UofMHealthBlogs.org http://uofmhealthblogs.org The University of Michigan Health System Blog Hub Tue, 07 Jul 2015 12:51:58 +0000 en-US hourly 1 http://wordpress.org/?v=4.2.2 Living with a urinary diversion or neobladder http://uofmhealthblogs.org/cancer/living-with-cancer-2/living-with-a-urinary-diversion-or-neobladder/23601/ http://uofmhealthblogs.org/cancer/living-with-cancer-2/living-with-a-urinary-diversion-or-neobladder/23601/#comments Tue, 07 Jul 2015 12:51:58 +0000 http://uofmhealthblogs.org/?p=23601 Read on! →]]>

urinary diversionA patient with bladder cancer called and told me that she was scheduled to have her bladder removed (cystectomy). Her daughter was getting married in another state and she wanted to know about traveling after the surgery. I was happy to tell her that people with a urinary diversion are usually able to return to the life, work, and hobbies they previously enjoyed, including travel.

When the bladder is removed, it is necessary to create a new method for the patient’s body to handle urine. Urinary reconstruction and diversion is a surgical method to create a new way for you to pass urine. There are three ways to do this, called urinary diversions:

  • Ileal conduit, the most common type of urinary diversion
  • Neobladder
  • Indiana Pouch, also called a Colon Pouch or Continent Cutaneous Pouch

After surgery, it takes time to regain your strength. It takes one to two months on average to feel well again. The goal of the surgery is not only to cure or eliminate the disease or defect, but to help patients go back to their work, hobbies and activities of everyday life. Adjustments to a urinary diversion take time and patience and a positive attitude.

Are there restrictions regarding work, activities, diet, or travel?

Work – Most people can return to their jobs. Some jobs require heavy lifting which can cause a stoma to herniate or protrude. A sudden blow near the stoma could also cause damage. Patients should check with their doctors about their type of work and any type of job hazards they should be aware of or try to avoid.

Physical activity – After the post-operative period, exercising and participation in sports and other activities is encouraged. Patients with urinary diversions can continue to participate in sports, though you should consult your doctor regarding sporting hazards and protective equipment that may be needed.

Diet – There are no eating restrictions, but if you have special dietary concerns, check with your doctor or health care team member. The colon pouch produces mucous and this can build up. If you drink lots of water, it dilutes the mucous.

Lifestyle – Smoking is an important lifestyle factor: if you smoke, we strongly encourage you to quit. Not only does smoking cause cancer – there is a high correlation between smoking and bladder cancer – but smoking can slow down your recovery.

Travel – There are no travel restrictions. It is important to be prepared; make sure you have enough supplies (there may not be a place to buy more supplies, depending on your travel destination). If you’re traveling for long periods, it’s always good to get up and stretch every two hours.

Medical alert bracelet – Always wear your medical alert bracelet. You’ve had a significant change to your internal anatomy. In the event of an emergency, medical personnel need to know about your condition.

If you have any concerns about returning to work, activities, diet or travel, be sure to ask your doctor.

There are times when you may feel discouraged or depressed after surgery, these are normal feelings. Discussing with family and friends may be helpful or seeking support from another patient who has had a similar surgery. The Bladder Cancer Advocacy Network and the U-M Comprehensive Cancer Center’s Bladder Cancer Support Group are other options for you to find support.

Take the next step:

  • Bookmark these resources for patients with bladder cancer, compiled by the U-M Comprehensive Cancer Center.
  • Read more about living with urinary diversions from the Bladder Cancer Advocacy network:
  • Still have questions? Call the nurses at the University of Michigan Cancer AnswerLine™. They can help patients or their loved ones find a clinical trial or provide insights into the newest and latest cancer treatments. Feel free to call at 1-800-865-1125 or send an e-mail.

2013 annette 1The Cancer AnswerLine™ nurses are experienced in oncology care, including helping patients and their families who have questions about cancer. These registered oncology nurses are available by calling 800-865-1125 Monday through Friday, 8 a.m. – 5 p.m. Your call is always free and confidential.

 

 

Cancer-center-informal-vertical-sig-150x150The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.

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DIY Shaker Activity http://uofmhealthblogs.org/childrens/camp-little-victors/diy-shaker-activity/23594/ http://uofmhealthblogs.org/childrens/camp-little-victors/diy-shaker-activity/23594/#comments Tue, 07 Jul 2015 03:19:57 +0000 http://uofmhealthblogs.org/?p=23594 Read on! →]]>

mott blog - clv 2015 - musical shaker activity1Musical shakers are a great activity for kids of any age. You can vary the activity based on the ages of the group you are working with!

Supplies:

  • Plastic fillable eggs
  • Rice, dry beans (try different things to experiment with the sound)
  • Tape

Instructions:

Fill your egg with some type of dry, small material like rice, beans, lentils, etc. Close the egg and seal closed with tape. Instant egg shaker! Put different ingredients in different eggs to hear how the sound changes. You can also try to find different sizes of eggs to experiment with how that affects the sound.

mott blog - clv 2015 - musical shaker activityA fun DIY shaker game is a version of hot potato. Sit in a circle and pass the egg from person to person. The person with the egg when the music stops has to name their favorite color, food, etc. Then play again. Or, you can play the traditional hot potato way and the person with the egg when the music ends is out. Keep playing until you have a winner.

