Dr. Dana Johnson: Enjoy Safer, Happier Holidays

Originally published on December 25, 2013, in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson: How do I allow my child and myself to enjoy the holiday season more completely?

Dear Reader: Planning ahead and realizing that the holiday hustle and bustle can affect your child is the first step. The holidays should be a fun and exciting time for everyone, especially young children. As hard as it may be, children will handle all the excitement best if they are kept on a somewhat normal schedule.

Children appreciate consistency, so even when sleeping somewhere other than your home, it is best to follow typical nap times and bedtimes as well as pre-nap and bedtime routines. Sleep deprivation can cause a child to sleep more poorly, which further exacerbates the sleep deprivation.

While most adults can make up for late bedtimes by sleeping in later, many young children will not do this. There are children who will wake up about the same time every day no matter what time they fell asleep. If you will be at a party beyond your child’s bedtime, consider hiring a babysitter or talking with the host ahead of time to determine if there is a place your child can safely be placed to sleep.

It is difficult for adults to avoid all the delicious food temptations of the holiday season, and it is even harder for children. Before all the sweets and goodies are made available, offer your child a nutritious, well-balanced snack or meal. This may mean feeding them before going to a party or bringing healthy options with you. If they are already full, the temptation of sweets will be less.

Remember moderation is best. Combine sweets with healthy foods. Don’t leave the sweets sitting out within reach, as it is much easier for adults and children to nibble and consume numerous calories. Many of the holiday treats also can be choking hazards for young children.

Safety can be an issue during the holidays more than other times of the year. Unless the family you are visiting has young children, their home is unlikely child-proofed.

Most holiday decorations are not designed with the safety of small children in mind, as they often are breakable and have small pieces. Other hazards include decorative stocking hooks on a fireplace mantle (children can pull on the stocking, causing the heavy hook to land on them); Christmas trees (children can pull the tree on top of themselves, and real trees can become a fire hazard if they become overly dry); and lights (check for frayed wires or loose connections that could spark a fire).

Also, be especially aware of fireplaces, as many young children are burned by the glass on gas fireplaces each year.

It’s not just decorations that can pose hazards — the actual gifts can as well. Make sure toys are age-appropriate. Children under age 3 should not have toys with small parts, as these can pose a choking hazard. Keep older children’s toys and gifts that may have small parts or are breakable out of reach of younger children.

Some electronic toys and other gifts require button batteries, and many toys also have magnets. Either of these can be hazardous if swallowed. A healthcare provider should be called immediately in such cases (or even suspected cases).
If your child will be getting a bike, skateboard, scooter, skis, snowboard, etc., make sure he or she has a well-fitting helmet. If car travel is in your holiday plans, make sure children are secured in age-appropriate car seats or booster seats. Make sure the car is in good maintenance, keep the gas gauge above half a tank and have a winter emergency kit in the car.

Overall, be patient with your young child this holiday season. Schedules change, children are often around many people they don’t regularly see, and on top of it all, there is the added excitement of the season. Allowing them a little leeway is in order, although unacceptable behavior should still be corrected.

Have a wonderful and safe holiday season!

Read more: http://host.madison.com/news/local/ask/dr-johnson/dr-dana-johnson-enjoy-safer-happier-holidays/article_f0623636-284d-53cd-b40d-b8c556161fe4.html#ixzz2ogm6qFiI

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Healthy Weight and a Healthy Pregnancy

By: April Eddy, RN, CNS, CDE (APNP), Diabetes Clinical Nurse Specialist for Perinatal Services

Healthy weight can reduce the risk for multiple issues for a women’s health in general, but did you know how your weight can affect the chances of having a healthy pregnancy and baby?

Body Mass Index is a number calculated by comparing height and weight. A normal BMI is 20-25, overweight BMI 25-30, and obesity starts at a BMI of 30. Describing weight in this manner helps healthcare providers address the severity and likelihood of complications resulting from excess weight. It can also help direct goals for weight loss, as often times a weight loss reducing BMI by 1 point can greatly reduce risk for that condition. A BMI of 27 has been associated with an increased risk for type 2 diabetes. We know that a weight loss of 7% can greatly lower diabetes risk, so losing 14 pounds if you weigh 200 pounds can greatly lower risk of developing diabetes.

Women whose weight puts them in the obese category are more at risk for many issues during pregnancy including infertility, miscarriage, birth defects, twin pregnancies, gestational diabetes, gestational high blood pressure, urinary tract infections, complicated labor and deliveries, and c-section delivery with difficulty wound healing. These women are also at increased risk for certain conditions prior pregnancy including type 2 diabetes, high blood pressure and sleep apnea that can further complicate a pregnancy.

Women can also have problems with excess weight gain and retain more weight after giving birth. Women who are overweight and women who are obese do not need to gain as much weight during pregnancy. The Institute of Medicine provides guidelines for weight gain during pregnancy.

Unfortunately, most women do not receive guidance on this topic. It can be difficult for patients and providers to have these conversations. Sometimes women are never aware of pregnancy weight related risks and available resources to help them reduce risk.

There are many programs available to help people with healthy eating and weight loss. Avoid “diets” and fads and find out about healthy eating for you. Take advantage of area programs through your community or work. Ask to see a dietitian or if you have diabetes, a diabetes educator. All area HMO’s have these providers available and all of them also have healthy programs to assist participants with healthy eating and exercise. Many communities offer low cost programs through the local YMCA, city recreation departments, schools and churches. Not for you, work on setting up an individual plan.

Remember to always set goals that measure behavior and are simple, easy to measure progress. A goal of “I will exercise more” is probably not the best…a better goal may be “I will walk 30 minutes a day 4 times per week.” Find support to help you achieve your goal, this may be a spouse or friend who watches your child so you can exercise, or someone who will exercise with you and encourage you to go on those days you would like to skip. Losing weight is not easy but remember the rewards are great and any weight loss is a success.

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Dr. Dana Johnson: Holiday Gift Ideas

Originally published on December 18, 2013, in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson: Do you have suggestions on the best gifts for children this holiday season?

Dear Reader: It is the time of year that many children are compiling their list for Santa. As parents, we want to make sure their holiday wishes are met but some gift options are definitely better than others.

For children of any age, gifts that require children to use their own imaginations can be very educational. Especially for young children, I recommend limiting toys that have a single defined use or way to play with them (many electronic toys). Something as simple as blocks can be more educational and entertaining: they can be used to make a fort for other toys; they can be stacked into a tower; they can make a road for toy cars; and many other possibilities. For children under 2, sometimes the box and wrapping can be as or more entertaining than the toy inside.

Screen time is not recommended for children under age 2 so tablets, movies, etc are not appropriate for this age group. Also avoid toys with small parts that could be choking hazards for small children.

Some children can become overwhelmed by the number of toys they receive during the holiday season. Once the gifts are opened, leave a few out for your child to play with and put the rest in a closet. Pulling out one of these “new” toys can provide needed entertainment on a cold, snowy January day.

For many older children, electronic devices may be high on their wish list. While these can be educational and entertaining, their use still needs to be limited. For children over the age of 2, all screen time (TV, video games, computers, etc.) should be limited to a total of 2 hours or less per day. How the device is used and what games are played also need to be monitored. So if Santa will be delivering a new video game system or iPod, be ready to set limits on use from the beginning. If the ground rules are set and enforced from the beginning, hopefully there will be fewer battles regarding use later. Sometimes Santa will even provide these rules along with the gift.

