Straight Talk on Mammograms and Breast Cancer

Straight Talk on Mammograms and Breast Cancer

by | Oct 18, 2023 | Expert Health Tips

The primary focus of most women is not themselves. Women for the most part are focused on taking care of their family and put themselves at the bottom of the list. It is time to change this way of thinking and put you and your priorities at the top of your list! You must take care of yourself. No one is going to do it for you!

Why Should You Get Your Mammogram?

  • Mammograms detect breast cancer before it can be felt
  • Early stage breast cancer has a great prognosis (outcome)
  • The earlier breast cancer is identified the less invasive the surgery can be
  • Early stage breast cancer may be less likely to require chemotherapy

When Should I Start Getting My Mammograms?

  • Start getting your mammogram at age 40 and have them every year
  • You may need to start having your annual mammograms earlier than 40 if you have a family history of breast cancer
  • Start your monthly self breast exams in your 20s

What Factors Increase My Risk for Breast Cancer?

  • Family history of breast cancer
  • Alcohol intake
  • Smoking tobacco
  • Not having children
  • Prior chest radiation
  • Starting your menstrual cycle before age 12
  • Starting menopause after age 55 (longer exposure to estrogen in your life)
  • Taking hormone replacement therapy
  • A sedentary lifestyle
  • Having a breast cancer gene mutation such as BRCA

How Can I Decrease My Risk for Breast Cancer?

  • No tobacco
  • Minimal alcohol
    • Women who have three alcoholic drinks per week have a 15% higher risk of breast cancer
  • Four to seven hours of exercise per week can lower your risk of breast cancer by 20 to 30%
  • Weight management. Overweight women—defined as having a BMI (body mass index) over 25—have a higher risk of being diagnosed with breast cancer compared to women who maintain a healthy weight, especially after menopause
  • Breastfeeding can lower breast cancer risk, especially if a woman breastfeeds for longer than one year

What Are the Surgical Options for Breast Cancer Treatment?

  • Lumpectomy
  • Mastectomy without reconstruction (removal of all of the breast tissue)
  • Mastectomy with reconstruction (removal of all of the breast tissue and rebuilding of the breast)
  • Oncoplastic reduction (bilateral breast reduction and lift at the same time as the lumpectomy)

What Is Involved with a Lumpectomy?

  • Removal of the breast cancer and a small amount of surrounding tissue
  • Removal of a few axillary (underarm area) lymph nodes
  • Usually followed by radiation therapy
  • There is a 20% chance the cancer will reoccur after a lumpectomy alone
  • Radiation therapy can reduce the recurrence risk to 7-10%

What Is Involved with a Mastectomy?

  • Removal of the breast
  • Removal of a few axillary (underarm areas) lymph nodes
  • You can have reconstruction at the same time

There is no difference in survival rates or prognosis (outcome) with a lumpectomy and radiation versus a mastectomy. The surgical choice comes down to patient preference and breast size in relation to tumor size. You have to do what is best for you and no one else in that moment.

Take Care of You

I encourage all women now to take care of themselves. We are often focused on taking care of others, but to take care of others and be there for them, you have to take care of yourself! Take that step now and schedule your mammogram.

If you’re curious or nervous about a mammogram, here’s what to expect and how to prepare.

Dr. Rachel Jendro, DO, FACOS

Dr. Rachel Jendro, DO, FACOS

Bryan Breast Surgical Specialists

Dr. Rachel Jendro, DO, FACOS is proud to be the first fellowship trained Breast Surgical Oncologist to serve the community of Lincoln and greater Nebraska. Her motivation for serving the women of Nebraska is due to her lifelong mission to provide evidence-based medicine to enhance the standard of care through surgical expertise, compassion for women’s health, and emotional support. As an osteopathic surgeon, Dr. Jendro brings enhanced surgical training and vast experience from accredited medical institutions, and is committed to her patients through their entire journey.

As a native of Kentucky, Dr. Jendro attended the University of Kentucky. She graduated magna cum laude with a Bachelor of Science in Biology. Dr. Jendro received her medical degree from the Kentucky College of Osteopathic Medicine. Her general surgery internship and residency were completed at Grandview Medical Center in Dayton, Ohio. Dr. Jendro was selected as chief resident in her general surgery residency program at Grandview Medical Center. Dr. Jendro is board certified by the American College of Osteopathic Surgeons.

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Boundaries for Mental Well-Being

Boundaries for Mental Well-Being

by | Sep 18, 2023 | Expert Health Tips

Boundaries are limits we set between ourselves and others. They are separations that humans need to feel safe, valued and respected. Understanding the various forms of boundaries, recognizing when it’s time to set boundaries and learning how to set boundaries effectively is vital to maintain healthy relationships and safeguard our own well-being.

Types of Boundaries

  • Physical boundaries refer to personal space and physical touch. Healthy physical boundaries include an awareness of what’s appropriate and what’s not in various settings and types of relationships (hug, shake hands or kiss?). They may be violated if someone touches you when you don’t want them to or when they invade your personal space.
  • Intellectual boundaries refer to thoughts and ideas and include respect for others’ ideas and an awareness of appropriate discussion. Intellectual boundaries are violated when someone dismisses or belittles another person’s thoughts or ideas.
  • Material boundaries refer to money and possessions. Healthy material boundaries set limits on what you will share and with whom. Material boundaries are violated when someone steals or damages another person’s possessions or when they pressure them to give or lend them their possessions.
  • Time boundaries refer to how a person uses their time. To have healthy time boundaries, a person must set aside enough time for each facet of their life such as work, relationships and hobbies. Time boundaries are violated when another person demands too much of another’s time.

