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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Dr. Dana Johnson: Talking to Children About Death

Originally published on October 23, 2013 in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Dr. Johnson: My 6-year-old son’s grandmother has a terminal illness. How do we explain this to him and help him when she does die?

Dear Reader: I am sorry for the sadness your family is suffering. Just as all adults cope with grief differently, each child can react differently in these situations.

As parents, we often want to protect our children from anything that could be upsetting or painful. In this situation, however, it is best to be open and honest with your child.

I would strongly encourage you not to hide or sugarcoat the fact that his grandmother is very ill. Children can be very observant and know something is wrong by how parents and other adults are acting. Communicating with him in an honest and direct way often is best.

Of course, keep the information you share at a level he can understand. Allow him to ask any questions and answer them to the best of your ability. If heaven or other afterlife is a part of your beliefs, you can discuss this further with him.

It may be beneficial for your son to visit with his grandmother if this is possible. If she looks different or if there will be medical devices in the room, it is best to prepare your child for this. Explain what might be different. Explain medical devices on a level he can understand. For example, I often explain IVs to children as special straws that put medicine into the veins.

By school age, most children understand that death is permanent. How close your child is to his grandmother and how much she was a part of his everyday life likely will impact the extent of the loss he feels when she does pass.

Again, don’t shelter him from the fact that she has died, but take time to answer his questions as honestly as you can. Provide reassurance that you are there to support him and talk whenever he wants. It may also be helpful to reassure him that you are healthy and probably will live for a long time.

As I stated earlier, each child will react differently to their grief. Some will become quiet or cry, while others may have more behavior outbursts.

Don’t hide your own grief from your child. If your child sees you expressing your grief through crying or talking about your sadness, it shows him that it is OK to share these feelings. If they feel that talking about death is taboo, they will be less likely to share their feelings and may have more difficulty processing them.

Remember that grief doesn’t resolve quickly for you or your child. Continue to keep the conversation open.

If your grief or your child’s grief is affecting your ability to participate in other aspects of your life, it may be helpful to talk with a physician or counselor.

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-talking-to-children-about-death/article_b5d1215d-8de9-5b3c-9771-f57ed5522fdc.html#ixzz2iYP3rp29

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Meriter Children’s Center Open House

Please join us as we celebrate Meriter’s new Children’s Center! Tour the new building, meet our teachers and enjoy light refreshments as we begin the next chapter of the Meriter Children’s Center. Enrollment is available to both Meriter employees and the general public. 

Thursday, October 24 

Ribbon-Cutting: 4:45pm 

Community Open House: 5:00-7:00pm 

Location: 1021 Mound Street (1 block from Meriter Hospital)  












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Monona, DeForest Clinics Featured in Healthcare Design Magazine

The Monona and Deforest clinics have been recognized in the annual Healthcare Design magazine’s Architectural and Interior Design Showcase of Ambulatory Care Centers. You can view Meriter’s section of the magazine below, or by clicking here (Pages 108-109).

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Dr. Dana Johnson: Fireplace safety

Originally published October 16, 2013 in the Wisconsin State Journal. Dr. Johnson is a pediatrician practicing at the Meriter McKee clinic.

Dear Readers: If you have been reading this column for a while, you may recognize this topic from previous years. I am writing about it again because it saddens me each year when I see a child who has suffered burns from a fireplace. The injuries are often severe and can result in permanent scars.

Parents or caregivers often do not understand the dangers a gas fireplace poses to a child. I have even heard reports of dogs burning their nose on fireplace glass, so the risk isn’t only to children.

Fireplaces provide heat in the cold winter months and provide a nice ambiance. Most parents understand the dangers of a wood-burning or open fireplace and, fortunately, I don’t often see injuries from these. What parents overlook are the dangers of gas-burning fireplaces with a glass front.

Sometimes there is a sense of security, because children can’t get to the flame. However, burn injuries from touching the glass are the main cause of injury.

