Tag Archives: Nebraska Medicine

Summer!

August 11, 2016 by
Photography by Bill Sitzmann

The symptoms of heat exhaustion can develop swiftly and suddenly. If you are age 60 or older, not only does your risk for developing heat exhaustion intensify, but the symptoms can develop more rapidly and become more serious.

“Older people are especially prone to heat exhaustion because their bodies don’t adjust to heat as well,” says Dr. Mark Ptacek, a family practitioner at Nebraska Medicine. “Chronic medical conditions, as well as certain types of medications, can impair your ability to regulate your body temperature and perspire.”

HealthHeat exhaustion results from prolonged exposure to high temperatures, usually in combination with dehydration. The risk for heat exhaustion increases when the heat index—a combination of the temperature and humidity—rises to 90 degrees. A relative humidity of 60 percent or more hampers sweat evaporation, which hinders the body’s ability to cool itself, says Dr. Ptacek.

Heat exhaustion causes the skin to feel hot and moist, and to appear flushed. Other possible symptoms include heavy sweating, faintness, weakness, rapid pulse, low blood pressure, nausea, low-grade fever, headache, and dark urine. “If you are no longer sweating, your condition has grown more severe,” notes Dr. Ptacek.

If you or someone you know is experiencing signs of heat exhaustion, Dr. Ptacek recommends going to a cool place, sitting in front of a fan, removing extra clothing, rehydrating with cool water (iced or cold water can cause cramping), spraying or sponging with cool water, resting for two to three hours, and staying out of excessive heat for about a week. If you are nauseated, throwing up, or are very dizzy or light-headed, you should be taken to an emergency room, he says.

Dr. Ptacek recommends these tips to keep yourself well-hydrated during the summer:

  • Drink plenty of fluids. “We are a quart low on water when we wake up in the morning, so start your day with two glasses of water. Continue to drink lots of fluids throughout the day, even if you don’t feel thirsty. As you get older, you begin to lose your sense of thirst, and therefore you may already be at a fluid deficit.”
  • Drink before you feel thirsty. When your body begins expressing thirst, this means you are starting to get behind your body’s fluid needs.
  • If you are exercising and perspiring a lot, drink fluids with extra electrolytes such as sports drinks.
  • Avoid drinking alcohol, which acts as a diuretic, causing your body to lose fluids and desensitizes your body’s needs for water.
  • Avoid caffeine, which decreases your body’s blood volume and also acts as a diuretic, making you more dehydrated.
  • Exercise in the early morning or late evening.
  • Avoid sugary drinks, which can cause your body to lose more fluid.
  • Wear light-colored and loose-fitting clothing.

Sixty-Plus

Geriatric Nurses

April 21, 2016 by
Photography by Bill Sitzmann

Some people just don’t get it when it comes to the health of older adults. Many believe that elderly people are always tired. But that’s a myth.

“It’s also not true that an older person doesn’t have a brain that works as well,” says Sara Wolfson, geriatric nurse practitioner for the University of Nebraska Medical Center (UNMC) Home Instead Center for Successful Aging.

Myths such as these lead to ageism that can affect how older adults are treated (or under-treated) for illnesses.

A geriatric nurse can sort it out. This registered nurse specialist has the skills to recognize what’s normal for older adults versus what’s abnormal.

Beth Culross

Beth Culross

“We are really focused on looking at the process of aging and how we can help older adults maintain their  health and prevent health problems as they age. What is normal at age 80 might not be normal for 40 or 50,” says Dr. Beth Culross, an R.N. with a Ph.D. in gerontology. She teaches undergraduate gerontology at the UNMC College of Nursing in Omaha.

Geriatric nurses often function as case managers who help patients live with chronic illnesses, giving them a greater chance of staying independent and active.

“With case management, there are a lot of phone calls, checking on them, answering questions about medication, seeing how a visit to the ER went,” Wolfson explains.

She says it’s important to keep older adults out of hospitals. “Being in the hospital weakens people. It takes longer to recover. Some get confused. Older people have less reserve when they get sick.”

Geriatric nurses can be found working in hospitals, clinics, physicians’ offices, long-term care facilities—and in patients’ homes.