Signs It’s Time to Set Boundaries

  • Feeling chronically taken advantage of emotionally, financially or physically
  • Saying “yes” to please others at your own expense
  • Not meeting your needs because you tend to fear conflict and give in to others
  • Often feeling disrespected by others, but not standing up for yourself
  • Fearing abandonment, so settling for less than you deserve
  • Engaging in people-pleasing behaviors in order to be liked and receive approval
  • Engaging in disrespectful behavior that hurts others
  • Flirting with those already in relationships or flirting when you are in a relationship even when it harms others
  • Doing whatever you want to get your needs met and believing that limits don’t apply to you

Setting Boundaries Means…

  • Verbalizing what impacts your comfort levels —Using clear, brief statements to clarify one’s comfort level and needs.
  • Learning how and when to say “no” —Brief and clear is best (“I appreciate your invitation, but that won’t work for me this weekend.”) A dissertation is not necessary, and often invites further discussion rather than closure of the subject.
  • Being honest and transparent—Marking a decision to set a boundary isn’t enough. You must also communicate those boundaries to the people they involve. They are not mind readers.
  • Knowing how to expand, or constrict, the boundaries we set—Healthy boundaries mean being able to adjust depending on the situation.

How to Set Boundaries the Right Way

  • Think through what you need/want to accomplish—Give yourself time to consider what is important and consider your personal values—what matters to you.
  • Understand that different relationships require different boundaries—Boundaries with an intimate partner may be flexible, while work relationships call for more consistent, rigid boundaries.
  • Evaluate your relationships—If you aren’t getting enough of what you value such as respect, family time, etc., then the relationship may need to change or end.
  • Realize it takes practice and patience—Change is unsettling even though the end may strengthen and empower. Give it time and expect to practice, practice, practice.
  • Pay attention to relationship changes and hold your ground—Expect resistance because others have learned to be comfortable in their former manner of relating and have gotten a payoff for your “old behavior.”

If you find yourself struggling with boundaries and are not sure if visiting with a mental health professional may benefit you, take our free, confidential, online screening.

Ruth Few

Clinical Social Worker, Bryan Behavioral Health Services

Ruth Few graduated from the University of Nebraska-Lincoln with her master’s in social work in 1969. Since 2004, Few has worked at Bryan Health as a mental health therapist and clinical social worker specializing in psychosocial assessments, individual and group therapy, and discharge planning.

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Don’t Let Balance Issues Hold You Back

Don’t Let Balance Issues Hold You Back

by | Aug 22, 2023 | Expert Health Tips

Now is a great time to get out and enjoy opportunities for fun. Maybe it is a walk in the park, looking around and enjoying the birds and nature. Or it may be watching your child or grandchild’s soccer game or even playing lawn games like bocce ball at home! Or maybe it is getting out and enjoying dining in a restaurant with friends or a musical performance.

But if you feel your balance is not good and you are worried about a fall or injury, you may miss out on all these and many other fun opportunities. Don’t let concerns about balance hold you back! You can improve your balance. The first step is determining the cause and then developing a plan to address it.

Here is information to help you get back to activities that are important to you.

Common Conditions that Affect Your Balance

Balance is a broad term and can be affected by so many factors. Your balance can be affected because of:

  • Tight/inflexible muscles
  • Weaker muscles
  • Abnormal sensation (numbness/tingling)
  • Visual problems
  • Inner ear problems
  • Anxiety or fear of falls

These factors play a role on how we are able to sense information for balance and then how our muscles and nerves respond. Sometimes if those systems aren’t giving us fast enough or accurate information, we cannot react fast enough and feel unsteady.

Emotions also play a role. If we have a history or near falls or instances of instability, we may be anxious or fearful of falls. Then we self-limit, meaning we stop doing these or other activities because of this fear. As we decrease our activity, our muscles can get weaker and our joints/muscles get less flexible which makes activities that were previously easier to do harder. It is a circle that just keeps expanding and can eventually have some significant negative impacts on our mobility and overall health!

Ways to Improve Your Balance

There are several activities that can help improve your balance. You can do these on your own, or you may want to have an assessment by a physical therapist trained in balance problems to identify specific causes and create a customized program to improve your balance.

Activities You Can Do on Your Own

  • Walking, biking and climbing stairs are good ways to strengthen muscles in your lower body; a recumbent bike is a safe way to start if you have significant concerns about your balance
  • Stretching loosens your muscles and can reduce tightness and inflexibility
  • Yoga strengthens and stretches muscles; Tai Chi moves, which are gradual shifts in weight from one foot to another with additional moves, offers a good approach to improve balance

Benefits of Working with a Physical Therapist

Physical therapy is a way to identify factors that affect your balance and help you gain confidence with your activities. A physical therapist can help assess areas that can play a role in your day-to-day activities.

Stretching programs and certain strengthening activities can help target those areas if needed. Other activities can be designed to increase stability when doing specific tasks that you have avoided because of your balance such as walking and turning your head, walking on unlevel/unpredictable surfaces or being able to adjust your body positioning when in crowded areas.

In addition to strengthening exercises, physical therapy teaches you ways to make adjustments as needed based on your activities! We want you to be able to enjoy your life and not miss out on all those important and fun times!

Take Steps Now to Improve Your Balance and Your Life

Bryan Health has physical therapists trained in balance problems to help you on the path to a life with better balance. The Bryan Center for Dizziness and Balance provides more information about balance, ways to improve it and innovative treatment approaches.

Laura Corbridge

Laura Corbridge

Bryan Health Physical Therapist

Laura Corbridge received her master’s degree in physical therapy from the University of Iowa in 1999. She has worked with both adult and pediatric patients and specializes in treating those with neurological disorders including traumatic brain injury, stroke and other progressive neurological disorders. She also treats patients with chronic lung conditions. Laura has had advanced training in balance and vestibular rehabilitation including Neurocom Balance master integration training and Emory University’s certification of vestibular competency. Laura provides comprehensive vestibular balance testing services and pulmonary therapy.