The glass on the front of a gas-burning fireplace can reach temperatures above 400 degrees in 6 minutes, and it takes 45 minutes for the glass to cool completely after the fireplace is turned off. Touching the heated glass can be enough to cause second- and third-degree burns.

Third-degree burns can require skin grafting. Both types of burns of the hand can cause scarring that may limit hand movement and require therapy.

Young children who are just becoming mobile are especially at risk. They lack good coordination and can fall on the glass or touch it when reaching out to brace themselves. They also don’t have the dexterity to quickly pull their body or hands away from the heat, so they can endure deeper and more extensive burns.

Also, the flame of the fireplace is interesting to young children, so it draws their attention. And, of course, they want to touch it.

Even with children 2 or 3 years old, injuries can occur. Because the fireplace is not a cause of injury at other times of the year, its dangers are easily forgotten.

My best recommendation is to leave the fireplace off when your young child is awake. Until my son was 3½ years old, I never turned on the fireplace in our home while he was awake.

At 3½, I still wouldn’t let him walk within a couple feet of the fireplace, and I kept reminding him that it was hot and would hurt.

The timing of when a parent can feel safe having the fireplace on depends on their child’s understanding of and willingness to avoid the dangers.

Another safety option is a barrier. This barrier needs to be rigid and not movable by a young child. It also cannot be made of material that will become hot itself when in close proximity to a fireplace. Screens are now being made with this in mind.

If your child ever suffers a burn, immediately run cool water over the wound until it is cool or pain has improved. You also can place the burned area in a bowl of cool water.

Do not use ice or rub the burn. Do not coat in butter or other substances, as this can cause further injury. If needed, the burn area should then be covered with sterile gauze.

If pain or redness does not resolve after a couple of hours, or the burn is extensive or oozing, you should immediately call your child’s doctor or take your child to the emergency room for treatment.

Care also needs to be sought for burns to the hands, face, genitals or over a moving joint, as management is important to prevent long-term disability from scarring.

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-fireplace-safety/article_7a2f390a-dc34-5abb-b175-da3ae6bdc3ca.html#ixzz2i06Cr64D

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Reconstructive Options for Patients with Breast Cancer


As a plastic surgeon, I have the privilege of treating women who suffer from breast cancer, a potentially life-threatening disease that is becoming all too common. After the general surgeon completes the cancer removal operation, I am given the job of restoring patients with an appearance that is natural. While some may think that my goal is to have a spectacular result, I actually believe that my best result is one in which a patient incorporates the reconstructed breast into her body image, thereby softening the physical, social and mental trauma of breast cancer.

As a reconstructive surgeon, the most important thing is for patients with breast cancer to know the wide range of reconstructive options available. Even in a country with advanced medical care such as the United States, less than 50% of women are counseled regarding their reconstructive options before undergoing surgery. I am an integral part of the breast care team; if you see one of our breast surgeons you will be able to understand your reconstructive options and make an informed decision which is best for you.

Reconstructive options begin for women that are undergoing a “lumpectomy” procedure, or a procedure where the cancer is completely removed but the remainder of the breast is left intact. Occasionally, these operations may result in a deformity that can be corrected or improved with reconstructive surgery, either immediately or in a delayed fashion. Also, many patients are surprised to learn that in cases where the cancer is only on one side, the opposite breast (without cancer) can be reduced or, if a choice of mastectomy on the non-cancer side is made, reconstructed in an effort to restore symmetry between the two sides.

For patients who are undergoing a mastectomy for their cancer treatment, the reconstructive options are broad, and even patients who have decided against reconstruction may benefit. As described above, if a patient has their breast removed on one side, a breast reduction on the opposite, non-cancer, side may help patients fit into clothes better and feel more balanced after their mastectomy operation.

