What Can I Do to Improve My Sleep?

What Can I Do to Improve My Sleep?

Do any of these scenarios sound familiar?

  • It’s Sunday afternoon and while sitting in my recliner watching television, I end up taking a nap over two hours. Why am I not able to fall asleep at my normal bedtime hour?
  • I had to work late and ended up eating later than normal, then watched TV and browsed on my iPhone. Why am I not able to fall asleep?
  • I had a cup of coffee or a caffeinated product during an evening meeting. Why am I not able to sleep?

It can be very frustrating when you can’t get sleep. And often, the more you worry about not being able to get to sleep the worse it is! Most people don’t realize that simple changes in your daily habits can have a big impact on your sleep.

3 Ways to Improve Your Sleep

Sleep is a vital human function just as important as the oxygen we breathe, the water we drink, and the food we eat. Here are some helpful hints on how to improve your sleep:

Keep a Consistent Sleep Schedule and Make Sleep a Priority

    • Find the amount of sleep you need to help you feel refreshed and energized during the day. Sleep needs vary for each person; there is no magic number.
    • Get up at the same time each day.
    • Avoid naps if possible. If you need a nap, limit the nap to less than an hour and no napping after 3 p.m. A nap longer than an hour or after 3 p.m. will alter your sleep-wake schedule and make it more difficult to fall asleep at night.

Develop Healthy Habits

    • Exercising regularly will help you sleep more soundly.
    • Eat regular meals and do not go to bed hungry. If you are hungry before you go to bed, eat something that is easily digestible, such as a piece of toast (carbohydrate).
    • Avoid excessive liquids before bedtime. This will reduce the number of times you wake up to go the bathroom at night.
    • Decrease caffeine products. Caffeinated beverages and foods (such as coffee, tea, cola, and chocolate) can make it difficult to fall asleep. Caffeine will affect your sleep for up to eight hours after consumption.
    • Avoid alcohol, especially before bedtime. Alcohol may help you fall asleep more easily but will wear off, causing you to wake up more.
    • Smoking may disturb sleep. Nicotine is a stimulant that could interfere with falling asleep.

Create the Right Sleep Environment

    • Make your bedroom comfortable and free from light and noise. Room-darkening shades, earplugs, and/or white noise may help.
    • Have a comfortable mattress and pillow.
    • Find a bedroom temperature that works for you. Cooler rooms often promote better sleep.
    • Stop using your electronic devices 30-60 minutes before your bedtime. The screens on the devices emit a blue light that suppresses the production of melatonin. Melatonin is a natural hormone produced to regulate our 24-hour sleep-wake cycle. Think of it this way: lights off=melatonin on, lights on=melatonin off
    • Do not take your problems to bed. Plan time earlier in the day to work on problems or plan your next day activities.

Take Steps for a Good Night’s Sleep – ZZZs, please!

When you get a good night’s sleep, it’s amazing how much better you feel the next day. It also improves your overall health.

In some cases, there are health conditions that can prevent you from getting the sleep you need, even when you adjust your daily habits to improve your sleep. If this is the case for you, it’s important to talk to your doctor to determine what might be impacting your sleep.

Cindy Dahl

Cindy Dahl

Registered Sleep Technologist

Registered Sleep Technologist, Bryan Center for Sleep Medicine

You may also like

When Should You Start Screening for Colon Cancer? 50? 45? Never?!

When Should You Start Screening for Colon Cancer? 50? 45? Never?!

When Should You Start Screening for Colon Cancer? 50? 45? Never?!

If you answered 45 – good for you! Most people don’t realize that the recommended age by the American Cancer Society (ACS) to begin these screenings has been lowered from 50 to 45—and sooner if you have an increased risk or family history.

Here are some other questions you may have:

  • Why was the age to start screening changed from 50 to 45? Studies show colorectal cancer among people younger than 50 is on the rise. The ACS determined that screening starting at age 45 could help save more lives.
  • Why is screening important? The earlier cancer is found, the more treatable it is. A significant number of people with colon cancer, especially early in their disease, don’t have symptoms. One screening method, a colonoscopy, not only detects cancer, but can prevent it by removing precancerous growths before they become cancer.
  • How could this benefit me? If found early, colon cancer can be easier to treat. But colon cancer can also be prevented through screening. That means you don’t have to undergo treatment to beat it; you can prevent it from happening and go on living your life.

If you answered never – you’re probably in good company because many people don’t want to think about this or take the time to do it. But I refer you to the above facts and hope you’ll reconsider your answer.

As an oncology (cancer) nurse navigator and mother of two, I understand that life gets busy and our own wellness is easy to put off for a later time—especially during a pandemic! With our lives being different this past year whether it be working from home, children remotely learning at home, dealing with the stress of not seeing family and friends, and of course, our ongoing daily to-do lists, we have all experienced many changes.

The one thing that remains the same is the need to keep ourselves and our families healthy and safe. This can start with regular checkups with our doctors, which should include screening for colorectal cancer if you are 45 or older, and sooner if you have a family history of colon cancer.

Answers to Common Colon Cancer/Colonoscopy Questions & Misperceptions

The following information is provided by David Newton, MD, a gastroenterologist with Gastroenterology Specialties, through a recent podcast. We encourage you to listen to the entire 10-minute podcast to get more detailed information.

How can you screen for colon cancer?
There are two ways to do this:

  • A sensitive test that looks for signs of cancer in a person’s stool (a stool-based test)
  • An exam that looks at the colon and rectum (a visual exam)

What is the benefit of a colonoscopy (a type of visual exam)?
A colonoscopy is the single most important tool we have for the detection of polyps or tumors. During a colonoscopy, a gastroenterologist screens your colon looking for any growths or polyps. If a polyp is found early, it can be removed before it has a chance to become cancerous.