You can also play a copy-cat game – the first person can shake out a certain rhythm, with the next person attempting to follow the same rhythm.

Choose favorite songs and perform them with your shakers while dancing together or parading around your yard! The sillier the better!

Take the next step:


Meredith SchlabigMeredith Schlabig, MT-BC, is a Music Therapist at C.S. Mott Children’s Hospital. Our Board-Certified Music Therapists provide music therapy services to patients and families during their hospitalization. Music therapy services are tailored to each child and family. The music therapy team collaborates directly with the patient’s care team to provide quality interventions throughout hospitalization. A music therapist can engage patients and family in active music making through playing instruments, singing, song writing and recording, or passive music listening to assist in relaxation, provide distractions for medical procedures, decrease anxiety and support healing.

mott blog - clv 2015 - camp thumbCamp Little Victors is the virtual summer camp program from C.S. Mott Children’s Hospital.  Each week, for six weeks, participants receive an email full of ideas and activities to help keep families busy, happy and healthy all summer long.  Learn more and sign up.

 

 

best children's hospitalUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.

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DIY summer nature journal http://uofmhealthblogs.org/childrens/camp-little-victors/diy-summer-nature-journal/23585/ http://uofmhealthblogs.org/childrens/camp-little-victors/diy-summer-nature-journal/23585/#comments Tue, 07 Jul 2015 02:48:48 +0000 http://uofmhealthblogs.org/?p=23585 Read on! →]]>

mott blog - clv 2015 - SUMMER NATURE JOURNALA summer nature notebook is a fun way to notice the changes and special events of summertime.

Throughout the summer, the days grow longer and then shorter again. Temperatures rise and fall. We have days of rain and days of sunshine. Plants grow and bloom. Encourage your child to notice changes, in the light, the stars, in plants and animals and the weather. Have him or her make note of these observations in the journal.

Collecting a few leaves or flowers (with permission, of course) will also tell the story of summer and give you material for beautiful summer cards.

Materials:

  • A small notebook
  • Plain paper to press plants. Think about how many pages you want to have in your notebook, you can add more later. Stack the paper up and use a three-hole punch to make a row of holes the left side of the pages.
  • Heavy paper or card stock, for summer cards. Cardstock should be cut in half, and folded later to make small cards.
  • Pencils, watercolors, colored pencils, or pens
  • A small collection of plants that you have permission to collect
  • Large heavy books to press your plants or a flower press
  • Online sunrise/sunset calendar

Optional materials:

  • Flower press
  • Wax paper
  • Constellation finder to learn about the summer constellations
  • Other books that help you identify and learn more about plants, animals and weather including cloud activity

Journal Entries

Each journal is unique to the individual, so pick and choose the things that appeal most to your child.

  • Each day write down sunrise and sunset (use the newspaper or a weather app to get the information). Note if it was dark or light when you woke and went to sleep.
  • Note things like:
    • The first butterfly you saw (the name, or a picture of it)
    • The first night you saw a firefly, then when you started to see lots of fireflies.
    • When did it get too dark to see outside?
    • The different types of flowers you see or when they went to seed.
    • When you heard the first cicada singing?
    • A big thunderstorm.
    • Unusual cloud patterns.

Throughout the summer, wherever you go, write down at least one sentence about the light, the plants, stars, clouds and anything else you notice.

Pressing Memories

Before picking anything, ask permission. Select one favorite leaf or flower each day or week. On a sheet of plain paper, write where you found the plant, and something you noticed about the day — maybe the weather. You might also like to write something about what you did that day.

  • Arrange your flower or leaf lying flat on the paper with the writing.
  • Use another plain piece of paper and lay it on top of the plant.
  • Place the two pieces of paper with the plant in a flower press to flatten and dry your plant.
  • If you don’t have a flower press, no worries! Just press the sheets and plant between two heavy books.

With each day or week, add new stacks of paper and plant material. Remember to weigh the paper down with a heavy book or with the flower press. Mark a date at least three weeks away on the calendar when you will open the press. On that date gently open the press. Remove the pressed plants and papers. Choose which pressed plants you want to make into cards, and which ones for the summer journal.

Making a Journal or Cards

Flip the plant and pages so the plain paper with no writing has the plant lying face down on it. Brush glue on the page with writing, covering the area where you will place your plant. Carefully place your pressed plant on the glue, right side up. Flatten the edges and be sure all edges have glue.

You can also cover paper with a sheet of wax paper. Lay a piece of wax paper the same size as the card on top of the glued plant and paper. Place a clean dry cloth on top of the wax paper. With an adult, use an iron to flatten the wax paper and seal the pressed plant to the paper.

To make your journal, stack all the pressed plants and notes by date together so all the holes line up. Thread a heavy string or a ribbon through the holes to complete your very own Summer Survey Notebook.

Enjoy your memories of summer!

