patients who suffer with lower back pain. It is immensely rewarding to offer my patients treatment options that:

  • Are effective
  • Done as an outpatient procedure with short recovery times
  • Provide immediate pain relief
  • Reduce the need for opioid pain medications

An interventional radiologist is a doctor that performs minimally invasive procedures through small nicks in the skin while using image guidance such as real-time x-ray, ultrasound or CT. Most procedures are outpatient and can be performed with just a local anesthetic.

Causes and Treatment Options for Lower Back Pain

A good physical exam with the addition of proper imaging of the spine when needed helps determine the cause of back pain. Initial diagnostic and treatment options may include:

  • Fluoroscopy – A technique that uses x-rays to obtain real-time moving images of the body
  • CT-guided steroid facet joint injections – Facet joints are part of the spine’s bony framework; the injection uses local anesthetic

Low Back Pain and SI Joint Pain

The sacroiliac joint (also known as SI joint) is the joint between two bones which are located in the back of your pelvis, on the left and right side. SI joint pain includes lower back pain that feels dull and aching. It can also spread to the hips, buttocks and/or groin. Some of the most common areas where you might feel SI joint pain is in the buttocks, lower back or side of the thigh.

Low Back/SI Joint Pain Treatment

If steroid injections relieve lower back pain for only a short time, a rhizotomy procedure can be performed to relieve the pain for a longer period of time. A rhizotomy procedure involves placing special needles that heat up the sensory nerves. This effectively burns a small segment of the nerve so that pain impulses can’t be sent. Pain relief lasts until the small segment is healed, which usually takes one to two years.

Sciatica

Sciatica is pain, numbness or tingling caused by a problem with the sciatic nerve. This is a large nerve that runs from the lower back, through the buttocks and down the leg. Sciatica is most commonly related to a compressed nerve in the lumbar spine from a herniated disk.

Sciatica Treatment

If physical therapy or over the counter anti-inflammatory/pain medications have not been effective, an epidural injection of steroid/anesthetic can help confirm the diagnosis and offer temporary and sometimes long-term relief.

Lumbar Spinal Stenosis

Lumbar spinal stenosis is narrowing of the spinal canal, or passageways in the spine. These passageways contain the spinal cord and nerves. The narrowing is most often caused by degenerative changes in the spine as we age. The spinal cord and the nerve roots that exit the spinal canal can become pinched. Symptoms include pain, numbness and/or cramping in the legs when walking or standing. Sometimes the symptoms can be relieved by leaning forward when sitting or walking, such as leaning over a shopping cart to decrease the pain.

Lumbar Spinal Stenosis Treatment

For moderate spinal stenosis, a small implant about the size of a dime can be placed between the bones (spinous processes) in your lower back. These bones can be felt by placing your fingers down the center of the back. The implant increases the space where your nerves exit the spine, relieving your pain.

Diagram of lower back pain

Osteoporosis

Osteoporosis affects more than 50 million people in the United States. As we age, our bones become thinner, increasing the risk of spinal compression fractures. These fractures can result from a fall, lifting something or sometimes from no event at all. If you have severe back pain that gets worse when you move, this could be caused by a compression fracture.

Treating Compression Fractures of the Spine

Minimally invasive treatments such as kyphoplasty and SpineJack vertebral augmentation stabilize the fracture and decrease pain. These procedures insert bone cement into the proper areas of the spine to ease your pain. The procedures take less than an hour. Most patients have immediate pain relief and go home the same day.

View videos to learn more about these procedures and how they relieve pain

Kyphoplasty Treatment: Esther’s Story

SpineJack Treatment: Duane’s Story 

Get Relief for Your Lower Back Pain

If you suffer from back pain and would like to learn more about our minimally invasive therapies to relieve your pain, call Bryan Interventional Radiology at 402-481-3095.

To schedule a consultation, call the Bryan Scheduling Center at 402-481-5121.

Interventional Radiologists

Advanced Radiology at Bryan Medical Center

The interventional radiologists of Advanced Radiology at Bryan Medical Center offer expertise and options to treat your back pain.

