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What's New August 14, 2015

Endourology Fellows Abdul Al Ruwaily and Sapan Ambani

Michigan Urology Faculty, Fellows, Residents, and PAs

2 Items, 15 Minutes

This week we have updates from Endourology fellows Abdul Al Ruwaily and Sapan Ambani. As both note, neither of them are strangers to What’s New thanks to numerous previous contributions. Nevertheless, they are still more than happy for the opportunity to share news about their personal and professional lives. This sort of openness and appreciation speaks to the family-like culture that has been cultivated in the Department of Urology. The great undertakings and accomplishments of our faculty, students and staff would not be possible without the structures of support we have in place. These elements of support, which were established thanks to years of consummate leadership, are what help to distinguish our Department of Urology from others. The support we show each other allows us all to go beyond what would be traditionally expected and produce or deliver something truly great.

The evidence of this family atmosphere also makes for very enjoyable What’s New contributions, so without further ado, here are comments from two of our fellows.

-Eric Anderson, Marketing and Communications Specialist 1. Abdul Al Ruwaily

The train of life is running fast, flying from one station to the next. For every station we leave behind, the good memories stay with us forever. It feels like it was only yesterday when I wrote the first “What’s new” 2 years ago. My journey in Michigan is near to its finish. My family and I love this place. I would like to take this opportunity to thank everyone in the department for another wonderful and supportive year. The Department of Urology at the University of Michigan is a very special place, and it is an honor to be a part of it.

At the beginning of the fellowship Now. (July 2013)

The training I received with the health service team has been wonderful, and the formal HSR training has been outstanding. I have been so fortunate to work closely with the entire HSR team in different research activities. Moreover, I have acquired through this period a master’s research degree in biostatistics, which has expanded my exposure to different research methodologies and has broadened my research interests and experience. I now feel confident that I have the foundation and versatility to tackle multiple types of research. Update on my research activity Talking about the research, my recent two papers have been accepted for presentation at the coming World Congress of Endourology (WCE), which will be held in London on October 2015. The first is mentored by Dr. Hollingsworth and entitled “How Much Information Is Lost When You Only Collect One 24-Hour Urine Collection during the Initial Metabolic Evaluation?” We observed substantial differences between consecutive 24-hour urine samples, which could affect provider decision-making. The second one is mentored by Dr. Wei and entitled “Urinary Incontinence after PVP vs. HOLEP Laser Prostatectomy: Matched Large Size BPH”. It showed that HOLEP results in slightly greater UI in the first 6 months after surgery; however, the degree of prostate tissue removal is much greater with the holmium laser, which may translate into longer-term benefits such as a decreased rate of retreatment and a decreased rate of delayed hematuria. Visa issue To attend WCE 2015 in London and come back to Michigan, I first had to fly for 16 hours to Saudi Arabia to renew my entry visa to the USA. I was hesitant to go, especially since my clinical year

will start soon. However, I did so, and the thing that I was afraid of happened. There was a delay in issuing the visa and at one point, I thought it would be not issued. After a long time (14 days), I sighed with relief and received my visa, and I ran to find the next flight back to Detroit. I came back full of enthusiasm to start my clinical year.

Me and my son (Yousef) with traditional clothes during the last visit to Saudi Arabia. Starting clinical training Currently, I am in my second month of clinical training. For me, the year will be very busy, as I transitioned from health services research (HSR) to a clinical role. I have passed the starting period, which was critical for me because I have not practiced for the last 2 years. I have had good support from all the staff I worked with. The clinical training here is very distinctive due to

the large variety of cases in addition to the skilled staff. I hope that I can get the full benefit of my time with the University of Michigan. Music in the operating rooms Music affects us in many ways, as it stirs deep emotions, from joy to sadness. It is natural to love music. However, what is the role of music in OR? Once the patient is sleep, music is played in many ORs. It has been observed that noise levels in some theaters frequently exceed those of a busy bar (no kidding!). Noise in OR is challenging communication, surgical performance, and compromising the safety of the environment. It is believed that a workplace noise limit of 55 decibels (A) (dBA) is necessary to ensure universally safe conditions. Background music can add 87 dBA to the already considerable ambient noise levels in an OR. 1-3 The Council on Surgical and Perioperative Safety (CSPS) endorses a safe surgery resource chart to reduce the risk of noise in the perioperative period.4

CSPS distraction’s chart.4 According to the chart: “CSPS recommends a multidisciplinary team approach to reduce the level of noise and create a safer environment for patients. It stresses that noise takes away from the silence team members may need to perform operations safely. It also warns that the use of cellular phones and accessories can cause distraction and bacterial contamination, which may compromise a sterile perioperative environment.”4

Finally, I am very grateful for the opportunity to be the first international fellow to participate in the HSR and endourology fellowship, and I am very grateful for the level of mentoring and support I receive as a fellow within the Dow Division of Health Services Research and the endourology team. References: 1. Gloag D: Noise and health: Public and private responsibility. Br Med J 1980; 281:1404–6 2. Fritsch MH, Chacko CE, Patterson EB: Operating room sound level hazards for patients and physicians. Otol Neurotol 2010; 31:715–21 3. Shambo L, Umadhay T, Pedoto A: Music in the operating room: is it a safety hazard?AANA J. 2015 Feb;83(1):43-8. 4. http://www.cspsteam.org/index.html Thanks and have a good weekend, Abdul