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A Parent’s Guide to Infant, Baby & Toddler Sleep

A Parent’s Guide to Infant, Baby & Toddler Sleep

by | Jul 24, 2023 | Expert Health Tips

Sleep—the one thing new parents are always deprived of themselves. But what about our little ones? How can we keep them safe and ensure they are getting enough sleep in the optimal environment? It starts when you bring your baby home.

What to Expect After Bringing Your Baby Home

Newborns sleep a significant amount when they are first born. I often joke that babies eat, sleep, pee and poop with new parents who are worried about how much their newborn is snoozing. And, I assure them this will change. Newborns sleep 16-18 hours a day, and then from ages 4-12 months, most babies need only 12-16 hours of sleep a day, including naps. That will leave plenty of time for all those other first milestones.

Creating the Optimal Sleep Environment for Your Baby

Where should babies be while they are sleeping? There are some key points all parents should follow.

Babies need to sleep alone, in their own space and on a firm mattress on their backs.

Many parents want to co-sleep with the baby in their bed. But, most beds adults sleep on are too soft, with too many extras like pillows and blankets that are suffocation risks for our little ones. It is recommended that babies sleep in their own crib, bassinet or portable pack ‘n play. The mattress should be firm and flat, and a fitted sheet may be used on top to keep it clean. If you are concerned about your baby being alone, it is okay to place their crib, bassinet or pack ‘n play right next to your bed so you can reach out and touch your baby.

I recommend parents always check the product they are using (crib, bassinet, etc.) with the Consumer Product Safety Commission to ensure it meets safety standards. This is especially important if buying second-hand items. The American Academy of Pediatrics (AAP) recommends babies sleep in their parents’ room for the first six months before moving to their own room.

Although babies often fall asleep in car seats, swings and bouncers, expert recommend moving them to their crib once asleep. Additionally, newborns are often held while sleeping. This is great and totally fine if the person holding the baby is awake, but if they begin to feel drowsy, they should lay the baby down to avoid an accident.

Babies who sleep on their backs are much less likely to die suddenly in their sleep versus babies who sleep on their tummies. I always tell parents to make sure the baby’s pelvis is flat when they lay them down. Babies who are laid on their sides can more easily roll to their tummies by accident, increasing their risk of Sudden Infant Death Syndrome (SIDS). Flat on the back is safest! Once babies learn to roll themselves from back to front and front to back, it is safe to allow them to roll during sleep. Even so, it is best to start them on their backs.

A few more tips…

  • Babies should never have pillows, stuffed animals, crib bumpers or blankets in bed with them, as these items increase their risk of suffocation.
  • Newborns often like to be swaddled. Typically, we should stop swaddling babies by 2-3 months and switch to using a sleep sack with their arms out for safe sleep.
    • Avoid weighted sleep sacks as the extra weight on your baby could mimic the same scenario as a baby sleeping on their tummies, resulting in crib death.
  • We never want babies to be too cold or too hot. I recommend keeping the thermostat between 68-72 degrees year-round to keep infants comfortable. You can always adjust the number of layers the baby is wearing to help regulate their temperature.
  • We do not recommend wearing a hat inside since the head is often how babies thermoregulate and they can easily get too warm.

How to Help Your Baby Know Day from Night

After birth, babies often have their days and nights mixed up. They do not have regular sleep cycles until around four months of age. There are a few tricks you can try to help your baby (and you) get a better night’s sleep.

At night when you want your baby to sleep, avoid overstimulation:

  • Always be as quiet as possible, speaking in soft, quiet tones and keeping other noise low
  • Keep the lights dim with only enough light for you to safely see your baby for things like diaper changes.
  • This will teach your baby that night is when we sleep.

Conversely, during the day, we want to be awake and play! To encourage this:

  • Have the lights on
  • Speak at normal volumes
  • Do things like vacuum and make noise
  • This will teach your baby that day is when we play, read books, sing songs and talk.

When to Begin Teaching Your Baby to Fall Asleep on Their Own

Starting at about four months of age, I suggest trying to have babies learn to fall asleep on their own. Prior to four months, we are used to putting them down when they fall asleep eating or being held. However, normal sleep/wake cycles have us all waking up several times throughout the night. If we wake up in a different scenario than where we fell asleep, it is startling. Teaching them to fall asleep on their own allows them to be able to fall back to sleep without needing to be held or fed by a parent.

Often parents will feed babies when they wake up at night to help them go back to sleep. This will cause your baby to become more of a trained nighttime eater. As babies get older, they should be able to sleep through the night without eating. Especially when they have teeth, feeding at night increases their risk of cavities.

Sleep Training

Deciding when to sleep train your infant is a hard decision. Often parents worry they are harming their child by letting them cry and not attending to them right away. Many infants, if allowed to cry for a few minutes at night, will fall right back to sleep on their own.

There are many different techniques for sleep training and all of them are equally effective. I suggest parents research the various techniques to determine which one is most comfortable for you. The key takeaway is that your child will not be psychologically damaged by learning how to fall asleep and stay asleep on their own. In fact, it is one of the first self-soothing skills that they will learn to better handle life’s many obstacles.

Bedtime Routines

Establishing a good bedtime routine will help your child learn it is time to wind down, go to bed and sleep. Here’s a few tips to get started:

  • It is best to avoid any naps in the late afternoon as those often recharge your toddlers’ batteries and bedtime will be a challenge.
  • Bedtime is an excellent time to have snuggle time while you read books to your child.
  • Have the lights dim and use a quiet voice to further encourage them to settle down and relax.
  • Although TV is not recommended for kids under two, if they are watching screens, be sure to discontinue use at least one hour before bedtime.
  • A comfort item can help a toddler with their bedtime routine.
  • Try to use a consistent sleep environment with a dark, cool and quiet bedroom. White noise with a consistent sound can be helpful at drowning out household background noise.
  • Don’t let those cuties convince you that they need one more book. Set expectations for when snuggle and book time is going to be over and lights are going to be turned off, before you get started on the routine.