Senior Assist, a home-visit program for patients ages 65 and older whose primary care physician is with Nebraska Medicine, is available at no cost through the Home Instead Center for Successful Aging. Home visits give the nurse a look at the person’s living environment, and consequently gives them a clue to what is going on with their physical and mental health. 

“One nurse went to the home of a patient who was constantly coming here because of congestion and found she wasn’t using her nebulizer,” says Wolfson. “Home visits give a heads-up if someone is having a problem.”

UNMC’s Home Instead Center for Successful Aging offers seniors a wellness center, outpatient clinic, assessment, and education in topics as diverse as fall prevention,  nutrition, arthritis, and tai chi. Nurses provide education as mandated by Medicare—information about medications, like blood thinners, or about general health and nutrition, like cutting back on sodium.

“We’re a center for people who are aging well and people who have a lot of chronic illnesses that need to be managed,” Wolfson says. “We take walk-in patients. They might have a cold, feel dizzy or tired.”

The center also provides dementia evaluation and diagnosis.

“We wouldn’t diagnose dementia on the fact that their memory is bad. It’s based on function. Are they still independent?  Taking medications?  Or are they not bathing? Are their clothes tattered?” says Wolfson, who points out that there are other geriatric clinics available in the area.

As people live longer and the number of people over age 65 increases, more nurses specializing in geriatrics are needed.

By 2030, one in five adults—88 million people—will be 65 or older, according to the U.S. Census. About 10,000 adults turn 65 every day.

Sara Wolfson

Sara Wolfson

“Most of the hospitals in the Omaha area have started recognizing this,” Culross says. “These hospitals have special designations around the need for care for older adults.”

There is a shortage of nurses in general and—because the number of aging adults is increasing—there is especially a need for certified geriatric nurses.

Almost half of all patients admitted to hospitals are over 65, but only 1 percent of registered nurses and 3 percent of advanced practice registered nurses are certified in geriatrics, reports the American Geriatric Society.

Adults over 65 account for nearly 26 percent of all physician visits, 47 percent of all hospital stays, 34 percent of all prescriptions, 34 percent of all physical therapy patients, and 90 percent of all nursing home stays, according to the Eldercare Workforce Alliance.

By 2030, 7.7 million people will have Alzheimer’s disease, up from 4.9 million in 2007.

“The fastest growing segment of the population in the United States are people 85 and over,” Culross says.

Recognizing what’s normal and what’s not for an aging adult is important for a geriatric nurse. So is listening. Allowing patients to talk about their experiences and life stories tells where they are now and how she can help, says Culross.

“I learn as much from my patients as they do from me. My husband tells me I’m really good at it because I like to talk.”

Fighting the World’s Worst Diseases

February 20, 2015 by
Photography by Bill Sitzmann

Originally published in March/April 2015 Omaha Magazine.

When patients with ebola flew into the heartland, the Nebraska Biocontainment Patient Care Unit activated for the first time.

Local healthcare workers are now helping hospitals nationwide to prepare for the next generation of infectious diseases.

As the Ebola epidemic worsened in West Africa last summer, a Nebraska nurse-turned-administrator wondered if Omaha might receive any patients. Shelly Schwedhelm wasn’t scared. She was ready.

“We were watching what was happening in Africa and started to gear up,” she says, speaking from her office inside Nebraska Medicine’s labyrinthine hospital cluster in Midtown at 42nd and Dewey.

Schwedhelm, 54, oversees the Medical Center’s biocontainment unit. She leads administrative, nursing, and logistical support for the unit’s 40-person staff of nurses, physicians, respiratory therapists, and patient-care techs. Few biocontainment units exist in the United States. The Med Center unit is especially rare, housing the nation’s largest hazardous patient capacity. It consists of five rooms and 10 beds, isolated behind security-card locked doors, and a decontamination room on the seventh floor of University Tower.

Before Schwedhelm knew any Ebola patients might arrive, she made sure all safety protocols were in place. The unit’s self-contained air ventilation system and autoclave—a pressurized heat chamber used to sterilize large amounts of waste—operated without flaw. Ebola can cause uncontrollable vomiting and diarrhea; any potential pathogens would be contained and decontaminated behind sealed doors. The unit opened with federal, university, and hospital funds made available in the aftermath of the September 11 terror attacks. The 2003 outbreak of SARS (Severe Acute Respiratory Syndrome) in Asia and Canada added impetus to local, state and federal coordination. It went online in March of 2005.