Take the next steps:

Mott Blog - CLV 2015 - take a pic promo


mott blog - matthaei thumgMatthaei Botanical Gardens and Nichols Arboretum are two properties in different locations operating as one unit within the University of Michigan, with a mission to inspire and enrich people’s lives through contact with plants and nature.  C.S. Mott Children’s Hospital is proud to partner with Matthaei Botanical Gardens and Nichols Arboretum to bring some of the adventures of the outdoors to Mott through regularly occurring activities for our Little Victors at the hospital. You can learn what activities are scheduled at the hospital during your visit by checking in with our Family Center on Level 2.

mott blog - clv 2015 - camp thumbCamp Little Victors is the virtual summer camp program from C.S. Mott Children’s Hospital.  Each week, for six weeks, participants receive an email full of ideas and activities to help keep families busy, happy and healthy all summer long.  Learn more and sign up.

 

 

best children's hospitalUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.

 

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Creamy blueberry “fridge” oatmeal http://uofmhealthblogs.org/childrens/camp-little-victors/blueberry-refrigerator-oatmeal/23567/ http://uofmhealthblogs.org/childrens/camp-little-victors/blueberry-refrigerator-oatmeal/23567/#comments Mon, 06 Jul 2015 17:18:50 +0000 http://uofmhealthblogs.org/?p=23567 Read on! →]]>

mott blog - clv 2015 - blueberry oatmeal 1Get your kids dreaming about breakfast with this delicious breakfast treat they’ll start preparing the night before.

Ingredients:

  • 1⁄3 cup old-fashioned oats
  • 1⁄3 cup plain yogurt (avoid vanilla or other flavored yogurts which often contain added sugars)
  • 1⁄3 cup low-fat milk
  • 2 tablespoons blueberries
  • 1 tablespoon chopped almonds, raw or toasted
  • 1⁄2 teaspoon honey or real maple syrup

  • mott blog - clv 2015 - blueberry oatmeal 2Pinch of salt
  • Canning jar or other container with a tight fitting lid

Instructions:

  1. Put all the ingredients in the jar.
  2. Screw the top and shake the jar to mix the ingredients.
  3. Place the jar in the refrigerator overnight.
  4. When you wake up, your creamy treat will be ready to eat.

These are also great for mornings on the go!

Take the next step:

This recipe was adapted from one from ChopChop Magazine. Check out their website for great ideas to get your kids involved in cooking and healthy eating!

 

Mott Blog - CLV 2015 - take a pic promo


 

mott blog - clv 2015 - camp thumbCamp Little Victors is the virtual summer camp program from C.S. Mott Children’s Hospital.  Each week, for six weeks, participants receive an email full of ideas and activities to help keep families busy, happy and healthy all summer long.  Learn more and sign up.

 

 

best children's hospitalUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.

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As easy as 1, 2, 3… http://uofmhealthblogs.org/childrens/camp-little-victors/as-easy-as-1-2-3/23559/ http://uofmhealthblogs.org/childrens/camp-little-victors/as-easy-as-1-2-3/23559/#comments Mon, 06 Jul 2015 16:51:51 +0000 http://uofmhealthblogs.org/?p=23559 Read on! →]]>

mott blog - clv 2015 - activity slip image2Here’s a great solution to keep on hand for all those “I’m bored” or “I have nothing to do” moments of summer. It can also be a great after-dinner activity to do as a family.

We call them 1, 2, 3 activity bags, but you can also use jars, boxes, etc.

  1. Print out our printable activity slips sheet.  You can print as many copies of the sheet as you want to make enough slips to last you the summer.
  2. Cut out your activity slips and divide them into three piles, each with the same number of slips.
  3. Fill out each slip with a portion of an activity – everything in one pile should be an activity (draw a picture, take a photo, write a story, etc.). Everything in the 2nd pile should be a subject (an animal, a person, a fictional character). And everything in the 3rd pile is what the subject is doing (catching a fish, baking a cake, driving a car).  Use our suggested ideas (below), and/or come up with some of your own that might appeal to your family. Use characters and activities your kids enjoy.
  4. Place each pile in separate bags, boxes or jars to keep around for the summer.
  5. When your child is looking for something to do, have him or her pull out one slip from each bag/box.

Parents can play, too!  Keep the containers handy and full throughout the summer so you have an answer next time you hear, “I’m bored.”  You could also make a special “vacation edition” to take along on a road trip.

Have fun!

ACTIVITY SLIP IDEAS

Category 1

  • Draw a picture
  • Write a story
  • Write a song
  • Create a dance
  • Take a picture
  • Make a movie
  • Create a skit

Category 2

  • Of your parents
  • Of your siblings
  • Of your grandparents
  • Of your pet
  • Of a dinosaur
  • Of a monkey
  • Of yourself

Category 3

  • Riding a kangaroo
  • Playing football
  • Baking cookies
  • Having a water balloon fight
  • Flying in a hot air balloon
  • Fighting off evil villains
  • Driving a double decker bus

Take the next step:

Enter to win 1 of 2 Project Life scrapbooking bundles!

a Rafflecopter giveaway


mott blog - clv 2015 - camp thumbCamp Little Victors is the virtual summer camp program from C.S. Mott Children’s Hospital.  Each week, for six weeks, participants receive an email full of ideas and activities to help keep families busy, happy and healthy all summer long.  Learn more and sign up.