Goodnight!

Sleep is a fluid issue. It is always okay to comfort a waking child when they are ill or if they need a diaper change, etc. There will be good nights and there will be sleepless ones. But hopefully these suggestions will help your family with getting the best night’s sleep for all.

Alicia Cruce, MD

Alicia Cruce, MD

Pediatrician at Pediatrics PC in Lincoln, NE

Dr. Alicia Cruce has been proudly serving the Lincoln community since 2003. She is originally from Blue Hill, Nebraska, and graduated from the University of Nebraska Medical Center (UNMC) in 2000. She finished her training with a pediatric residency in the joint UNMC/Creighton program in Omaha and is board certified. For most of her career, she has been teaching infant care classes to expectant parents at both St Elizabeth’s and at Bryan Medical Center.

Currently, she serves on the Lincoln Pediatric Quality improvement committee and has previously served on the Nebraska chapter for the American Academy of Pediatrics and as the Chief of Pediatrics at CHI/St Elizabeth’s Hospital. She is also a volunteer faculty member at UNMC and has taught many Physician Assistant, Nurse Practitioner, and medical students through the years.

Dr. Cruce is married to Dr. Mike Cruce, a school psychologist. They have three children and three dogs. Dr. Cruce enjoys reading, cooking, travel, and spending time with her family.

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Summer Eye Safety

Summer Eye Safety

by | Jun 19, 2023 | Expert Health Tips

For many families, summer is the most wonderful time of the year. School is out, days are long, sun is plentiful and vacations, cookouts and family time outdoors are common.

Here are four tips to keep your eyes safe during this summer season.

  1. Avoid Getting a “Sunburn of the Eye”
  2. Sunscreen Is Good, But Be Careful
  3. Watch Out for “Chlorine Eyes”
  4. Celebrate America, But Protect Your Eyes

Avoid Getting a “Sunburn of the Eye”

For many families, summer not complete without a trip to the pool, lake or ocean. Much like snow in the winter, sunlight can reflect off of the surfaces of the water and sand, resulting in a painful “burn” of the eyes called photokeratitis. Pain, redness, blurriness and even temporary vision loss can occur. Wearing the right sunglasses can help prevent photokeratitis.

Tips for Choosing & Wearing Sunglasses

  • Look for sunglasses that are marked “100% UV protection” or “UV400”. The darkness of sunglasses does not equate to their UV-blocking ability.
  • Children of all ages can wear sunglasses. Encourage the use of sunglasses early in life. This can help develop the habit for continued future use.
  • For added eye protection, wear a broad-brimmed hat. These hats also make a good choice for children that do not want to wear sunglasses.

Sunscreen Is Good, But Be Careful

Sunscreen is a vital part of our skin’s protection against UV damage. However, as many people know, sunscreen and your eyes don’t mix! Sunscreen can cause pain and irritation if it gets into the eye. If this happens, flush the eyes with cool water.

Tips for Keeping Sunscreen Out of Your Eyes

  • Do not spray sunscreen directly onto the face, even if the eyelids are closed.
  • Apply sunscreen to your hands first, and then rub it onto your face, taking care to avoid the area right next to the eyelid.

Watch Out for “Chlorine Eyes”

Swimming pools can be tough on the eyes. Chemicals used to keep the water clean, such as chlorine, can affect the natural tear film that keeps our eyes moist and healthy. This can result in red, gritty-feeling eyes and blurry vision.

Tips to Keep Your Eyes Feeling and Looking Good

  • Wear swim goggles in the pool.
  • Splash your closed eyes with fresh water immediately after getting out of the pool.
  • If a child wears glasses regularly, prescription goggles can be purchased and are usually fairly affordable. Speak to your child’s optometrist or ophthalmologist for more information.

Celebrate America, But Protect Your Eyes

The 4th of July has become synonymous with fireworks celebrations, both by professionals and at home. Despite their beauty, fireworks are dangerous and can lead to eye injuries.

Did You Know?

  • 14% of injuries resulting from fireworks are injuries to the eyes.
  • 33% of these eye injuries are in children 15 years of age or younger, with 14% of these injuries to children under the age of 5.

Tips for Practicing Firework Safety

The best way to avoid a potentially blinding fireworks injury is by attending a professional, public fireworks show rather than purchasing fireworks for home use. However, for those who wish to purchase fireworks for at-home use, consider the following safety recommendations:

  • Do not allow young children to play with fireworks. They may not understand the danger involved and may not act appropriately if an emergency arises.
  • Sparklers (often considered the ideal “safe” device for young children) are the most common cause of fireworks-related eye injuries in children. Sparklers burn at approximately 2,000 degrees Fahrenheit and should not be handled by young children.
  • Older children permitted to use fireworks should do so only under close adult supervision.
  • Keep a bucket of water nearby to use for emergencies and to pour on fireworks that fail to ignite or explode.

Enjoy Your Summer!

Hopefully, you can add these tips to your outdoor routine and get the most out of your summer season!

Don Sauberan, MD

Don Sauberan, MD

Eye Surgical Associates, Ophthalmologist

Donald P. Sauberan, M.D. specializes in pediatric ophthalmology and adult strabismus. He received his medical degree from the Medical College of Wisconsin. He served in the United States Air Force as a General Medical Officer at Davis-Monthan AFB in Tucson, AZ. He then completed his Ophthalmology residency at San Antonio Uniformed Services Health Education Consortium in San Antonio, TX. He then served as a general ophthalmologist at Offutt Air Force Base in Bellevue, Nebraska. After his military service, he completed his Pediatric Ophthalmology Fellowship at Children’s Mercy Hospitals & Clinics in Kansas City, Missouri. Dr. Sauberan has clinics in Lincoln, Columbus and Kearney, Nebraska.

