FAQs for the Flu Shot in 2020

FAQs for the Flu Shot in 2020

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

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

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

What is a flu shot?

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

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

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

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

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

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

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

Is the flu a serious illness?

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

Can the flu vaccine give me the flu?

No, the vaccine does not cause the flu.

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

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

Who should get a flu shot?

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

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

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

Does the vaccine work right away?

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

How long will the flu shot protect me?

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

What side effects can happen after a flu shot?

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

Where can I get a flu vaccine?

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

Michael Sayers, MD

Michael Sayers, MD

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

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

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

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

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

What is Atrial Fibrillation (AFib)?

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

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

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

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

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

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

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

How is AFib managed?

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

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

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

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

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

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

Matthew Kapalis, DO

Matthew Kapalis, DO

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

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Diabetic Foot Wounds: Myths, Care and Healing

Diabetic Foot Wounds: Myths, Care and Healing

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

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

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

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

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

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

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

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

What are some common myths about wounds and healing?

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

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

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

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

What about socks and footwear?

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

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

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

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

What are some tips for checking my feet?

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

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

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

Jeffrey Wienke, DPM

Jeffrey Wienke, DPM

Bryan Health Logo

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5 Ways to Keep Cool & Safe When Exercising Outside

5 Ways to Keep Cool & Safe When Exercising Outside

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

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

Hot Weather Guidelines

Take It Easy at First

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

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

Drink Plenty of Fluids, Preferably Water

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

But Don’t Drink Too Much!

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

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

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

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

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

What If You Start to Feel Sick?

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

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

Cramps

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

Heat Exhaustion

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

Heat Stroke

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

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

Any Amount of Exercise You Get Has Health Benefits

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

Cindy Kugler, MS, Bryan LifePointe

Cindy Kugler, MS, Bryan LifePointe

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

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

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

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

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

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

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

ATV Do’s and Don’ts

Do:

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

Don’t:

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

UNL Videos to Help You Prepare

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

Other ATV Resources for You

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

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

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

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

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

Have Fun and Be Safe!

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

Joni Folkerts RN, MSN

Joni Folkerts RN, MSN

Trauma Outreach & Injury Prevention Coordinator

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

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Your Ankle Pain: Could It Be Arthritis?

Your Ankle Pain: Could It Be Arthritis?

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

So What Causes Arthritis in Our Ankles?

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

Symptoms of Ankle Arthritis

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

Grade 1

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

Grade 2

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

Grade 3

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

Treatments for Aching Ankles

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

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

Who Needs Surgery and What Kind of Surgery?

Ankle fusion

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

Ankle replacement

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

What to Expect After Ankle Replacement Surgery

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

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

Dr. Eric So

Dr. Eric So

DPM

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

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

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

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

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

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

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

Strategies for Adults

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

Strategies to Help Young People in Your Life

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

We’re in this Together

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

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

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

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

David Miers, PhD, LIPC

David Miers, PhD, LIPC

Health Expert

David Miers, PhD, LIPC, is the Counseling and Program Development Manager for mental health services at Bryan Medical Center in Lincoln, Neb. 

Learn More About Our Counseling and Mental Health Services

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

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

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

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

How Do Kidney Stones Form?

Calcium or Uric Acid Build Up

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

Chronic Infection

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

Other Contributors to Kidney Stones

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

Kidney Stone Symptoms

Pain

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

What to Do if You Think You Have Kidney Stones

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

Treating Kidney Stones

Treatment depends on the size of the stone.

Water and Pain Meds for Smaller Stones

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

Surgery May be Needed for Larger Stones

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

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

Home or Hospitalization?

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

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

Preventing Kidney Stones

Hydrate

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

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

Eat Less Salt

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

Dr. Leslie Spry, MD FACP FASN FNKF

Dr. Leslie Spry, MD FACP FASN FNKF

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

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

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

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

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

Pets Improve Our Well Being

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

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

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

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

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

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

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

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

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

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

Volunteer or Visit

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

David Miers, PhD, LIPC

David Miers, PhD, LIPC

Health Expert

David Miers, PhD, LIPC, is the Counseling and Program Development Manager for mental health services at Bryan Medical Center in Lincoln, Neb. 

Learn More About Our Counseling and Mental Health Services

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Is Weight Loss Surgery Right for You?

Is Weight Loss Surgery Right for You?

My passion for weight loss management started when I worked in a family practice doctor’s office. There was a definite correlation with obesity and an increase in chronic diseases and decrease in quality of life. Now that my main focus is helping patients reach their weight loss and long-term health goals, I realize how absolutely life changing it can be.

I will admit most patients come in feeling defeated and have given up hope. Patients feel like they have tried everything from fad diets, extreme exercise and basically starving themselves. And, nothing was working. Some of these approaches led to temporary weight loss. But, they were simply unable to maintain the weight loss and often gained back more weight than they lost. When I see these patients, we talk about the benefits of surgery and a structured weight loss program for long-term weight loss. And, after the first visit they are already starting to feel a flicker of hope.

Benefits of Weight Loss Surgery

Where do I begin? There are so many! One thing I hear over and over is, ‘why didn’t I do this sooner’. Patients feel they have more energy, confidence and overall a better quality of life.

Losing Weight Improves Your Health

Weight loss surgery can help improve or even diminish major health conditions associated with obesity. Body Mass Index (BMI) is the ratio of a person’s weight to height. It is used to determine if a person is at a healthy weight, overweight, obese or morbidly obese. BMI calculators provide an easy way for you to find out your body mass index.

Here are some of the many conditions that can improve with weight loss.