 

 

best children's hospitalUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.

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Changing Colors http://uofmhealthblogs.org/childrens/voices-from-mott/changing-colors/23546/ http://uofmhealthblogs.org/childrens/voices-from-mott/changing-colors/23546/#comments Mon, 06 Jul 2015 15:50:03 +0000 http://uofmhealthblogs.org/?p=23546 Read on! →]]>
CIY carnation activity

Photo credit: PaintCutPaste.com

A fun way to teach kids about how our body uses the nutrients we give it is with a simple experiment involving carnations and food coloring.

You’ll need several white carnations (as many as you’d like to experiment with), food coloring, water and a few vases.

The experiment

Fill the vases up about a quarter of the way with water. Add about 10 to 20 drops of food coloring and stir it into the water. Cut off about an inch from the bottom of the stem of the carnation and place it in the vase. Now we wait. You can fill several different vases with different coloring if you’d like.

Every few hours, check back on the carnation to see if anything has changed. You might want to have your child keep a small notebook of observations.

How long does it take before the coloring starts to appear on the carnation’s petals? Consider coloring a picture of the carnation every few hours to note the changes. You can also use your phone to take pictures along the way so your child can compare the flower’s progression.  Does the carnation ever fully change colors? If so, how long does that take? Does the carnation stop changing colors? Do some colors move faster to the flower than others?

So how does this relate to your body?

Think of the colored water as the food and nutrients you take in. Think of the carnation as your body. When you eat or drink, it’s not just about how yummy it tastes. It’s about nourishing your body. The food travels down your throat into your stomach. Think of this like the stem of the carnation. The food is digested in your stomach and then the nutrients are sent out to your body to give you energy, strength and help you grow. Just like the flower sends the colored water out to the petals.

Unlike the carnation, your body needs more than water to live. Your body needs a well-rounded diet of fruits, vegetables, whole grains, and proteins. It’s also suggested to eat a colorful diet. Can you try to eat all colors of the rainbow?

Take the next step:

Mott Blog - CLV 2015 - take a pic promo


heather burrows mdDr. Heather Burrows is a pediatrician with a long-time association with the University of Michigan. After completing an undergraduate degree with distinction in Cellular and Molecular Biology, she earned a doctoral degree in Cellular and Molecular Biology and then graduated from the U-M School of Medicine in 2000. She next completed her residency in pediatrics at Mott Children’s Hospital. Her husband Bob is an Internal Medicine Hospitalist. They have a daughter Rose and a small dog Poppy. Her other interests include camping and sewing of all kinds. She sees patients at the East Ann Arbor Health and Geriatric Center.

mott blog - clv 2015 - camp thumbCamp Little Victors is the virtual summer camp program from C.S. Mott Children’s Hospital.  Each week, for six weeks, participants receive an email full of ideas and activities to help keep families busy, happy and healthy all summer long.  Learn more and sign up.

 

 

best children's hospitalUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.

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Should there be a dress code for doctors? http://uofmhealthblogs.org/general/should-there-be-a-dress-code-for-doctors/23538/ http://uofmhealthblogs.org/general/should-there-be-a-dress-code-for-doctors/23538/#comments Mon, 06 Jul 2015 14:53:17 +0000 http://uofmhealthblogs.org/?p=23538 Read on! →]]>
White  coat? Or casual? Or somewhere in between?

White coat? Or casual? Or somewhere in between?

If you live near a hospital, you’ve probably seen the sight: a young physician in loose blue scrubs, standing in line at the grocery store. You can’t help but wonder if the young physician is lost. After all, it appears that he or she belongs in an emergency room – not the dairy section.

The oversized bottoms, dangling bright orange pajama knot, deep V-neck and beeper ensemble not only look out of place, but lead to a slew of thoughts. Is he coming from or going to a shift? Could her clothes carry some sort of hospital microbe? What detritus has the outfit picked up on public transit or in line at the ATM that will track back to an operating room or patient? Has the American trend toward casual attire gone too far?

Regardless of profession, we all play out the sartorial ritual of considering colors, textures, and garments for work, school and play.

Clothing for doctors is more than just a matter of personal style: it is an emblem of their specialty, training and culture.

Making a good first impression

In some cases, a physician’s attire is functional. A surgeon’s scrubs protect regular clothes from stains and patients from infection.

Sometimes, it’s about creating a good first impression and projecting the more professional, conservative image often associated with medicine.

Go to a doctor’s office, for instance, and you’re more likely to find physicians donning a shirt and tie, or jacket and blouse when interacting with their patients. In almost all of these cases, the emblematic uniform of physicians – the white coat – is present.

This month, about 20,000 newly minted physicians will enter residency programs across America, to begin their professional journeys. Each will care for and influence the lives of countless patients.

And each has been trained to avoid “anchoring bias,” or to not to take the first thing they learn about a patient as the most important, lest they reach a biased conclusion or incorrect diagnosis. Yet few doctors or medical students consider the first impression they make on patients. And clothes have a lot to do with that.