“We’re centrally located,” Schwedhelm says, explaining the logic for an Omaha site in case of a national health emergency. “We’re about as close as you can get to being smack dab in the middle of the country.” March is the unit’s 10th anniversary. Schwedhelm has managed the operation for approximately eight years. She credits the establishment to Medical Director Dr. Phil Smith.

Her career with Nebraska Medicine spans 33 years. She started working in the emergency room as a nurse, but she quickly transitioned into leadership positions. She has managed the Post-Anesthesia Care Unit, operating room, and emergency room before assuming her current title, Executive Director of Emergency Preparedness. Schwedhelm first learned about Ebola during her nursing studies. At the time, Ebola was a virtual unknown, a mysterious killer that could wipe out entire villages. Even today there is no proven treatment or vaccine, though UNMC staff are working on some leads.

In 1976, the viral hemorrhagic fever known as Ebola first emerged in Zaire (now the Democratic Republic of the Congo). The virus took its name from a local river. In subsequent decades, rare and isolated outbreaks persisted in central Africa due to human contact with contaminated primates, bushmeat, or bats. West Africa’s crisis started in Guinea, spreading unnoticed in early 2014. By spring, Ebola reached Sierra Leone and Liberia. Doctors Without Borders declared the epidemic “out of control” in June with a global tally of 528 cases and 337 deaths.

The outbreak gained momentum fast. By Aug. 22, the disease struck 2,615 people with 1,427 deaths. In stark contrast, the world’s previous worst Ebola outbreak occurred in Uganda with 425 reported cases in 2001. By the year’s end, West Africa’s epidemic would surpass 20,000 cases and 7,800 deaths. The epidemic has continued into 2015. The World Health Organization reported on January 19 that 21,759 had fallen sick and 8,668 died from Ebola in Guinea, Liberia, and Sierra Leone.

African jungles where Ebola originated are a far cry from the rolling cornfields of northeast Nebraska, the land of Schwedhelm’s birth. She grew up on a dairy farm near Pender. Nursing has supplanted agriculture as her family’s occupation. Two of her sisters, her husband, and her brother-in-law work in nursing.

For the past decade, her biocontainment team trained regularly for infectious disease scenarios ranging from novel strains of influenza to coronaviruses such as SARS or MERS (Middle East Respiratory Syndrome), smallpox, or potential biological warfare by terrorists. Ebola has been on the unit’s list of disaster scenario drills from the beginning. But the hospital had not been tested with real-world activation. One near-activation roughly six years ago turned out to be a false alarm, malaria. “The unit has sat idle from the standpoint of patients, but we’ve always remained in a state of readiness,” she says.

Then in August 2014, she received the phone call that confirmed her premonitions. A representative from the State Department was coming. He arrived, toured the facility, and asked questions about logistics, transport, and protocol. Suddenly, the Nebraska Medicine joined two East Coast hospitals on a list of destinations for repatriated Americans with Ebola. “At that time it became very real to us,” Schwedhelm says. Preparations went into overdrive. “We spent the next month fine-tuning details, enhancing our staff, running through all the motions of testing all those things that we had tested for so many years.”

The State Department began a rotation: Emory University Hospital in Atlanta, collaborating with CDC headquarters. The National Institute of Health’s hospital in Bethesda, Maryland. Then came the Nebraska Medicine’s turn.

Omaha’s first patient arrived on Sept. 5. Dr. Rick Sacra had contracted Ebola in Liberia. The 51-year-old doctor was working for the Christian missionary group SIM. He flew from Africa to Omaha. “We had been in touch with our Emory colleagues, to gain insights on how they had dealt with their patient,” says Schwedhelm, “but we really didn’t know what to expect.” Text, e-mail and phone alerts buzzed biocontainment staff wherever they were. Kendall Ryalls received the notice while traveling with her fiancé. A programmed robotic voice broke the news to the registered nurse, “Biocontainment unit has activated. Please call.” She rushed back to Omaha.