Help to set your child’s expectations as they are preparing their lists. If the list to Santa becomes quite long or expensive, explain to young children that Santa may not be able to bring them everything as he has to bring toys to all little girls and boys. For teenagers, you can discuss more the cost of gifts and narrowing the list based what they want the most.

The holiday season can also be a great time to teach children the joy of giving. Taking the opportunity to volunteer or purchasing gifts for those less fortunate can be a valuable learning experience to teach children the value of sharing time and treasure with others.

I hope you have a wonderful holiday season!

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Johnson to people submitting questions.

Read more: http://host.madison.com/news/local/ask/dr-johnson/dr-dana-johnson-holiday-gift-ideas/article_d314cece-9ee2-5583-a3ba-f9002066dfdd.html#ixzz2nxjpTjqk

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Attend the Center for Perinatal Care Open House

We’re Blooming! Please join our Center for Perinatal Care Open House Celebration on Wednesday, January 15 from 5:00-8:00 pm.

This is the final step of the renovations of both women’s inpatient and outpatient units. Tour the new high-tech ultrasound rooms, learn more about our patient-centered, one room model of care and experience Meriter’s history of caring for expectant mothers.

Date: Wednesday, January 15
Time: 5:00-8:00 pm
Location: Meriter Hospital – Center for Perinatal Care
                     202 S. Park Street – Second Floor

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Four Reasons to Quit Smoking

By: Dr. Luke Fortney, Medical Director, Meriter Wellness Programs

  1. There is no safe level of exposure to tobacco smoke. Any exposure to tobacco smoke – even an occasional cigarette or exposure to secondhand smoke – is harmful. Secondhand smoke increases heart disease risk by 30% and causes as many as 46,000 heart-related deaths, each year, among non-smokers. Among children, second hand smoke is shown to be directly related to 300,000 new cases of bronchitis and pneumonia every year, as well as more frequent and severe asthma attacks, ear infections and overall respiratory infections.
  2. Damage from tobacco smoke is immediate. Tobacco smoke contains more than 7,000 chemicals and chemical compounds, all of which damage your lungs and DNA every time you inhale. Your blood circulates these toxins throughout every part of your body, causing DNA damage, which can lead to cancer. The toxin-filled smoke also causes damage to blood vessels and increases plaque buildup that results in heart attacks and strokes. Smoke damage to the lungs leads to asthma attacks, emphysema/COPD, chronic bronchitis and lung cancer. The good news is that all these issues are improved dramatically by stopping smoking.
  3. Cigarettes are designed for addiction. Nicotine is the most common form of chemical dependence on the US. Perhaps worse, tobacco products are intentionally designed & manipulated to make them more attractive and addictive. Because of this, nicotine products quickly lead to addiction, causing people to continue smoking even when they want to quit.Quitting is difficult and often requires several attempts, with many people relapsing due to stress. Meriter’s groundbreaking program, Mindfulness Training for Smokers, is designed to help individuals face and effectively deal with stressors. By helping smokers learn to better handle stress with basic mindfulness practices, more people are able to finally kick the habit—for good.
  4. Quitting smoking is possible! The majority of smokers are able to eventually quit (which is encouraging to know!) The following strategies are shown to be highly effective in helping smokers quit successfully.
    1. Talk to your doctor about smoking cessation during your next appointment. Just talking with your doctor for a few minutes can be extremely helpful, acting as the beginning to the quitting process.
    2. Counseling with an experienced smoking cessation therapist individually, with a group or on the phone is essential for most people. The more time you spend in person-to-person contact around smoking cessation, the better your chances are for quitting and staying quit.
    3. Medications can help. There are several options that can be tailored to your specific needs.

Mindfulness Training for Smokers at Meriter uses all of these strategies, simultaneously, which is why quit rates are so high. It all starts with YOU. Call us at 608-417-QUIT (7848). Let us help you quit smoking and take that first and most important step toward wellness!

Read this week’s blog post about Kelly Bodoh’s experience with the Mindfulness Training for Smokers program to learn how it can change your life.

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Quit Smoking with Mindfulness Training for Smokers

After completing Mindfulness Training for Smokers, Kelly Bodoh was able to take up running.

By: Kelly Bodoh, Smoking Cessation Coordinator

I’ve been running the stairs of my apartment building in preparation for “Hustle Up the Hancock,” an event comprised of running up 94 stories. I feel ready, and the sensation of being this alive in my body is beyond my wildest dreams.

After all, it wasn’t so long ago that my pulmonologist informed me that I was in the early stages of chronic obstructive pulmonary disease (COPD) after I explained my shortness of breath when carrying in the groceries. Yet, even witnessing the negative health effects of my two-pack-per-day habit wasn’t enough to inspire me to action. It was only after hearing about the Mindfulness Training for Smokers intervention when it was in its earliest stages of research that I began to think that freedom from smoking just might be possible.

Like you, I was well aware of the health risks caused by smoking. As a matter of fact, I was aware of those risks at the time of my first nicotine-laden inhalation. Yet, that information didn’t help me to manage my stress, comfort my broken heart or blow off steam. What I needed in order to move beyond my dependence on nicotine and change my smoking behavior was someone to show me how to step back and calmly navigate my triggers and urges. I needed someone to teach me more effective ways of coping with challenging situations and stress. I needed support and assurance that I, indeed, deserve optimal health and well-being.

That is what I found through the Mindfulness Training for Smokers program. Quitting is no longer considered a “pull yourself up by your bootstraps” endeavor. Smoking is a powerful addiction, worthy of the most effective treatments available, long-term support and continued care.

Even if you still feel the niggles of ambivalence that so often arise on the cusp of change, I encourage you to call me at 608-471-QUIT (7848) and find out more about how Mindfulness Training for Smokers can help you to acquire the skills and confidence to quit and stay quit for good. Whether your dream is to take up running, provide a healthier home for you and your family or just breathe a little easier, we’ll be here for you every step along the way.

Read “Four Reasons to Quit Smoking” to learn more about the dangers of smoking. Learn more about Meriter’s Smoking Cessation Programs today.

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How to Keep Stress In Check During the Holiday Season

Taking your dog for a walk can be a great way to build resilience to both predictable and unpredictable stressors.

By: Dr. Lindsey Duca, Health Psychology

Between snow storms, traveling with the family, holiday gatherings and out of town visitors, the holiday season has earned its reputation for bringing a healthy dose of stress along with sugar plums and mistletoe rendezvous. The good news is that while you may not be able to eliminate holiday stress, you do have a lot of options for taking care of your mind, body, and spirit during the holiday season and avoiding holiday burnout.

Take Care of your Mind and Body. Taking care of the basics can build resilience to both predictable and unpredictable stressors. If you are missing medications, skipping meals, not caught up on your sleep, and not moving your body, you are going to have less reserve in the tank when a new challenge arises. It may not be possible to prioritize all aspects of self-care (in fact, you don’t want to add to your stress by setting unrealistic goals!), but most of us can spend a few minutes taking a personal inventory and choosing one of two areas where a little change could go a long way.  Consider adding a walk with your dog, checking in with your doctor if you are having a hard time with a medication, or giving yourself permission to go to bed a little earlier. As Audre’ Lord wrote, “Caring for myself is not self-indulgence, it is self preservation”.

Build in Positive Experiences. It can be difficult to mitigate negative experiences and negative emotions, but you CAN proactively plan for positive experiences and positive emotions. Building positive experiences is like starting an emotional bank account– each time you do something pleasurable, however small, you are making a deposit. These small pleasures can give you a buffer for holiday stresses and help you build the emotional wherewithal to cope with setbacks and frustrations when they do occur. Even if your small pleasure is as simple as spending a few minutes singing along to the car radio, or having a 5 minute phone call with a friend, it can help to be mindful that this event is JUST FOR YOU. This can be particularly helpful during the holidays, when a lot of emotional energy may be spent on other priorities. When you build positive experiences, you are treating yourself with decency, love, and respect.  You may notice that the more attention you pay to positive experiences, the more you’ll experience!