In an informal survey in our hospital, only two out of 30 medical students said that they actually thought about their dress when caring for hospitalized patients. Yet, over half of the medical students we spoke to agreed that what they wear is likely to influence patient opinions about their doctors. This illustrates a larger discrepancy between what doctors ought to wear and what they do wear – one that may arise from competing concerns or lack of guidance.

Looking sharp. Doctors via www.shutterstock.com.

Just like the treatment doctors provide, that guidance should be grounded in evidence. For instance, a special report from infection-prevention experts found little evidence that germs on male doctors’ neckties, long sleeves, or white coats actually spread infections in a nonsurgical setting. So bans on such garments, such as those in place in some countries, may go too far.

Patients really like white coats

We recently published a study reviewing all available evidence regarding patient preferences for physician attire. We examined more than 30 studies that evaluated how patients viewed physicians’ attire.

In 21 of those studies, we found that patients had strong preferences about what physicians wore. And it looks like patients more often prefer for their doctors to wear formal clothing and white lab coats than not. Indeed, in 18 of the studies we reviewed, patients had a preference or positive association with this style of attire.

But as we reviewed these studies, three keys themes that suggest important variations in what patients may prefer their doctors to wear emerged. First, studies involving older patients or those from Europe or Asia all reported higher satisfaction when physicians wore formal attire.

Second, in emergency, surgical or intensive care settings, scrubs were not only preferred by patients, but also more often equated with professionalism. This makes sense, as in these more “hands-on,” procedure-oriented settings, formal suits, shirts and ties clearly seem out of place.

Finally, in doctors’ offices and outpatient clinics, scrubs were viewed unfavorably and often resulted in negative impressions.

Thus, from the patient’s perspective, a “one size fits all” approach may not work for doctor attire. Rather, the context in which a patient interacts with their doctor influences what they expect to see.

Given the tension between infection risk and patient preferences, it is not surprising that disagreement about dress code also exists among physicians.

After our study came out, the medical news website MedPage Today reported results from an informal, but still telling, online survey of over 2,000 patients and physicians about the “best approach to dressing for patient encounters.”

About 30% of doctors polled stated that they preferred to wear scrubs, casual attire or had no particular preference when caring for patients. However, more than 60% stated that doctors should wear white coats.

The online comments differed widely, with some physicians defiant in stating that they had “never worn a white coat in 30 years,” while others proclaimed, “priests and judges have their robes, we have our white coats.”

And despite clear patient preferences about what doctors wear while working, even the top-ranked hospitals in the nation, only a handful offer formal guidance on attire. Many vaguely recommend that clothes be “professional,” but without defining what professional means?

 

Keep your scrubs in the OR. Surgery via www.shutterstock.com.

A dress code for docs?

How, then, should doctors dress when caring for patients? Clearly, more evidence is needed to guide members of the medical community. So we have launched a large study that aims to better understand what patients prefer when it comes to physician attire.

We plan to survey thousands of patients from the US, Italy, Switzerland and Japan in settings that span outpatient clinics, doctors offices and hospitals. Because generational effects and familiarity matter, we will specifically assess how factors such as age or how often a person interacts with the health system shape patient opinions.

While we collect data for this study, what best practices can we recommend in the interim, especially those 20,000 brand new residents?

When in doubt, formal attire with long-sleeved shirts and ties for men, and business attire for women, should prevail in nonemergency or nonoperative settings.

This practice should hold true not just for weekdays, but also when physicians are working weekends and after typical business hours. Patients and their expectations remain unchanged, regardless of hour or day.

While scrubs are appropriate for operating or emergency rooms, we suggest changing into more formal attire to visit patients in the hospital or the clinic. Regardless of the occasion, flip-flops, showy jewelry or jeans simply don’t belong in the hospital, just as scrubs do not belong outside the hospital environment. Especially not in the grocery store.The Conversation

Vineet Chopra is an assistant professor of Internal Medicine at University of Michigan Medical School.
Sanjay Saint is a professor of Internal Medicine at University of Michigan Medical School. Both are members of the U-M Institute for Healthcare Policy and Innovation and the VA Ann Arbor Healthcare System’s Center for Clinical Management Research.

This article was originally published on The Conversation.

Take the next step:

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Breast density and breast cancer risk http://uofmhealthblogs.org/cancer/prevention-and-awareness/breast-density-and-breast-cancer-risk/23500/ http://uofmhealthblogs.org/cancer/prevention-and-awareness/breast-density-and-breast-cancer-risk/23500/#comments Wed, 01 Jul 2015 17:15:33 +0000 http://uofmhealthblogs.org/?p=23500 Read on! →]]>

breast density

In Michigan, a new law went into effect on June 1 requiring that mammography service providers inform patients if they have dense breast tissue on screening mammography. Michigan is the 23rd state to enact a law like this. So what exactly is breast density and what does it mean if you have dense breasts?

We talked to Renee Pinsky, M.D., an assistant professor of radiology at the University of Michigan whose specialty is breast imaging. Dr. Pinsky was involved in helping to shape Michigan’s dense breast notification law.

mCancerPartner: What do we mean when we talk about breast density?

