hiatal hernias

Q&A with Dr. Jonathan Kiev: What to know about hiatal hernias

Dr. Jonathan Kiev

A hernia is a medical condition that occurs any time an internal organ or tissue bulges into an area where it shouldn’t be. Hernias don’t always cause noticeable symptoms, but they can cause serious problems if left untreated.

In honor of Hernia Awareness Month, we sat down with Dr. Jonathan Kiev, a new cardiothoracic surgeon at UK HealthCare, to discuss a specific type of hernia called a hiatal hernia.

What is a hiatal hernia?

A hiatal hernia occurs when a portion of the stomach sneaks out of the abdomen above the diaphragm. This occurs fairly frequently and can cause symptoms of pain, heartburn and bloating depending on the size and location of the hernia. Most patients have no symptoms at all, and the hiatal hernia is only discovered incidentally during another test or procedure.

Why do hiatal hernias occur?

Hernias occur because of a weakness in the tissue. This can be caused by aging or even trauma, which may have caused a disruption in the abdominal wall layers. Pregnancy and obesity are known to contribute to the development of hiatal hernias, as well.

Can patients do anything to treat their hernia?

Generally, the answer is no, unless there are symptoms or if the hernia is large enough to require surgery. Patients who have heartburn or gastroesophageal reflux disease, or GERD, are given medications once they are evaluated by their physician to be sure that there are no other more serious medical conditions.

When is surgery for hiatal hernia necessary?

If the symptoms are disabling, like the person is having difficulty swallowing or they’re having food get stuck after eating, then surgery is appropriate. If a patient is anemic – a condition where their blood doesn’t have enough healthy red blood cells – sometimes the hernia can be the cause of anemia, and this can be relieved with surgery, as well. Rarely, a large hernia can become trapped, and emergency surgery is necessary to relieve the constriction.

How is a hiatal hernia diagnosed?

Beyond a good health history and physical exam, a physician may order a swallowing test with dye or a CAT scan to see if the stomach is above the diaphragm. Specialized tests by a gastrointestinal doctor might include an endoscopy, which looks at the lining of the esophagus and stomach for evidence of acid that may cause irritation.

What can patients expect if they need surgery?

Surgery can be done through the abdomen or the chest. Thankfully, today’s techniques allow the procedure to be performed with tiny incisions in a couple of hours so recovery is quick and pain is minimal. Most patients go home in a day or two and recuperate over the next several weeks.

Most patients go home in a day or two and recuperate over the next several weeks. Surgeons that specialize in minimally invasive procedures and thoracic surgeons are experts in the repair of hiatal hernias. Your physician can refer you to a surgeon in your area.

Are dietary changes necessary after surgery?

Patients can still eat all the foods that they enjoy, although they may be encouraged to modify their intake and meal frequency.

Is a follow-up necessary after this surgery?

Surgeons like to follow their patients closely to be sure that these hernias don’t come back. We know that the larger hernias have a higher likelihood of recurrence, and special procedures are done to minimize this. Overall, the results of this surgery are excellent, and patients are very satisfied afterward.


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exercise memory

Could exercise help ward off dementia? UK study aims to find out.

Allison Caban-Holt

Allison Caban-Holt

Written by Allison Caban-Holt, PhD, of the UK Sanders-Brown Center on Aging

Experts at the World Health Organization say that a sedentary lifestyle is one of the leading risk factors for death worldwide. We all know that being active can reduce our risk for diabetes, heart disease or even stress. But might it also help ward off dementia?

Recently, researchers have been studying the relationship between exercise and cognitive performance, bringing hopeful news about the benefits that exercise can provide patients who have degenerative brain diseases and cognitive impairment caused by Alzheimer’s disease.

The UK Sanders-Brown Center on Aging is one of 15 centers pairing with YMCAs across the country for a study called “Exercise in Adults with Mild Memory Problems,” or EXERT. EXERT will explore whether physical exercises such as stretching, balance and range of motion versus moderate-to-high intensity aerobic exercise can slow the progression of early Alzheimer’s disease memory problems (known as “mild cognitive impairment”) in older adults.