Dr. Sauberan is board certified and a member of the American Board of Ophthalmology, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology & Strabismus, Nebraska Medical Association, Lancaster County Medical Society, and the Nebraska Academy of Eye Physicians & Surgeons.

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Supporting Positive Mental Health in Your Child

Supporting Positive Mental Health in Your Child

by | May 16, 2023 | Expert Health Tips

Recent data released from the Centers for Disease Control & Prevention (CDC) shows that one in four high school students are feeling persistently sad and hopeless, and nearly one third are struggling with poor mental health.

As a child and adolescent psychiatrist, I am seeing an increase in mental health issues like depression and anxiety in youth of all ages. My goal is to share information and resources to help parents and their children. This can help families identify proactive measures and know when to seek help.

5 Ways You Can Promote Good Mental Health

It’s important for parents, caregivers and our youth to know there is hope, there is help, and there absolutely can be healing. Here’s what you can do to encourage healthy mental wellbeing.

Focus on Lifestyle

Positive lifestyle practices are incredibly important in development and general health of our youth. Good physical health promotes good mental health and vice versa. Encouraging good sleep habits, exercise and well-balanced meals is a great way to promote physical and mental wellbeing.

5-4-3-2-1 Grounding Exercise

During periods of anxiety or panic, this strategy can help your mind focus in the present. This is especially helpful when your mind may be bouncing from thought to thought. To do this exercise, focus on:

  • 5 things you can see
  • 4 things you can hear
  • 3 things you can touch
  • 2 things you can smell
  • 1 thing you can taste

Encourage the Arts

Listening to music, creating crafts, drawing, coloring and painting are positive for our mental health.

Practice Relaxation & Meditation

Relaxation techniques and meditation can make teens feel calmer, reduce stress and build self-awareness. By creating time for self-reflection and self care, these practices can help people struggling with mental health manage their feelings.

4-7-8 Breathing Technique

This creates calmness by regulating your heartbeat and breathing. Here’s how you do it:

  • Close your mouth, inhale through nose, counting to 4
  • Hold breath, counting to 7
  • Exhale through your mouth, making a whoosh sound, counting to 8
  • Repeat process three more times

Know Your Child & Look For Changes

Symptoms of depression and anxiety can vary from person to person and even day to day, so how do we distinguish “normal development” from potential mental health concerns? The first step is to know your child well enough to understand what their “baseline” is. This will give you a comparative perspective when trying to discern if there is a reason to be concerned. Things to look for include:

  • Decline in grades
  • Change in sleep habits, eating habits or friend groups
  • Increase in oppositional behaviors
  • Concern of substance use
  • Changes in level of isolation or withdrawal tendencies

Talk With Your Teen

Communication is the best way to strengthen the trust and connectedness between you and your child. As you open the lines of communication with your teen:

  • Show support
  • Be compassionate
  • Seek to understand
  • Avoid questioning or suggesting that your child’s concern could be a personality flaw or character trait issue
  • If your child is unwilling to open up to you, offer them help in finding a trusted person to share their struggles with instead
  • Be prepared to talk about possible next steps, which may or may not include treatment

Sometimes it can be had to start a conversation. You might be afraid of saying the wrong thing or just having trouble getting more than a one-word response. If you find yourself in this situation, here is a suggestion to open the conversation:

  • “I’ve noticed you haven’t seemed like yourself lately. How can I help?”
  • “I care about you and am here to listen. Do you want to talk about what’s going on?”

When to Seek Help

If you find yourself in a situation where communication and other resources you try are not effective, your child may benefit from a mental health evaluation and treatment. Treatment may include counseling sessions, Cognitive Behavioral Therapy, medication, coping strategies and more. The most important aspect is that the plan be specific to your child and their needs.

If you are concerned about suicidal thoughts, it’s okay to ask if they are having these thoughts. Asking the question doesn’t give someone those thoughts. Rather, it gives them an opening to express feelings they may be having.

If you have an immediate concern for your child’s safety, do not leave them alone. Warning signs indicating an immediate concern include:

  • Talking or writing about death, dying or suicide
  • Thinking about or threatening self-harm or suicide
  • Seeking access to means of suicide, such as gathering pills or weapons
  • Giving away prized possessions
  • Feeling hopeless, helpless, worthless or trapped

In these situations, it’s best to call 988, a suicide prevention lifeline, and lock up any potentially lethal objects. Children who are actively trying to harm themselves should be taken to the closest emergency room. Police and rescue personnel can assist with this if they are unwilling.

Additional Resources

At Bryan Health, we have a wide array of resources available to you. Visit our teen resources website to learn about self-confidence tools, suicide prevention, community resources, substance abuse, finding a mental health provider and more!

Learn more about Bryan Psychiatry services and available resources, or take an online screening today.

Matt Wittry, DO

Matt Wittry, DO

Child and Adolescent Psychiatrist, Bryan Psychiatry

As a child and adolescent psychiatrist, Dr. Wittry’s focus is working with youth and their families to help create positive change. The most important part of this process is building relationships and trust with you. This includes actively listening to you and your child and knowing the right questions to ask to fully understand and evaluate areas of concern. Through this evaluation, a diagnosis is made. Then, you will work together with Matt to develop a treatment plan to meet the unique needs of your child and family.

Dr. Wittry’s approach includes working with your child and you as the parent. He will also include any other individuals you feel would be helpful such as teachers, caregivers, etc. Depending on the child and situation, he will meet with you as a group and also with the parents and child individually.