What about the home-based stool kits; how do they work and are they effective at detecting cancer?
These tests can detect if cancer is present. FIT DNA testing is widely available now, and studies show they will catch 93% of cancers, which is a good number. But when looking at it closer, the test missed one in 13 colon cancers, and about 60% of larger precancerous polyps in the right colon, which we know through studies contributes to 20-30% of overall cancers diagnosed in the U.S.

One of the big differences between these tests and a colonoscopy is that with a colonoscopy, you can not only detect cancer but prevent it by removing precancerous growths.

Many people consider a home test (FIT or FIT DNA test) to avoid a colonoscopy. However, if the home test is positive, the next step is a colonoscopy.

Does insurance cover colon cancer screening?
Colon cancer screening is covered at 100% in Affordable Care Act compliant health plans.

  • If you choose a colonoscopy for screening, it is covered at 100%.
  • If you first choose a FIT or FIT DNA test, that test is covered under your screening benefit. But, if the home test is positive, you will then need a colonoscopy and that colonoscopy would be considered diagnostic and would not be covered 100% by the insurance carrier. This would be subject to both co-pay and deductibles toward the maximum out-of-pocket amount.

Note: At this time insurers are not required to (and some might not) cover the cost of colorectal cancer screening before age 50.

What about the ‘prep’ you have to do for a colonoscopy?
Times have changed! You no longer have to drink a gallon of salty water. There are many small volume prep products on the market. The one we use is only about 25 ounces of a solution that you mix with the clear liquid of your choice. In fact, many of our patients are amazed at how easy it is. So, don’t let misconceptions about what the prep was like in the past affect your future. The preps now are much easier and shouldn’t discourage you from getting a colonoscopy.

You Have the Power to Prevent Colon Cancer

Screening is a way to help find colorectal cancer early or help prevent it altogether. Being an oncology nurse navigator, I have walked alongside many patients during their journeys with colorectal cancer and feel passionate about this topic.

I hope you will go home, talk with your family and add regular screenings to your calendar—so we can stay strong and healthy for ourselves and families.

To learn more, visit the American Cancer Society.

Breanna Nedved, RN

Breanna Nedved, RN

Breanna Nedved, RN, is an oncology nurse navigator at Bryan Medical Center. This is a specially trained nurse who helps patients and their families through each step of cancer treatment.

You may also like

Should I Take Aspirin to Prevent a Heart Attack?

Should I Take Aspirin to Prevent a Heart Attack?

There’s been a hot and cold romance with the daily use of aspirin to prevent heart attacks and other conditions for years. On one hand, it’s been shown to reduce the risk of a stroke or heart attack. On the other hand, it’s been shown to increase the risk of bleeding, especially in the brain and gastrointestinal tract. And, of course, all of this leads to confusion. How do you know what’s best for you?

Follow the Research

The answer is, there is no one right answer for everyone. Many factors can play into what’s best for you – your age, current health condition, past health history and more.

Your Age

New research found that the risks of daily aspirin begin to outweigh the benefits starting at age 60. This research released in October 2021 by the United States Preventative Task Force showed the risk of aspirin causing potentially life-threatening bleeding in the brain or gastrointestinal tract increases with age. So this is definitely something for you and your doctor to consider, especially if you have a history of bleeding.

Your Health History

What if you’ve had a heart attack or stroke in the past, or you have heart disease? Does this change what you should do? Yes. If you’ve had a heart attack or stroke, taking low-dose aspirin has been found to be beneficial.

In medicine, randomized controlled trials provide the best information in terms of providing scientific data to guide decision making. Multiple trials have shown two things:

  • Aspirin is not beneficial for primary prevention. Primary prevention means preventing a first-time stroke, heart attack or other cardiovascular condition. If you don’t have a heart condition, most people would not benefit from taking aspirin daily.
  • On the other hand, if you’ve had a heart attack, stroke or heart disease, aspirin is used for secondary prevention. This means to prevent a second heart attack, stroke or other condition. Why? Because once you have these conditions, you are at a higher risk for them to occur again.

To Use or Not Use Aspirin

This can be a complex decision. The best way to decide this is to talk to your doctor to assess your risk level. Each person is slightly different. Some people have higher risks of stroke and heart attacks, while others have higher risks of bleeding.

Your doctor can provide information on the risks and benefits for your specific situation to determine if taking aspirin is right for you.

Dr. Zach Singsank

Dr. Zach Singsank

Interventional Cardiologist

Zach Singsank is an interventional cardiologist with Bryan Heart.

https://www.bryanhealth.com/find-a-doctor/profile/zach-singsank/

You may also like

Women Don’t Talk About it but They Should Know About it: Gynecological Cancer

Women Don’t Talk About it but They Should Know About it: Gynecological Cancer

Compared to other cancers gynecologic cancer is relatively rare, but it is still important for women to know about it and take action for prevention and treatment. Some forms of it can be prevented by taking simple steps. Others have no preventative measures and require awareness of symptoms to seek treatment.

As a gynecologic oncology surgeon, I want women to know the facts, be aware of the role they can play, and be able to have access to the best treatment when needed.

Gynecologic Cancers in Nebraska

  1. Endometrial cancer – This is a type of uterine cancer and is cancer of the lining of the uterus. This is the most common gynecological cancer treated in Nebraska.
  2. Ovarian and fallopian tube cancers – These are the most lethal gynecological cancers we treat.
  3. Cervical cancer – This is actually the most common gynecological cancer worldwide, but it’s the third most treated in Nebraska.
  4. Vulvar cancer – This is a rare skin cancer.
  5. Vaginal cancer – This cancer is also rare.

What You Should Know about these Gynecologic Cancers

Endometrial (Uterine) Cancer

Prevention: There is no specific prevention for this type of cancer. However, it is seen more frequently in women who are obese and have diabetes or other medical conditions that go along with obesity. This is likely due to prolonged estrogen stimulation from fatty tissue.