2. Sapan Ambani I’m on a little bit of a streak with What’s New lately! Since this is now my 6th entry for WN, I have a feeling you know enough about me that I can refrain from the basic demographics and instead focus on something a bit more interesting. Earlier this year, I tied the knot, and it was a crazy couple days. As many of you know, Hindu weddings are a big production. There are many rituals, colors, and celebrations and they generally last several days. Although the official wedding festivities start at my parents’ house in Jackson two days before the actual wedding ceremony (vivah sanskar in Sanskrit), most of my immediate family came into town the weekend before. Although it could seem like a

burden to have 50 people come early for a wedding, it’s actually a blessing. Holding a 3 day celebration for 150-450 people takes a lot of work, and the whole family comes into town to help. Everyone has a job, but their main job is to make Shoshana, our parents, and me comfortable and stress-free. It’s the first example of how a Hindu wedding is a family event.

Covered in turmeric paste

On Thursday morning, the day starts with a ceremony called Graha Shanti. This is a smaller ceremony (~50-100 people) that kicks off the religious and social festivities leading to the wedding celebration by asking for blessings from all the gods, goddesses, and holy planets. This is followed by the pithi. All the women of my family ceremoniously get me ready for the wedding by “cleaning” me with turmeric paste. It’s a lot of fun, but I think it’s something they just made up to mess with me.

That evening was the Mehndi party. Mehndi, or henna, is a turmeric-based paste that is used as a symbol of good luck and health and is applied to the hands of women. This dyes the skin for days to weeks. The bride’s mehndi tends to be very intricate, so Shoshana’s mehndi took over 3 hours to apply! The rest of the

night is a fun party filled with dancing, dinner, and drinking (almost all my pictures have me holding an Oberon).

The view of the Cobo ballroom from the Crowne Plaza. Rained before and after but not during the wedding. Friday was mostly a day to transition to downtown Detroit for the rest of the festivities. Our home hotel was the Crowne Plaza (formerly the Hotel Pontchartrain) at the Riverfront, overlooking Cobo hall. That evening was a welcome dinner for all our guests. We had a jazz band, caricaturist, henna artist, and a ton of food!

Two cool guys trying to steal my ride.

The festivities started early Saturday morning outside of the Cobo center ballroom with the Hindu ceremony. Traditionally, the wedding starts with the groom’s procession. No I did not come in on an elephant, camel, or horse. I came in on a 1965 Mustang convertible (so I guess a “horse”) with a couple hundred of my friends and family dancing and leading the way.

It ends with a small ceremony where I meet Shoshana’s parents and they lead me into the mandap, which is a structure with four pillars that the wedding ceremony is conducted. Indian weddings are different than other ceremonies in that it is partially a social event for the guests as well. There is a lot of talking in the audience, but that’s totally normal!

Shoshana is hidden behind a sheet. I could almost look over it.

The rituals in a Hindu wedding are performed in Sanskrit and I understand almost nothing the priest was saying. The ceremonies vary widely, but a few common rituals are central. The Ganesh puja (worship Lord Ganesh (not Palapattu) to remove all obstacles), Kanyadaan (giving away of daughter), Agni puja (the holy fire acts as a divine witness to the marriage), and Saptapadi (taking seven steps with each step including a vow to each other). I can tell you there was nothing more exhilarating than sitting behind the sheet waiting to see Shoshana!

After we concluded the Indian wedding ceremony, the guests were surprised with lunch and the Buddhist ceremony on the Detroit Princess Riverboat. If you haven’t been on it, it’s a

beautiful trip down the river with a great view of downtown Detroit.

The Buddhist wedding ceremony was definitely a highlight for many of the guests. Since a large number of our guests were Indian, they were excited to see something different, and it did not disappoint. The readings and blessings put together by Shoshana’s mother and our priest, Greg Supa, were beautiful. Many mentioned to us that they found our vows entertaining too. I promised Shoshana that I would go salsa-dancing with her, and she’s still waiting. Many of you heard that I was freaking out because NBC’s the Voice was holding auditions at Cobo the same day, and there were going to be thousands of people crowding our space. Although it did not interfere one bit, one of the highlights of the day was when Shoshana and I were walking back and walked through the crowd of people waiting to audition, and we received a large round of applause. I’m hoping some of our wedding footage makes it on the show.

The urology crew. Nobody can out fist-pump Ryan.

Finally, we were able to get to the real party that evening. The reception was a blast. My cousin and sister MC’ed the evening and roasted us pretty well (they somehow found some incredibly embarrassing videos of me in my awkward years and decided to show it to everyone). Although it was a long day, it couldn’t have ended any better.

Although I was crazy neurotic with wedding planning for over a year (aka “groomzilla”), we were blessed to have the help and support of many people. People keep asking us, how does it feel to be married? Well, basically the same, except without a ridiculous wedding to plan! Thanks for taking the time to read this!