His specialty is working with children and teens, and their families, to help in areas such as:

  • Depression, anxiety and bipolar disorder
  • Anger management/defiant, oppositional behaviors
  • Attention deficit hyperactivity disorder (ADD/ADHD)
  • Autism spectrum and intellectual/developmental concerns
  • Abuse and PTSD (post traumatic stress disorder)
  • Eating disorders
  • Behavior and school problems
  • Pattern of mood swings
  • Significant life changes and relationship difficulties

Treatment involves evidence-based care and a holistic approach. This may include a combination of medication management, coordination of care with other therapies, and learning and developing new skills.

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Exercise Is the Best Way to Manage Arthritis Pain

Exercise Is the Best Way to Manage Arthritis Pain

by | Apr 17, 2023 | Expert Health Tips

Your knees, hips or back are stiff and sore and sometimes hurt with certain movements, so why would you want to strength train or do other types of exercise? Simple: Exercise is crucial for people with arthritis of all kinds because it:

  • Increases strength and range of motion
  • Reduces join pain
  • Helps to combat fatigue
  • Keeps your muscles and surrounding tissue strong to support your bones
  • Helps with weight management, which puts less stress on your joints
  • Improves balance
  • Improves sleep
  • Eases depression

If you don’t exercise, your supporting muscles weaken, creating more stress on your joints. Alternatively, when you move more throughout the day, you increase the lubrication in your joints so everything is easier to do!

Useful Exercise Tips to Get the Relief You Need

  • Start slowly and warm up with some range of motion exercises for your joints.
  • Stay within a pain-free range of motion and progress as your strength increases.
  • Use a supportive sleeve or elastic wrap around your affected joint to keep swelling down and make exercise more comfortable.
  • Plan light, moderate and heavier exercise days throughout the week to help with recovery and progression.
  • Wear proper footwear with support and cushion when doing weight-bearing exercises.
  • Strength train two times a week with an exercise for every major muscle group. Just don’t do this two days in a row. Give your body a recovery day.
  • Keep impact activities low.
  • Train at a time of day when your symptoms are better.
  • Use heat prior to exercise and ice afterwards.
  • Progress slowly in intensity and/or duration. This is key!

It is very common to have muscle soreness as you adapt to the exercise, but you should not experience sharp pain. If you have a flare up, take a rest day, do an activity that is low impact or shorten your duration and/or intensity.

Benefits of Exercise for Arthritis

Exercise is one of the best treatments for arthritis. Starting with light cardiovascular activity and easing into strength training will help reduce inflammation that causes pain. You may think exercise will aggravate your joint pain, but that is not the case. It is the lack of exercise that can make your joints even more stiff and painful.

For best results, attend a class specific for arthritis. A warm water class can be a great way to start. Ideally, find a qualified trainer to create a program for your specific needs.

Personalized Arthritis Care at Bryan LifePointe

Our certified exercise professionals will create a training and exercise program that can help you transition into regular physical activity. Making activity a routine in your lifestyle is the best way to manage arthritis. We can help you create a program that is specialized to you. Below are services specific to arthritis plus much more.

To learn more about Bryan LifePointe services and how we can help with your arthritis pain, give our team a call at 402-481-6300 or visit our office in Lincoln today!

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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How to Be Your Own Best Advocate at a Doctor’s Appointment

How to Be Your Own Best Advocate at a Doctor’s Appointment

by | Mar 20, 2023 | Expert Health Tips

Have you ever gone to your doctor’s office and thought, “I have several questions I want to ask” and then gone home and realized you forgot to ask them? This happens to many people for multiple reasons. You may feel anxious during your appointment. You may feel uncomfortable asking a question. Or you may feel overwhelmed, answering so many questions about your health that you may simply forget the questions you wanted to ask. Whatever your reason is, here is what you can do to better self-advocate at your next appointment.

Prepare to Answer Basic Questions First

Knowing what to expect up front can help alleviate some anxieties. So, this is the basic process to expect during a doctor’s visit.

  1. In today’s world, you’ll start with COVID-19 questions, insurance information, emergency contacts and verifying your address.
  2. You’ll go to the scale. This part always makes me nervous because I don’t want to look.
  3. Your vitals are taken—blood pressure, temperature and pulse.
  4. You’ll review your medications and how you take them. It’s very important that you also share information on vitamins, natural supplements and any over-the-counter items you take. This helps your doctor make sure nothing interacts.

It’s a lot to go through, and all of this can occur before you get to the reason for your visit. While it may feel overwhelming now, there are steps you can take to be more confident and get the most out of your visit.

You & Your Doctor Are a Team

You both have a common goal—to take care of your health. To achieve that goal, you have to work together. This starts with being honest and sharing information with your healthcare provider. By being forthcoming, it helps them examine, diagnose and treat the problem. If you feel too uncomfortable sharing information, the doctor can’t do their job, let alone offer you optimal care.

Here’s what to do to avoid “losing your voice” when the white coat walks into the room:

  1. Prepare a list of questions before your visit. Write them down and bring that list with you to the doctor’s office. Having that list to reference will make sure you get all of your questions answered.
  2. Bring a friend or family member with you if you know you’re going to be overwhelmed. They can help you listen and ask the questions. Having a support person with you can be very comforting during a doctor’s visit.
  3. Be patient while the receptionist and nurse ask you questions. Your answers will be passed along to the doctor. This information also helps correctly pay for your bill so you don’t have to worry about it later.
  4. Write down the information you receive during the appointment. You can bring a notepad or use the notes app on your phone. Taking notes will help you remember everything that was said during the visit, including instructions for a treatment plan.
  5. Call back or send a message through your patient portal if you have questions after your visit. We want you to follow your care plan, so we’re happy to clear up any confusion. You can only follow our recommendations if you fully understand what we suggested.

