Tag Archives: M.D

Kugler Vision

April 1, 2017 by
Photography by Bill Sitzmann

People who wish they could have 20/20 vision without glasses or contacts have options. There are seven safe, effective laser vision procedures that can enable most people to see clearly without corrective lenses, and Kugler Vision is the only medical practice in Omaha that specializes in them all: LASIK, ASA, SMILE, ICLs, Corneal Inlays for near vision, Refractive Lens Exchange, and Corneal Crosslinking. Kugler Vision also offers Refractive Laser Cataract Surgery. The primary focus is on finding a customized solution for each patient based on his or her unique vision challenges and lifestyle. All eligible staff members have had a refractive procedure themselves, so they understand the freedom and confidence that comes from seeing the world in a new way.

“It’s so much more than just not wearing contacts or glasses,” explains Dr. Lance Kugler. “It’s deeper than that. It’s a transformational experience that changes how you interact with the world. It’s such an incredible honor to be doing what I do.” As director of refractive surgery at UNMC, Dr. Kugler is in charge of resident education and research programs that advance the field of refractive surgery.

kuglervision.com • 402.558.2211

This sponsored content is a page from the publication Faces of Omaha.  To read the entire magazine, click the image:

Alzheimer’s Disease

December 10, 2015 by

Caring for a loved one with Alzheimer’s disease can be both physically and emotionally demanding. “As the disease progresses, the amount of care the Alzheimer’s patient requires rises dramatically, as does the toll it takes on the caregiver,” notes Daniel Murman, M.D., neurologist at The Nebraska Medical Center.

While there are things you can do to better prepare yourself for the caregiver role, the thing to remember is that Alzheimer’s progresses differently in each person, as do the caregiver circumstances and ability to cope with the disease.

 “I remember noticing changes in my wife for about a year but I couldn’t put my finger on it,” says Allan Schur, husband of Sharon Schur, who was diagnosed with Alzheimer’s in 2005 when she was just 54 years old. “It took my daughter, who hadn’t seen her for almost a year, to step in and tell me that she needed to be seen by a doctor.”

The most difficult part about being a caregiver is dealing with and managing guilt, notes Schur. “No matter how much you try, no matter how much you do, you cannot change the course of what is always a terminal disease,” he says. “There are no ‘survivor’s walks’ for Alzheimer’s.”

Schur also recommends starting each day as a new day and not dwelling on the past or thinking about what might have been. “The most important day in the life of a caregiver is today,” he says.

While it may sound contradictory, Schur says it is also important to be proactive. “Early in the disease you have to teach your loved one new tricks before they need to use them and while they have the capability to learn.” For example, there are phones where you can insert pictures of a child, friend or caregiver on large buttons so the user can press the picture of the person he or she wants to dial. “By the time I realized my wife needed this type of phone, it was too late to teach her how to use it,” says Schur.

Schur adds other tips. “Early in the disease, note the places you like to go and which ones have family restrooms. This will help you later when your loved one may need assistance.”

Participation in a support group is vital. “You can learn from the successes and failures of other caregivers,” says Schur. “You will be reminded that others are walking down a similar path and learn new coping mechanisms. You will see that you are not alone and that’s a pretty big deal some days.”

And lastly, be proactive about their care, stresses Shur. “I reached a point where I realized that if I continued with this 24/7 job, my loved one would outlive me. Tour facilities while you can and well before you need to place your loved one in a long-term facility.”

“Alzheimer’s is a long and emotional process, and caregivers should not feel guilty about seeking outside resources to assist them whenever possible,” says Dr. Murman. He suggests using resources such as the Alzheimer’s Association and the local Agency on Aging.

Visit the Alzheimer’s Association at alz.org to learn more.

Alzheimers

Overloaded Backpacks

August 25, 2014 by

Overloaded backpacks cause stress on the spine and shoulders, resulting in muscle fatigue and strain, claims the American Academy of Orthopaedic Surgeons (AAOS). In fact, the excessive weight in backpacks may cause a child to develop poor posture or slouch excessively.