Participants will receive a free 18-month membership to a participating YMCA, a free personal trainer for 12 months, a personalized exercise program, medical evaluations and the opportunity to relax, meet new people and have fun.

To be part of this trial, participants must be between 65 and 89 years of age, experiencing mild memory problems, and able to exercise four times a week at the Lexington High Street YMCA for 18 months. Other criteria for the study include general good health, no recent history of regular exercise and not currently on insulin.

For more information about participating, please contact Molly Harper, EXERT study coordinator, at molly.harper@uky.edu or 859-323-2978, or visit the National Institutes of Aging website.

You or someone you know might be able to help prove the idea that “what’s good for the heart is good for the brain.”


Next steps:

  • Sanders-Brown recently teamed up with The Balm in Gilead to raise awareness about memory-related disorders in the African-American community. Learn more about the partnership.
  • Alzheimer’s disease usually affects people who are 65 or older. If there’s a senior in your life, be aware of these signs and symptoms of the disease.
men's health month

Men, now’s the time to fine-tune your health

June is Men’s Health Month, which means it’s the perfect time to take a look at what men of all ages can do to live a heathier lifestyle.

From keeping your heart healthy to being proactive about cancer screenings, here’s what you can do to be the healthiest version of yourself:

  • Know your family’s medical history. Knowing your family’s health story can give you insight into what preventive actions you can take in order to stay healthy. Genetics can play a role in your risk for heart disease, Alzheimer’s, some cancers and osteoporosis. Check out a blog by UK Gill Heart & Vascular Institute’s Dr. Gretchen Wells for more about the benefits of knowing your family’s health history.
  • Be proactive about cancer screening. Regular cancer screenings can help catch early signs of the disease and find treatment options. The American Cancer Society recommends most men get regular screenings for prostate, lung and colon cancers at age 50. If you have a family history of cancer, talk with your healthcare provider about when you should start regular screenings.
  • Exercise regularly. Staying active will help to maintain a healthy weight, and it can also help reduce high blood pressure, high blood sugar and cholesterol. Aim for 30 minutes of moderate activity five times a week. Something as simple as a brisk walk or bike ride with a friend will work wonders for your overall health. Don’t know where to start? Check out our five-step guide to beginning a new exercise routine.
  • Stop smoking. Toxins in cigarettes can damage your lungs and can lead to lung cancer. Your heart takes a beating, too. If you do smoke, now’s the time to quit. Check out our guide for finally kicking your smoking addiction.
  • Talk to someone. Depression affects more than 6 million men in the U.S. Men are less likely to talk about how they are feeling, but it is important to know warning signs of depression and ways to find help and treatment. Learn more about the symptoms of depression and what you can do if you or a loved one needs help.
  • Don’t put off regular healthcare visits. You may feel perfectly healthy and not see the need to go to the doctor, but it is important to make sure you see a healthcare provider regularly. Some medical issues, like high blood sugar and high cholesterol, may not have any early symptoms, but a physician can provide diagnosis and treatment.
  • Stay social. If you’re having trouble sticking to a health regimen or just want some help in staying healthy, ask your friends and family join in on your new journey to a healthier life. You’re more likely to stick to your healthy lifestyle if you have support and others that can hold you accountable for your actions.

Although June is Men’s Health Month, it is important to remember that your health matters all year long. By making these simple lifestyle changes, you can have a lasting, positive impact on your health.


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drowning

Drowning isn’t obvious. Here’s how to spot someone in trouble.

Many of us assume we know what it looks like when a person is drowning: Waving hands, splashing water and shouts for help.

Unfortunately, drowning isn’t nearly that obvious. One of the most alarming things about drowning is that unlike its depiction in Hollywood, it’s a deceptively quiet event.