 For patients who do choose reconstruction, their options fall into three categories: using the patient’s own tissue, using breast implants or a combination of the two methods. When patients decide to use their own tissue, it typically comes from the abdomen. The skin, fat and muscle from the abdomen can be used to reconstruct one or both breasts in a procedure called a TRAM flap operation. In recent years, a procedure that spares the muscle and uses only skin and fat, called the DIEP flap operation, has gained in popularity and is one we are proud to offer here at Meriter Hospital. For patients who pursue reconstruction with breast implants, this reconstruction typically begins by placing an inflatable implant inserted at the time of the mastectomy. Over a period of several weeks after surgery, this implant is inflated in the office; this inflation process restores the dimensions of the original breast pocket, and creates a space for a permanent implant, placed in the second stage of reconstruction. Nipple reconstruction may also be performed at that time or later.  Finally, in some patients who cannot have reconstruction using their abdominal tissue, a procedure that combines both the patient’s own tissue (from the back) and the use of an implant is performed.

It is important to emphasize that there is no reconstructive option that is “better” or “worse.” Every patient is different, and I will help educate you in the options best suited to your body and to the desires you have for your own reconstruction. Similarly, while there are many reconstructive options available, it is also important to recognize that not every option is available for every patient. Your weight, breast size, history of radiation therapy or previous surgery may have an impact on the type of reconstruction best for you.  The rationale and reconstructive recommendations suited to you can only be determined with a consultation. Finally, if you have been treated for breast cancer in the past but did not pursue or were not offered reconstruction at the time and have now become interested, you still have options you can pursue after a “delay” in reconstructive treatment. It is as simple as setting up an appointment with your plastic surgeon to discuss these options.

One of the first plastic surgeons in history described our specialty as one that “restores and makes whole.” This goal holds true today in all types of breast surgery in my practice. It would be a pleasure and honor to see you.


Dr. Jeffrey D. Larson

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2013 Halloween Candy Trade-In Party

We want your candy – but don’t worry, it’s for a good cause!

Bring your extra Halloween candy and join us at the Meriter/Physicians Plus Halloween Candy Trade-In Party! The event will take place on Saturday, November 2 from 9 – 11:30 a.m. at the Meriter West Washington clinic. Kids can trade-in their extra Halloween candy for a fun, healthy treat – as well as drawing entries for fabulous prizes geared towards active lifestyles!

The more candy you bring in, the more entries you receive!  All candy will be sent to U.S. Troops through Operation Gratitude.

Planning to be downtown anyway for Kids in the Rotunda or the Farmers Market? Just stop by! Free parking is available at the clinic!

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Meriter Health Services Prepares for Future through Strategic Affiliation

Affiliation with UnityPoint Health will offer new efficiencies and resources for Meriter, Physicians Plus and Dane County patients

MADISON, Wis. (October 10, 2013) Meriter Health Services announced today that it has agreed to combine operations through an affiliation agreement in which it will become an affiliate of UnityPoint Health, a nationally recognized, integrated health system headquartered in West Des Moines, IA. The affiliation will allow Meriter to thrive in America’s changing health care environment, while advancing its commitment to high-quality patient care.

“I’m proud and delighted to announce this affiliation with UnityPoint Health,” said MHS Board Chair Virginia Graves. “It’s the best of both worlds for Meriter and Physicians Plus Insurance Corporation. We will remain a locally-run, community health system, while also gaining the benefits of a broader regional system’s services, experience and expertise.

This is good for our patients, members, employees, the regional health care system and the local economy.”

 “Like Meriter, UnityPoint Health has a culture of patient-focused care, community-minded spirit and high-quality, lower-cost health care,” said Jim Woodward, President, Meriter Health Services.   “In the affiliation, UnityPoint Health will provide resources to MHS, supporting and enhancing the services provided to the community, including taking an ownership interest in Physicians Plus and providing clinical practice and management support to Meriter Medical Group.”

The affiliation is pending state and federal regulatory approvals, which is anticipated later this year.