Warning signs: Post-menopausal bleeding is the most common warning sign. If you experience any bleeding, even minor spotting or a discharge after menopause, this needs to be evaluated to rule out uterine cancer. When following up on this symptom, about 75% of the time uterine cancer can be diagnosed at an early stage.

Ovarian Cancer

Prevention: If you carry the BRCA (BReast CAncer gene) one and two or BRCA genes, you should talk to your doctor about risk-reducing surgery because for certain groups of patients this may be something to seriously consider. It is clear that removing the ovaries and fallopian tubes reduces the risk of ovarian cancer significantly.

Warning signs: Unfortunately, there are no early warning signs. Ovarian cancer grows silently and spreads extensively before it causes much in the way of symptoms. And when symptoms occur, they are very common such as constipation, bloating and pelvic pressure. It’s normal for these symptoms on their own to come and go. But if you experience these symptoms and they persist, and continue to progress – for example, first you have constipation, and then you also have bloating and then you have nausea or vomiting, that is a reason to see your doctor.

Cervical Cancer

Prevention: There is actually a vaccine that is very effective against the human papillomavirus (HPV), which causes cervical cancer. This is an amazing step forward. A recent report shows cervical cancer is declining and this is likely due to the vaccination.

Screenings/Early Detection: A Pap smear or test is a very effective screening test for cervical cancer. While this test doesn’t diagnose cancer, it alerts your doctor to take a closer look. It’s also important to know that the vast majority of women who have an abnormal Pap smear do not have nor do they ever get cervical cancer. Even after the age where Pap smears are recommended, women should continue to have yearly exams with their doctor so that symptoms they may or may not be aware of can be evaluated.

Warning signs: Abnormal bleeding at any time (before or after menopause).

What Can You Do

The 3 most important things women can do are:

  • Get your regular Pap screenings for cervical cancer; continue yearly exams after Pap tests are no longer recommended.
  • Be aware of warning signs and if you experience them, talk to your doctor – don’t put it off.
  • Know your family history.

You know your body and are the best one to be aware, take steps where you can and seek medical advice for early detection.

Dr. Peter Morris

Gynecologic Oncology Surgeon

Dr. Peter Morris is a gynecologic oncology surgeon with Cancer Partners of Nebraska. He is specifically trained in the surgical and medical treatment of gynecologic cancers, which include the uterus, cervix, fallopian tubes, ovary, vagina and vulvar area.

This is a very narrow field of specialty with extensive training. After medical school, there is a four-year residency in general obstetrics and gynecology followed by a three-year fellowship in gynecologic oncology.

You may also like

Is It Heartburn or Am I Having a Heart Attack?

Is It Heartburn or Am I Having a Heart Attack?

It’s 9 p.m. on a Thursday night and my phone rings. I am on call for the hospital, but this time, the caller is actually a family friend. She says, “I keep having issues with indigestion and what feels like really bad heartburn. I’ve tried taking TUMS but it doesn’t seem to help. Do you think that I should get this checked out?”

As we talked more, we determined it would be best for her to seek medical attention. Thankfully she did, as she was found to have coronary artery disease. This is a condition that develops when the major blood vessels that supply blood to your heart become hardened or narrowed. In this case, my family friend needed a stent to help open the narrowed artery and regain blood flow in that area of her heart. After receiving the stent, her symptoms were resolved.

Heartburn vs. Heart Attack – How do I know what it is?

It can be hard to tell the difference between heartburn and a heart attack because the symptoms can overlap. Heartburn is discomfort from stomach acid backing up into the esophagus (the tube that carries food from your mouth to your stomach). A heart attack is when the flow of blood to the heart is blocked.

Here are some symptoms that can help you determine the difference between heartburn and a heart attack.

Symptoms of Heartburn:

  • Upper abdominal burning sensation that you also feel in your chest
  • Happens after eating or when you lay down or bend over
  • Can awaken you from sleep, especially if you ate within two hours before going to bed
  • Antacids usually provide relief
  • You may notice a sour taste in your mouth
  • May have a small amount of stomach contents rise up into the back of your throat

Symptoms of a Heart Attack:

  • Pain, pressure or tightness in the middle of your chest that you may also feel in your neck, jaw, shoulder, arms or back
  • Shortness of breath, especially with exertion
  • Cold sweat
  • Fatigue
  • Lightheadedness
  • Nausea, indigestion, heartburn or abdominal pain

Warning signs of a heart attack can vary from person to person. The most common symptom of a heart attack for both men and women is chest pain or pressure. Women are more likely to experience more “non-traditional” symptoms such as shortness of breath, nausea or jaw pain. Heart problems are more common as we get older and in people who have high blood pressure, diabetes, high cholesterol, tobacco use or a strong family history of coronary artery disease.

Don’t Ignore What You Think is “Just” Indigestion

It may be indigestion, but it may be something more serious. This is especially true if you have what you think is heartburn frequently and antacids don’t help.

Other conditions, such as esophageal spasms and gallstones, can mimic signs of a heart attack.

The best rule of thumb is, “if in doubt, check it out.”

One final note: If you are experiencing unexplained chest pain, call 9-1-1 or have someone drive you to the nearest ER.

Chris Balwanz, MD, is a cardiologist with Bryan Heart.

Chris Balwanz, MD

Chris Balwanz, MD

I am from Omaha, Neb., and specialize in cardiac imaging. I believe that a team approach in which the patient is comfortable and confident in their care leads to the best outcomes. This involves high-tech procedures and imaging as well as listening to the patient’s concerns and giving them all our attention to provide them the best quality care possible.

You may also like

How to Survive the Holidays with Diabetes

How to Survive the Holidays with Diabetes

It’s that time of year when the leaves are falling, days are getting shorter and finally it’s jacket weather. For those living with diabetes this can be a tough stretch ahead…the dreaded Holidays.

