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.

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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.

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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.

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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.

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What Is a Thyroid & How Does It Affect My Health?

What Is a Thyroid & How Does It Affect My Health?

Although small, your thyroid has a big impact on your overall health. When it’s working as it should, most people don’t think about the role of their thyroid. As an endocrinologist, my specialty is the diagnosis and treatment of hormone-related conditions.

So, let’s talk more about this little gland and how it helps your body.

What Is a Thyroid?

The thyroid is a butterfly-shaped gland that sits in the front of the neck. Its job is to make thyroid hormone (T4) which circulates through the blood to the rest of the body. This hormone helps your body use energy.

How Does the Thyroid Work?

The thyroid works by creating T4 (which has 4 iodine molecules) that the body converts to T3 to use as energy when needed. The pituitary, which is a small gland in the brain, regulates how much thyroid hormone is created by producing thyroid stimulating hormone (TSH). There is a feedback loop created to keep everything in balance.

Drawing that illustrates how the thyroid works.

If the TSH increases, then the thyroid responds by making more T4. If the T4 increases, then the pituitary responds by reducing the amount of TSH produced. It’s like a faucet; the TSH turns on the T4 and the T4 turns off the TSH.

What Is Hypothyroidism?

Hypothyroidism is when the body does not have enough thyroid hormone (T4). This causes an increase in the TSH. It might also be referred to as an underactive thyroid.

Drawing of how hypothyroidism works.

Diagnosing hypothyroidism: Diagnosis is made when laboratory blood tests show an elevated TSH and a low T4.

Symptoms of hypothyroidism can vary but include: Feeling colder, getting tired more easily, drier skin, becoming depressed and developing constipation.

Some causes of hypothyroidism are: Hashimoto’s disease, surgical removal of the thyroid, radioactive iodine, thyroiditis, some types of medication and damage to the pituitary gland.

  • Hashimotos is an autoimmune disease where antibodies (TPO or thyroid peroxidase antibodies) cause damage to the thyroid, making it unable to produce thyroid hormone. This can happen quickly or over several years. It is more common in women and tends to run in families.

Treatment of hypothyroidism: Prescription levothyroxine (T4). It is important to take this medicine first thing in the morning without any other medications, supplements or food.

What Is Hyperthyroidism?

Hyperthyroidism is when the body produces too much thyroid hormone (T4) which results in a decreased TSH. It might be referred to as an overactive thyroid.

Drawing that shows how hyperthyroidism works.

Diagnosing hyperthyroidism: Diagnosis is often made when laboratory blood tests show a low TSH with an elevated T4 and/or T3. Some patients may need an ultrasound and thyroid uptake scan to diagnose toxic thyroid nodules or thyroiditis.

Symptoms of hyperthyroidism can include: Nervousness, anxiety, increased sweating, palpations (which can cause an irregular heart beat), hand tremor, difficulty sleeping, muscle weakness (especially upper arms and thighs) and increased frequency of bowel movements.

Some causes of hyperthyroidism include: Grave’s Disease (autoimmune), toxic nodules, thyroiditis or too much thyroid hormone replacement.

  • Grave’s Disease is an autoimmune disease and the most common cause of hyperthyroidism. It is caused by an antibody called TSI (thyroid stimulating immunoglobulin) that triggers the thyroid to produce too much thyroid hormone. It can also be associated with an eye disease that causes bulging of the eyes.
  • A thyroid nodule is an abnormal growth of tissue within the thyroid gland. A toxic nodule causes the thyroid gland to produce excessive amounts of thyroid hormone without the influence of TSH.
  • Thyroiditis is an inflammation of the thyroid gland that results in damage to the thyroid cells. It can be caused by several things including infection, autoimmune disease or some medications. Some women may also experience thyroiditis within a year after giving birth. Symptoms are usually those of hyperthyroidism initially and then hypothyroidism as the thyroiditis runs its course. In most people, thyroiditis resolves itself.

Treatment depends on the cause of hyperthyroidism: If the cause is Grave’s Disease, it can be treated with medication, radioactive iodine or surgical removal of the thyroid gland. A toxic nodule is treated with surgical removal of the nodule. Thyroiditis usually improves on its own with treatment of the underlying cause, and patients often receive treatment only for symptoms they are experiencing.

What Should I Do if I Think I May Have a Thyroid Problem?

Consult with your doctor about your symptoms and/or concerns.

Madeline Jones-Ryan, DO

Madeline Jones-Ryan, DO

Madeline Jones-Ryan, DO is an endocrinologist with Complete Endocrinology, part of Bryan Physician Network.

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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 2021 calendar—so we can stay strong and healthy for ourselves and families.

