World Kidney Day: Get to Know Your Kidneys

World Kidney Day is celebrated on March 12th. Our kidneys are vital organs that play a key role in keeping us healthy. But what exactly do our kidneys do and how we keep our kidneys functioning properly? Let’s find out.

What is a kidney? What do our kidneys do?

“A kidney is a filter that removes toxins and fluid from your body,” says Dr. Tony Alvarado, a nephrologist at New Braunfels Regional Rehabilitation Hospital. “Most people have two kidneys. They are the size of a fist, and they filter 200 quarts of blood per day.”

How do we keep our kidneys healthy?

As it turns out, staying physically fit has a positive effect on your kidneys according to Dr. Justin Black, a physical medicine and rehabilitation doctor at NBRRH. “Physical fitness helps improve a person’s endurance, strength, balance, and overall independence. But it also helps you with decreasing your blood pressure, improving circulation, and helping with your blood glucose,” notes Dr. Black. “Those things are all very important for your overall kidney health – maintaining good blood pressure and blood glucose.”

What are the signs of kidney disease?

Kidney disease can be a silent issue that many people don’t even know they have. Because of that, it can be challenging to diagnose. Certain factors increase the risk of kidney disease. “Patients with high blood pressure, diabetes, or a family history of kidney issues should look into getting checked,” Dr. Alvarado shares. Speak with your doctor about having blood work or other tests done if you have any of these risk factors.

What can I do to prevent kidney disease?

“Kidney disease, and the progression of kidney disease, is often preventable with lifestyle modifications,” adds Dr. Alvarado. “These include drinking enough water, avoiding smoking, making sure you’re physically active, and controlling any medical problems you may have.”

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Physical Therapy for Pelvic Floor Dysfunction

Pelvic floor dysfunction is a common condition, affecting about 25% of women age 20 and over. Unfortunately, many suffer in silence. But pelvic floor physical therapy can address urinary incontinence and other symptoms of this condition.

What is a pelvic floor?

The pelvic floor refers to a group of muscles, ligaments, and connective tissues in the lowest part of your pelvis. These tissues work together to provide support to the contents above them, such as your bowel, bladder, uterus, vagina, and rectum. They lend to pelvic stability and help with the function of pelvic organs, such as voiding and sexual function. Additionally, they play a huge role in posture and breathing.

What is a pelvic floor physical therapist?

Pelvic floor physical therapists are specially trained in the anatomy, physiology, and function of the lumbopelvic region. Pelvic floor physical therapists are trained to identify and treat dysfunction with the pelvic floor, as well as the contributing systems. The goal is to have a positive effect on the system as a whole.

What is pelvic floor dysfunction?

Pelvic floor dysfunction presents in many ways. One of the most common and easily recognized is urinary incontinence. Urinary incontinence refers to accidental urinary leakage. This can occur with urge, but also with intra-abdominal pressure. Examples include coughing, sneezing, and laughing. Functional activity, such as walking, standing, lifting, exercising, etc., may also be a cause.

Though very common, urinary incontinence is not normal. Television commercials suggest the use of protective pads to deal with the symptoms of urinary incontinence. However, pelvic floor physical therapy can have such a positive effect, these things are not necessary. A complete resolution to urinary incontinence is possible.

How does pelvic floor physical therapy work?

You may have heard about Kegel exercises as a means to strengthen the pelvic floor. Pelvic floor physical therapy goes way beyond Kegels. Examples of common treatments include strengthening muscles that are weak and relaxing muscles that might be too tight and not doing their job effectively. Soft tissue manipulation may be involved to help with soft tissues and joints that may be contributing to pelvic floor dysfunction. Patients are educated on lifestyle modifications, bladder retraining, and other ways to have a positive impact on the individual’s symptoms.

Who suffers from pelvic floor dysfunction?

Pelvic floor dysfunction is very common. Women of all ages are affected. Statistics suggest that about 25% of individuals aged 20 or older suffer from some level of pelvic floor dysfunction. Most likely you or someone you know is affected by this. Unfortunately, many individuals suffer in silence for years.