Cope Ahead of Time. Some stressful experiences can be extremely predictable– you know they are coming and you can guess that you will have a strong emotional reaction. When a predictable stressor is on the horizon (and the holidays can be full of these!), you have the opportunity to develop a strategy for coping ahead of time so you feel more prepared for the challenge.

There are 4 basic steps to coping ahead of time:

1) Describe the situation– Be specific about what is going to trigger a stress reaction and what concerns you have. Are you anticipating spending time with a difficult relative? Are you worried about hosting a large event? Are you trying to balance health goals with holiday parties and treats? Have a sense of exactly what problem you are anticipating, and develop a very clear understanding of what you would consider a positive, realistic outcome.

2) Choose a coping strategy- Be thoughtful about whether the predictable stressor is one you can problem-solve, or one that you will do best to simply survive. In some cases, you may have more options than you think, and engaging in a personal brain-storming session, either on your own or with a neutral third party may present some options you had not previously identified. However, some stressors may not respond to problem-solving. In this case, your best option may be to focus on self-care and to be very mindful of not making the stressor worse. This can be particularly true with interpersonal stressors, which can often come up during the holiday season. Regardless of the type of stressor you are envisioning, be thoughtful about which strategy will work best for you. Be specific—it is often helpful to write coping options out in detail and to be evaluative about which one seems like the best fit for the situation at hand.

3) Visualize the situation– Once you have a clear sense of what you concern is and have chosen a coping strategy you think may be helpful, it is time to practice! Visualize yourself in the predictably stressful situation—be sure to envision the situation in detail, in the present tense, and make it as vivid and real as possible. Neuroscience research shows that visualization can be as effective as actually doing something in terms of how your brain processes information. In fact, visualization is often used by professional athletes, including former Badger QB Russell Wilson, as part of their mental preparation before competition, and is used as a performance enhancer.

4) Rehearse coping effectively– This is a particularly useful step if the stressor you are envisioning is interpersonal. In addition to visualization, it may help to physically rehearse exactly what you would like to do in the situation. This may include your actions, thoughts, what you say and how you would like to say it, even your body language. It will likely also be helpful to rehearse coping with potential problems that come up—we all benefit from a good back up plan! When you are rehearsing, be sure to make this a realistic world, but also to rehearse the situation going as well as is reasonable to expect. You want to visualize yourself coping EFFECTIVELY.

Final thoughts–Reach out. Sometimes seeking professional assistance can be an essential stress management strategy. If you are feeling overwhelmed, are struggling to manage stress on your own, or worry about the impact of stress on your emotional and physical wellbeing, discuss a health psychology or behavioral health referral with your doctor.

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Dr. Dana Johnson: Getting a Pet

Originally published on December 4, 2013, in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson: We are considering getting a pet for our family for Christmas. What recommendations do you have?

Dear Reader: This is a timely topic for my family — we introduced a new puppy to our household recently. We’ve had a dog before so we somewhat knew what to expect, but it has been about 10 years since we had a new puppy.

We were quickly reminded that a puppy means nighttime awakening and frequent potty breaks outside, even in the cold and snow. These frequent outdoor trips, however, don’t guarantee there won’t be accidents indoors.

I can tell you, though, that in the short time our dog has been a part of our family, she has already stolen each of our hearts.

There are several things you should consider before deciding that a pet is right for your family.

First, is it the right time? No matter what type of pet you get, it will take extra time and attention. If your family is already super busy and has limited free time, adding an animal to the mix may only increase stress.

With your family’s schedule and your child’s developmental stage in mind, decide how demanding of a pet you want.

A fish only requires feeding and water changes periodically. A guinea pig, hamster, bird or similar pet also requires minimal care compared to a cat or dog.

Even if you get the new pet with the idea that it will be your child’s responsibility to tend to, they may need help or frequent reminders to make sure the animal is cared for adequately.

If your child loses interest after a couple of weeks or months, maybe another family member is willing to take over the responsibility.

If not, discuss with your child that the animal’s health is at stake and if they are unwilling to care for the pet, you will need to find it a new home. Don’t blame your child or tell them they are too selfish; just present it in a matter-of-fact way that the animal has to be cared for properly.

Research the types of animal you are considering. Determine if it is a good animal for your child’s age and what you are seeking in a pet.

It can be important to know life expectancy. If the life expectancy of the animal is short, you will need to be prepared to address the death of the animal when it occurs.

If you are looking for a dog or cat, research the various breeds. Some are much better family pets than others. Also, adopt only from a reputable breeder or shelter.

All animals can carry disease, so it is important for them to have regular veterinary care. It is also important to wash hands thoroughly with soap and water after touching the animal.

An animal can be a great addition to a family but may or may not be right for your family at this time.

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Johnson to people submitting questions.

Read more: http://host.madison.com/news/local/ask/dr-johnson/dr-dana-johnson-getting-a-pet/article_b7b4cdf6-bb9c-53f5-9d70-4cb0cc92fb95.html#ixzz2mWBTBV00

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Six Ways to Beat a Cold This Winter

On average, adults experience 2.5 colds per year while children experience five colds per year. Keep these six tips close as cold season approaches.

By: Dr. Luke Fortney, Family Medicine

As winter approaches, people gather in close proximity in colleges, schools, daycares, clinics and workplaces. Humidity drops and indoor heating leads to dry air. Many experts believe that these and other factors can contribute to a rise in the common cold.

On average, adults experience 2.5 colds per year while children experience five colds per year. Even though the common cold is considered a nuisance illness, it has a significant decrease on quality of life in terms of physical, social and emotional functioning. Follow these tips to beat your cold this winter.

1. Frequent hand washing. Although hand sanitizer is helpful, it is not as effective as hand washing. It is important to note that hand washing is most effective if it lasts at least 20 seconds or as long as humming the “Happy Birthday” song from beginning to end.
2. Reducing stress. Research has shown that immune function and mood are correlated, with positive affective states resulting in stronger immune function and decreased illness. If you find yourself feeling stressed this winter, try deep breathing exercises, simple mindfulness practices, and a quiet day of rest. These practices can be helpful in treating and preventing a cold.
3. Avoid vigorous exercise while sick. Although regular exercise is encouraged, intense exercise should be temporarily halted while you have symptoms of a cold. Research has shown that cold symptoms worsen with excessive exercise. Alternative activities include short walks or light home yoga.
4. Smoking Cessation. Tobacco use significantly prolongs symptoms and increases the chance of getting a cold. Smokers who present with cold symptoms present an ideal opportunity for cessation counseling. Learn more about Meriter’s smoking cessation programs.
5. Limiting alcohol to low-to-moderate use. Excessive alcohol use and abuse should be avoided. However, low-moderate consumption has some health benefits. One study found that 1-2 drinks a day, especially red wine, predicted fewer to less severe colds compared to heavy drinkers.
6. Nutritional recommendations. It is recommended to consume low amounts of sugar during your cold. This includes avoiding soda, candy, sweets and desserts. However, not all sweeteners are created equal. Honey has antioxidant properties, and research shows that 1-2 teaspoons of honey 3 times a day can significantly reduce cough frequency and severity.

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Part Two: Preventing Type 2 Diabetes with a Healthy Outlook

Team sports can foster confidence and teamwork and can range from soccer to baseball to swimming.