Dr. Pinsky: Breast density is determined on a mammogram image. It describes the relative amounts of fat versus fibrous and glandular tissue in the breast. The fat appears as dark or black and the fibrous and glandular tissues appear as white. A mammogram with more white than black is described as dense. The problem arises because cancers appear white on a mammogram. It is difficult to discern a white cancer from the background white tissue in a dense breast.

mCancerPartner: Does breast density change as you age?

Dr. Pinsky: Yes, the general trend is to become less dense with age; however, this is not the case for all women. Factors that can negate the natural tendency to become less dense include taking hormone replacement therapy, as well as weight loss (which would decrease the relative amount of fat or less-dense tissue). Earlier in life, pregnancy and lactation also increase breast density. Weight gain and the medication tamoxifen are known to decrease breast density.

mCancerPartner: Outside of a mammogram, is there any way to know if you have dense breasts?

Dr. Pinsky: Breast density, as it is described today, is an assessment made on a mammogram. You cannot determine your breast density by the way the breasts look or feel. It is not standardized for other imaging techniques.

mCancerPartner: What is the concern over dense breasts that drove this new legislation?

Dr. Pinsky: The new legislation requires that radiologists notify patients of their breast density after their mammogram is performed, along with their mammogram results. The concern over dense breasts is twofold. First, there is the issue of masking, where a cancer that appears white could be hidden in a very dense, white background. A cancer is easier to detect against a fatty or non-dense background. The second issue regarding breast density is that women with dense breasts have a slightly increased risk of breast cancer compared to women with less dense breasts.

mCancerPartner: So, someone with dense breasts has a higher risk of breast cancer?

Dr. Pinsky: Yes, women with heterogeneously dense breasts or extremely dense breasts, which are the two highest categories of breast density, are at slightly increased risk of breast cancer compared to women with less-dense breasts. This has been described in different ways. Women who have extremely dense breasts have a relative risk of breast cancer that’s approximately 2.1 times the risk of women with average breast density. When comparing women who have heterogeneously dense breasts with women with average breast density the risk of breast cancer is approximately 1.2 times. It is recommended that this increased relative risk be part of the discussion to assess the need for additional screening or risk reduction intervention.

mCancerPartner: What screening options are available for women who have dense breasts?

Dr. Pinsky: It is recommended that women of screening age follow the Michigan Cancer Consortium screening guidelines for annual mammography after the age of 40 regardless of their breast density. If tomosynthesis is available, it is recommended as well.

Some women who have dense breasts will need additional screening if they have other risk factors that place them in a high-risk category such as:

  • greater than 20% lifetime risk for breast cancer
  • history of genetic mutations such as BRCA1 or BRCA2
  • untested first degree relative of a BRCA1 or BRCA2 mutation carrier
  • history of thoracic radiation prior to age 30

For these women, we recommend supplemental annual MRI screening in addition to their annual mammogram after the age of 30. Women ages 25-30 should have just MRI.

There’s also an intermediate-risk range in which women with dense breasts should discuss supplemental screening with their clinician. These risk factors include:

  • approximately 15-20% lifetime risk or strong family history of breast cancer
  • prior history of breast cancer
  • prior history of a biopsy with LCIS or atypia

Additional screening options include screening breast ultrasound, screening MRI and in some institutions, screening molecular breast imaging.

Take the next step:


Renee PinskyRenee Wayne Pinsky, M.D., is an assistant professor of radiology and director of medical student education for breast imaging at the University of Michigan Medical School. She specializes in breast imaging, conducting mammograms and other screening and diagnostic tests at the U-M Comprehensive Cancer Center.

 

 

Cancer-center-informal-vertical-sig-150x150The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.

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Strokes Steal 8 Years of Brain Function http://uofmhealthblogs.org/neurohealth/strokes-steal-8-years-of-brain-function/23455/ http://uofmhealthblogs.org/neurohealth/strokes-steal-8-years-of-brain-function/23455/#comments Tue, 30 Jun 2015 19:10:13 +0000 http://uofmhealthblogs.org/?p=23455 Read on! →]]>
Human brain injury or damage and neurological loss or losing memory and intelligence due to physical concussion trauma and head injury or alzheimer disease caused by aging with red gears and cogs in the shape of a thinking mind.

A new study shows that having a stroke ages a person’s memory and brain function by almost 8 years

A new study from the University of Michigan shows that having a stroke ages a person’s memory and brain function by almost eight years. Stroke, a publication of the American Heart Association, will publish the results in its July issue. The study team comprised members of the University of Michigan Medical School and School of Public Health and the VA Center for Clinical Management Research. The National Institutes of Health funded the study.

We talked with Deborah A. Levine, M.D., MPH, lead author of the study and a University of Michigan Medical School assistant professor, to learn more about the study and her thoughts on stroke prevention.

What was the effect of stroke on brain function?

We found that having a stroke meant that our participants’ score on a 27-item test of memory and thinking speed dropped as much as it would have if they had aged 7.9 years.

By measuring participants’ changes in cognitive test scores over time—from 1998 to 2012—we could see that both blacks and whites did significantly worse on the test after their stroke. 

Why did your team undertake the study?

For years, researchers have known that blacks have a greater incidence of dementia. We were trying to find out if that is because of racial differences in acute stroke, the impact of stroke on cognitive health or other factors. We study differences in risk of stroke and cognitive decline between blacks and whites to better understand the reasons for these differences and also to better understand what causes these diseases.