To learn more, visit the American Cancer Society.

See a Colonoscopy

Bryan patient Ruth Van Gerpen and her doctor, Mark Griffin, MD, gastroenterologist, share details about this important screening for colon and colorectal cancer. Hear about the prep, see the actual procedure and how potential polyps (growths) can be discovered and removed.

Colon Cancer: Preventable. Treatable. Beatable.

10-minute podcast with David Newton, MD, gastroenterologist with Gastroenterology Specialties

Get the facts about colon cancer screenings including differences between home tests and colonoscopies, new details on how cases in younger people are increasing, insurance coverage and key points you need to know, and more.

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.

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Fish Oil Benefits: New Research May Surprise You

Fish Oil Benefits: New Research May Surprise You

Many of us have heard of fish oil and how it can benefit heart health, and as a cardiologist, I get asked a lot of questions about it. The truth is, studies vary on this supplement. Here is information from recent studies that provide insights into the benefits of fish oil.

It All Starts with Omega-3 Fatty Acids

Omega-3 fatty acids are most abundant in marine animals. A lot of the interest in omega-3 fatty acids and fish oils have come from observations that populations who eat a lot of fish are less likely to develop heart disease. Studies have shown that eating fish once or twice a week is associated with a reduced risk of heart disease. Other animal meats also contain omega-3, but fish, in particular, is a rich source of omega-3 fatty acids.

Research Trials & a Stunning Result

In nutrition and medicine, a lot of findings start with an observation and that’s exactly the way it was with omega-3 fatty acids. The observation being that people who eat more fish tend to live longer and have a lower risk of heart disease.

Out of this came a series of trials to study omega-3 fatty acid supplements because we think these polyunsaturated fatty acids are one of the main reasons fish is such a healthy food to include in our diets. So, the question became, “can we extract that out of the fish and use it as a supplement to try and protect us from heart disease?”

Many of the trials produced some conflicting results about whether these supplements are helpful.

But one trial had stunning results. This trial studied a prescription form of omega-3 fatty acids, called icosapent ethyl; the brand name is Vascepa. This product is highly regulated and highly purified, and the study showed it provided impressive heart protecting benefits.

Breaking Down the Research

The information about fish being a part of a healthy diet that protects us from heart disease has become so much a part of our understanding that omega-3 fatty acid supplementation is still a part of the American Heart Association guidelines to help prevent heart disease. And of course, we always recommend eating fish to protect against heart disease.

But, how effective are fish oil supplements? Three specific trials tested the fish oil supplement hypothesis. These were well-conducted studies published in the New England Journal of Medicine. Let’s break them down.

The VITAL Trial

This study was done using the types of omega-3 fatty acids you’ll find as over-the-counter supplements at the same dose recommended by the American Heart Association, which is one gram per day. These trials looked primarily at prevention for men over 50 or women over 55. Over 25,000 enrollees were followed for five years. Some received omega-3 supplements, and some received a placebo. This study showed no difference in major cardiovascular events (which included heart attacks, strokes and heart disease).

So, there was no benefit that they could document in this huge trial for five years.

The ASCEND Trial

This trial also used over-the-counter supplements but studied people with diabetes who did not have a history of heart disease. Over 15,000 people participated in the trial. They took the same dose of a fish oil supplement, one gram per day, and were followed for seven years. Again, the study did not show a significant reduction in cardiovascular events.

The topline data from these two studies is that over-the-counter fish oil supplements did not seem to protect people from cardiovascular events.

The REDUCE-IT Trial

The results of this study were positive and impressive. This was a highly credible study published in the New England Journal of Medicine. It included over 8,000 patients with established heart disease, or who had diabetes plus additional risk factors. They were followed for five years. These participants were already taking a statin, a cholesterol lowering drug, so they were already getting the standard protective, preventive therapy that we recommend for all patients who’ve had a cardiovascular event.

So, these patients were receiving good care, but they still had high triglycerides, which are associated with heart event risks. Omega-3 fatty acids are particularly good at lowering triglycerides, so the thinking was perhaps those who still had high triglyceride levels despite taking a statin would benefit from this specific form of polyunsaturated fatty acid. A key difference in this study is that patients took a highly purified form of omega-3 fatty acid. It’s called icosapent ethyl; the brand name is Vascepa. This prescription drug had already been approved by the FDA for treatment of patients with severe elevations of triglycerides, one form of circulating fats in the bloodstream. To test the effects of icosapent ethyl (Vascepa) on heart disease, subjects were given four grams a day versus a placebo, and were followed for five years.