“I wish I would have come in sooner,” is something pelvic floor PTs hear often. Many times individuals are embarrassed or feel this is a normal part of aging. Others are unaware physical therapy can treat their condition, while some are afraid of what pelvic floor physical therapy entails. Hopefully reading this eases any discomfort you may have. These are muscles like any other, and a pelvic floor physical therapist will treat them as such.

Kelsie Martin is a physical therapist at New Braunfels Regional Rehabilitation Hospital. Kelsie holds a bachelor’s degree in Family and Consumer Sciences, with a focus on family and child development, and a Doctor of Physical Therapy degree from Texas State University. Kelsie has completed specialized training in the treatment of pelvic floor dysfunction, through Herman and Wallace Pelvic Rehabilitation Institute, as well as pregnancy and postpartum care through the American Physical Therapy Association. Kelsie loves having the opportunity to positively impact the lives of members of her community through physical therapy and is passionate about providing patient-centered care. 

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9 Health-Related Podcasts Worth Checking Out

Podcasts are a great way to learn something new. You can listen anywhere: in the car, at the gym, at your desk, while cleaning your house. They come in many different formats: interviews and stories, short and long, daily, weekly, and monthly. And you can find them on any topic you could imagine. We’re most interested in health-related topics, so here’s a list of 9 health-related podcasts worth a listen!


TEDTalks Health


Is any list of top podcasts complete without the inclusion of a TEDTalks series? Probably not! TEDTalks Health is a collection of short (appx. 15 minutes long) presentations on health-related topics. Bonus: these episodes include video. With over 150 episodes covering a wide range of topics, you’ll have no problem finding something new to learn.


Ten Percent Happier with Dan Harris

iTunes | Spotify

Dan Harris, a journalist at ABC News, has an incredible story. A wartime correspondent, Dan found himself hooked on drugs and struggling after returning stateside, culminating with an on-air panic attack. He found relief through daily meditation. “Ten Percent Happier” began as a book about his experience, since evolving into an app for meditation and this podcast. In the podcast, Dan interviews “smart people” from all walks of life about meditation, including physicians, celebrities, executives, and even the Dalai Lama.


JAMA Clinical Reviews

iTunes | Spotify

An interview series from the American Medical Association’s peer-reviewed medical journal. JAMA Clinical Reviews features interviews with authors of the latest clinical reviews. Recent topics include “A New Path for Gun Research Funding,” “Bariatric Surgery and Cardiovascular Outcomes in Patients with Type 2 Diabetes,” and “Responsible Use of Opioids to Treat Cancer Pain.” The interviews are high-quality and accessible, even if you don’t have a clinical background.


Nursing Podcast by NRSNG

iTunes | Spotify

If you’re a nursing student, this podcast is for you. The episodes are short (under 30 minutes) and focus on helping nursing students to feel more confident. The host, Jon Haws, RN, uses anecdotes from his own experience in nursing school to relate to the anxieties and struggles of aspiring nurses, providing tips along the way.


Louisville Lectures: Internal Medicine Lecture Series Podcast


This video podcast from the University of Louisville is published approximately once per month. Episodes are recordings of internal medicine lectures from university staff and guest lecturers. Over 200 lectures are available on-demand. Geared toward clinicians.


The NeuroNerds

iTunes | Spotify

This unique podcast was created by two survivors: Joe Borges (stroke) and Lauren Manzano (brain injury). Joe and Lauren, self-described nerds, designed The NeuroNerds to “create a community for like-minded nerds and fans of pop culture, who have suffered from brain injuries and are looking for support on their journey to recovery.” Episodes vary – some more “neuro” and some more “nerd” – but the unique and personal approach to this podcast makes learning about and understanding stroke and brain injury very accessible.


The WoMed

iTunes | Spotify

A relatively new podcast, The WoMed is hosted by nurses Danielle (D) Maltby and Danielle (Dani) LeVeck. D & Dani focus on “all things Women in Medicine” in an honest and raw way, sharing their experiences and interviewing other women from the world of medicine. There’s a good reason this podcast has shot up the charts just 19 episodes in.