Every day in the U.S., about 10 people die from drowning. Among children 15 and under, it is the No. 2 leading cause of deaths (just behind car accidents). And for every child who dies from drowning, there are five others who require emergency room care or hospitalization.

Although it may be difficult to identify someone who is drowning, there are common behaviors that might indicate something is wrong. The behaviors are known as the instinctive drowning response. That term was coined by Francesco A. Pia, PhD, a lifeguard and internationally recognized expert in drowning prevention. Here’s what Pia says a drowning person might look like:

  1. They’re quiet. Struggling to breathe makes it almost impossible to call for help. They may also be bobbing up and down as their mouth goes above and below the water line.
  2. They won’t be waving for help. In fact, the body’s natural response is to extend the arms laterally, allowing the person to push down and lift their head above water.
  3. They’ll be upright in the water. People who are drowning will not kick their legs and will appear relatively still. Their bodies will appear to be straight up and down in the water.

When a person is drowning, they’ll only be above water for between 20-60 seconds total. That’s why recognizing the more subtle signs of someone in distress can mean the difference between life and death.


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water safety tips

8 tips to keep kids safe around water

Before you head to the pool or lake this summer, be sure safety is on your mind, especially when children are around.

Among children age 15 and under, drowning is the No. 2 leading cause of death. Whenever children are near water, follow these safety rules:

1. Be aware of small bodies of water

This includes bathtubs, fishponds, ditches, fountains, watering cans – even the bucket you use when you wash the car. Children are drawn to things like these and need constant supervision to be sure they don’t fall in. Make sure you empty containers of water when you’re done using them.

2. Keep a watchful eye

Children who are swimming – even in a shallow toddler’s pool – should always be watched by an adult, preferably one who knows CPR. Be within arm’s length, providing “touch supervision” whenever infants, toddlers or young children are in or around water. Empty and put away inflatable pools after each play session.

3. Enforce safety rules

No running near the pool and no pushing others underwater.

4. Don’t forget life jackets

A life jacket fits properly if you can’t lift it over a child’s head after it’s been fastened. For children younger than 5, particularly non-swimmers, life jackets should have a flotation collar to keep the head upright and the face out of the water.

Don’t allow your child to use inflatable toys or mattresses in place of a life jacket. These toys may deflate suddenly, or your child may slip off into water that is too deep.

5. Safety in the backyard

Backyard swimming pools (including large, inflatable above-ground pools) should be completely surrounded by a fence that keeps children out without adult supervision. Keep toys out of the pool area when not in use so children are not tempted to enter without supervision.

If your pool has a cover, remove it completely before children go swimming. Also, never allow children to walk on the pool cover.

6. Avoid hot tubs

Spas and hot tubs are dangerous for young children, who can easily drown or become overheated in them.

7. Adults, stay away from alcohol

Don’t drink alcohol when you are swimming or supervising. It presents a danger for you as well as for any children you might be supervising.

8. Eliminate distractions

Talking on the phone, working on the computer and other tasks need to wait until children are out of the water.


Next steps:

  • When someone is drowning, it often goes unnoticed. No splashing. No waving. No yelling for help. Visit the blog tomorrow to find out how you can identify someone who’s drowning and what you can do to help.
  • Before you head outside to enjoy the summertime sunshine, be sure to protect your eyes with tips from our eye care expert. 
UK Sports Medicine Research Institute

New UK Sports Medicine Research Institute focuses on injury prevention, athlete performance

UK celebrated on Tuesday the opening of the new UK Sports Medicine Research Institute (SMRI), spearheaded by the UK College of Health Sciences and supported in part by a grant from the U.S. Department of Defense.

The 10,000-square-foot facility, part of the UK Nutter Training Facility on campus, will conduct research into injury prevention and performance optimization for professional and collegiate athletes, the tactical athletes of the U.S. military, and physically active people of all ages in Kentucky and beyond.