Being at the forefront of advances in medicine allows Advanced Radiology to offer patients the latest treatments in addition to current treatments. Dr. Budler was one of the first 10 physicians in the United States and the first in Nebraska trained on the SpineJack procedure. The Advanced Radiology team has the most experience in Nebraska in performing vertebral augmentation procedures like the SpineJack to relieve back pain.

Meet interventional radiologists of Advanced Radiology at Bryan Medical Center: Michael Budler, MD; John Allen, MD; Kyle Pfeifer, MD; Jeffrey Himmelberg, MD!

Foods & Exercises to Reduce Your Arthritis Pain

Foods & Exercises to Reduce Your Arthritis Pain

The pain and discomfort of arthritis can have a big effect on your quality of life. A good exercise program and a healthy diet have been shown to increase your mobility (ability to get around) and provide medication-free pain relief.

3 Areas of Focus to Reduce Your Arthritis Pain

As a nurse practitioner, I believe knowledge is power. Here are three items I share with my patients to improve their daily life with arthritis:

  • Foods to avoid because they can increase inflammation and arthritis symptoms
  • Foods that can decrease some of your arthritis pains
  • Exercises you can do without causing stress and pressure on your joints


Foods to Avoid if You Have Arthritis

There are certain types of foods that are considered pro-inflammatory, meaning they can increase inflammation. In general, more inflammation equals more pain, specifically in your joints.

Limit the following in your diet to avoid inflammation:

  • Sugar
  • Saturated fats
  • Trans fats
  • Refined carbohydrates
  • MSG
  • Aspartame
  • Alcohol

Foods high in sodium also have been found to increase inflammation, so it’s important that you try to limit these types of foods in your diet.

Most people in America tend to have diets that are high in saturated fats and trans fats. A good step is to look at food labels and make sure these are limited, if not completely eliminated from your diet.

In general, try to avoid the inner aisles of the grocery store. Most foods in this area contain refined carbohydrates and things we need to avoid because they increase inflammation. Plus, this is where you’re more likely to find processed foods. For the most part, if you can’t pronounce the ingredient on the label, it’s probably not a good choice.

Foods and Supplements that Help Arthritis Pain

Many foods are considered to be anti-inflammatory. Lowering inflammation can decrease arthritis pain.

Include these foods in your diet to help fight inflammation:

  • Omega 3s, such as fish like salmon, dark leafy greens, olive oil and nuts
  • Cherries 
  • Green tea
  • Whole grains
  • Citrus fruits like pineapple and oranges
  • High fiber foods

Glucosamine and chondroitin supplements

Our general rule with supplements like glucosamine and chondroitin is to give it a try for about three months. If you do not notice a difference in your joints and your joint pain, stop taking it. Many times people find that after they stop taking it, they notice it really was working and making a difference. I have several patients that absolutely swear by glucosamine and chondroitin.

Exercises to Ease Joint and Arthritis Pain

Low impact exercises that don’t put a lot of pressure on your knees and ankles are good options if you have arthritis.

Low impact exercises include:

  • Swimming – try lifting weights in the water for an added workout
  • Machines like a NuStep, where you’re moving back and forth and not putting weight on your knees
  • Gentle walking
  • Weight lifting with the guide of a trainer who can show you ways to lift weights and still protect your joints
  • Yoga and Tai Chi

Take Steps to Control Your Arthritis Pain and Feel Better

By reducing inflammation, you’ll have more energy to get out and walk, stretch and do other activities. If you need a bit of direction, working with a personal trainer or a nutritionist is a wonderful option.

Knowledge is power. The more you know about your disease process, proper nutrition and exercise, the better prepared you’ll be to take steps toward feeling better and living a more active, less painful life.

Want More Information on the Ways to Manage Arthritis?