Continuum: A Healthcare Podcast

iTunes | Spotify

Focused on educating and inspiring, Continuum is a monthly podcast published by Vibra Healthcare and Ernest Health. Covering a broad range of topics, from heart disease in minority populations, the current state of ventilator weaning, and tips for new amputees, we interview experts from throughout the healthcare world.


Progress Notes: Inspirational Stories of Patient Success

iTunes | Spotify

Every day, incredible people conquer serious health issues. Strokes survivors, quadruple amputees, people living with spinal cord injuries – their perseverance, determination, and grit are sure to inspire. In Progress Notes, these moving stories are shared in bite-sized episodes (about 5 minutes long) each week. If you find yourself struggling, be it with a health issue or some other challenge, check out this podcast and draw motivation from these amazing individuals.

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What is Sepsis?

Sepsis is the body’s extreme response to infection — and a life-threatening medical emergency. More than 1.5 million people contract sepsis in the United States each year. Over 200,000 of those people die from sepsis. As such, preventing infections that can lead to sepsis is a critical task in any hospital.

Who is most at risk for sepsis?

Anyone can contract an infection that leads to sepsis, but certain populations are at higher risk. These include:

  • Individuals aged 65+ or less than one-year-old
  • Those with weakened immune systems
  • People with chronic diseases, such as lung or kidney disease, diabetes, or cancer
  • Patients who have recently had surgery, have an open wound or burn, or invasive device, such as a catheter

What are the signs and symptoms of sepsis?

Symptoms of sepsis include an elevated heart rate, low blood pressure, and shortness of breath. A person with sepsis will also appear confused or disoriented. And since sepsis is the body’s response to an infection, common signs of infection will often be present. These include fever, chills, clammy or sweaty skin, and extreme pain or discomfort.

How do hospitals prevent sepsis?

Preventing sepsis is rooted in preventing the infections that can lead to sepsis. With healthcare-acquired infections affecting one in every 20 to 30 patients in the United States, this is no small task. Every person who enters the hospital plays a role in prevention.

Proper handwashing is one of the most critical components of infection prevention in a healthcare setting. Vaccinating staff and patients against influenza, pneumonia, and other illnesses also reduce the risk of infection. An antibiotic stewardship team ensures antibiotics are administered properly and remain effective. And when patients arrive with an infection, precautions including proper signage and the use of personal protective equipment minimize the risk the infection spreads.

What if I think I have sepsis?

If you have an infection that isn’t healing, or if you suspect that you or a loved one has sepsis, seek medical attention immediately. Sepsis is a medical emergency.


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Are Vaccines Only for Kids?

When we think about vaccines, we think about children. Measles, mumps, rubella, and chickenpox. We (hopefully) get our kids vaccinated, to protect them from these diseases. But are vaccines only for children?

Absolutely not! Vaccines protect people of all ages from disease. But adults often neglect to immunize themselves, putting themselves at risk of serious illness. But this doesn’t only affect ourselves — it affects our communities, too.

The Front Lines Against Disease

The most vulnerable people are those whose health is already compromised. For that reason, hospitals and other healthcare facilities are on the front lines of fighting disease. By keeping disease out of our hospitals, we keep that at-risk population safe.

A critical component of this is ensuring hospital staff are fully and properly vaccinated. Hospitals screen new hires to make sure they are immune to specific types of diseases. If they need vaccines, they’ll be provided to protect themselves and their patients. Flu shots are administered each fall. These vaccines, in conjunction with other precautions, such as proper handwashing and seasonal visitor restrictions, go a long way toward keeping patients healthy.

Additionally, an infection control nurse will work with patients to receive vaccinations. This includes the aforementioned immunizations, but also vaccines against diseases like pneumonia and the shingles. The infection control nurse meets with patients to educate them on these diseases and their vaccinations.
Immunizations are indispensable in protecting the health of our communities. While hospitals take care to vaccinate employees, please don’t wait to immunize yourself! Get your vaccines and guard yourself — and your community — against serious disease.