How did you analyze the data?

We analyzed data from more than 4,900 black and white seniors over the age of 65.

We merged two sources of information for our analysis: detailed surveys and tests of memory and thinking speed over multiple years from participants in the Health and Retirement Study, a large, national study of older Americans, and Medicare data from the same individuals. We then zeroed in on the participants who had no recent history of stroke, dementia or other cognitive issues but who suffered a documented stroke within 12 years of their first survey and cognitive test in 1998.

In this group of older adults, stroke did not explain black-white differences in cognitive decline or impact cognition differently by race.

What is the link between stroke and cognitive decline, and why is this study significant?

Cognitive decline is one of the most feared aspects of aging. It increases older adults’ risk of death, disability and dependent living, and decreases their quality of life.

Stroke is a major and preventable cause of cognitive decline. Our study shows that stroke is associated with significant cognitive decline. By preventing stroke, we can reduce an individual’s risk of cognitive decline, and most strokes can be prevented. Individuals of all racial and ethnic backgrounds can ask their doctors to screen them for stroke risk factors. They can also estimate their own risk of stroke using online scoring systems, such as the National Stroke Association’s Stroke Risk Scorecard. With this information, adults and their doctors can work together to implement preventive strategies that will reduce their risk of stroke.

How can we prevent stroke?

Control your blood pressure and cholesterol. If you’re taking medication for either of these conditions, make sure you take it on a regular basis as prescribed by your doctor. Don’t smoke. If you have diabetes, make sure you’re controlling your blood sugar. And always be active, even in old age. Think about adopting a Mediterranean diet, which can reduce the risk of stroke and cognitive decline.

If you have had a stroke, it’s critical to prevent another stroke from happening because second strokes are more lethal and disabling than first strokes.

Controlling risk factors like high blood pressure, high cholesterol and diabetes, and engaging in healthy lifestyles and behaviors can prevent 80% of repeat strokes.

How can rehabilitation play a part after a person experiences stroke?

Rehabilitation after stroke can improve function and cognition. Many stroke survivors recover.

Take the next steps

2/21/11 Environmental portrait of Dr. Deborah Levine at the CVC.

Deborah A. Levine, M.D., MPH, is Assistant Professor of Medicine in the Departments of Internal Medicine and Neurology and Research Scientist, Center for Clinical Management and Research at the VA Ann Arbor Healthcare System. She sees patients at the University of Michigan Health System. Levine’s primary research interests are the epidemiology, prevention and care of stroke and cardiovascular disease with a focus on vascular risk factors, medication adherence and health disparities. She founded the University of Michigan General Medicine Post Stroke Clinic.

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For more than 160 years, the University of Michigan Health System has been a national leader in advanced patient care, innovative research to improve human health and comprehensive education of physicians and medical scientists. The three U-M hospitals have been recognized numerous times for excellence in patient care, including a #1 ranking in Michigan and national rankings in many specialty areas by U.S. News & World Report.

 

 

 

 

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Fresh, summer produce makes healthy eating a snap http://uofmhealthblogs.org/cardiovascular/fresh-summer-produce-make-healthy-eating-a-snap/23443/ http://uofmhealthblogs.org/cardiovascular/fresh-summer-produce-make-healthy-eating-a-snap/23443/#comments Tue, 30 Jun 2015 16:32:12 +0000 http://uofmhealthblogs.org/?p=23443 Read on! →]]>

blueberries blogMichigan farmers markets and roadside stands are open, offering fresh-from-the-farm fruits and vegetables. Right now is the best time to get the following healthy, locally grown summer produce:

  • Basil comes a variety of flavors, including Sweet Genovese, cinnamon, lemon, opal and Thai basil. A small portion of basil (2 chopped tablespoons) has trace amounts of many minerals and vitamins such as magnesium, potassium, folate and Vitamins A and K.
  • Blackberries and blueberries are in season July through August. Enjoy these sweet, ripe, juicy local berries — one of the great treats of summer. Added benefit: They’re naturally low in calories and high in nutrients.
  • Butter lettuce Soft and tender, butter lettuce (also called Boston or Bibb) contains plenty of Vitamin K – along with C and A. Vitamin K in particular promotes good bone health. Lettuce, in general, is also full of folates, a water-soluble version of Vitamin B that helps boost the body’s ability to produce cells.
  • Fresh, sweet corn is in season mid June through August. Besides being a delicious addition to any meal, it is also rich in phytochemicals. According to researchers, corn oil has been shown to have an anti-atherogenic effect on cholesterol levels, thus reducing the risk of various cardiovascular diseases.
  • Sweet cherries are in season from late spring through early summer. They’re high in fiber and potassium and low in calories: one cup of cherries is about 100 calories. Cherries are full of anthocyanins, a type of phytochemical believed to be high in antioxidant activity.
  • Fresh peas such as sugar snap peas, snow peas and green peas are at their peak from April through July. As part of the legume family, peas are low in fat and high in fiber and are a good source of plant protein.
  • Flavorful and low in calories, radishes offer a distinctive flavor and are a good source of vitamin C. Choose radishes that are deep in color with solid roots for the best flavor.
  • Apricots pack beta-carotene, potassium, vitamin C and fiber and are a low-calorie choice to satisfy your sweet tooth. Apricots are in peak season from May to August. Grilling apricots brings out their sweetness.
  • Technically a vegetable, rhubarb is often used as a fruit in pies and jams. In season from April through July, rhubarb stalks area good source of vitamin C, potassium and manganese.