“With its national reputation for excellence in quality health care, Meriter will be an outstanding addition to the UnityPoint Health family,” said Bill Leaver, President and CEO of UnityPoint Health. “We are a good fit together.  UnityPoint Health is a health system of 15 hospitals in 8 regions.  Meriter is a strong regional organization just like our other 8 regional health systems.  We were fortunate to find in Meriter, an integrated health system that could also offer an HMO to our network. We see Physicians Plus growing in strength and geographic market coverage over time.”

Meriter patients and Physicians Plus members can continue to see their doctors and receive care locally, just as before. “Nothing changes for patients and members,” Leaver said. “Meriter and UnityPoint Health hope to build upon current relationships with local health organizations.”

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 nonprofit 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.

About UnityPoint Health

UnityPoint Health is one of the nation’s most integrated health systems. Its physician-led team of professionals communicates clearly and effectively to address a patient’s health care in the most appropriate setting: whether that is a clinic, a hospital or services provided within the home. Through relationships with more than 280 physician clinics, 30 hospitals in metropolitan and rural communities and home care services throughout its 8 regions, UnityPoint Health provides care throughout Iowa and in Central and Western Illinois.

UnityPoint Health entities employ more than 24,000 employees, working toward innovative advancements to deliver the Best Outcome for Every Patient Every Time. Each year, through more than 4 million patient visits, UnityPoint Health, UnityPoint Clinic and UnityPoint at Home provide a full range of coordinated care to patients and families. With annual revenues of $2.7 billion, UnityPoint Health is the nation’s 13th largest nonprofit health system and the fourth largest nondenominational health system in America.  UnityPoint Health provides community benefit programs and services to improve the health of people in its communities.


Mike Flaherty
(608) 509-3997

Leah Huibregtse
(608) 516-2256

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Community Resources Can Ease Breastfeeding Challenges

Breastfeeding your baby can be one of the most wonderful, lovely, challenging things a woman ever does. Simply put, breastfeeding is naturally feeding your infant. If nature had its way, a mother would continue to feed her infant, naturally, for as long as she and the infant wanted to. Usually that’s at least a year or more. So why do so many mothers find it difficult to nurse for more than a few months, even a few weeks?

In today’s American society, we find varying degrees of help and support to nurse, especially after leaving the hospital with our newborn. Family members, jobs, even physicians all play a role on when and where we nurse our babies, and for how long we are able to be successful.

In order to maintain and build a milk supply for a growing infant, that infant needs unrestricted access to the breast to nurse whenever he or she is hungry. This allows the infant to determine the supply that he or she needs to be able to grow. However, less and less mothers find themselves able to be with their infant to give them the access to the breast whenever they are hungry. Our society, unlike other countries around the world, doesn’t provide a new mother and her infant the time of support for this most healthy feeding and growing to take place.

In the US, many new mothers find themselves returning to work a few short weeks, or months, after the birth of their infant. And while we are making great strides as a society in helping to support a mother in the work place to pump her milk, every breastfeeding mother will tell you how that’s just not the same as nursing your infant. A mother’s hormones don’t respond the same way to a pump, and many working mothers trying to pump find it difficult to keep up their supply to meet their infants needs.

Publicly we have barriers making it hard for mothers to nurse when outside the home. While laws have now been passed making it illegal to discriminate against a nursing mother and infant, many women still find discomfort breastfeeding openly.

So how can we help each other, thereby helping our newborns, to continue to enjoy the benefits of nursing? Connect with whatever help and support you may need! Whether it’s finding a physician who will provide the help and support for nursing you need. Find those community resources, mother-baby groups, play groups and other outlets where you can feel comfortable publicly nursing. Talk to your employer to find a solution for you to express your milk as often as you need to. And most importantly, if you feel you may have to quit, but neither you nor your infant really want to, take advantage of all the sources of advice, help and support to provide the means to do so. Meriter’s Mother-Baby hour, the Breastfeeding Helpline and Outpatient Lactation Clinics are just a few examples of those resources available to you.