Liz Morris, RN, MSN is the Employee Health/Infection Control Nurse at Southern Indiana Rehab Hospital in New Albany, IN. She received a bachelor’s degree from Spalding College and a master’s degree from the University of Louisville. Liz is a member of APIC (Association for Professionals in Infection Control and Epidemiology).

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Every Step Counts: Tips for Beginning a Heart-Healthy Diet

When most people hear “heart-healthy diet,” they think they will never be able to eat salt again. Reducing sodium intake is an important part of a heart-healthy diet. But there are other ways to adjust your diet to improve your heart health, too.


The DASH diet stands for Dietary Approaches to Stop Hypertension. This diet has been found to improve blood pressure, even without a full reduction in salt intake. The diet focuses on eating lots of fruits and vegetables, lean meats, low-fat dairy, legumes, nuts and seeds, and whole grains.

You can start working toward this diet with small, simple changes each day. Add in an extra serving of fruits and vegetables. Swap out white bread or white rice for their whole-grain counterparts. These changes are easy to make and will get you started down the right path.

What About the Salt?

If you are ready to cut back on your sodium intake, there are few things to keep in mind. One is that sea salt and regular table salt contain roughly the same amount of sodium. Sea salt should not be considered an adequate salt alternative.

Salt substitutes, such as potassium chloride, may not be the solution, either. People with kidney disease, or those taking certain medications like diuretics, should avoid these alternatives. They can cause a dangerously high spike in potassium levels in these individuals. Before using a salt substitute, check with your doctor.

Salt-free seasoning blends, such as Mrs. Dash, can be a great option for cutting back on your sodium intake. These alternatives use herbs & spices to flavor your food, rather than salt.

Every Step Counts!

Most importantly, remember that every step counts! Whether you just shake the salt shaker once instead of twice or add in an extra helping of vegetables, each step gets you closer to a heart-healthy diet and keeping your heart and blood vessels healthy.

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Rehabilitation After a Lower Extremity Amputation

There are currently about two million people in the United States living with limb loss. Every year, 185,000 people undergo an amputation, with below-the-knee amputations most common. With that number expected to double over the next few decades, the need for rehabilitation after a lower extremity amputation is likely to grow.

Why are amputations becoming more frequent?

There are several factors contributing to the increased frequency of amputations. One of which is the result of medical advances. Such advances in surgical amputation have saved the lives of many patients with life-threatening infections, such as sepsis.

However, the most serious factor involves diabetes. Foot ulcers precede about 85% of lower extremity amputations. This wound on the foot starts a cascade of events leading to an amputation. This occurs most commonly in diabetics. Statistics paint a sobering picture, with amputations caused by diabetes increasing 25% from 1988 to 2009. That number isn’t expected to decrease, either.

How does rehabilitation help after an amputation?

If you or a loved one are facing a lower extremity amputation, your physician might recommend rehabilitation. Inpatient rehabilitation hospitals are uniquely positioned for recovery from a lower limb amputation. As a new amputee, there are two key goals to focus on in rehabilitation.

The first is to regain function. This includes the ability to manage your own daily self-care without the benefit of both of your lower extremities. This can be very difficult for a new amputee. Inpatient rehabilitation provides techniques and interventions to help you become successful and independent. The second is to prepare your body, including the amputated lower limb, for use of a prosthesis.

This process takes time and specialized care. In a rehab hospital, you will be seen by a physician and participate in three hours of therapy each day. Your physical and occupational therapists will work on addressing your unique needs for returning to your home and community. Medication management, pain control and healing of the incision are all priorities for your interdisciplinary care team.

During your stay, objective information is obtained and documented. This information goes with you for consultation with a prosthetist. The prosthetist can use this information to help make the right decision on your individual prosthetic limb. This level of communication is important to ensure you get a prosthetic limb suited for your individual case, and to help you transition to a productive life following your amputation.