The AAOS recommends that the maximum weight of the child’s backpack should not exceed 15-20% of the child’s weight. A child who weighs 80 pounds should not carry more than 12-16 pounds in her backpack. This figure may vary depending on the child’s strength and fitness level.

Tips to Prevent Back Pains and Injuries:

  • Using a backpack with wide, padded straps and a padded back
  • Using a hip strap when backpacks are overloaded
  • Firmly tightening both straps in order to hold the backpack two inches above the waist
  • Placing heavier items close to your back
  • Using proper lifting techniques: bend at the knees and use the legs to lift the backpack, placing one shoulder strap on at a time
  • Making frequent stops at your locker to unload books
  • Using a backpack with wheels

Watch for the following warning signs that a backpack is too heavy: change in posture when wearing the backpack, pain while wearing the backpack, struggling when putting on or taking off the backpack, red marks on the shoulders, tingling or numbness in arms or legs.   

John P. Sheehan, M.D.,
Pediatric Orthopaedist,
Boys Town National Research Hospital

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Camping with Kids

June 14, 2014 by

If you are looking for a way to create more family time, camping may be the perfect adventure. By turning off the daily routines and plugging into nature, your family can explore a whole new world that surrounds them. Throw a line in the pond, chase after a butterfly, toast marshmallows over the campfire—the things to do are endless. And best of all, you are creating family memories that will last a lifetime.

Preparing for Your Camping Adventure
Make preparing for your camping trip fun for the whole family. Boys Town Pediatrics recommends:

  • Reading a book about nature to help get your children familiar with insects, animals and plants they may see during the camping trip.
  • Having your children help pack the cooler and camping supplies. Younger children might like to pack a few toys from home.
  • Asking your children what they want to do on the trip, and write it down so you can make sure to do at least one thing from everyone’s list.
  • Doing a test-run sleeping under the stars in your own back yard. This will give you the opportunity to alleviate any fears before the trip.

Camping Safety Tips

The excitement of exploring nature is a big part of the camping experience. Boys Town Pediatrics would like to recommend a few safety tips to help you enjoy a fun-filled family trip.

  • Never go in the water alone and always wear a life vest.
  • Tell others where you are going.
  • If you get lost, stay put. Trying to retrace your steps can actually get you more turned around when your family will be out looking for you.
  • Do not pick or touch plants you do not know—they may be poisonous.
  • Make noise when you walk so you don’t sneak up on unexpected animals.

The joy of camping is that it can tie in something every family member enjoys; swimming, fishing, exploring, cooking, and just relaxing in the midst of nature. And don’t worry if everything doesn’t go just as planned—that’s what creates the best family stories!

Don’t forget! (Feature in a pull out box)

  • Sunscreen
  • Bug repellant
  • Rain gear
  • Extra clothes
  • Flashlight (extra batteries)
  • Blankets
  • First aid kitsmall

Keeping Mind and Body Active

April 5, 2014 by
Photography by Bill Sitzmann

Mike Egger, 66, has always enjoyed tinkering around the garage, maintaining his cars and lawn equipment and doing just about anything mechanical. Since he developed Parkinson’s disease some 20 years ago, these are some of the things he still enjoys most in life, but they also serve another purpose. They help keep his body and mind active—essentials in helping control the symptoms of Parkinson’s disease.

Parkinson’s is a progressive disorder of the nervous system that advances slowly and affects movement, muscle control, and balance. It is the second most common nervous system disorder after Alzheimer’s disease.

It is estimated that as many as 3 to 4 percent of the population will develop Parkinson’s symptoms during their lifetime and the risk is even higher in Nebraska. “While we don’t have a cure for Parkinson’s, we continue to make progress in diagnosis and treatment,” says John Bertoni, M.D., Ph.D., neurologist and director of the Parkinson’s Clinic at The Nebraska Medical Center. “We are continually learning more about the disease and there are many new treatments coming down
the pipeline.”

People may have Parkinson’s for many years before it becomes apparent, notes Dr. Bertoni. Some of the more subtle early-stage symptoms include: loss of sense of smell, thrashing in sleep, depression, loss of facial expression, excessive sleepiness during the day, constipation, shortening of one’s steps, and a diminishing arm swing when walking. Other symptoms include slowness, rigidity, and tremors at rest.