Ryalls changed from street clothes into special scrubs. She donned personal protective equipment with the help of a colleague: booties tied up to her knee, an isolation gown wrapped around her body from neck to knee, blue hood draped over head and neck, clear face shield, white respiratory mask, three layers of gloves, etc. Then she took her temperature. Ready to go.

Sacra was non-communicative, very ill, severely dehydrated, depleted of electrolytes. Gradually, he improved with a cocktail of experimental drugs and a blood transfusion from a fellow doctor who had recovered from Ebola. “You are with the patient one-on-one for hours and weeks at a time,” Ryalls says. “You are with them so much. You don’t have that with any other nursing job.”

When Sacra regained enough strength, he used a stationary exercise bike (to minimize muscle atrophy) in confinement. He and Ryalls are both avid cyclists. The nurse would sit in the room, wearing full-body biohazard suit, encouraging Sacra’s effort on the bike or just chatting. Ryalls’ dark brown eyes were the only distinguishable features behind her mask and visor. Three weeks later, Ebola cleared from Sacra’s blood. He was released. Ryalls could finally shake Sacra’s hand without layers of gloves. He instantly recognized Ryalls “from my eyes,” she recalls with a laugh.

“I’m now an official lifetime Huskers fan! Go Big Red!” he announced at a celebratory press conference. Sacra also reaffirmed dedication to his medical mission, planning a return to Liberia where he contracted the disease. Recovered Ebola patients are thought to have immunity.

Spirits soared in Omaha. The same day Sacra was discharged, disaster struck Texas. A sick Liberian national named Thomas Eric Duncan reported to a Dallas hospital. Duncan had Ebola. He infected two nurses before dying on October 8. It was the first case of Ebola diagnosed on U.S. soil.

“We felt like we were going really good, and then that happened. There were a lot of questions from the outside, ‘Could that happen here in Omaha?’” says Schwedhelm. She felt “an almost overwhelming responsibility to make sure that every precaution was taken.” She questioned herself, “was every conceivable safety feature in place?” And her answer was always the same. “Yes. The staff was confident, and I was confident,” Schwedhelm says.

After the Dallas story broke in national media, the staff started to feel pressure from the community. One biocontainment nurse’s daughter was disinvited from a birthday party. Another was excluded from a family Thanksgiving dinner. In contrast, others received letters applauding the hospital’s efforts and unconditional support from informed family members. Ryalls told a friend about her job in the hot zone. Before a scheduled meet-up, the friend left her one-year-old baby at home to be extra safe. Ryalls didn’t take it personally. “She was just being cautious. There are pretty scary numbers about the disease in the media.” But at the same time, Ryalls felt assured that strict protocol and safety gear would prevent possible contact with fluid. The virus can only spread via body fluid to mucus membrane contact.

“I think the entire country has stepped up because of all this. Unfortunately for Dallas, they were first in having someone randomly come in, but because of them, I think the country is better prepared at all entry points,” Schwedhelm says.

The next patient, Ashoka Mukpo, arrived in Omaha on October 6. He had contracted Ebola in Liberia. The 33-year-old cameraman for NBC tested Ebola-free 16 days later, adding another victory to the Med Center’s effort. The third patient, Dr. Martin Salia was gravely ill upon arrival. A false negative test in Sierra Leone had delayed his evacuation and treatment. He came off the airplane at Omaha Eppley on a ventilated isolation stretcher.

Up until Salia’s arrival, respiratory therapist Jean Bellinghausen had been helping the biocontainment team with donning and doffing protective gear. Salia’s urgent medical condition necessitated a breathing tube, and Bellinghausen transitioned into the hot zone. The 44-year-old Salia died two days later on November 17. “Deeply saddened would be an understatement,” Bellinghausen says, recalling the mood of the biocontainment unit. “We all felt like it was a great privilege to care for him. In that small window of time he shared his life with us.”

Biocontainment unit staff gathered to hold a memorial to honor the life of the U.S. immigrant who chose to serve his native Sierra Leone during a time of need. He was the chief medical officer and only surgeon at United Methodist Kissy Hospital in Freetown. His wife and two children live in Maryland.