Kevin Nicholson, PT is the Director of Therapy Services at Vibra Rehabilitation Hospital of Amarillo. He is passionate about stepping out of the normal “therapy box” to help patients improve and return home. He has also worked as a PT assistant prior to becoming a PT, and has a combined 31 years of experience in the field of physical therapy. In his off time he enjoys watching professional basketball and mixed martial arts, and he enjoys barbell training.

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Infection Prevention in Hospitals

Hospitals are a place of healing and recovery. But they are also a place where infections can spread easily if proper precautions aren’t taken. In the United States, healthcare-acquired infections are an all-too-frequent occurrence, affecting one out of every 20 to 30 patients. Fortunately, with everyone working together, the risk of infection can be greatly minimized.

What are the risk factors for infection?

There are a number of factors that contribute to the high risk of infection in a healthcare setting. Because patients are in a state of reduced health, their immune systems are often weakened. This leaves them more susceptible to infection. Additionally, they may have an open surgical wound, central line or catheter, all which make it easier for bacteria to enter the bloodstream.

Bacteria can also be quite resilient. If left alone, some bacteria are able to live on surfaces for up to eight months. Patients, visitors, and staff may also contribute to this risk if they arrive with the flu. Each year, approximately 36,000 people die of the flu in the United States. Finally, antibiotics can be a factor, with one in four prescribed inappropriately.

How do we minimize the risk of infection in a hospital?

Minimizing the risk of infection in a hospital begins with education and prevention. An infection control nurse works in tandem with hospital leadership to lead these efforts. Patients, visitors, and staff all play a role in preventing infections.

Proper handwashing is at the center of these efforts. This involves every person washing their hands thoroughly before entering and leaving a patient’s room. Hand sanitization stations are also placed outside of each patient room and at all entrances and exits. Secret surveyors and ongoing education reinforce compliance.

Particularly during flu season, visitor restrictions exist to limit the spread of germs. Staff and patients are vaccinated as recommended, and staff remains at home when sick. Staff health is one of the best ways to prevent the spread of flu in a healthcare setting.

Interdepartmental collaboration is also key in defending against the spread of infection. This involves making sure all surfaces are thoroughly disinfected and oversight for administering antibiotics. An antibiotic stewardship team reviews prescribed regiments for appropriateness and effectiveness. This team involves the infection control nurse, pharmacist, and medical director, among others.

What about patients who arrive with an infection?

Hospitals prepare for a patient with an infection before they arrive on site. Outside of the patient’s room will be a station containing all the necessary personal protective equipment (PPE) to enter the room. This PPE might include gowns, masks, and gloves, and is available for both staff and visitors. PPE is used when a patient has contagious organisms to prevent the spread of those organisms. Signage is also posted on the patient’s door, alerting everyone of what precautions need to be taken. These signs are often color-coded for ease of recognition.

Once the patient arrives, the infection control nurse meets with the patient. The nurse provides education on what organisms they are dealing with and what protocols should be followed. This helps the patient to be an advocate for themselves, both with their care team and their visitors. Patients play a key role in their own safety by knowing the signs of infection and encouraging everyone to keep their hands clean.

Patients, staff, and visitors all play a role in preventing the spread of infection in a hospital through education and collaboration.

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A Unique Perspective: International Nurses in the United States

With the United States facing a shortage of nurses, many healthcare organizations are looking abroad to meet demand. Those nurses, while highly qualified to care for their patients, also offer a unique perspective on healthcare in America. We spoke to several international nurses from Vibra Hospital of Fargo about their experiences.

Why did you decide to become a nurse?

Wangari (Kenya): It is something I wanted to do since I graduated from high school.

Abu (Nigeria): As a child, I always liked nurses, and later learned that it is a profession that helps humanity.

Anne (United Kingdom & Nigeria): I have a passion to provide evidence-based nursing care to patients.

Mary (Nigeria): My passion to care for the sick.

Patience (Nigeria): Because of my passion to care for people.

Ruth (Kenya): I love to take care of people who are not able to care for themselves.

What made you want to come to the United States to work as a nurse?

Ruth: I wanted a change, having worked in different capacities as an RN. I wanted to experience what being an RN in the US is like.