Mike and his wife, Mary, believe that Mike probably had Parkinson’s disease for about 10 years before he was actually diagnosed.  “I had noticed a change in his gait, one of his arms wasn’t swinging much anymore, and he had developed a slight tremor in one of his hands,” she says. The signs were so slight, however, that she attributed them to an old injury caused by falling off a horse.

As the symptoms became more pronounced, Mike saw a doctor and was diagnosed at age 50 with Parkinson’s. “The disease progressed so slowly at first that I barely noticed it, or maybe I was in denial,” he says.

Initially, Mike took medications to help control his symptoms. Most people with Parkinson’s can get significant control of their symptoms with medications and a combination of other therapies including occupational therapy, speech therapy, nutrition counseling, support groups, and
regular exercise.

Medications can help alleviate problems with walking, movement, and tremors by increasing the brain’s supply of dopamine. In Parkinson’s disease, certain nerve cells (neurons) in the brain gradually become sick. These neurons are responsible for producing the chemical messenger dopamine. A reduction of dopamine levels causes abnormal brain activity, which can lead to the symptoms of Parkinson’s disease.

“Recent studies have revealed that people who are not over-treated with medications do the best in the long run,” says Dr. Bertoni. “We have also found that those who take an active role in their own care, who exercise regularly, stay engaged, and participate in support groups, do the best in managing the disease and living a relatively healthy, active, and quality life.”

Mary, who is the president of the Nebraska chapter of the American Parkinson’s Disease Association (APDA), says that the organization offers more than 20 support groups throughout the state for both Parkinson’s patients and their caregivers.

As Mike’s disease continued to progress, he eventually had to quit work. The medications also became less effective, and the side effects of the drugs grew to become worse than the symptoms themselves, a common problem among people who have been taking medications for many years.

When Parkinson’s disease patients stop responding to medications, a surgical procedure called deep brain stimulation may be considered. Deep brain stimulation involves implanting an insulated wire into a target area of the brain. The lead is connected to a small pulse generator implanted beneath the skin, which generates mild electric pulses to the brain to reduce Parkinson’s symptoms, including tremors.

Mike had the procedure performed nearly two years ago and says it has essentially eliminated his tremors. His biggest challenges include trying to walk steadily and maintaining his balance. Aside from that, Mark says, “I still do everything now that I’ve always done, but I don’t do them quite as well and not as fast.”

While a definitive cause for Parkinson’s has not been found, a combination of factors may play a role, notes Dr. Bertoni. These include aging, having an inherited gene, and exposure to environmental triggers. Some speculate that the relatively higher incidence of the disease in Nebraska may be due to exposure to farm chemicals.

Despite some of the daily challenges of dealing with Parkinson’s disease, Mike continues to maintain a positive attitude. “I figure there are many people who have worse things than me,” he says. “I just try to roll with it and stay positive.”

The APDA assists people throughout the state. Visit parkinsonsne.org or call 402-393-2732 for additional information.

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Endometriosis

December 13, 2013 by

If you’ve experienced extended pelvic pain, you’re not alone. As many as 15 to 20 percent of women between the ages of 18 and 50 will experience chronic pelvic pain that lasts six months or more. Pelvic pain can have many causes and sometimes it’s difficult to find a specific cause.

It is estimated that approximately 70 percent of these women will have endometriosis, a painful disorder in which tissue that normally lines the inside of your uterus—the endometrium—grows outside the uterus, or anywhere else where it’s not supposed to grow. It usually grows on the ovaries, the fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the abdomen or pelvis.

“The problem with endometriosis is that it can be difficult to diagnose.”
—Ginny Ripley, family practitioner at Nebraska Methodist Health System

The condition becomes troublesome when the displaced tissue continues to act as it normally would if it was inside the uterus and continues to thicken, break down, and bleed with each menstrual cycle. However, because the tissue is outside of the uterus, the blood cannot flow outside of the body. The displaced tissue can build up around the affected area and can become irritated, resulting in scar tissue, adhesions, or fluid-filled sacs called cysts. For women in their childbearing years, the adhesions may block the fallopian tubes and cause infertility.