“Our research and scholarly endeavors offer the brightest hope for transformation and change for our Commonwealth and the broader world we serve,” UK President Dr. Eli Capilouto said. “This sentiment fuels the work of this university, and it fuels the work of the Sports Medicine Research Institute.”

Capilouto held the institute up as an example of the university’s efforts to collaborate across disciplines in addressing the challenges and disparities that face the Commonwealth, noting that seven UK colleges are involved in the work of the SMRI, in addition to personnel from UK HealthCare.

There is no similar facility within 400 miles of Lexington.

State-of-the-art technology

The SMRI is outfitted with sophisticated equipment to assess biomechanical, physiological, musculoskeletal and neurocognitive health. It’s supported by a team of eight core faculty, staff, and research assistants and 40 affiliate faculty. In addition to its Lexington location, SMRI operates a facility in Camp Lejeune, N.C., where its team works directly with MARSOC – the Marine Corps Forces Special Operations Command.

A biomechanics laboratory conducts motion analysis studies using 14 cameras and a dual-force plate system in the floor, similar to the technology used to make video games and animated movies. Equipment shaped like a horse simulates realistic movement for jockeys and other equestrians.

There is also a neurocognitive lab that uses virtual reality to assess visual acuity, reaction times and balance, which are critical measurements for concussion recovery.

Other equipment is designed to measure oxygen consumption, workload and metabolic costs, physiological stress, and the influence of sleep deprivation/fatigue, all of which are important contributors to musculoskeletal strength, endurance, operational performance and injury risk.

Dr. Scott Lephart, dean of the UK College of Health Sciences and founder of the SMRI, leads the $4.2 million Department of Defense grant that helped launch the institute. He said that the military can adapt from lessons learned in athletics and vice-versa.

“The elite warriors of the U.S. military are expected to be at peak performance in extremely dangerous and unpredictable situations, and there’s no room – either financially or personally – for them to sustain a preventable injury,” said Lephart, who is also UK Endowed Chair of Orthopaedic Research. “Our research with athletes both military and civilian is mutually beneficial, and it will result in strategies for injury prevention and performance for every walk of life.”

Impacts in education, health

University of Kentucky Provost Tim Tracy emphasized that the SMRI serves an educational need, in addition to its missions in research and clinical care, noting that the program provides educational experiences for both undergraduate and graduate students across the university.

“With this emphasis on collaboration, the different branches of UK’s mission – education, research, service and care – converge in the work of the SMRI,” he said.

Dr. Michael Karpf, UK executive vice president for health affairs, predicts that SMRI’s impact will extend far beyond the realms of tactical warriors and professional athletes.

“SMRI is a powerful merger of research, outreach and collaboration, enhancing UK HealthCare’s efforts to address chronic disease and poor health in Kentucky,” Karpf said.

UK Director of Athletics Mitch Barnhart noted that the SMRI was not just a valuable resource for UK athletes, but for professional and youth athletes across Kentucky and nationally.

“This is yet another example of the power of partnership on our campus,” Barnhart said. “By working together, we are creating cutting-edge resources for athletes both here at UK and beyond. The efforts of the SMRI will help minimize injury and maximize athletic performance in sports ranging from football to NASCAR and from basketball to horse racing.”

UK Sports Medicine Research Institute

Leaders from UK, UK HealthCare and UK Athletics came together to celebrate the opening of the SMRI.


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Every year, there are plenty of Americans who suffer the pains of kidney stones. Fortunately, you can help prevent stones by keeping well-hydrated.

Keep kidney stones away by drinking plenty of water

Written by Dr. Amul Bhalodi, a physician at UK Urology.

Amul Bhaoldi, MD

Amul Bhalodi, MD

Each year, more than a million people in the U.S. will seek treatment for mild to severe pain caused by a kidney stone. Overall, one in 11 individuals in the U.S. will be affected by kidney stones at some time in their life.