Sharon Marshall, BSN, RN, IBCLC
Meriter Lactation Services

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Dr. Dana Johnson: Vaccinations Best Way to Prevent Flu

Featured in the Wisconsin State Journal on October 2, 2013

Dear Dr. Johnson: Do you recommend the flu shot for otherwise healthy school-age children?

Dear Reader: With the fall season here, we are entering cold and flu season, whether we want to admit it or not. Influenza season is October to mid-May, with a peak usually in January or February, although it can vary from year to year. Now is the time to begin taking steps to prevent you and your children from contracting the influenza virus.

Influenza is a respiratory illness with fever, chills, runny nose, cough, sore throat, decreased energy and body aches. Unlike the common cold, influenza symptoms tend to be more severe and often last over a week. Many children with the common cold may miss a day or two of school. Children with influenza often need to be out for an entire week, sometimes more.

Children under 2 years of age, adults over age 65 and those with chronic medical issues (especially lung issues such as asthma) are most likely to suffer from the complications of influenza, which can include bacterial pneumonia, sinus infections, ear infections, dehydration and worsening of underlying health problems.

While small children can have vomiting and diarrhea with influenza, when most people say they have the “stomach flu,” the illness they have is caused by a virus, not influenza.

One of the best ways to decrease your family’s risk of contracting influenza is to have everyone vaccinated. There are two ways to give the vaccine: nasal mist and injection. The injection is approved for age 6 months and up. The nasal vaccine is approved for age 2 to 49 years old. There are some health conditions for which the nasal vaccine is not recommended.

Individuals with egg allergy can receive the flu vaccine. However, if it is a severe egg allergy (more than hives), it is best to discuss with your allergist before receiving the flu vaccination.

While infants under 6 months of age cannot receive the flu vaccine, I recommend all their household members and close contacts do. This limits the risk of the infant coming into contact with someone with influenza.

Some children 8 years old and younger will require two vaccinations a month apart. Your child’s doctor can help you determine if your child needs one or two doses this year.

Some people worry that the influenza vaccine will give them the flu. While it is true that you may experience headache and fever (more common for children under age 2) as well as possible muscle soreness where the shot was given, you cannot get the flu from the vaccine. These symptoms are the effects of the vaccine going into the muscle and your body developing an immune response to the vaccine.

The nose spray can cause a runny nose. It takes about two weeks for antibodies to the flu to develop, so it is possible to contract influenza after the vaccine is given but before immunity has developed.

Most clinics and some pharmacies now have a good supply of flu vaccines, so it is a good time to get you and your family protected. You can find more information about influenza, the vaccination and other ways to keep your family healthy at flu.gov.

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Meriter Wins 3 National Awards

Meriter is proud to announce that it has again been recognized as one of the best patient care providers in the nation at the recent National Research Corporation’s 19th Annual International Patient-Centered Care Symposium in Baltimore.

Meriter received three major awards at the symposium:

  • Innovative Best Practice Award –Meriter Health Services
  • Adult Doctor Rating –Meriter Medical Group
  • Pediatric Doctor Rating –Meriter Medical Group

The Innovative Best Practice Award is based on the innovative use of resources that result in significant improvements in cost, quality, patient satisfaction and safety. This is the second year in a row that Meriter Health Services has received this award.

The Adult Doctor and Pediatric Doctor awards were based on patients’ ratings of their doctors in patient satisfaction surveys conducted April 2012-March 2013. Last year, Meriter Medical Group also won Top Performing Organization for patient satisfaction with pediatricians and Most Improved Organization for an increase in patient satisfaction in adult primary care.

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Help Feed the Hungry This Thanksgiving

Thanksgiving – thousands of reasons to be grateful!

You can easily make a big difference this Thanksgiving. Simply “Like” Meriter on Facebook and we will make a $5 donation to the Goodman Center. We hope to donate up to $2,500 before Thanksgiving, November 28.

For many years, the Goodman Community Center has provided groceries to 2,000 families across Dane County so they, too, can make a traditional Thanksgiving meal to share with their families. They can do this because every year people like you have helped. We hope you’ll help this year by “Liking” Meriter.