“The problem with endometriosis is that it can be difficult to diagnose,” says Ginny Ripley, family practitioner at Nebraska Methodist Health System. “It doesn’t show up in ultrasounds or CAT scans, so the only definitive way to get a diagnosis is through surgery. Surprisingly, we’ve found that the severity of a woman’s symptoms do not correlate to the severity of the condition.”

So while some women with extensive endometriosis may have no symptoms at all, others may experience painful periods, heavy periods or bleeding, pelvic pain during ovulation, and pain during bowel movements or urination. The pain is usually located in the abdomen, lower back, or pelvic areas. Many women don’t realize they have endometriosis until they go to the doctor because they can’t get pregnant, or if they have a procedure for another problem. It is estimated that 20 to 40 percent of women who are infertile have endometriosis.

Because of the difficulty in diagnosing endometriosis, it is often a matter of ruling out other causes first before arriving at a diagnosis of endometriosis, notes Dr. Ripley. Other common causes of pelvic pain include fibroids, chronic pelvic inflammatory disease caused by long-term infection, pelvic congestion syndrome, an ovarian remnant, irritable bowel syndrome, interstitial cystitis, and musculoskeletal factors.

The type of treatment a woman receives will depend on the severity of symptoms and whether or not she is planning to become pregnant. Several treatments have to be tried before it is determined what works best. Many women can be treated successfully with anti-inflammatories or a combination of anti-inflammatories and oral  contraceptives and/or hormone therapy. Anti-inflammatories help reduce bleeding and pain. Birth control pills and hormone therapy help shrink the endometrial tissue by lowering hormone levels and help suppress the growth of additional endometrial implants—but they also prevent pregnancy.

“While the tissue growth may come back, it often cleans up the area long enough to allow a woman to conceive.”
—Katherine Finney, M.D., obstetrician/gynecologist University of Nebraska Medical Center

In more severe cases in which all other options have been exhausted, surgery may be recommended to remove the extra tissue growth, says Katherine Finney, M.D., obstetrician/gynecologist at the University of Nebraska Medical Center. Surgery is performed laparoscopically. This means that the doctor places a small, lighted tube through a small incision in your belly and looks for signs of displaced endometrial tissue. The tissue can then be removed or destroyed through heat or cauterization.

“While the tissue growth may come back, it often cleans up the area long enough to allow a woman to conceive,” says Dr. Finney. “Rates of conceiving are higher after surgery, but some women may still need fertility treatments to help as well.”

If pregnancy is not a goal, medications, such as hormone therapy, can be taken following surgery to prevent the growth of new or returning endometriosis, says Dr. Finney.

For women with severe pain due to endometriosis, a hysterectomy may be considered as a last option; however, this is rarely needed anymore. “We do far fewer hysterectomies today than we have in the past because we have so many other effective options,” says Dr. Ripley.

Some women may not require treatment, as they have no or only mild symptoms, while others can have notable symptoms due to pain and/or infertility issues. Treatment is typically based on symptoms. If you are near menopause, you may want to consider managing your symptoms with medications rather than surgically. Once you stop having periods, endometriosis will usually stop causing you problems, notes Dr. Finney. In rare cases, post-menopausal women will still experience continued pain, in which case their physician should evaluate them to determine if they are a candidate for surgery.

Bipolar Disease

November 25, 2012 by

“My husband didn’t know if he was going to come home to Cruella Deville or Dolly Levi from Hello Dolly.” That’s how Jane Pauley, broadcast journalist and former co-host of the TV morning show Today, described her battle with bi-polar disease in a interview on Healthy Minds, produced by New York Public Radio. “Who knows what provokes it, but it was like a swarm of bees that wants a target,” she says.

Being diagnosed with bipolar disease was a shock, recalls Pauley, but getting a diagnosis and subsequent treatment, however, allowed her to regain some normalcy in her life again.