Kidney stones are often caused by dehydration. Not surprisingly, that means we see an uptick in cases during this time of year, when the weather is hotter and the risk of dehydration increases.

What are kidney stones?

Kidney stones are hard, pebble-like pieces of material that form in one or both kidneys when your urine contains more crystal-forming substances – such as calcium, oxalate and uric acid – than the fluid in your urine can dilute. In addition, your urine may lack substances that prevent particles from sticking together, creating an ideal environment for kidney stones to form.

Kidney stones can vary in size from tiny crystals that can only be seen with a microscope to stones more than an inch wide. Tiny stones may pass without you even noticing but can be extremely painful. Stones of any size can become stuck in the urinary tract causing swelling of the kidney and severe pain in the abdomen or lower back.

How can you prevent kidney stones?

The most effective way to prevent kidney stones from forming is to drink plenty of water. Dehydration is one of the most common causes of kidney stones. When we are dehydrated, urine is too concentrated and minerals can build up and form stones.

In fact, during the warmer or hotter times of the year, you’re at greatest risk of becoming dehydrated. That’s why it’s important to drink more water than you usually drink during the cooler times of the year.

Kidney stones can form at any age, but they usually appear in people between 40 and 60 years old. Of those who develop one stone, half will develop at least one more in the future.

Common symptoms

Symptoms may not appear until the stone moves around within the kidney or passes into the ureter – the tube connecting the kidney and bladder. The most common signs and symptoms are:

  • Severe pain in the side and back, below the ribs.
  • Pain that radiates to the lower abdomen and groin.
  • Pain that comes in waves and fluctuates in intensity.
  • Pain during urination.
  • Pink, red or brown urine.
  • Cloudy or foul-smelling urine.
  • Nausea and vomiting.
  • Persistent need to urinate.
  • Urinating more often than usual.
  • Fever and chills if an infection is present.
  • Urinating small amounts.

If you have these signs or symptoms, seek medical attention. Treatment depends on the stone’s size and location. A CT scan or X-ray can help pinpoint the location and estimate the size of a kidney stone.

Depending on what your doctor finds, you may be prescribed medicine and advised to drink lots of fluid. Or, you might need a procedure to break up or remove the kidney stone.

So, as you head outside this summer, remember to hydrate!


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Before heading outside this summer, make sure you and your family follow all of our sun protection tips. These steps can help prevent skin cancer.

Don’t get burned – here’s how to protect your skin in the sun

It only takes 15 minutes in the sun to damage your skin.

Before you head outside to enjoy the warm weather and sunshine, here’s what you need to know to protect your skin.

Sunscreen

Sunscreens are assigned a sun protection factor (SPF) number that rates their effectiveness in blocking ultraviolet (UV) rays. Higher numbers indicate more protection. You should use a broad-spectrum sunscreen with at least SPF 15, even on cool or slightly cloudy days.

Broad-spectrum on a product’s label means the sunscreen filters out ultraviolet A (UVA) and ultraviolet B (UVB) radiation exposure. UVA rays penetrate deep into the skin and are mostly responsible for premature aging and skin cancer. UVB rays affect the surface of the skin and cause sunburn.

Don’t forget to put a thick layer of sunscreen on all parts of exposed skin. Get help for hard-to-reach places like your back. Here are some additional things to keep in mind when using sunscreen:

  • Sunscreen wears off. Put it on again if you stay in the sun for more than two hours and after swimming, sweating or toweling off.
  • Sunscreen without an expiration date has a shelf life of no more than three years, but its shelf life is shorter if it has been exposed to high temperatures. Be sure to check your sunscreen’s expiration date.
  • Some makeup and lip balms contain some of the same chemicals used in sunscreens. If they don’t have at least SPF 15, don’t use them by themselves.

Avoid peak sun

Try not to schedule outdoor activities between 10 a.m. and 4 p.m.

Shade

You can reduce your risk of skin damage and skin cancer by seeking shade under an umbrella, tree or other shelter. Even when you are in shade, be sure to protect your skin by using sunscreen or wearing protective clothing.