These tips will help to make you feel empowered the next time you step into a doctor’s office. After all, you are your best advocate! If you or someone you know could benefit from a professional consultation, take our free, confidential mental health screening online from the comfort of your home today.

Stacy Waldron, PhD

Stacy Waldron, PhD

Licensed Psychologist, Bryan Medical Center Counseling Center

Dr. Stacy Waldron provides treatment for individuals of all ages across the lifespan and specializes with adolescents and adults. She offers individual and family therapy to help clients with stress, anxiety, mood disorders, life transitions and chronic pain. This includes helping individuals with stress management, assertiveness training, communication and problem solving skills as well as relaxation training. She also provides psychological assessments that include bariatric surgery evaluations, spine surgery, and spinal cord stimulator evaluations.

Waldron earned her doctorate in counseling psychology from the University of Southern California in Los Angeles. She serves on the Board of Psychology for the State of Nebraska, the Board of Directors for the Midwest Pain Society, and the Association of State and Provincial Psychology Boards.

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What’s Weighing Heavy on Your Heart? How Weight Impacts Your Heart Health

What’s Weighing Heavy on Your Heart? How Weight Impacts Your Heart Health

by | Feb 20, 2023 | Expert Health Tips

Obesity in the United States is increasing at an alarming rate and is a primary cause of our country’s current health crisis. More than 40% of Americans are now obese, rising from 23% in 1990. Many times the terms “overweight” and “obese” seem interchangeable. However, the CDC has specific definitions for each depending on a person’s Body Mass Index (BMI):

  • Overweight = BMI of 25.0 to < 30
  • Obese = BMI of 30.0 or higher

About three out of four adults in America are presently overweight, and the trend is only expected to increase. Obesity promotes buildup of cholesterol in your arteries, leading to heart attacks and strokes. It also gives way to high blood pressure, sleep apnea, depression, poor physical health and diabetes. As a heart doctor, the majority of diseases that I treat every day are partially due to obesity.

3 Steps to a Healthy Weight and Happy Heart

  1. Calculate your Body Mass Index (BMI): Use this BMI Calculator. It’s a quick and easy way to assess if your weight could cause health issues. It assesses your weight-to-height ratio. A healthy BMI is less than 25.
  2. Measure your waist circumference: This is measured just above your hip bones after exhaling. A waist circumference measuring over 35 inches for women or over 40 inches for men places a person at a higher risk for developing heart disease and type 2 diabetes.
  3. Increase exercise and reduce calorie intake: Increasing exercise and reducing calorie intake are great ways to lose weight. In general, we recommend the Mediterranean Diet, which is high in fruits, vegetables, whole grains, nuts and beans. It includes fish, poultry and dairy products with only limited red meat. This diet is associated with a lower risk of heart disease, strokes and several cancers.

Losing weight can be difficult for many. If you find yourself in need of a healthy change and are discouraged by the lack of results you’re seeing, know that you’re not alone. Bryan Health is here to support you along your journey.

Resources Available to Take Control of Your Weight

Bryan Health offers a multitude of resources and support when it comes to weight loss. Our team of professionals will provide education and lifestyle changes to embrace healthy eating habits, increase activity and promote positive behavior patterns you can live with for the rest of your life. We’re here to assist you in exploring which weight loss option is right for you.

Online Risk Assessment

A great first step towards a healthy weight is to take Bryan’s free WeightAware Risk Assessment. This assessment will only take seven minutes to complete, and at the end, you will receive personalized, confidential information that will help you:

  • Learn your current health status
  • Assess and identify your potential risk for conditions impacted by weight
  • Identify medical and lifestyle factors to reduce your risk of developing certain health conditions
  • Take action to reduce your level of risk through the many services available at Bryan Health

Bryan Bariatric Services

Bryan Health offers weight loss surgery, along with the education and support for your success. Call us at 402-481-5454 to schedule a consultation today.

Bryan LifePointe

Bryan LifePointe offers many services to help you on your weight loss journey. Wellness Revolution, our newest program, provides exercise, nutrition and health coaching for your overall success. Learn more at Wellness Revolution by calling 402-481-6300.

Joseph Kummer, MD, FACC

Joseph Kummer, MD, FACC

Bryan Heart Cardiologist

Born and raised in Omaha, Nebraska, Dr. Joseph Kummer attended Creighton Prep High School and the University of Nebraska Medical Center. After subsequent training in Chicago and Detroit at Northwestern Memorial Hospital and Henry Ford Hospital, Kummer became a diagnostic cardiologist at Bryan Heart. He specializes in heart catheterizations to find blockages in arteries and cardiovascular clinical work like treating hospital patients for rhythm disorders, heart failure, chest pain, and more. Kummer finds his work deeply rewarding because he can help people resolve their problems with the best quality cardiology care in Nebraska.

Learn More About Joseph Kummer, MD, FACC

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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?!

by | Feb 15, 2023 | Expert Health Tips

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 three, I understand that life gets busy and our own wellness is easy to put off for a later time! Whether we are busy with work, carting kids to activities, attending social events or our ongoing daily to-do lists, the one thing we all have in common is the need to keep ourselves and our families healthy and safe.

This can start with regular checkups with our doctors, which should include screening for colorectal cancer if you are 45 or older, and sooner if you have a family history of colon cancer.

Answers to Common Colon Cancer/Colonoscopy Questions & Misperceptions

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

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

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

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

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

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

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

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

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

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

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

You Have the Power to Prevent Colon Cancer

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

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

To learn more, visit the American Cancer Society.