Jaimie Russell

Jaimie Russell

APRN-NP

Jaimie Russell, APRN-NP, is a nurse practitioner with the Arthritis Center of Nebraska

Advice about Eating Fish: What Pregnant Women and Parents Should Know

Advice about Eating Fish: What Pregnant Women and Parents Should Know

Can you eat too much Salmon or Tilapia?

A healthy diet during pregnancy is important for the proper growth and development of your baby. As a specialist in Maternal-Fetal Medicine, I am often asked about eating fish during pregnancy. 

  • How much fish can I eat?
  • Can I eat sushi?
  • Are there “good” and “bad” fish to eat during pregnancy?
  • Is fish good for my baby’s brain development?
  • What about mercury? That’s bad, right?

Luckily, there are some clear guidelines about eating fish for pregnant women, infants and children, and people in all stages of life!

How does eating fish affect my baby’s health and brain development during pregnancy?

  • Fish, including finfish and shellfish, is low in saturated fat, high in protein and healthy to eat during pregnancy. It is also the primary dietary source for two n-3 (also called omega-3) long-chain polyunsaturated fatty acids.
  • For your baby’s optimal eye and brain development, moms need to include foods with omega-3 fatty acids in their diet.
  • Omega-3 fatty acids are especially important for moms during the last trimester of pregnancy and while breastfeeding as this is when your baby’s brain is rapidly developing.
  • Omega-3 fatty acids are also available as supplements and in fortified foods such as milk, yogurt, bread and even chocolate. You’ll just need to read the nutrition label to find out if the food includes omega-3 fatty acids. This can be an alternative source of omega-3 fatty acids for women who cannot or choose not to consume fish.

What about mercury?

  • While mercury is present in all fish, the levels vary depending on the type of fish.
  • One to three servings per week of a variety of seafood high in omega-3 fatty acids and low in mercury are recommended by the United States Food & Drug Administration and Environmental Protection Agency.
  • Mercury, also called methylmercury, is toxic to your baby’s developing brain. For this reason, it is important to avoid eating fish high in mercury. It cannot be ‘cooked out’ of the fish, and over 95 percent of it is absorbed. You want to gain the benefits of omega-3 fatty acids that fish provide while limiting the negative side effects of mercury.
  • Avoid eating fish high in mercury such as: king mackerel, marlin, orange roughy, shark, swordfish, tilefish (Gulf of Mexico), tuna and bigeye.

Can I eat fish caught at a lake, river or coastal area?

  • Fishing is a popular pastime for many Nebraskans.
  • Check for advisories about the safety of eating fish caught in areas where you plan to fish. This can usually be found on websites or through a Google search.
  • If no advice is available, the United States Food & Drug Administration recommends limiting the amount of fish you eat caught in these areas to six ounces (one average meal) per week and not eating any other fish during that week.

What about sushi?

If you’re pregnant, you should only eat cooked fish. And if you love sushi, don’t worry! There are many sushi options that use cooked fish. You can usually find these options on the menu or you can ask your server.

Which fish are good for me, my baby and family?

To answer the question in this blog title, Salmon and Tilapia are in the Best Choice category, and two-three servings per week is recommended.

The following table sums it up nicely!

Advice for eating fish.

Follow this link for more advice regarding eating fish from the FDA.

What is a Maternal-Fetal Medicine doctor?

Benjamin Byers, DO

Benjamin Byers, DO

Maternal-Fetal Medicine Specialist

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

He has been in practice in Lincoln since 2014. Before this, he was a doctor in the US Army for 13 years, achieving the rank of lieutenant colonel. Although native to Iowa, he is an avid Cornhusker fan!

How to Promote Healthy Screen Time for Your Kids

How to Promote Healthy Screen Time for Your Kids

Today’s children are growing up immersed in digital media. In the past couple years, we have seen an explosion of social media, different devices and ways for kids to interact with technology.

The concept of screen time is also changing. Kids used to spend their screen time watching TV. Now with computers children and teens are not really watching as much TV, although they are watching shows on their computers. And of course they’re watching YouTube! They’re also on Instagram and Snapchat. Plus, a lot of their schoolwork and homework is done on the computer.