Wangari: To advance my career and hopefully use the experience and knowledge gained to help my home country, Kenya.

Abu: The United States offered broad opportunities for development professionally through education and best practices.

Anne: I needed to experience nursing in a different setting and grow rapidly in my career.

Mary: I decided to come to the USA to gain more experience in nursing and to put in my best in applying evidence-based practice in caring for the sick.

What are some of the differences between being a nurse in the US and where you worked previously?

Mary: The computer charting, digital vital signs and feeding pumps, infusion pumps, PEG tubes…I’m used to manual and paper charting. Also, the use of narcotics. Where I’m coming from, they are basically for surgery or terminal ailments, like cancer. In America, it is used constantly, even for minor pain.

Patience: In Nigeria, we use paper charting and its computer charting in the US. Most of the equipment here we didn’t have, such as a tube feeding pump. Frequent use of narcotics is common here.

Anne: In Nigeria, most of the procedures are carried out manually, such as giving feed through PEG tube and not using the syringe pump.

Ruth: Learning the different cultural practices.

Wangari: There are quite a number! Insurance covers relatively more in Kenya. Management of pain is different. There is less and more restricted use of narcotics in Kenya. The technology in the US is more advanced. More machines that make work easier. I appreciate that here in Vibra, we have an education department that helps keep us abreast with knowledge changes in healthcare and makes room for consultation when the need arises.

Abu: Here in the US, you have all you need to function optimally and according to standard procedures. In my previous country, so many things necessary may not be readily available and can sometimes be frustrating. Also here in the US, there is advanced technology that simplifies and makes your work easier, such as the Hoyer Lift.

What was your experience like coming to Vibra?

Patience: It has been nice. I learned new things and met new friends.

Mary: It has been pleasant and goal-oriented.

Ruth: Every day I’m learning something new. Friendly and supportive staff.

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How to Keep Safe After Hip Surgery

Falls and accidents can happen to anyone, but patients who have been hospitalized, weak, and had recent surgeries are at greater risk. This is especially true for those who have recently had hip surgery. By taking proper precautions you can reduce the risk of injury. Here are some tips on how to keep safe after hip surgery.

Start with the Basics

The first thing you can do is adhere to some general home safety practices for all households. Make sure that you have proper lighting throughout your home. Remove clutter near rugs. Secure your pets to keep them from getting underfoot. Install handrails on all stairs. And keep your floors dry to prevent slipping, especially in the bathroom.

Stairs and Ramps

When you return to your community, you may be faced with obstacles. During an inpatient rehabilitation stay, your therapist will prepare you to handle the challenges that may arise. It’s not uncommon for people to use equipment for walking assistance immediately after hip surgery. You may be issued a walker to aid in dealing with obstacles. For your safety and balance, remember to remain close to your walker at all times. After an operation, your physician may issue you hip precautions to follow, so there may be positions and movements that you should avoid. When going up stairs, you may want to lead with your stronger leg, but when stepping down, use your operated leg.

Bed Transfers

When approaching your bed, stand with your back to the bed, then back up until the back of your good knee touches the bed. You will bring your operated leg forward. Remember to move your body as one, and do not twist. Your therapist may issue you a leg lifter to help you get your operated leg onto the bed. Keep your walker within easy reach of your bed.

Car Transfers

It can be helpful to put the seat as far back as it will go. Keep your hips above your knees, especially if the seat is low. Stand with your back to the car, feel with the back of your good knee and sit, but watch your head. Finally, lift your legs one at a time.

Tub Bench Transfers

Install grab bars in your shower or tub for support as you get in and out. With your walker, back up until you feel the tub bench behind you. Reach back for the bench with one hand first, then the other. Then sit down.

Using a Hip Kit

To protect your hip, you must learn safe ways to do daily tasks. This includes getting dressed and undressed. Be sure to continue to follow your hip precautions according to your surgery. Your therapist may have issued you a hip kit package with tools to help manage getting dressed. This may include long-handled equipment to remove and retrieve your socks. Pull your sock onto the front of the sock aid device, slip your foot into the sock, and then pull back on the sock aid.

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