The results were something we had never seen before related to benefits. They showed a:

  • 25% reduction in the combined end-point of heart attack, stroke, cardiovascular death and some coronary revascularization (i.e., getting a stent)
  • 26% reduction in just heart attack, stroke and death
  • 20% lower risk of death in people getting this highly purified form of omega-3 fatty acids versus a placebo

Impressive Outcomes for Highly Purified Prescription Supplement

We’ve never seen anything like these results in this area of study. It’s important to emphasize that the positive results of the REDUCE-IT trial came from a very specific form of omega-3 fatty acids in a highly purified prescription drug. This was a powerful study, and I think it will influence behavior and opinions about fish oil supplementation and omega-3 fatty acids. Over-the-counter supplements, which aren’t as highly purified or regulated, did not have the same result.

Ways to Improve Your Heart Health

If you have a history of heart disease of any kind, such as stents, angioplasties, bypass or a coronary event, you might want to discuss this purified form of omega-3 fatty acid, called Vascepa, with your doctor to see if it would be helpful for you.

As far as over-the-counter fish oil supplements, as a physician it’s difficult for me to make a strong argument for it. But if I have patients that feel it is beneficial for them in how they feel, I tell them that as long as it’s not causing you harm, ‘go for it.’ Especially if it’s not unreasonably expensive.

In cardiology and in our culture, we have a long history of trying to find that essential element out of the food and making it into a supplement, thinking that’s going to help our health. And for the most part, when put to a rigorous test, these generally fail to protect us from heart disease.

I would much rather see you eat a healthy, plant-based-leaning diet, with healthy fish and meat incorporated on a regular basis.

Dr. Keith Miller, MD

Dr. Keith Miller, MD

Health Expert

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

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Should Pregnant Women Get the COVID-19 Vaccine?

Should Pregnant Women Get the COVID-19 Vaccine?

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

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

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

Vaccines & Pregnancy

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

  • Flu vaccine
  • TDAP or Pertussis

Why are these vaccines recommended?

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

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

How does this relate to COVID-19 vaccines?

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

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

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

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

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

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

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

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

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

Other Common Questions About the COVID-19 Vaccine

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

What about breastfeeding and getting the vaccine?

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

Is there someone who doesn’t need the vaccine?

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

Is there someone who should get the vaccine?

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

What if I had COVID-19 already?

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

Does the COVID-19 vaccine cause infertility?

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

Medical Resources for Your Review

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

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

Sean Kenney, MD

Sean Kenney, MD

Maternal-Fetal Medicine Specialist

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

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COVID-19 Vaccines: Facts, Myths and Hope

COVID-19 Vaccines: Facts, Myths and Hope

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

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

How were the vaccines developed?

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

How will people get the vaccine?

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

Could the vaccine give me COVID-19?

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

Can the vaccine cause side effects?

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

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

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

How will the vaccines be distributed?

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

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

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

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

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

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

What age groups will be allowed to receive the vaccine?

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

Will children get the vaccine?

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

What are the ingredients in the vaccine?

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

A chart with the ingredients included in the COVID vaccines.

Information via CDC.gov

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

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

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

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

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

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

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

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

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

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

Can the vaccine impair my fertility?

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

I’m immunocompromised, should I get the vaccine?

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

How long does immunity last?

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

What is this idea called herd immunity?

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

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

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

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

Learn More

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

Watch Vaccine Development, Facts, Myths & Hope.

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

Watch the General Overview and Vaccine Myths & FAQs.

Katie Packard, PharmD

Katie Packard, PharmD

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

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

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

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

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

What Can You Do?

Understand the Stages of Grief

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

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

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

Find a Balance in Your Thinking

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

Think About What You Can and Cannot Control

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

Have Empathy

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

Build Connectedness

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

Understand When to Seek Help

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

Know the symptoms of depression:

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

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

David Miers, PhD, LIPC

David Miers, PhD, LIPC

Health Expert

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

Learn More About Our Counseling and Mental Health Services

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FAQs for the Flu Shot in 2020

FAQs for the Flu Shot in 2020

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

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

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

What is a flu shot?

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

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

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

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

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

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

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

Is the flu a serious illness?

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

Can the flu vaccine give me the flu?

No, the vaccine does not cause the flu.

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

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

Who should get a flu shot?

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

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

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

Does the vaccine work right away?

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

How long will the flu shot protect me?

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

What side effects can happen after a flu shot?

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

Where can I get a flu vaccine?

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

Michael Sayers, MD

Michael Sayers, MD

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

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

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

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

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

What is Atrial Fibrillation (AFib)?

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

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

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

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

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

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

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

How is AFib managed?

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

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

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

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

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

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

Matthew Kapalis, DO

Matthew Kapalis, DO

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

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