By: Michelle Swader, Dietitian

Here are a few additional ways to help your child stay at a healthy weight and prevent the onset of diabetes at a young age. Read Part One: How to Prevent Type 2 Diabetes in Children for additional information on preventing diabetes in children.

Physical Activity: Being physically active plays a large role in the health and growth of children. It has many physical, social and mental benefits, and the healthy effect of exercise continue for hours after the activity is complete. The American Academy of Sports Medicine recommends 30-60 minutes of moderate physical activity per day for children. If your child is not getting the amount of activity he or she should, here are some tips:
• Team sports can foster confidence and teamwork, and it can range from soccer to baseball to swimming.
• Get involved! Families that are active together create quality family time, and it’s a great opportunity for parents to model healthy behaviors, and get some physical activity of their own!
• Keep it fun! Hiking in the woods, biking, skateboarding and dancing are some great ways to get some physical activity into your day.
• Start slow and explore. If your child is starting and activity for the first time, overwhelming them with too much commitment or level of difficulty can turn them off. Keep in mind that you may need to try several different activities to fun the ones that your child will want to keep doing…hopefully for the rest of their lives!

Healthy Outlook: Focusing on a variety of foods, using seasonal foods, learning about portions sizes and cooking at home can help keep a healthy relationship with food. Having kids involved in the shopping and cooking, as much as they can, can help empower them to try new foods and can prevent unhealthy attitudes about eating and fear of certain foods.

Children should learn how to choose their own healthy diet, and why it’s important, but they should also learn that no one can be perfect all the time, and there are times and places for special treats. Having a healthy but realistic attitude towards food and exercise will help you and your family enjoy your healthy lifestyles.

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Healthy Recipes Featured in the Community Cooking Class

Oven “Fried” Chicken
4 portions
4 Piece  Chicken breast, bone less, skinless, 5-8 oz (can use bone in, if skin removed)
2 Cups  Panko bread crumbs, or regular standard bread crumbs
2 Eggs, beaten
1 Tablespoon  Garlic powder (or adjust to taste)
1 Tablespoon  Black Pepper (or adjust to taste)
Pinch   Cayenne (or adjust to taste)
½ Cup  Grated Parmesan Cheese (or adjust to taste)
1) Remove any fat/skin from chicken breast
2) Mix all spices together with Panko breadcrumbs
3) Dip the chicken breasts in the beaten egg and then into the seasoned breadcrumbs
4) Place on a cookie sheet (sprayed with PAM) and Bake at 350 degrees for 35 minutes, or until internal temperature of the chicken is 165 degrees
Southern Beans and Sweet Potatoes
4 portions
2 Cups Frozen green beans (fresh can be used as well)
4  Sweet Potatoes (peeled)
1/2 Cup  Olive Oil
1  Tablespoon  Garlic (fresh)
½  Teaspoon  Black Pepper (or adjust to taste)
2  Tablespoon   Balsamic Vinegar
½ Cup  Sliced Almonds
1) Steam Green beans, to personal liking, until tender
2) Wash, peel sweet potatoes and cut into bite size pieces. Place on cookie sheet (sprayed with PAM) and sprinkle with a pinch of salt and a Tablespoon of olive oil. Bake these at 350 degrees for 12 minutes or until tender
3) Mix together olive oil, garlic, pepper and balsamic vinegar together then add cooked beans and potatoes
4) Add almonds and toss everything together. This can be served warm or cold
Garlic Parmesan Mashed “Potatoes”
4 portions
1  Large bag Frozen cauliflower (fresh can be used as well (2 heads)
¼  Cup Parmesan Cheese (grated)
¼ Cup  2% milk
1  Tablespoon Garlic (fresh)
½  Teaspoon  Black Pepper (or adjust to taste)
1  Tablespoon Dried chives (fresh can be used as well)
1) Steam cauliflower until tender (in a pot of boiling water)
2) Once cooked place in bowl and mash by hand or place cauliflower in blender
3) Add Parmesan cheese, milk, garlic and pepper (amounts can be adjusted based on personal preference)
4) Once everything is mix and the consistency is close to mashed potatoes top with dried chives and small amount of butter (if desired)
Pumpkin Pie Fluff
4 portions
1 Large can Pumpkin
1 Tablespoon  Cinnamon
1 Teaspoon  Nutmeg
1 Container Fat free cool whip
1 Large box French vanilla pudding (Fat free)
1) Add all ingredients into a bowl and whisk together.  Let refrigerate for at least 2 hours. Top with whipped cream and sprinkle with a little cinnamon/nutmeg mixture.
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Dr. Dana Johnson: Constipation Concerns

Originally published on November 27, 2013, in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson: My 3-year-old daughter has been having hard golf ball-sized stools. Should I be concerned, and what can I do?

Dear Reader: Stooling patterns between individuals can definitely vary, but hard, dry, painful or difficult-to-pass stools are an indication of constipation.

Constipation is a very common problem that most people must deal with at some point in their life. Usually, it is temporary and self-resolves, but it can also be more persistent and require treatment.

Constipation is one of the most common causes of belly pain in small children. While babies can have constipation, it is less common in this age group, especially in exclusively breastfed babies.

For babies, the consistency of the stool is more important than the frequency. For babies who are having hard, thick or pellet stools, it is best to talk with their doctor about possible causes and treatments.

Constipation is much more common in older children. There are various causes, and one of the most common is diet. Lack of fiber and fluids can increase constipation. An illness with a change in appetite can cause constipation. It also can be a side effect of some medications.

In addition, constipation can be a result of a child holding their stool. They do this for various reasons. They may be too busy playing to take time to go to the bathroom. They may not feel comfortable stooling at school or in public restrooms. They may have had a hard stool that hurt to pass, so they don’t want to go again for fear it will hurt again.

When they hold the stool, more water is absorbed from it into the intestine and the stool becomes harder, making the constipation worse.

Abdominal pain is one complication of constipation. In some cases, this can be severe. It is usually the worst after a child eats. The pain is felt across the whole abdomen and improves after a relatively short period of time (five to 30 minutes) only to recur later.

Pain related to constipation is caused by the intestine contracting in an effort to push the stool out but causing discomfort when pushing against the hard stool. The pain often improves when a child does stool.

Rectal bleeding with blood on the outside of the stool or on the toilet paper after wiping can occur when the hard stool causes tears in the rectum called fissures.

Over time, the rectum can become so distended from large stools that the child may no longer feel the urge to stool until the stool is too large to pass. There can then be leakage of liquid stool (accidents) around this big stool. This is called encoporesis.

One of the best treatments for mild or intermittent constipation is to increase foods in the diet with fiber and increase the amount of water intake each day. This is one instance that I also might recommend drinking fruit juice. The sugar in the juice can help pull water into the stool and soften it.

Encouraging your child to take regular bathroom breaks (especially after meals) throughout the day also can help promote a regular stooling pattern.

For children who don’t respond to increased fiber and water or who have more severe constipation, a medication to soften the stool is often recommended. Sometimes we also need to use a medication to stimulate the body to push the stool out (laxative), rectal suppository or an enema, depending on the symptoms and severity. These should not be used without first discussing it with your child’s doctor.

If your child has constipation that is not resolved with increased fiber and water or has abdominal pain or significant constipation, I recommend checking with her doctor to determine the best treatment.

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Johnson to people submitting questions.