All of this changes how we look at screen time.

Changing Times and a New Way to Look at Screen Time

In the past, the recommendation was two hours of screen time a day, and that was pretty straightforward. Nowadays, if we set a two-hour limit a lot of kids would hit that before lunchtime because they’re doing homework on screens in their classrooms. So we have to look at screen time differently. Rather than a specific number of hours per day, we need to look at what types of media children are using and the value of the interaction.

Think of Screen Time like the Food Pyramid

There are things we should have sparingly and there are things that should fill more of our plate.

At the top of the pyramid, the fats and sweets of screen time use, is mindless watching. This is where a child sits in front of the TV (or on an iPad or computer) and watches cartoons. This is fine when parents need to make dinner, or the child needs a break to watch their favorite show. It’s just not something you want to do all the time.

Below that on the food pyramid I think of watching shows with your child. This is better because you’re able to engage with your child. Instead of your child just sitting there, you can enjoy the show with them. You can ask, “What would you do if that happened to you?” Or, “What do you think she’s going to do next?” This creates a conversation and encourages your child to think about different things while watching something fun.

Below that, and even better, are educational games where your child can either learn something or solve puzzles. This engages your child’s mind. So when you’re breaking up screen time, you can allow more time for activities versus mindless show watching.

Guidelines for Screen Time by Your Child’s Age

Under 18 months

Use screens as sparingly as possible. Sometimes younger children will be exposed to screens when older siblings are watching TV or are on the computer. I would try to be aware of this and prevent it from happening as much as possible.

Around age 2

You can start to introduce screen time. I encourage parents to be very consistent and thoughtful about what types of digital media your children are exposed to. Giving a child a cell phone at a restaurant to help them wait until the food arrives, that’s fine. I worry more when kids are at home and instead of playing with a parent, sibling or toy, they’re in front of a TV or tablet.

Early Tweens and Older Children

Starting in the early tween years (and even around age 8), I would definitely have a very close eye on your child’s screen time use. This is where children develop a lot of habits they might have for the rest of their life in terms of screen time and the way they interact with others online.

For older kids, there’s Instagram, Snapchat and a million other social media platforms. Being very careful about how much time you allow your child to have on these platforms is critical. It’s also important to make sure they aren’t replacing all of their interaction with their friends and peers with online interaction.

Guidelines for parents:

  • Know your child’s passwords
  • Be able to look at their phone/device at any time
  • All devices should sleep, meaning charge somewhere other than the bedroom so notifications don’t disrupt sleep
  • Children should use their screens in public places in the house, the family room or kitchen table

Setting guidelines gives your child some autonomy and also protects them from some of the dangers that exist with social media.

Be a Role Model

The other thing I share with parents is being a role model for your child. So if I as a parent tell my children to get off their screens, but then I’m getting notifications and looking at my phone at the dinner table, or pulling my phone out when we’re having family time, I’m not modeling what I want my children to do.

It’s very important to have time where we say no phones, and we put them in a basket or a different room, and sit down for dinner or a nice conversation without anyone getting notifications or hearing text message dings. We have to model self-control as parents and say, “Okay, I’m going to put my phone on silent so we can talk, relax, watch this show together, read books or go play outside.” This shows your child what’s important to you.

Set Family Rules for Screen Time

Whatever you decide for your family, I encourage you to sit down and talk about it together, write it on a piece of paper, put it on the fridge and say, “This is our plan for screen time.” It shows your children that screen time is important for all of us.

Setting rules for everyone, and modeling that behavior as parents, reinforces that while screens are useful and have a lot to offer us, there are more important ways to interact and more important things to do than be consumed with our screens all the time.

Join our Facebook Group

Phil Boucher, MD is a pediatrician with Lincoln Pediatric Group. You’re invited to join his Facebook group for parents called “Present and Productive Parents.”

Join today, start learning and connecting with other parents.

Phil Boucher, MD

Phil Boucher, MD

Pediatrician with Lincoln Pediatric Group.

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