Recipes

ChoppedChowChow blog

Chopped Chow Chow is just one delicious recipe from the Regents of the University of Michigan.

Make the most of summer produce with these healthy recipes.

Chopped Chow Chow

Servings: 24

  • 1 red bell pepper, seeded and diced
  • 1 Hungarian pepper, seeded and diced, about 1/2 cup
  • Corn kernels from 1 ear of corn
  • 1 green tomato, diced
  • 1 1/2 cups cauliflower flowerettes
  • 1 cup English cucumber, diced, or pickling cucumbers
  • 3 carrots, diced, about 1 cup
  • 1/2 onion, diced
  • 1 jalapeno chile pepper, seeded and finely diced
  • 1 teaspoon celery salt
  • 2 teaspoons sea salt or kosher
  • 1/2 cup sugar
  • 1 cup white wine vinegar or cider vinegar
  • 1/2 cup water
  • 1 teaspoon mustard seed
  • 1 teaspoon ground turmeric

Method

  1. In a glass bowl, mix together vegetables, celery salt, and sea salt. Set aside.
  2. In a large saucepan, combine the remaining ingredients. Cook over medium heat until sugar is dissolved. Add vegetable mixture and continue to cook over medium heat until heated through but not boiling, approximately 5 minutes.
  3. Spoon mixture into glass storage containers and refrigerate, making sure that the vegetables are covered with the cooking liquid.

Nutrition Information (per serving – ¼ cup)

35 calories, trace total fat, 0 mg cholesterol, 299 mg sodium, 9 grams carbohydrates, 1 gram dietary fiber, 1 gram protein

Copyright 2015 Regents of the University of Michigan

Fresh Peas and Radish Salad

Servings: 8

  • 8 ounces fresh shelled peas
  • 4 ounces fresh spring radishes
  • 4 ounces edamame, shelled 2 ounces arugula
  • 3 ounces red onions, slivered ⅛ cup olive oil
  • 3 ounces shitake mushrooms 2 ounces arugula
  • 4 ounces firm tofu ⅛ cup light soy sauce
  • 2 ounces white balsamic dressing ½-ounce fresh chive, chopped
  • 1 ounce fresh parsley, chopped 1 lemon zest and juice
  • 1 Tablespoon fresh cracked black pepper

Method

  1. Blanch the peas, radishes and edamame and shock in ice water
  2. Toss the onions, shitakes and radishes in the olive oil, white balsamic and pepper
  3. Roast in oven at 350 degrees for 5 minutes
  4. While in the oven sprinkle tofu with soy and cut into ½-inch cubes
  5. Toss with the edamame, arugula, parsley and chives
  6. Toss in the roasted items and drizzle with the lemon zest and juice

Nutrition Information (per serving)

110 calories (45% calories from fat), 5 grams total fat, (.5 grams sat. fat), 5 grams protein, 11 grams carbohydrate, 4 grams dietary fiber, 0 mg cholesterol, 250 mg sodium

Source: University Unions

Strawberry Rhubarb Crumble

Servings: 8

  • 1 pound rhubarb (washed and cut into 1” lengths)
  • 1 pound strawberries (cleaned, hulled, and halved)
  • 3 Tbsp tapioca (quick cooking)
  • 1⁄2 tsp cinnamon
  • 1 cup brown sugar
  • Vegetable cooking spray
  • 1 1⁄2 cups oatmeal
  • 1/3 cup brown sugar, packed
  • 2 egg whites
  • 1⁄2 cup slivered almonds (or chopped pecans)
  • 1⁄4 tsp freshly ground nutmeg

Method

  1.    Preheat oven to 350°F.
  2.   In a large mixing bowl, combine rhubarb, strawberries, tapioca, cinnamon and 1 cup of brown sugar. Mix well.
  3.    Pour into 10-inch pie dish or 8x12x2 inch baking dish coated with vegetable cooking spray.
  4.    In the same large mixing bowl, combine all of the remaining ingredients and mix well.
  5. Distribute evenly over the fruit.
  6.    Bake in a preheated oven for approximately 45 minutes, or until the filling is bubbly and the crumble is golden.

For a more elegant presentation, bake in individual dishes. You will need to reduce the cooking time by 10-15 minutes.

Nutrition Information (per serving)

284 calories (14.8% calories from fat), 4.7 grams total fat, (.5 grams sat. fat), 5 grams protein, 59 grams carbohydrate, 4.5 grams dietary fiber, 0 mg cholesterol, 28 mg sodium, 115 mg calcium

Copyright 2009, The Regents of the University of Michigan, Ann Arbor, Michigan 48109

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Frankel-informal-vertical-sigThe University of Michigan Samuel and Jean Frankel Cardiovascular Center is a top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at umcvc.org.

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