Read more: http://host.madison.com/news/local/ask/dr-johnson/dr-dana-johnson-constipation-concerns/article_31f2f951-70b2-5786-90b8-38a06a4801c7.html#ixzz2lrMxQ9MG

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Part One: How to Prevent Type 2 Diabetes in Children

A healthy diet is right for everyone in your family, so you can all follow the same diet to stay healthy and strong.

By:  Michelle Swader, Dietitian

We are seeing type 2 diabetes appear at an earlier age than in previous generations. In the past, the disease was most typically diagnosed in people over 40, but it is now being found in children and teens. Why is this happening? Many things influence a disease such as diabetes, but achieving and maintaining a healthy weight can help to prevent it. Fortunately, there are things you can do to help your child stay at a healthy weight and prevent the onset of diabetes at a young age.

Healthy Diet:
This is not a temporary fad diet, but a way of eating for life. A healthy diet is crucial for all children to grow and learn their best. The good news is that a healthy diet is right for everyone in your family, so you can all follow the same diet to stay healthy and strong.
A healthy diet should be made of mostly:
• Vegetables
• Fruits
• Lean meats
• Low-fat dairy products (like milk and cheese)
• 100% whole grains (like breads, cereals, crackers, rice, popcorn)

Snacks vs. Treats: Approach daily “snacks” like small meals. They should still have a balance of a few of the items above, just in smaller portions. Snacks should be 100 calories for young children and up to 300 calories for active teenagers. “Treats” are more like desserts, and should be rare during the week, or for special occasions. This will keep the “junk food,” containing processed foods, added sugars, and empty calories to a minimum, while making sure the foods you and your family eat every day are full of good nutrition like protein, fiber, vitamins and minerals. Here are some healthy ideas to help you plan for the next snack-time:
• Homemade trail mix: 1/4 cup each: whole-grain cereal, raisins or any dried fruit, and your choice of nuts, such as almonds, walnuts or sunflower seeds
• Low-fat cottage cheese, yogurt or frozen yogurt topped with fresh fruit
• Eight ounces of low-fat plain or chocolate milk and whole wheat pretzels
• Whole-grain crackers, string cheese, and fruit
• Raw vegetables with low-fat ranch dressing, and a hard-boiled egg
• Instant oatmeal made with low-fat milk in the microwave. Top with cinnamon or cocoa powder and top with berries
• English muffin or whole-wheat pretzels with peanut butter, almond butter, or sunflower seed butter
• Bowl of whole-grain cereal and low-fat milk
• Small container of low-fat Greek yogurt
• Mini bagel spread with low-fat cream cheese and jam, with low-fat milk
• Hummus and whole wheat pita chips
• Slice of pizza
• Low-fat microwave (or homemade) popcorn tossed with Parmesan cheese
• Hard-boiled egg and whole-grain roll

Look for part two of preventing type 2 diabetes in children later this week.

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Dr. Dana Johnson: Preparing Sibling for Baby

Originally published on November 13, 2013, in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson:
We are expecting a baby. How do we prepare our 3-year-old for the addition to the family?

Dear Reader:
First of all, congratulations. How to best prepare an older sibling can vary greatly based on the child’s age and personality. If your child is old enough to understand, you can talk about how the baby is in your belly and will be coming home soon.

Picture books about babies can be helpful. Share your excitement about the new baby. If your child is old enough, you can also talk about how the baby will cry at times and need extra attention.

If your child is interested, you can buy a doll and begin showing him or her how to care of the baby. Try to make any changes to beds, bedrooms, potty-training or routines in advance of the baby’s arrival so the sibling doesn’t feel the baby is taking something from them or become overwhelmed by too many changes.

When the baby arrives, allow the older child to be involved as much as possible, if they are interested. Some young children are ambivalent to the new baby and this is OK. Other children are very interested in the new baby.

Try to make the interactions positive. Instead of saying, “Don’t touch the baby’s face,” you can say, “The baby likes it when you touch her feet.” Allow your older child to feel helpful by getting you diapers, helping to fasten the diapers, replacing a spit-out pacifier, etc.

Expect some regression of behaviors and behavioral outbursts. This is very normal when there is such a big change. Be consistent with discipline but understanding of the changes in behavior.

Try to keep your older child to their typical routine. Make sure he or she has opportunities to burn off some energy during the day.

Set aside time each day for your older child. This doesn’t have to be a long period, but use it to read, play games or just talk. You also can have time to connect by allowing the older child to sit with you while you feed the baby.

Ask for help. Having a new baby in itself can be overwhelming but two children can be even more so. Ask family and friends to play with your older child when they come to visit. This helps the older child to feel special and shows them that the baby is not getting all the attention.

I do not recommend leaving a toddler alone with the baby in a room. The toddler may attempt to do something they think is helpful like picking up a crying baby and end up harming the baby. As any parent of a toddler knows, they can be unpredictable and don’t always follow parental direction.

You are approaching an exciting new event in your family’s life. Congratulations!

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Johnson to people submitting questions.

Read more: http://host.madison.com/news/local/ask/dr-johnson/dr-dana-johnson-preparing-sibling-for-baby/article_d331df33-4a31-557e-96a8-7c9dff23d7a1.html#ixzz2lClwVC80

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10 Tips For Healthy Skin This Winter

To keep your skin soft and itch-free, apply lotion or cream as soon as you finish washing your hands or bathing.

 By: Dr. Michael S. Pomroy, Dermatologist

Although Healthy Skin Month is coming to a close, winter is just getting started!  Dry skin can occur at any time throughout the year, but it is most prevalent in the winter when the low humidity, cold temperatures and harsh winds can damage your skin’s natural barrier to the environment. To help keep you skin soft and itch-free, follow these ten tips: 

1. Bathe in lukewarm water. Hot water may feel good, but it can be very damaging to your skin. 

2. Use mild, fragrance-free cleansers. Many soaps are harsh detergents, which can damage your skin while cleaning it. Choose a mild, fragrance-free, soap-free cleanser. It is important to understand that unscented does not mean fragrance-free. Unscented means that a “masking” fragrance is used to ensure the product has no scent. 

3. Moisturize after showering or hand-washing. Apply a lotion or cream as soon as you finish washing your hands or bathing. Moisturizing while your skin is still damp will help to lock in moisture during the harsh winter months. 

4. If your skin is particularly dry, use creams instead of lotions. Creams are far more hydrating than lotions. Read the label carefully; in general, lotions tend to come in a pump form, while creams come in a tub or tube. 

5. Choose non-irritating clothing and laundry detergent. Wool and other rough fabrics can be irritating to your skin.  If you do wear wool, wear cotton, silk, or other soft fabrics underneath.  Use laundry detergent that is free of fragrance and dyes and avoid using fabric softener and dryer sheets. 

6. Use a humidifier. Humidity levels during the winter are very low. Dry air literally sucks the water out of your skin. Even if you do not have a central unit, scattering a few smaller units throughout the house can be helpful. Aim for an indoor moisture level between 40% and 50%. Investing in an inexpensive hygrometer (humidity monitor) can help you easily keep track of your house’s humidity. 

7. Do not sit directly in front of a fireplace or space heater. This can cause quick and dramatic drying of the skin. 

8. Wear lip balm. The lips are very prone to dryness in the colder months and can result in painful cracking.  Choose something that feels good on your lips and has as few ingredients as possible. 

9. Apply sunscreen — even during winter. It’s important to protect your skin from harmful UV rays on cold, dreary days in the winter. Before going outside, apply a broad-spectrum sunscreen with an SPF 15 or higher to all exposed areas of your body. 

10. Talk to a pro. Following these simple tips can be very helpful in treating and avoiding most cases of “winter itch.” If you’re skin gets exceptionally dry and these tips aren’t helping, or if you develop eczema or another skin irritation, consult a dermatologist.