Does this sound familiar? It’s much tougher to get that evening walk in after work when it is dark by 6 p.m. School and family activities are in full swing and there’s not a minute to spare for stress relief, let alone meal planning. Your workplace office starts piling up with not so healthy snacks. You get a call from the in-laws telling you they are going to park their RV in front of your house for the month of December. Wait…wasn’t that a movie from the 90s?

What You Already Know

You probably expect this article to focus on food and exercise. You are right, as both are necessary to control blood sugars, but just for a moment. Food choices are extremely important. I rely on our diabetes educators to teach patients the finer points of diet and carbohydrate counting, whereas I like to keep things as simple as possible.

Advice I Often Give to Patients Includes:

  • “Try to avoid the unhealthy carbs.”
  • “Drink more water.”
  • “Try eating your veggies and protein on your plate before you eat your mashed potatoes.”
  • “Move more.”
  • “Be less efficient.” As in park farther from the entrance, take the stairs instead of the elevator.
  • “Try walking for 5-10 minutes after each major meal to lower your post meal blood sugars.”

These can all be helpful, but frustratingly managing your blood sugars is more complex than this.

What May Surprise You

When I sit and talk with patients our conversations often drift towards personal stressors and how these affect blood sugars. The holidays can be overwhelming for everyone. For those living with diabetes, it’s extra challenging. Checking blood sugars and taking medications on time is often easier said than done. I’ve heard many patients describe having diabetes as another full-time job they don’t get paid for.

So How Does “Stress” Raise Blood Sugars?

What exactly does that mean? I often use a grizzly bear analogy, however, you can fill in the blank with your dreaded reptile/insect/animal. A person encounters a bear in the woods and a “fight or flight” mechanism is triggered. A series of neurological and chemical changes occur in our bodies. Our body wants to make sure that our muscles, brain, and heart all have the fuel (glucose) they need to run away.

  • Cortisol and adrenaline are released from adrenal glands into the bloodstream – raising blood sugars
  • Glucagon is released from the pancreas, freeing stored glucose from the liver – also raising blood sugars

Fortunately, most of us won’t run into bears this holiday season, but on a smaller scale, daily stressors (whether emotional or physical) can cause dramatic swings in blood sugar for those living with diabetes. This is very apparent to those who use continuous glucose monitors (CGM). One can often find dramatic differences in glucose readings on workdays versus non-workdays and days with family conflict versus those without. It’s very eye-opening.

Tips to Get Through this Stressful Time of Year

So what are a few tips to get through this stressful time of year?

  • Have a game plan – anticipate stressors, and pick your battles
  • Be prepared – don’t leave home without medications, spare testing supplies, etc.
  • Don’t beat yourself up – if you have some bad numbers it’s not a math test result, just a number. Keep testing!
  • You are not alone – you shouldn’t feel like you are on an island. Diabetes affects the whole family. Enlist their help in your preparation. Educate family members on your signs and symptoms of both low and high blood sugars
  • Go easy on the alcohol – it can mask symptoms of lows and highs, not to mention leading to poor food choices. Alcohol is known to worsen other health conditions common to diabetes such as high blood pressure, high triglycerides, depression, anxiety, and poor sleep quality.

Take It One Day at a Time

Knowing what can affect your blood sugar levels and focusing on this – even with little steps and small changes – can make a big difference in how you feel. Try to work in ways to get exercise, make good food choices and keep your stress at bay. Serenity now! Wait, wasn’t that another 90s show.

Happy Holidays!

Aaron Ward, MD, Internal Medicine

Aaron Ward, MD, Internal Medicine

Dr. Aaron Ward is an internal medicine doctor. He has a special interest in diabetes prevention and management. For those living with diabetes, he is dedicated to working with patients and using emerging diabetes technologies to improve health.

“I get so excited when my patients have breakthroughs with new technologies, or are able to prevent or cut back on medication use through lifestyle changes or new therapies.”

You may also like

Breast Cancer Awareness and Prevention: Be Your Best Advocate

Breast Cancer Awareness and Prevention: Be Your Best Advocate

As a doctor, my training and focus is entirely on breast health. I love my patients and love what I do. One thing that is extremely important to me is empowering women to take control of their health – especially their breast health.

Did you know breast cancer affects 1 in 8 women? This means that the average woman has a 12% risk of developing breast cancer in her lifetime. But, the risk can increase with certain factors such as a family history of breast cancer or lifestyle habits.

While there are some things you can’t change, there are many you can. Being informed and actively engaged is the best way to take care of yourself. You have to know your history and your body. No one will take care of you like you will. Be your best advocate!

Here are a few breast cancer facts to help you.

9 Factors that Increase Your Risk for Developing Breast Cancer

  • Family history of breast cancer
  • Alcohol intake
  • Smoking tobacco
  • Not having children
  • Starting your menstrual cycle before age 12
  • Starting menopause after age 55 (longer exposure to estrogen in your life)
  • Taking hormone replacement therapy
  • An inactive lifestyle
  • Having a breast cancer gene mutation such as BRCA – this is determined through genetic testing

6 Factors that Decrease Your Risk for Developing Breast Cancer

  • No tobacco
  • Minimal alcohol intake
  • Routine exercise
  • Not taking hormone replacement
  • Being at your ideal body weight
  • Breastfeeding

What Does the Research Show, and What Do I Need to Know

Alcohol Consumption: Compared to women who don’t drink at all, women who have 3 alcoholic drinks per week have a 15% higher risk of breast cancer. Experts estimate that the risk of breast cancer goes up another 10% for each additional drink women regularly have each day.