Diabetes

Weight loss surgery is an effective treatment option for obesity-related diabetes, especially Type 2. If you have a BMI (body mass index) of over 35, this type of surgery may be the right choice for you. After your weight loss surgery, your sensitivity to insulin will increase which means you should respond better to oral medication and any requirement for insulin injections will be reduced. Patients generally achieve a lower A1C after weight loss surgery.

Heart Disease

Losing weight makes a world of difference in helping to protect and maintain your heart health. Current research shows a significant drop in cardiovascular risk for those who have had bariatric surgery compared to those who have not. After surgery, losing weight takes a bit of strain off the heart and lowers the risk of heart failure.

High Cholesterol

We all know too much cholesterol can cause potentially serious problems. Conditions associated with high cholesterol levels include heart disease, stroke, diabetes and high blood pressure. After gastric bypass surgery, patients often achieve near normal cholesterol and triglyceride levels within just a few months. Lowering cholesterol levels helps to clear plaque and also reduces risks associated with cholesterol build-up in the arteries.

Sleep Apnea

Sleep apnea is when a person stops breathing while asleep. This can cause many health problems. Bariatric surgery is proven to reduce the effects of sleep apnea, and in some cases, cures sleep apnea.

Cancer

There seems to be a link between some cancers and obesity. However, according to several recent clinical studies, weight loss surgery reduced cancer mortality rate in patients from 29-89% when compared to a group of individuals with morbid obesity who have not had weight loss surgery.

Depression

Research shows depression and obesity are closely related. One is known to lead to the other, and vice versa. After bariatric surgery and lifestyle changes, self-esteem is known to increase. As a result, this type of surgery most definitely can help those with depression and low self-esteem related to their appearance.

Acid Reflux

Many studies have proven that gastric bypass surgery can give those with obesity excellent control of issues associated with acid reflux. In fact, weight loss surgery may be an even better option for acid reflux because patients will also benefit from significant weight loss.

Osteoarthritis

There’s a known link between obesity and osteoarthritis of the knee and hips. For those with obesity, knee or hip surgery to treat osteoarthritis may not be an option due to their weight. Weight loss after bariatric surgery can help improve osteoarthritis. This weight loss may also make a person eligible for knee or hip surgery, if it is still needed.

Qualifications for Weight Loss Surgery

You may qualify for bariatric surgery if:

  • You are 100 pounds overweight or more, with a BMI of 40 or greater, or
  • You have a BMI of 35 or greater with one or more serious health conditions linked to being obese, such as diabetes, high blood pressure or sleep apnea, and
  • You have not been able to lose weight in other ways, such as diet, exercise or medications

Other Considerations

There are several things to consider when contemplating weight loss surgery. You can look at it from two different angles both personally and financially. Here are a few questions you can ask yourself to help answer this question:

Are you looking to surgery for the right reasons? Bariatric surgery is meant to improve your overall health, it is not done for cosmetic reasons. Looking better is a “side effect”; feeling better is the goal.

Does your insurance plan cover weight loss (bariatric) surgery? Many insurance plans include bariatric surgery coverage. However, if you don’t have this coverage, we have other options available.

Do you have the emotional support you need? It is crucial that you have a strong support network of family and friends that will be there to help you through the process. We recommend close friends and family become educated about the lifestyle changes, risks and benefits of weight loss surgery so they can support you.

Ways the Bryan Bariatric Program Can Help You

At Bryan Bariatric Advantage, we have a specialized team to help you through your weight loss journey. This team includes a nurse practitioner, dietitian and surgeons. We also collaborate with mental health and exercise experts, as well as other specialty services as needed to ensure your success.

As the Bariatric Nurse Navigator, I can guide you through the entire process. Together, we can decide if surgery is right for you. We can also look at weight loss medication, if and when appropriate.

Our dietitian uses her weight loss nutrition expertise to prepare you for surgery and the life-long diet changes after surgery to achieve your goals. If surgery is not for you, she will help you to address your personal barriers with weight management and set goals to break through those barriers for good!

We’re here for you – to support and help you with compassion and expertise, and help you determine and navigate your best course to the ultimate goal of a long, happy and healthy life.

Learn More About Bryan Bariatric Advantage

Tara Wenta

Tara Wenta

APRN

Tara Wenta, APRN, works with Bryan Bariatric Advantage

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

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

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

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

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

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

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

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

Ways You Can Help Someone With a Cancer Diagnosis

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

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

Here are some ways you can provide support:

Keep in Touch

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

Visit

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

Know What to Say (And Do)

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

Know What Not to Say

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

How to Help

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

Ways the Bryan Cancer Program Can Help

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

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

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

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

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

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

Joanna Morgan MSN, RN, OCN

Joanna Morgan MSN, RN, OCN

Oncology Nurse Navigator

Joselyn Hayes BSW, CSW

Joselyn Hayes BSW, CSW

Oncology Social Worker

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

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

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

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

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

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

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

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

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

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

If you are in your:

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

Taking a Dose of My Own Medicine

I recently did my own cardiovascular health assessment.

Here are my stats:

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

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

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

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

What Can Be Measured Can Be Managed

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

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

Find Out Your Risk & Take Action if Needed

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

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

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

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

Bryan LifePointe Campus, 7501 S. 27th St.

To learn more and register, click below!

Other Free Risk Assessments

HeartAware

Offered by Bryan Health

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

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

My Life Check

Offered by the American Heart Association

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

Remember to Exercise!

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

dr miller at the good life halfsy finish line

Let’s Improve our Heart Health Together

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

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

Dr. Keith Miller, MD

Dr. Keith Miller, MD

Health Expert

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

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