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Dr. Dana Johnson: When to Treat Eye Drainage with Antibiotics

Originally published on November 13, 2013, in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson: My toddler has been sent home several times from day care due to eye drainage. When does this need to be treated with antibiotics?

Dear Reader: There are multiple reasons that young children have eye drainage. The eye drainage can be watery and clear to thick and purulent (containing pus). The drainage can be one way the body tries to heal or clear irritation.

A health care provider can help you determine the cause of the drainage, but the urgency of evaluation depends on associated symptoms.

The first step is to determine if the drainage is associated with redness or inflammation of the eye. Conjunctivitis (or pink eye) is inflammation of the conjunctiva. The conjunctiva lines the inside of the eyelids and the sclera (white part of the eye).

This inflammation can be caused by various issues, including bacterial infections, viral infections, allergic reactions, trauma or irritation from contaminants (something getting into the eye).

While drainage from the eye can cause irritation and some pinkness to the outside of the eyelid and around the eye, any significant redness, swelling or pain can be a sign of a serious bacterial infection around the eye and should be evaluated immediately by a health care provider.

If your child has drainage and conjunctivitis, they should be seen by their doctor to determine the likely cause and the best treatment. Bacterial infections can be very contagious, so antibiotic eye drops are usually prescribed to treat the infection and prevent spreading to others.

The best way to decrease the spread of infection is to avoid touching the eyes and also to practice good hand washing. Do not share things that come in contact with the face such as washcloths, towels, etc.

Most of these infections are not serious, and many would resolve without treatment. The exception to this is eye infections in the newborn period.

There are other common causes of eye drainage that are usually not associated with redness. During the newborn period, sometimes the duct that goes from the inside corner of the eye to the nose is not fully opened.

This is called nasolacrimal duct obstruction, or blocked tear duct, and is present in up to 10 percent of newborns. The eye continues to make tears, but they are unable to drain into the nose so there are excessive tears draining out of the eye.

After sleep, there can be a small amount of crusting on the eye, but the white part of the eye and the inside of the eyelid should not be red. More than 90 percent of these cases resolve without treatment by the time the infant is 12 months old.

Older children can have a temporary blockage of the nasolacrimal duct due to nasal congestion. With cold symptoms and thick nasal congestion, the duct can become blocked and lead to some drainage from the inside corner of the eyes. There shouldn’t be any inflammation of the eye along with this, and it should resolve as the cold symptoms resolve.

No matter the cause of your child’s eye drainage, it is best to at least discuss it with a doctor to determine if a clinic appointment for evaluation is needed.

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Johnson to people submitting questions.

Read more: http://host.madison.com/news/local/ask/dr-johnson/dr-dana-johnson-when-to-treat-eye-drainage-with-antibiotics/article_1411e22f-a396-5c1f-813f-ca370489103c.html#ixzz2kXIuUoyo

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National Bladder Health Week: How much do you know about your pelvic floor?

Urinary incontinence affects 25 million people in the US, and one out of three US adults has experienced loss of bladder control. November 11th – 15th is National Bladder Health Week. Take this quiz to find out how much you know about your bladder and pelvic floor.

1. Pelvic floor disorders include:
a. Bladder control issues
b. Accidental bowel leakage
c. Pelvic organ prolapse
d. All of the above

2. True or false: If I have diarrhea, taking fiber will make it worse.

3. Which of the following beverages can irritate the bladder?
a. Caffeine
b. Tea
c. Artificial sweeteners
d. Alcohol
e. All of the above

4. Which of the following strategies can be used to treat pelvic floor disorders?
a. Pelvic floor muscle exercises
b. Medication use
c. Lifestyle modifications
d. Surgery
e. All of the above

5. True or false: Having difficulty controlling my bladder or bowels is a normal part of aging.

6. Which of the following strategies can be used to prevent pelvic floor disorders from occurring or getting worse?
a. Quitting smoking
b. Avoiding constipation
c. Maintaining a healthy weight
d. Doing pelvic floor muscle exercises
e. All of the above

Answer Key:
1. D – all of the above! Bladder control issues include overactive bladder (OAB) with or without urinary leakage as well as stress urinary incontinence. OAB is caused by bladder muscle contractions at inappropriate times, and can result in feelings of urgency and frequency (needing to rush to the bathroom frequently) with or without loss of urine. Stress urinary incontinence refers to loss of urine with coughing, jumping, laughing, sneezing, lifting, etc., and is caused by a weakness in the urethra (the tube through which urine leaves the bladder). Accidental bowel leakage can happen from stool being too hard or too loose as well as from damage to the nerves and muscles of the pelvic floor from childbirth, surgery, or radiation. Pelvic organ prolapse refers to relaxation of the ligaments and tissues of the vagina, and can cause a feeling of a bulge coming out of the vagina. That bulge may contain the uterus, bladder, or bowels.

2. False! Fiber is used to treat constipation because it pulls water into the stools, but if stools are too loose, fiber provides bulk to absorb excess water and make stools well-formed. Not only that, fiber also helps keep cholesterol low, prevents colon and rectal cancer, and can prevent complications of diverticular disease.

3. E – All of the above! Minimizing consumption of these bladder irritants helps some women regain control of their bladders, without ever needing to take medicine or have surgery. Other things you can do include maintaining a regular voiding schedule and practicing your pelvic floor muscle exercises… Come learn more Wednesday, November 13th!

4. E – All of the above! Sometimes doing pelvic floor muscle exercises and making simple changes to your lifestyle can cure pelvic floor disorders. If those strategies are not successful, we can use medications, pessaries (rubber support devices), electrical stimulation, or surgery to help you Break Free from Pelvic Floor Disorders!

5. False! Pelvic floor symptoms are not a normal part of aging, and you do not have to live with them. They are usually not dangerous, so you do not need to treat them if they do not bother you… But if they do bother you, there are lots of things you can do to regain control.

6. E – All of the above! There are lots of things you can do to prevent pelvic floor disorders from occurring or getting worse. Come learn more at our Take the Floor: Break Free from Pelvic Floor Disorders Event!

Take the opportunity to come learn more from our team of specialists, including UW Health Doctors Heidi Brown (Urogynecology) and Sarah McAchran (Female Urology) and Meriter Monona Pelvic Floor Physical Therapy Women’s Health Clinical Specialist Victoria Hurwitz at a special Bladder Health Awareness event!

Take the opportunity to come learn more at our Take the Floor Tonight: Break Free from Pelvic Floor Disorders event Wednesday, November 13th, 6:30 – 8:30 PM, Hotel RED (1501 Monroe Street, Madison, WI 53711) with pelvic floor specialists Doctors Heidi Brown (Urogynecology) and Sarah McAchran (Female Urology) and Meriter Monona Pelvic Floor Physical Therapy Women’s Health Clinical Specialist Victoria Hurwitz. Register today at http://www.breakfreefrompfds.org/events.

Heidi Brown, MD, MAS

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Meriter Wins 2013 eHealthcare Leadership Awards

Meriter is proud to announce that is has again been honored with two national eHealthcare Leadership Awards, presented by eHealthcare Straegy & Trends.

Meriter received the 2013 Silver eHealthcare Leadership Award for Best Doctor Directory and the 2013 Gold eHealthcare Leadership Award for Best Intranet.

Meriter.com also won the 2012 Platinum eHealthcare Leadership Award for the Best Doctor Directory. Meriter’s physician directory conveniently gives patients the option to meet a Meriter doctor online by viewing a doctor’s picture, video and medical philosophy. Patients also have the option to request an appointment with a doctor within Meriter’s physician directory.