Bipolar disease is a serious mental illness that is associated with extreme mood swings from mania to depression. “It is one of the most serious illnesses we deal with because of the disruptive nature of the disease,” says Sharon Hammer, M.D., psychiatrist at the University of Nebraska Medical Center (UNMC). “It is more serous than depression or schizophrenia because it can lead to risky behaviors, such as drug and alcohol abuse, damaged relationships, and suicide. And because of the impulsive nature of the disease, there is often no time to intervene.”

The average onset of bipolar disease tends to occur in older teenagers and young adults ages 20 to 25 years old. “Many women may start to experience symptoms of depression in their teenage years followed by their first manic episode in college,” says Hammer. “This is a very risky time because the college years are often mixed with stress, sleep deprivation, and alcohol use, which are all triggers for episodes.”

“It is one of the most serious illnesses we deal with because of the disruptive nature of the disease.” – Sharon Hammer, M.D., psychiatrist at UNMC

Women with bipolar disease typically spend about 80 percent of the time in depression and 20 percent in mania. Episodes of mania are characterized by abnormal elevated moods that include irritability, being easily agitated, impulsivity, racing thoughts, and insomnia.

Many women tend to be in denial and don’t start taking it seriously until they have children, notes Hammer. Even then, it is often misdiagnosed as depression or anxiety due to the extended depressive states associated with the condition, and the fact that women are twice as likely to have depression than men. In fact, bipolar disease is the most under-diagnosed mental illness and the most challenging to diagnose, notes Hammer.

Misdiagnosis can create more problems because medications used for depression and anxiety are different than those used to treat bipolar disease and can make the condition worse.

In addition, untreated bipolar disease tends to gain momentum and become more malignant with time, says P.J. Malin, M.D., a psychiatrist with Alegent Creighton Clinic and an associate professor of psychiatry at Creighton University School of Medicine. “It can be very disruptive to other parts of your life. Approximately 60 percent of people with bipolar disease will develop substance abuse problems, and it carries a 15 to 20 percent suicide rate.

“Early treatment of the disease can help prevent the disease from getting more aggressive. Untreated bipolar disease, on the other hand, lowers one’s life expectancy by 10 years.”

If you are being treated for depression and are not responding to depression medications or you are experiencing negative or an unusual response, it is important to communicate this with your provider, adds Malin.

“Early treatment of the disease can help prevent the disease from getting more aggressive.” – P.J. Malin, M.D., psychiatrist with Alegent Creighton Clinic

You can also do your own test by taking the Mood Disorders Questionnaire (MDQ) online, which provides fairly accurate results and can help you and your clinician determine whether you are bipolar, notes Hammer.

Environmental factors and heredity appear to be the major risk factors for bipolar disease, says Malin. “There are different theories as to how the environment plays a role, but they include: obstetric complications, intra-utero viral infections, use of hallucinogenic drugs, and traumatic life events, such as the death of family or friends or abuse.”

Treatment typically involves a combination of medications and counseling that may be necessary over a person’s lifetime. “Counseling is huge for long-term success and stabilization,” says Robin Houser, a counselor for Nebraska Methodist Hospital’s employee assistance program, Bestcare EAP. “Bipolar disease is a lifetime problem, and counseling can help people learn coping techniques and avoid unhealthy thinking and unhealthy patterns of behavior. A lot of people think that once they have become stabilized that they don’t need medications or counseling anymore, but that’s when we’ll start seeing imbalances and manic episodes occur again.”

Women with bipolar disease are very sensitive to stress, lack of sleep, and environmental and seasonal changes, all of which can trigger an episode, notes Hammer. Practicing healthy lifestyle habits like getting regular exercise, adequate sleep, managing stress, and light therapy during the winter months can help keep the disease stabilized.

 “Counseling is huge for long-term success and stabilization.” – Robin Houser, counselor for Nebraska Methodist Hospital

Postpartum is also a common time to experience recurrences, probably because of sleep deprivation, says Hammer. There are medications that are safe to use during pregnancy, which are important to take to prevent a relapse. If a woman stops her medications during pregnancy, it can take up to six months to get the symptoms under control again, says Hammer.

“Newer medications as a whole have fewer side effects,” she says, “but it’s important that you are matched with the medication that works best for you and has the fewest side effects.

“Patients who are being followed and treated by a trained health care professional can function vey well and live a normal life.”