Exercise: Research shows a link between exercising regularly at a moderate or intense level for 4 to 7 hours per week and a lower risk of breast cancer. Exercise consumes and controls blood sugar. It also limits blood levels of insulin growth factor, a hormone that can affect how breast cells grow and behave. People who exercise regularly tend to be healthier. They are more likely to maintain a healthy weight and have little or no excess fat compared to people who don’t exercise.

Fat cells make estrogen and extra fat cells make extra estrogen. When breast cells are exposed to extra estrogen over time, the risk of developing breast cancer is higher.

Ideal Body Weight: Overweight and obese women — defined as having a BMI (body mass index) over 25 — have a higher risk of being diagnosed with breast cancer compared to women who maintain a healthy weight, especially after menopause. Being overweight also can increase the risk of the breast cancer coming back (recurrence) in women who have had the disease. This higher risk is because fat cells make estrogen; extra fat cells mean more estrogen in the body, and estrogen can make hormone-receptor-positive breast cancers develop and grow.

Breastfeeding: Breastfeeding can lower your breast cancer risk, especially if you breastfeed for longer than one year. There is less benefit for women who breastfeed for less than a year, which is more typical for women living in countries such as the United States.

Signs and Symptoms of Breast Cancer

  • Breast mass (or a lump in your breast)
  • Breast redness
  • Breast skin dimpling
  • Nipple inversion
  • Nipple discharge
  • Nipple and areolar scaling, thickening or redness
  • A mass (lump) in the underarm area

Breast Cancer Screening

Early detection is your best defense. Take these steps for peace of mind.

  • Start your self breast exams in your 20s
  • Start your mammograms at age 40
  • Start your mammograms earlier if a family member had breast cancer at a young age
  • Always get a 3D mammogram
  • If you have dense breast tissue:
    • Get an MRI six months after your mammogram
    • Whole breast ultrasound can be used in addition to a mammogram

Follow up for the Care You Need

If you notice a concerning change in your breasts, schedule an appointment with your doctor. Make sure you share your concerns and the issue is investigated. Any change in your breasts should prompt an exam and diagnostic imaging.

Take care of yourself and be your best advocate!

Get More Information & Tips with our Podcast: 3 Ways to Beat Breast Cancer

Dr. Jendro shares ways to prevent breast cancer, detect it and treat it with personalized care.

Rachel N. Jendro, DO, FACOS, fellowship trained breast surgical oncologist

Rachel N. Jendro, DO, FACOS, fellowship trained breast surgical oncologist

Dr. Rachel Jendro completed medical school in Kentucky, followed by a five-year general surgery residency in Ohio. She continued her training at Moffitt Cancer Center in Florida, completing a breast surgical oncology fellowship. Her focus is exclusively on breast care, treatment and surgery.

Learn more about Dr. Jendro!

You may also like

The Truth About Knee Pain

The Truth About Knee Pain

If you’re experiencing knee pain, you’re not alone. Knee pain is quite common and the reasons behind why we experience it can vary. Here’s what you need to know about knee pain and some ways to treat it.

What Are the Causes of Knee Pain?

As an orthopedic surgeon, I see many people with knee pain. This pain can be caused by many things: age, sports injury, or overuse—even genetics. Most commonly, we see knee osteoarthritis, which is essentially the breaking down, wear and tear, of your knee joint. Our knees are covered in cartilage, which allows them to move and glide smoothly. When that cartilage surface starts to wear and break down (as most things do over time), the knee starts to hurt. We call that break down of the cartilage osteoarthritis. It’s a basic part of aging, and almost no one can escape it!

Why is Osteoarthritis So Painful?

It’s painful for many reasons. As already noted, osteoarthritis is the wear and tear of your joints. This causes inflammation, and in turn, inflammation causes pain. The pain also comes from losing the cushioning in our knees; we start to see more “bone on bone” wear. This simply means that the bones rub against one another because that natural cushioning cartilage is worn away. This creates friction and more swelling, and it leads to more pain.

What are the Signs and Symptoms of Knee Arthritis?

Symptoms vary from person to person, but the most telling sign is pain – especially with activity such as bending or flexing your knee. Consider these symptoms that you may experience with knee arthritis:

  • Is it hard to get from a sitting to a standing position?
  • Do you have trouble kneeling down, does your knee become more painful, or is it downright difficult to get off the ground once you’re kneeling?
  • Is your knee swollen – even if you didn’t have any injuries or falls?
  • Do you have pain at night? Do you have trouble falling asleep due to knee pain?

Who Is Most Likely to Get Knee Arthritis?

Knee pain and arthritis are rather universal, especially as we get older. Our knees do a lot of the heavy lifting in life. Those with knee pain might have very physical jobs, or could be athletes or just very active. They may be seeing pain from a previous injury when they were younger. Traumatic injuries are another cause of ongoing knee pain. Really, everyone is at risk of developing osteoarthritis of the knee at some point in their lives.

Is My Knee Pain Due to Arthritis, and What Can I Do About It?

How we treat knee pain and arthritis depends largely on the extent of the damage to your knee and how the pain is affecting your overall quality of life. Of course, we try to take care of it through less aggressive, non-surgical approaches. There are various treatment options to consider before moving to something like joint replacement.

Treatment options include:

  • Non-steroidal anti-inflammatory drugs – These include aspirin, Ibuprofen, Aleve, or prescription anti-inflammatories.
  • Activity modification – Your doctor and/or physical therapist can work with you to ensure you aren’t doing things to aggravate the pain and inflammation.
  • Weight loss – Carrying extra weight is bad for your knees, so there will be some people for whom weight loss can be very effective in easing pain.
  • Steroid injections in the knee – These also help with inflammation and pain.
  • Viscosupplementation (or hyaluronate acid injection) – Another type of injection that eases inflammation by adding a sort of “fluid film” and padding into the joint, decreasing friction between the bones.

Next steps: What Can I Do About My Knee Pain?