Meriter’s intranet won the Platinum eHealthcare Leadership Award for Best Intranet Site in 2012 and 2011. The judging criteria for the Best Intranet Site was based on how well the organization uses its “internal network” to enhance employee productivity and satisfaction.

In 2011 meriter.com also won the gold eHealthcare Leadership Award for the Best Overall Internet Site and in 2010 meriter.com won the eHealthcare Leadership Award for the Best Site Design.

Meriter was also recently named Healthcare’s Most Wired for the third consecutive year.

About Meriter Health Services
Meriter Health Services is a nationally recognized health system comprised of Meriter Medical Group, offering primary and specialty care; Meriter Hospital, a not-for-profit 448 bed community hospital; and Physicians Plus Insurance Corporation. Meriter is a 2013 recipient of the National Research Corporations’ coveted Innovative Best Practice award, Top Rated Adult Doctors award and Top Rated Pediatric Doctors award. Meriter provides a comprehensive array of patient-focused inpatient and outpatient services to meet the health needs of Dane County. For more information, visit meriter.com.

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Thank You, Forensic Nurses!

The entire staff of Meriter Health Services would like to join the International Association of Forensic Nurses in recognizing forensic nurses around the world for the extraordinary work they do. 

The Meriter Hospital SANE (Sexual Assault Nurse Examiners) program is the only program of its kind in Dane County. The more than 400 patients SANE nurses cared for in 2012 included women and men, ranging in age from infancy to late-adulthood. SANE nurses perform medical-forensic exams with kindness and empathy. Working daily with victims and sometimes perpetrators of violence, they provide compassionate, ethical and evidence-based care.

In addition to caring for patients, the SANE program educates the community about sexual assault, strangulation and medical care for victims.  In 2013, the program educated over 1,000 people from a variety of locations and backgrounds.

THANK YOU to Meriter SANE Nurses and all forensic nurses for the exceptional work you do and the incredible impact you have on your patients and your community!

What is a SANE/Forensic Nurse?
Sexual Assault Nurse Examiners (SANE) are the largest subspecialty of forensic nurses in the US. They have specialized education / clinical preparation in the medical forensic care of a patient who has experienced sexual assault or abuse. SANEs work collaboratively with others in the community, such as advocates, law enforcement and legal professionals.  Vice President Joseph Biden said in a commentary written in 2006, “Forensic Nurses play an integral role in bridging the gap between law and medicine.”
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Join Us for a Family Night Out

Enjoy a night with your family before the holiday season kicks into full gear!

Meriter is hosting a family night out at our DeForest-Windsor clinic (located near the intersection of Hwys. 19 & 51) on Tuesday, November 26 from 5:30-7:30 pm. Join us for a family-friendly show and snacks. Feel free to bring your own blanket to sit on.

Our Meriter physicians will also be hosting a teddy bear clinic. Have your children bring their favorite stuffed animal for a head-to-toe check-up – and to experience, first-hand, tips on how to live healthy.

The first 100 kids to bring a non-perishable food item, which will be donated to the Community Action Coalition, will receive a $10 Mattel Toy Store gift card. Parents can enter to win a $1,000 Visa Gift Card, and other prizes.

This event is open to the community and the drawing is free, without any obligation.

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Meriter Home Care Agency Receives HomeCare Elite Recognition

Meriter Home Care Agency is pleased to announce achievement of HomeCare Elite recognition in 2013. HomeCare Elite™ is a compilation of the top 25% most successful home care providers in the United States based on standardized performance measures using publically available data. This year, those measures include quality of care, quality improvement, patient experience, process measure implementation, and financial management, with the greatest weight given to quality of care.

Meriter Home Care Agency has earned this award 7 out of the 8 years since the inception of the recognition in 2006.
Please join us in congratulating Meriter Home Care Agency staff in this recognition.

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Tips to Prevent Diabetes

Weight loss has consistently been shown to be an effective means of preventing type 2 diabetes.

A week does not go by where a patient does not ask me about whether or not they have diabetes. It can either stem from symptoms they are having that could be attributable to diabetes and/or a family history of the condition. The patient’s interest is also heightened by media coverage of the growing epidemic of obesity in this country and the risk this holds for developing diabetes. Indeed, type 2 diabetes, which comprises 90% of all diabetics, is a growing public health problem.

In addition to obesity, the rise in diabetes is also attributed to a sedentary lifestyle as well as unhealthy dietary habits. Seventy-nine million people in the U.S. have prediabetes. Their risk of developing type 2 diabetes is 4-12 times higher than it is for people with normal glucose numbers. Why the importance of preventing this condition? Diabetes can lead to the development of a number of disabling and costly complications including amputation, stroke, heart disease, kidney failure, and blindness. Another way to look at this is that one third of U.S. adults exhibit prediabetes. Since prediabetes confers significant risks for developing type 2 diabetes, prevention becomes a key component to one’s health care. Sadly, only 7% of persons with prediabetes are aware that they have prediabetes.

Looking at this another way, the costs associated with diabetes mellitus in this country are increasing. Even though people with diabetes comprise less than 6% of the U.S. population, roughly 1 in 5 health care dollars is spent caring for people with diabetes.

As for prevention, there is strong evidence showing that early detection of people at high risk followed by changes in lifestyle can reduce the incidence of type 2 diabetes mellitus and its complications. Efforts are underway at Meriter to increase awareness. Making patients aware that they can reduce that risk by making modest lifestyle changes is of paramount importance.

Even so much as a small weight loss upfront can reduce this risk. Each year 11% of persons with prediabetes who do not lose weight and do not engage in moderate physical activity will progress to type 2 diabetes mellitus. Weight loss has consistently been shown to be an effective means of preventing type 2 diabetes. Ideally, losing 10% of one’s body weight would have huge benefits but it should be stressed that even a lesser amount of weight loss would be beneficial as well.

Another way to prevent this epidemic is by dietary intervention. Increased consumption of green, leafy vegetables reduces the risk of type 2 diabetes in contrast to the popular belief that a diet high in fruits and non-leafy greens reduces this risk. Decreased consumption of processed foods, red meat, sugar-sweetened beverages, and starchy foods may retard the progression of type 2 diabetes. Watching intake of high-fat dairy is also prudent to decrease one’s risk. A Mediterranean diet with its consumption of olive oil, nuts, low-fat dairy and moderate alcohol consumption (mainly red wine) is also quite healthy. As an interesting aside, patients who drank more than 4 cups of coffee had a lower risk of type 2 diabetes compared with those who drank less than 2 cups per day. Increasing coffee consumption, however, as a public health strategy cannot be recommended at this time.

Aside from what has already been mentioned, there are certain medications that have been studied for the prevention of diabetes. Without going into great detail, the most studied has been metformin. It is probably the safest. Interventions that use drugs are less preferred than diet and exercise since the drugs’ effects tend to wane after their use is stopped and adverse effects may also result not to mention the cost associated with taking pills.

Several patients have asked me about using vitamin D as a means of preventing diabetes. Suffice it to say, the current evidence is insufficient to recommend this supplement for the prevention of diabetes. 


Gerhard Kraske, MD MPH

Learn more about Meriter’s Diabetes Clinic.

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Dr. Dana Johnson: Halloween Safety

Originally published on October 30, 2013, in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

The leaves are changing color, the temperatures are dropping and the ghouls are coming out. Each year, I enjoy seeing all the children dress up for Halloween. However, as adults we have to remember to keep safety a priority. On average, twice as many kids are killed while walking on Halloween compared with other days of the year. Whether a parent, a homeowner or someone driving on Halloween, we all have an important role in keeping children safe.