Many families will appreciate the gift of a warm holiday meal.

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Dr. Dana Johnson: Hand Washing a Key to Health

Featured in the Wisconsin State Journal on September 18, 2013.

Dear Dr. Johnson: My child seems to get sick every year after a couple weeks of school. Is there anything I can do to prevent this?

Dear Reader: With the start of school, in the pediatrician’s clinic we often begin to see an increase in the number of visits from children who are sick with the common cold and other viruses. Children are again in close contact and sharing all their wonderful germs.

While there is nothing you can do to protect your child or yourself completely from the common cold and other illnesses, there are some steps you and your child can take to help ward them off.

The number one step is good hand washing. This can prevent a child who has just wiped their nose or coughed into their hands from leaving the virus on a toy or a friend’s hand when they next touch it. It can also prevent a child who has picked up a virus from that toy or friend’s hand from introducing it to their body.

The most common ways germs are introduced to the body are when a child touches their eyes, wipes their nose, puts their fingers in their mouth or touches food before they eat it. Children should be taught and encouraged to practice good hand washing whether they are sick or well.

Good washing takes time — roughly 20 seconds, or two rounds of the “Happy Birthday” song. The backs of the hands, between fingers and under nails all should be scrubbed before the soap is rinsed off.

Alcohol-based hand sanitizer is an acceptable substitute when soap and water are not available. It also needs to coat all the surfaces of the hand, not just the palms. Hand sanitizer is not effective against all germs or on visibly dirty hands.

In addition to good hand washing, teach children to cough and sneeze into their elbow or shoulder. This prevents the germs from going onto their hands and subsequently onto anything they touch.

If they don’t cover their cough or sneeze, the germs can go into the air. The germs will then wait for the next lucky child to touch the object they are now on. If a child coughs or sneezes into their hand or a tissue, they should immediately wash their hands before touching anything else.

Ill children should stay home to prevent spreading a virus. While it is not reasonable for all children with the sniffles to stay home, a child who has a fever, significant cough or runny nose or symptoms that would prevent them from fully participating at school should be kept home.

Remember, however, that this alone will not fully prevent the spread of infection. Children are often contagious before they show symptoms of an illness.

To prevent your child from getting the more serious illness of influenza — which can result in prolonged fever, cough, decreased energy and other significant complications — I encourage all children and adults over the age of 6 months to be vaccinated against influenza each year (unless they have medical contraindications). Some children over age 2 can avoid the shot and receive the nasal flu mist instead.

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Dr. Dana Johnson: Language Development

Featured in the Wisconsin State Journal on Sept. 25

Dear Dr. Johnson: My 18 month old doesn’t seem to be talking as much or as clearly as other kids her age. Should I be concerned?

Dear Reader: Language delay occurs in one out of every five children and is the most common developmental delay. While using peers as a guide for developmental milestones can sometimes be helpful, it is not always the best measuring stick.

Especially between the age of 12 and 24 months, there is a wide variation in normal language development. Some 18 month olds have several individual words they use regularly and others are speaking in complete sentences. Both can be normal development. The most important aspect is that a child is developing new words and showing gains in communication skills.

Language development can be divided into three components:

1. Speech. This is marked by the ability to produce sound.

2. Expressive. Can be verbal or nonverbal ways of communicating ideas, desires and feelings.

3. Receptive. This means the ability to understand what is heard and seen.

Some children may show delays in just one area, while others may have delays in multiple areas.

The first step in evaluating your child would be to determine if she is delayed for her age. I recommend talking with her doctor to help you determine this. They may use age-based questionnaires to assess this and other areas of development, including fine motor, gross motor, personal-social and problem-solving.

If you or the physician have concerns after this evaluation, a more detailed evaluation can be completed by a speech therapist or through the federally mandated Birth to 3 Program.