If you’re experiencing knee pain, there are steps you can take to relieve your pain. The first step would be to talk to your health care provider and get an evaluation of your knee to determine the cause of the pain and possible treatment options.

The bottom line is you don’t have to live with knee pain. I encourage you to get an evaluation, find out your treatment options, and get back to enjoying life!

Brad Webb, DO

Brad Webb, DO

Brad Webb, DO, is a board-certified orthopedic surgeon, fellowship-trained in adult reconstruction and total joints.

Learn More

You may also like

Setting Expectations for Your Children

Setting Expectations for Your Children

It’s important to have clear expectations for your children starting at a young age. Having specific rules about chores, curfew and other expectations can make life easier for you and your child. It can also help your child gain confidence, grow and learn to be responsible. As your child gets older and learns to uphold expectations, some of these expectations may decrease—and others may be added.

It’s also crucial to have set rewards and consequences when expectations are met or not met. The best way to do this is to sit down with your child and come up with reasonable expectations, as well as reasonable rewards and consequences.

What does a Plan for Expectations, Rewards and Consequences Look Like?

Here are a couple examples of how this might look for you and your child, how to put the plan in place, and how having a plan in advance can help both you and your child.

Example A – Consequences

You and your child create a plan related to curfew. You both agree:

· Curfew is 10 p.m. on weeknights

· If they are late getting home, they will lose their phone for three days

A few weeks after establishing these rules and expectations, your child doesn’t get home until after 11 p.m. In the moment, it can be easy to become upset, but having a set plan beforehand helps immensely.

Instead of saying “you’re grounded, give me your phone,” you will be able to say “because you didn’t get home by curfew, you will lose your phone for three days.” Since this was agreed to in advance, you and your child will already be aware of the consequence of staying out later. This way you’re not put on the spot trying to determine a consequence in the heat of the moment, and your child is not caught off guard by the consequence since they participated in creating it.

Example B – Rewards

Setting expectations can also work to reward your child. If you have younger kids, you could have a list of chores and expectations that they can do to gain rewards. When they meet a certain number of chores/expectations a day, they might be able to earn one hour of screen time. Another option might be that they aren’t allowed to have screen time until they complete a certain number of tasks.

Tips for Setting Expectations & Consequences/Rewards

Here’s a list of tips to follow when setting expectations and consequences/rewards.

  • Be clear and concise
  • Be reasonable
  • Don’t take away things for an undetermined amount of time
  • Don’t say “you won’t get your phone back until you learn to respect me” as that is a very subjective measure and difficult to quantify for both you and your child
  • Having a set amount of days is the easiest way to have a consistent and clear expectation
  • What works for one child may not work for another; plans should be individualized for each child
  • Write down or print the list of expectations and consequences/rewards, and keep them somewhere visible for the family
    • This will help your child remember what is expected, as well as know what will happen if they decide to stay out later than curfew or fail to do chores
  • Make sure the list is manageable for you and your child; having too many expectations will be overwhelming
  • Be consistent – if you sometimes give the reward or consequence and sometimes don’t, this will create confusion for your child

Want Ideas for Reasonable Expectations?

There are several online resources available to help! You can search reasonable expectations by age and developmental level, as well as advice from other parents. Just remember each child is unique, and what works for others may not work for your child.

Here’s one resource you may want to check out: The Ultimate List of Age-Appropriate Chores.

If your child sees a therapist, they will also be able to help you and your child come up with a plan.

Set Expectations & Help Your Child Grow

It’s never too soon or too late to set expectations to help your child grow and become responsible, and to celebrate your child’s achievements as they take on responsibilities. The key is to work together, set reasonable expectations and consistently follow through.

Also, remember life’s a work in progress! There may be times when you need to adjust expectations or set new expectations, and this is perfectly fine.

Arianna Shay, PA-C

Arianna Shay, PA-C

Arianna Shay, PA-C is a physician assistant with Bryan Heartland Psychiatry. She graduated from Union College with a masters degree of physician assistant studies in 2019. She has worked in child and adolescent psychiatry for over two years, and is part of a wonderful inpatient team of providers, therapists, social workers, nurses and mental health technicians. Arianna works with children, teens, parents and families.

You may also like

CBD Oil: Does it work? Is it Safe? What Do I Need to Know?

CBD Oil: Does it work? Is it Safe? What Do I Need to Know?

Many of us have been stuck in traffic and noticed roadside signs or smoke shops advertising for CBD oil. But, does it work? Is it safe? Is it legal? How is it different than marijuana?

As a doctor, I had these same questions and did my own research. Based on this, I can tell you that it’s legitimate and it works!

What Is CBD Oil?

CBD (or Cannabinoid) oil is extracted from the marijuana plant. The CBD portion of the plant is extremely valuable, particularly in treating pain. CBD oil is used to unlock the body’s own endocannabinoid system, which affects metabolism, diabetes, pain regulation, inflammation, digestion and so much more. Also, it’s important to know that CBD oil has none of the hallucinogenic properties typically associated with marijuana or THC.

Benefits of CBD Oil

Some of the many benefits of CBD oil include:

  • Natural
  • Powerful anti-inflammatory
  • Fewer/no side effects compared to current medications
  • No hallucinogenic properties
  • Pain relief

Who Can Benefit from CBD Oil?

In our experience, CBD oils work well for a number of people including those who:

  • Have chronic pain
  • Cannot tolerate non-steroidal anti-inflammatory drugs (NSAIDs)
  • Have allergies/dependence issues with opioids
  • Have tried numerous pain relief options unsuccessfully
  • Are not healthy enough for surgery or surgery did not successfully provide pain relief

How Do I Take CBD Oil?