For parents: Pick a safe costume for your child.

  • Flame resistant.
  • Comfortable and appropriately fitting shoes and costume so they won’t trip.
  • Props that are soft and flexible so they won’t cause injury if fallen on.
  • Face painting is preferred to masks, because masks can obstruct vision. If using a face mask, make sure there are large eye holes. Test makeup on a small area first and remove before bed to prevent skin irritation.
  • Add reflective tape to costumes and treat bags, and have your kids carry glowsticks and flashlights.
  • Parents should also bring a flashlight and a cell phone.
  • Young children should be with an adult.
  • Older children should go with at least two other children. They should have a planned route and time to be home (wear a watch). Discuss safety before they leave.

For children:

  • Only go to homes with lights on.
  • Do not enter the home.
  • Do not take candy from people in cars.
  • Follow traffic safety rules: Cross at corners. Walk on sidewalks or the left side of the road facing traffic when a sidewalk is not available. Don’t cut across yards.
  • Eat dinner before trick-or-treating to prevent over-consumption of candy. Parents should inspect candy before consumption. Tampering is rare, but any candy that is not in original wrapping should be discarded. Avoid homemade treats unless cooked by someone you know well.
  • Consider trading in excess candy at a candy trade-in event. They are offered at various locations around town, including Saturday at the Meriter Pediatric Clinic at 345 West Washington Ave.

For homeowners:

  • Make sure driveway, walkway and yard are free of obstructions.
  • Keep jack-o’-lanterns and other luminaries away from the walkway to prevent fires. Consider using non-flame candles.
  • Consider offering non-candy treats such as stickers, temporary tattoos, plastic rings, raisins, fruit rolls or crackers.
  • Keep pets away — they can get frightened and inadvertently bite or jump on trick-or-treaters.

For drivers:

  • Slow down in residential neighborhoods and school zones. Remember that popular trick-or-treating hours are from 5:30 to 9:30 p.m.
  • Be especially alert and take extra time to look for children at intersections, on medians and on curbs. Children are excited and may move in unpredictable ways.
  • Slowly and carefully enter and exit driveways and alleys.
  • Reduce any distractions inside your car, such as talking on the phone or eating, so you can concentrate on the road and your surroundings.
  • Drive with your headlights on, so you can spot children from greater distances. Remember that costumes can limit children’s visibility and they may not be able to see your vehicle.

Have a safe and fun Halloween!


This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Johnson to people submitting questions.

Read more: http://host.madison.com/news/local/ask/dr-johnson/dr-dana-johnson-halloween-safety/article_65e7cf0e-a8e7-53dd-a130-354dec56fbfe.html#ixzz2jDLDe0wt

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7 Tips for Keeping Your Kids Healthy This Halloween

It’s that time of year again when BIG bags of candy start appearing on the store shelves.  And with the rising rates of childhood obesity, it’s important to provide healthy alternatives to the traditional Halloween treats.  Here are 7 helpful hints to keep your little ones healthy and happy this Halloween season!

  1. Instead of handing out candy this year try these healthy alternatives:
    Granola or cereal bars
    Trail mix snack packs with nuts, seeds, and dried fruit
    Mini pretzel packs
    Fig cookies
    Animal crackers
    Goldfish crackers
    Sugar-free gum
  2. Or ditch snacks altogether and hand-out non-food items:
    Mini Play dough containers
    Spider rings
    Halloween pencils
    Tiny decks of cards
    Glow necklaces
  3. Little ones would likely even be happy with a dime or nickel.  So, take the money you would normally spend on candy (some of the bags are $6.99 for 30 pieces!) and get change in dimes and nickels and put them in your Trick-or-Treat basket.
  4. Don’t send your children Trick-or-Treating on an empty stomach.  Make sure they have a healthy, well balanced meal before heading out so they aren’t tempted to snack on their candy.
  5. Always keep your children’s Trick-or-Treat candy in your possession and out of their reach.  This ensures that your children are not eating a pound of candy right before bed each night.
  6. Set a limit of candy that your children can have ahead of time (i.e. maybe 1-2 pieces each day).  Eventually your children will probably forget they have Halloween candy and you can throw it out.
  7. If your child needs a treat for a party or school try making these easy recipes:
    Banana Ghost Pops.  Peel a banana, cut in half and then cut in half length wise again. Dip in vanilla or honey greek yogurt and use mini chocolate chips for eyes.  Put a stick in the bottom and freeze before serving.
    A platter with a pumpkin made out of carrots, cucumbers for the mouth, broccoli for the stem and dip containers for the eyes and nose.
    Clementines with pumpkin faces drawn on them.Sincerely,

    Krista Kohls, RD, CD
    Meriter Clinical Dietitian

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A Review of Breast Health and Breast Cancer Reduction Strategies

Having a diet composed predominately of fruits and vegetables resulted in a lower risk of breast cancer.

In the United States, breast cancer is the most common cancer in women and the second most common cancer death in women. Breast cancer screening and early detection is the best strategy for breast cancer detection. Reducing risk factors and living a healthy lifestyle are the best strategies for continued breast health. Here are some healthy tips on what you can do yourself to reduce your risk of breast cancer.


1) Use alcohol in moderation. Breast cancer has been shown to be higher in women who consume 1-3 drinks/day compared to abstainers.
2) Don’t smoke. Smoking is carcinogenic to your body.
3) Breastfeed your babies. A protective effect of breastfeeding has been shown against breast cancer.
4) Eat a healthy diet. A diet composed predominately of fruits and vegetables, resulted in lower risk of breast cancer. The influence of red meat/processed meats, refined grains (white bread, white rice, and white pasta), sugary foods, and high fat diary is not clear. Replace these foods with lean meats, low fat dairy, whole grain breads, brown or whole grain pasta, brown rice, and avoid white sugar whenever possible. Whole grain foods have a lower glycemic index, therefore less sugar in the blood stream.
5) Maintain a healthy weight or at least don’t gain weight after menopause. Obesity and weight gain in postmenopausal women is associated with an increased risk of breast cancer.
6) Exercise 150 minutes per week. 30 minutes of walking most days, is great exercise for your body. Walking is also a weight bearing exercise and good for bone density and the prevention of osteoporosis. If you can’t walk because of joint problems, try swimming or biking. Just keep moving!!
7) Have your Vitamin D levels checked by your doctor. Studies have determined in postmenopausal women, breast cancer was decreased by 12 percent when Vitamin D3 levels where kept above 27 ng/ml. Many people in the Midwest have low Vitamin D levels because we are not exposed to enough sun especially in the Fall and Winter months. Sunshine is needed for the body to synthesize Vitamin D into a useable form for the body. Also Vitamin D is needed for your body to absorb calcium to prevent osteoporosis. If you supplement with Vitamin D, make sure it is D3.
8) Know your breast tissue. Do self-breast exams enough so that you know what normal breast tissue is for you. Even if you forget to do exams monthly, it’s ok as long as you keep doing them. It’s best to start doing breast exams after you have seen your doctor and she/he has done a breast exam. This way you know what your normal is.
9) Limit postmenopausal oral hormone replacement therapy use to 3 years or less. Long-term use (or greater than 3 years) has been associated with the higher risks of breast cancer.
10) Discuss how often you should get your mammogram with your primary care physician as recommendations vary depending on many factors including family history. Regular mammograms are important over the age of 40. Always get a mammogram before starting hormone replacement therapy.


Carolyn Hedrington, MSN, APNP

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