Breanna Nedved, RN

Breanna Nedved, RN

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

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Beating the Winter Blues

Beating the Winter Blues

by | Jan 16, 2023 | Expert Health Tips

I’ll admit, winter has never been my favorite season. I would gladly trade cold weather, less sunlight and getting sick more often for sunny days at the beach. The “winter blues” is a common term used to describe the increased sadness, lower energy and reduced interest in enjoyable activities many people feel during the winter months. For many people, these symptoms are minor and manageable with a few lifestyle changes, but for others, they become more intense and may develop into seasonal affective disorder (SAD).

What Is Seasonal Affective Disorder (SAD)?

Seasonal affective disorder (SAD) is a type of depression that follows a seasonal pattern. Most often, symptoms are prominent in winter months but can follow other patterns as well. Symptoms of SAD include:

  • Depressed mood
  • Less interest in activities
  • Difficulty sleeping or oversleeping
  • Being more fidgety and restless or more slowed down than usual
  • Fatigue
  • Reduced ability to think or concentrate
  • Recurrent thoughts of death or suicidal ideation

One or several of these symptoms may occur for short periods of time. If you notice these symptoms becoming more persistent and affecting your relationships, work or school activities, you will want to actively take steps to manage them.

Ways to Manage Seasonal Affective Disorder

The cold weather and shorter days of winter are inevitable. The effects of seasonal affective disorder do not have to be. Take steps today to manage symptoms and allow yourself to thrive during all seasons of the year.

Get Moving

Physical exercise is one of the best ways to tackle depressive symptoms. It releases endorphins, improves physical health and can provide a sense of accomplishment.

Reach for Healthy Foods

Foods that are high in whole grains, protein and healthy fats provide energy and boost your mood. Sometimes this can be challenging. Some indulgence is okay (maybe even needed), but allowing large portions or high-sugar foods to become the basis of your diet will only worsen symptoms of SAD.

Stay Connected

When depression sets in, reaching out to friends and family can be daunting. Ironically, it is also one of the best ways to improve your symptoms. Having lunch with a friend, texting a family member or joining a book club are all ways to stay connected when sunlight and outdoor activities may be limited.

Try Bright Light Therapy (BLT)

BLT involves sitting in front of a light box for 30-60 minutes a day to mimic exposure to sunlight. Light boxes can be found for as little as $70 and do not require any special training to use.

Consider Professional Help

Both medication and mental health therapy have been shown to be effective at reducing the intensity of SAD symptoms.

Be Proactive

Because SAD follows a regular pattern, it is easier to anticipate the onset of symptoms than it is for other types of depression. While this pattern may not be exact, beginning these management strategies during the months leading up to the typical onset of symptoms will reduce the intensity and distress caused by symptoms.

Take an Online Screening

If you or someone you care about are concerned about Seasonal Affective Disorder or other mental health conditions, take our online screening now. Many screenings are available. All screenings are confidential and provide information to help you determine your next steps.

Nate Christensen, MS, LIMHP

Nate Christensen, MS, LIMHP

Mental Health Therapist, Bryan Counseling Center

Nate Christensen (he/him) provides therapy to adults with a wide variety of presenting concerns. He has experience working with individuals diagnosed with schizoaffective disorder, schizophrenia, bipolar disorder, depression, anxiety, and personality disorders utilizing Dialectical Behavioral Therapy (DBT), cognitive behavioral therapy, and solution-focused techniques. Nate earned his master’s of counseling degree from the University of Nebraska at Omaha.

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Grieving During the Holidays

Grieving During the Holidays

by | Dec 19, 2022 | Expert Health Tips

The grief bubbles up unbidden. I never know when or where it will surface, but inevitably it comes when I least want it. My mom contracted COVID-19 six months ago. She nearly died of complications from the virus. The anticipatory grief I experienced was different from the residual grief I feel now — grief over the many losses that came as a result of Mom’s sudden change in health.

As a hospital chaplain, I regularly interact with patients, family members, and staff who are experiencing dying, death, and grief. The process of grieving often strips away the surface layers of a person’s life, revealing new depth and meaning, as well as flaws. And most people don’t like that last bit.

Giving Ourselves Grace

We struggle with imperfection, just like we struggle with loss and injustice and the profound sense of “missing” that grief brings. I think the holidays often highlight those feelings. We want to feel a thrill of hope and joyful anticipation of good to come. Instead, we might be wondering if we are biologically related to the Grinch. The simple answer? No, we are just grieving.

I have found it helpful to be honest with myself about loss this year. Instead of “shoulding” on myself — thinking I should feel this or that emotion, then working to replace what I really feel with said emotion — I take a step back from the emotion. I name it for what it is and then ask myself, “What is this connected to in your life?” Often, the source was a memory that needed to be acknowledged before I could accept the loss and let go of the grief.

Experiencing New Joy

Letting go of grief doesn’t mean getting over the loss. Rather, thinking about the loss no longer causes pain. There is now room for new experiences and the making of happy memories even while remembering the past. Through the years, people have shared the following strategies that have helped them balance the two:

  • Remember and acknowledge your loved one in meaningful ways.
  • Take good care of yourself by eating healthy, drinking plenty of water, getting moderate exercise and choosing activities that nourish your soul.
  • Limit social gatherings to what brings you joy and helps lift your spirits.
  • Limit the extraneous stuff — decorations, cards, gifts, shopping — and delegate tasks that seem overwhelming or too emotional. Family and friends are often eager to help with these things.
  • Start a new tradition or new variation on an old tradition. For instance, if you always opened presents after church on Christmas Eve, try having a family brunch and opening presents on Christmas morning.

Connecting with Others

Every person’s experience of grief is different. Sometimes, it can feel as though grief has isolated us from the support of our family, friends or faith community. If you or someone you care about is struggling with grief and loss, resources are available to help you reconnect. Please reach out.

Grief and Loss Resources

Here are a few resources you may want to consider:

Trisha Wiscombe

Trisha Wiscombe

Chaplain, Bryan Pastoral Care

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