There are a wide range of methods for taking CBD oil to experience its benefits. These include:

  • Sublingual – where you place the oil under your tongue so it dissolves and absorbs into your blood through tissues under the tongue. With this method, there are also many different flavors available.
    • At Capital Foot & Ankle, most of our sublingual options are full-spectrum, meaning they contain more of the hemp plant than just the CBD, including small amounts of THC (less than 0.3%). THC is the chemical found in marijuana. It can have side effects such as hallucination. Less than 0.3% of THC is a healthy amount.
    • We also carry isolated CBD sublingual oil, which contains no THC.
  • Gummies and soft gels that can be taken orally
  • Topical options which you apply to your skin

How Can I Learn More & Find Out What’s Best for Me?

Stop in and ask our experts. All of our staff are trained on the use of CBD oil and available to answer your questions. CBD oil is an over-the-counter product–you don’t need a prescription or an appointment to obtain and benefit from this natural remedy for many health conditions.

Capital Foot & Ankle:

  • Located at: 5055 A Street on the 4th floor of the 5055 Building
  • Hours: Monday-Friday, 8 a.m.-5 p.m.
  • Phone: 402-483-4485
Jeffrey Wienke, DPM

Jeffrey Wienke, DPM

Dr. Jeffrey Wienke, DPM, is a foot & ankle specialist at Capital Foot & Ankle.

You may also like

7 Ways to Strengthen Your Bones & Lead an Active Life

7 Ways to Strengthen Your Bones & Lead an Active Life

Our bones are amazing structures that keep us upright, and along with muscles, ligaments and tendons, they allow us to move and participate in activities that make life worthwhile!

Bones are made of minerals—calcium and phosphate—proteins, collagen and growth factors that stimulate growth of bone tissue. Just like your car needs routine maintenance, your bones also need care and attention.

Factors that affect the growth and strength of your bones

Healthy bone remodels, which means bone cells are formed and turned over in a metabolic cycle. This process can be affected by certain medical conditions, medications, age and habits.

Bone density is a measurement that shows the strength and thickness of your bones. Bone density is at its highest around age 25. After this, you lose about 0.5% of your bone mass each year until age 50. Then, the rate of bone loss increases. Osteoporosis occurs when you lose too much bone mass. This loss of bone density weakens your bones and can make them more prone to fractures. In fact, two million bones are broken each year due to osteoporosis.

As an orthopedic trauma surgeon, I fix broken bones, and many of my patients had fractures as a result of osteoporosis. If you break a bone, we work to take care of the fracture and to optimize your bone health during recovery and beyond. My ultimate goal is to help people take steps for healthy bones before a break happens.

Are you at risk for osteoporosis?

There are risk factors we can control, and some we cannot. Osteoporosis is more common after age 50, and affects women more than men. Smoking, drinking more than 2-3 alcoholic beverages per day, taking certain medicines, vitamin D deficiency, menopause, hormone disorders and poor nutrition can put you at risk of osteoporosis.

7 Steps You Can Take for Healthier Bones

1. Get a Bone Mineral Density Test (DEXA Scan)

What is a DEXA scan and when should I get one?

This test is the best way to determine your bone health. It uses low doses of X-rays to measure the amount of minerals – mainly calcium – in your bones. Test results show the strength of your bones and can help your provider know if you are at risk for osteopenia or osteoporosis.

Women should receive this test starting at age 65, or age 55 if you have high risk factors. Men should receive this test starting at age 70.

2 & 3. Get Enough Calcium & Get Enough Vitamin D

How much calcium and vitamin D do I need and how do I get this in my diet?

How much calcium and vitamin D you need depends on several factors. Women and men have different nutritional needs, and these vary based on your stage in life.

Daily dietary requirements for: Calcium Vitamin D
Infants None needed 400 IU/day if breastfed
Children 700-1,000 mg/day 600 IU/day
Teens and young adults 1,300 mg/day 600 IU/day
Adults under age 50 1,000 mg/day 400-800 IU/day
Pregnant women 1,500 mg/day 800 IU/day
Lactating women 2,000 mg/day 800 IU/day
Women age 50+ 1,200-1,500 mg/day 800-1,000 IU/day
Men age 50-70 1,000 mg/day 800-1,000 IU/day
Men age 71+ 1,200 mg/day 800-1,000 IU/day

Eating a well-balanced diet will help you get much of the calcium and vitamin D you need.

  • Dairy products such as yogurt, cheese, milk and even ice cream (yay!) are rich in calcium and vitamin D
  • Green veggies (spinach, broccoli), mushrooms, egg yolks and some fatty fish provide vitamin D
  • Look for fortified foods with added vitamin D such as tofu, plant milks, cow’s milk, orange juice, cereals and yogurt
  • For those who don’t get enough calcium and vitamin D in their diet naturally, supplements are available over-the-counter

4. Exercise

How much and what type of exercise do I need to keep my bones healthy and strong?

You should get 30 minutes of weight-bearing exercise most days of the week. Some examples include fast walking, light weight lifting, using resistance bands, dancing, yoga and riding a bike or stationary bike.

The good news is you can do most of these things in the comfort of your own home! There are also many great exercise programs available in the community for those who would like someone to guide them.

5. Prevent Falls

Why is this important and what can I do to reduce my risk of falling?

Falls are the #1 cause of osteoporosis-related fractures in men and women over age 55. Here are steps you can take to protect yourself and prevent falls.

Ways to prevent falls inside your home

  • Make sure you remove throw rugs and clear clutter on the floors and stairways
  • Don’t walk around in socks or slippers
  • Use rubber mats in the shower
  • Use nightlights
  • Be careful with your pets running around your feet

Ways to prevent falls when you’re outside

  • Wear shoes with good traction
  • Watch for slippery floors and curbs
  • Use a cane or walker if you feel unstable (especially in bad weather)
  • Have your vision and hearing checked regularly

Bryan offers balance testing and fall evaluations to access your risk of falling. This evaluation will look at your health history, assess your joint movement, muscle strength and test your mobility and walking skills. This information will allow your therapist to design a program to address your unique needs to help you get stronger and feel more comfortable on your feet.