A speech therapy evaluation may be covered by insurance, but subsequent session numbers may be limited as far as coverage is concerned. The Birth to 3 Program (Part C of the Individuals with Disabilities Education Act) supports families of children with delays or disabilities under the age of 3. Starting at age 3, evaluations can be done through the local school system even before a child enters school.

With the Birth to 3 Program, the initial evaluation is free. Anyone with concerns about a child’s development can refer them to Birth to 3 for an evaluation.

I believe one of the biggest advantages of the program is that the evaluation and services are offered in the child’s home. This allows the child to be in their natural environment to facilitate accurate evaluation of skills and optimization of learning.

To meet eligibility for Birth to 3 services, there needs to be a developmental delay of at least 25 percent in one area of development, a physician-diagnosed condition with a high probability of developmental delay, or an atypical (unusual) development that adversely affects the child’s overall development.

In Wisconsin, we have a Parental Cost Share System in which parents who are determined to be financially able will share in the cost of early intervention services for their child.

Each county in the state administers its own Birth to 3 Program. More information can be found at www.dhs.wisconsin.gov/children/birthto3.

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Mindfulness Training Prevents Burnout, Boosts Compassion Among Doctors

This article was featured in The Huffington Post on September 13, 2013.

A growing body of research has shown multiple benefits of mindfulness, including helping smokers quit their habit, improving sleep quality, and even helping students score higher on standardized tests. Now, mindfulness training has been linked with a number of positive outcomes for physicians and their patients.

Mindfulness practice — the cultivation of a focused awareness on the present moment — can improve physicians’ performance by not only preventing burnout, but also by helping them better connect with their patients, according to two small, recent studies in the September/October issue of Annals of Family Medicine.

In the first study, conducted by Dr. Luke Fortney, M.D., of the Meriter Medical Group in Madison, Wisc., and his team, 30 primary care physicians underwent a short mindfulness training course. They were then assessed for job satisfaction, quality of life and compassion for up to nine months after the course.

Compared to physicians who were not trained in mindfulness, participants showed improvements at one day, two months, and nine months after they were trained in the course. The researchers found that at nine months, the physicians were significantly less burnt out and had lower levels of depression, anxiety and stress, compared with doctors who didn’t undergo the training course. They also scored higher on scales measuring compassion.

Mindfulness training programs could be an effective, low-cost way to prevent physician burnout, which can have a number of negative effects on the health care system, the physicians themselves, and patients, researchers said.

“Burnout negatively affects quality of care with profound personal implications, including suicidal ideation,” the study’s authors noted. “Furthermore, physician attrition due to burnout is both disruptive to continuity of patient care and costly to health care organizations.”

A second study found that patients can benefit significantly from working with mindful physicians. Researchers at Johns Hopkins University conducted observational research on 45 clinicians who completed the Mindful Attention Awareness Scale — a measure used to gauge an individual’s level of mindful awareness while conducting everyday activities — and who cared for more than 400 HIV-positive patients at four HIV specialty clinics. Clinicians who scored higher on the mindfulness scale were more like to engage in patient-centered communication, meaning that the clinician and patient built a greater rapport and spent more time discussing psychosocial issues faced by the patient. The patients of mindful clinicians also reported high overall satisfaction.
“The benefits of mindful practice extend beyond the practitioner to his or her patients,” Breach and the authors of the study concluded. “It is not only that mindful practitioners can listen attentively, but that their patients are empowered to make their voice heard in areas that matter to them.

Mindfulness has been associated with a number of physical and mental health benefits, including lower stress levels, improved cognitive functioning, and a decreased risk of developing various chronic illnesses. Mindfulness meditation has even been shown to boost creativity and empathy.

Mindfulness training programs can have wide-reaching benefits not just in the doctors’ office, but also in the classroom. A recent University of Wisconsin study found that mindfulness programs are effective in reducing stress and burnout among teachers, and a body of research supports the learning benefits of mindfulness for both schoolchildren and college students.

Click here for The Huffington Post article.

Please click here to read another article on mindfulness training that was published in The New York Times.

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