Clothing

Long-sleeved shirts, long pants and skirts can protect you from UV rays. Tightly woven fabrics offer the best protection. A wet T-shirt offers much less UV protection than a dry one, and darker colors protect more than lighter ones. Some clothing certified under international standards is specifically manufactured to provide UV protection.

If wearing this type of clothing isn’t practical, try to wear a T-shirt or a beach cover-up. Keep in mind that a typical T-shirt has an SPF rating lower than 15, so use other types of protection as well.

Hat

For the most protection, wear a hat with a brim all the way around that shades your face, ears and the back of your neck. Tightly woven fabric, such as canvas, works best to protect your skin from UV rays. Avoid straw hats with holes that let sunlight through. A darker hat may offer more UV protection.

If you wear a baseball cap, you should also protect your ears and the back of your neck. Wear clothing that covers those areas, use a broad-spectrum sunscreen or stay in the shade.

Sunglasses

Sunglasses protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.

Sunglasses that block both UVA and UVB rays offer the best protection. Wrap-around sunglasses work best because they block UV rays from entering on the side.


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screen time

Is too much screen time affecting your health?

If you’re feeling overly stressed or unproductive, it might be a sign that you’re spending too much time staring at your smartphone.

That’s not surprising. In fact, data from a 2016 Nielsen study shows the average American spends almost 11 hours in front of screens each day. All that exposure to technology takes a toll on our overall health.

A growing body of research suggests that time staring at a screen can lead to health issues such as obesity, depression, anxiety, blurred vision and lack of productivity. Although it’s hard for all of us to go more than a few hours without technology, there are benefits to putting down your smartphone and enjoying the digital-free life.

These benefits include:

  • Reduced stress.
  • Healthier sleep habits.
  • Improved mental and physical health.
  • Boosts in productivity and creativity.

Here are some tips to limit screen time:

  • Use a device other than your smartphone as an alarm.
  • Charge your phone and other electronics outside of your bedroom.
  • Avoid checking emails after work.
  • Limit phone use an hour before going to bed.
  • Spend only 30-40 minutes on non-work-related devices each day.
  • Eat dinner at a table instead of in front of the TV.
  • Use the 20/20/20 rule to keep your eyes healthy. For every 20 minutes spent looking at a screen, look at an object 20 feet away for at least 20 seconds to help reduce strain on your eyes while at work.
  • Get moving. Aim for 30 minutes of brisk activity five days a week. A bike ride or walk with friends gets you away from your smartphone and works wonders for your overall health, too.

Sources: National Institutes of Health, The Vision Council


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e-cigarettes are not safe

What you might not know about e-cigarettes

Think e-cigarettes are better for you than other tobacco products? You may want to think again.

Although it is true that vapor from an e-cigarette does not contain the toxins and tar that tobacco smoke contains, it does contain nicotine, one of the most addictive known substances and one that’s harmful to your health, too. Here’s why you should think twice before trying e-cigarettes.

E-cigs won’t help you quit

Despite what you might have heard, e-cigarettes are addictive because they contain nicotine, just like other tobacco products.

Nicotine exposure can cause lasting harm to the brain and promote sustained use.

E-cigarettes are not safe during pregnancy

E-cigarettes and other electronic smoking products, like vapes, contain nicotine, which can cause birth defects and long-term health consequences for the developing brain and body of an unborn child.

They’re more appealing to non-smokers

One of the biggest fears with e-cigarettes is that their flavorings will attract non-smokers, particularly teenagers, and lead to a lifelong nicotine addiction. The younger a person is when they are exposed to nicotine, the harder it is for them to quit later in life.

The bottom line is it’s better not to smoke at all. If you’re a smoker trying to quit, be sure to seek out support to help you along the way. See our list of resources below. And if you’re a non-smoker, remember, that first e-cigarette could lead to a lifetime of trying to quit.


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