Learn more and schedule an appointment today. 

6. Don’t Smoke

Smoking reduces the blood supply to your bones. It also decreases your body’s absorption of calcium, which is necessary for bone health. The nicotine in cigarettes slows production of bone-producing cells.

It’s hard to make lifestyle changes, especially when we’ve had a habit for many years. Talk to your primary care provider about programs or medications that can help you start the process of quitting. It’s also helpful to have a good support system around you to keep you encouraged and on the right track. Ask your significant other to quit with you!

7. Limit Alcohol Intake

Alcohol interferes with your body’s ability to absorb calcium and vitamin D. It also interferes with the hormones important to bone health which can lead to bone loss.

Limit alcohol intake to no more that 2-3 drinks per day (1 drink is 5 ounces of wine, 1.5 ounces of hard liquor, or 12 ounces of beer).

I’ve already been diagnosed with osteopenia or osteoporosis…is it too late for me to have healthy bones?

It’s not too late! Talk to your doctor about treatment options. This might include prescription medicine to increase your bone density. Also, make sure you take steps to optimize your nutrition, calcium and vitamin D intake. 50% of women with untreated osteoporosis will go on to break a bone – so taking these steps is important for your health.

Your bones need your support so they can work to support you!

The human body is an incredible machine, and it requires care and attention to run efficiently and stay healthy. Our bones need us to eat a well-balanced diet including enough calcium and vitamin D, exercise, and keep away from smoking and excessive drinking. Taking these steps will help us avoid bone loss and risk of fractures. It’s also important to get your bone density checked, and if diagnosed with osteopenia or osteoporosis to make sure it’s treated appropriately.

Taking care of your skeleton will help you keep doing the things you enjoy in life!

Alesha Scott, DO

Alesha Scott, DO

Dr. Scott is an orthopedic/trauma surgeon with Bryan Trauma.

You may also like

Are You Getting Enough ‘Vitamin N’?

Are You Getting Enough ‘Vitamin N’?

‘Vitamin N’ is Nature. And nature is nurture.

Our weather is getting nice for outdoor activities, and guidelines for COVID-19 are starting to ease. What better time to take it outside for a rejuvenating, wellness-boosting nature break?

Research Shows Nature’s Health Benefits

Walking, gardening, hiking, biking, bird watching and other outdoor activities all offer health benefits. Take a walk or a bike ride on our trails or around an area lake, start up a game of Frisbee, or find a serene spot for yoga or stretching. These activities not only help increase our fitness but are excellent ways to relax and relieve tension.

Research shows there are many therapeutic benefits to being in nature: helping with sleep, boosting energy and decreasing stress hormones among them. Studies point out that just a 20-minute ‘nature pill’ can reduce stress hormones. Add several of these sessions per week, and research says you might see decreased depression, anxiety and negative thinking. Time in nature can lower blood pressure and even help with blood sugar control for those with diabetes.

Your physical fitness will improve, too. Get outside to help with weight loss goals, as well as reduce your risk of heart disease. Look to local and state park organizations for programs and trails; it can make for a great family and friend activity, too. Area lakes are another healthy source for fresh air, sunshine and movement.

How to Stay Safe Outside

Here are some things to remember to ensure your safety in the great outdoors:

Use Sunscreen

Choose a broad spectrum sunscreen that blocks both UVA and UVB rays, and make sure it’s a minimum of SPF 15. If you plan to spend the day outside in the sun, boost that to at least SPF 30. Make sure you apply it to all areas of sun-exposed skin, and don’t scrimp! Sunscreen helps prevent the immediate pain from a sunburn, as well as skin cancers related to sun exposure.

Stay Hydrated

Bring plenty of water on your adventure. If you’re exercising or working in the garden, this is doubly important. Most healthy adults should drink about 2 liters of water per day. This need increases with strenuous activity or time spent in the heat. Sports drinks replenish electrolytes lost through sweating and may be useful if you’ve been exercising or if you’re prone to sweating a lot.

Signs of heat-related illness may at first be mild. However, symptoms can become progressively worse and may involve elevated temperatures, lightheadedness, nausea, vomiting and muscle cramps. Severe dehydration often requires emergent treatment and IV hydration. The best treatment for dehydration is truly prevention.

Remember Insect Spray

This is especially important if you’re hiking or spending time in more undeveloped areas, like lakes and wooded parks. Mosquitoes, spiders and ticks can be more trouble in warmer weather. While most bug bites are only a nuisance, some can cause more serious diseases such as West Nile, Zika and Lyme disease. Choose an Environmental Protection Agency-registered repellent that has DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), para-menthane-diol (PMD) or 2-undecanone as the active ingredient.

Always read the label, but some general precautions include:

  • If using both sunscreen and bug repellent, apply the sunscreen first
  • Do not use insect repellent on children younger than age 2
  • Keep repellent out of the eyes, nose and mouth
  • Do not apply bug repellent on children’s palms
  • Clean your hands after applying
  • Do not apply repellent under clothes

Get Back to Nature for Your Mental & Physical Health

Our culture promotes too many indoor, sedentary activities. It’s time to promote a “back to nature movement” and reap the positive contributions of ‘Vitamin N’.

Whether you go it alone or with others, when you do more activities out in nature, you’ll gain improved fitness and energy, while reducing tension and depression.

Julie Wiekamp, PA-C

Julie Wiekamp, PA-C

Julie Wiekamp, PA-C, is a physician assistant at Cheney Ridge Family Medical Clinic. She cares for patients of all ages and has a special interest in women’s health, nutrition, high blood pressure and diabetes.

Learn more about Julie and the care she provides.

You may also like

Pin It on Pinterest