After a lull, activation status resumed in the biocontainment unit. An anonymous medical worker in Sierra Leone had high-risk exposure to Ebola while caring for patients. The patient flew to Omaha for monitoring and requested privacy. No signs of Ebola showed after 21 days in isolation. The patient departed Omaha on January 22.

“Situations are getting better in West Africa all the time: better supplies, better support services, and better control of the environment,” says Schwedhelm. “We have a lot of military support there, but there is still a raging epidemic that we need to control.” While she suspects more Ebola patients could arrive in Omaha, the center is also leading U.S. hospitals to prepare for potential infectious disease outbreaks on American soil. Schwedhelm’s team has hosted four training courses in collaboration with the CDC in late 2014 and early 2015. Medical professionals and administrators traveled to Omaha from nearly 40 health systems nationwide. She says the CDC hopes to establish between 35 and 50 hazardous disease centers across the United States.

“We really weren’t ready, as a country, and that’s frightening,” she says. “If you have a novel virus, then we need more than three places that could care for patients and do it safely.”

Time magazine recognized “The Ebola Fighters” as the 2014 Person of the Year. Likewise, the Omaha World-Herald recognized Nebraska Medicine’s Ebola team as “Midlanders of the Year,” an honor reserved in past years for such luminaries as Husker legend Tom Osborne and then-U.S. Sen. Chuck Hagel.

Schwedhelm and her nurses—though humbled and honored by the distinction—are quick to deflect praise. “Those real heroes and ‘People of the Year’ are on the front lines fighting every day with limited supplies, working in dire circumstances,” she says.

Ebola continues to spread in West Africa. People continue to die. Doctors continue to risk their lives to squash the outbreak. Schwedhelm and Nebraska Medicine will continue doing everything they can to aid the effort until the goal is accomplished.

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Enlarged Prostate

January 16, 2015 by

Trouble urinating. Weak urine flow. Frequent urination or frequently getting up in the middle of the night. While many men chalk these symptoms up to “getting older,” they are often a sign of an enlarged prostate.

An enlarged prostate is one of the most common problems among men over 50.  The good news is that, in many cases, the symptoms caused by an enlarged prostate can be relieved with medical advice, says Chad LaGrange, MD, urologist at Nebraska Medicine. By age 60, about a half of men will have an enlarged prostate and by age 85, that number climbs to 80 percent.

Living with these symptoms can be uncomfortable, embarrassing, and can prevent you from getting a good night’s sleep, notes Dr. LaGrange. Some men may even avoid leaving the house for any longer length of time for fear of bladder leakage.

“Many men will put up with these symptoms for months until they become intolerable before seeing a doctor,” says Dr. LaGrange. “This can result in permanent damage to the kidneys and bladder. It’s always important to see a doctor early on to determine if it’s something that needs treatment and to rule out more serious problems like an infection or prostate cancer.”

The prostate grows throughout a man’s life. As it enlarges, the layer of tissue surrounding it stops it from expanding. This causes the gland to press against the urethra like a clamp, which can obstruct the flow of urine. Over time, the constant straining of the bladder muscle may cause it to become thicker and overly sensitive, causing it to contract with just small amounts of urine, resulting in the need to urinate frequently. Eventually, as the urethra opening becomes more restricted, the bladder cannot completely empty, which can lead to a urinary tract infection or kidney and bladder damage.

“Oftentimes, an enlarged prostate is not a serious problem and can be treated with lifestyle changes and behavior modification,” says Dr. LaGrange. “Medications are available that can shrink the prostate and relax the muscles in the prostate so the flow is better. Our goal is to avoid surgery until
absolutely necessary.”

Ultimately, treatment will depend on your symptoms, how severe they are, and whether you have other medical conditions, notes Dr. LaGrange. If you are not able to urinate at all, have significant bleeding, kidney failure, or are not responding to medical therapy, you may be a candidate for surgery. Resection of the tumor growth that is pressing against the urethra is the most common surgery for an enlarged prostate. The risks and benefits should be discussed thoroughly with
your physician.

“A lot of men think these problems are a normal part of aging and they just have to live with them,” notes Dr. LaGrange. “Just remember, if you are experiencing these symptoms, you are not alone, and in most cases, we can help you greatly reduce your symptoms with the appropriate medical therapy.”

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