Checkup. acrossroads. What paths led to the rising CLEVELAND CLINIC FAMILY. At a Choosing a Healthier Path. Welcoming New Patients

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1 Beachwood Family Health and Surgery Center FAMILY CLEVELAND CLINIC Checkup Spring/Summer 2004 Health Information from the Family Health Center Closest to You Welcoming New Patients acrossroads At a Choosing a Healthier Path Imaging: MRI and CT scan appointments available New services at Beachwood FHC: Neurosurgery consults Pain management Schedule your child s physicals for the sports/school year now! Call 216/ clevelandclinic.org/fhc What paths led to the rising obesity epidemic in America? Experts agree the causes are a fairly simple combination of environment, lifestyle and genetics. Human physiology, unchanged from our ancestral days of famine and the daily struggle to procure food, still screams EAT whenever food is available. Trouble is, goodtasting (though not necessarily good-for-you), prepared and inexpensive food is always available today. We re hard-wired to gobble it up, and we do. Although other parts of the world are beginning to experience some weight problems too, Europeans generally do not, despite enjoying rich foods. The difference? Smaller portions, less snacking, fresher and less-processed food, more walking, and less lust for convenience and ease. They don t rely on microwaves or power gadgets. They don t drive to the grocery store: They walk daily to pick up fresh foods from small markets. And they focus on the pleasure of it all. Instead, we hop in the car to go around the corner, come home and pick up the remote. And we sit in front of the television (where food is heavily promoted), video games or the computer and we have desk jobs. We don t burn off enough calories in our everyday lives. This sedentary lifestyle is somehow stressful too. And when stress levels rise, one study shows, many people reach for increasingly unhealthy foods and exercise less. While watching the reading on the scale creep higher by a pound or two a year, Americans worry more about food than other cultures that are thinner. We know that being overweight increases the risk for many diseases. But the impact of overeating is delayed by decades, so connecting downing doughnuts today to clogged arteries years later is tough. For some of us, genetics causes a susceptibility to putting on pounds. Researchers have identified genes associated with obesity. But we simply cannot let environment, lifestyle or genetics excuse us. The facts are simple: Too much input (calories) and too little output (physical activity) means weight gain. It s time to fight the fat and make some pretty big lifestyle changes. How can we do that? Some suggestions: Rid schools of pop machines and fast foods, and add healthy choices. Reduce intake by 100 calories a day. Get a pedometer and work yourself up to walking 10,000 steps a day to stave off creeping weight gain. Eat breakfast and take time to prepare and enjoy healthier meals. Stop eating when you re full: Don t indulge in dessert just because you are used to ending your meal with something sweet. Above all, understand why changing your lifestyle is important: You are preventing future health problems and ultimately increasing your quality of life. To make an appointment with Beachwood Family Health Center specialists, call the Cleveland Clinic Appointment Center, 7 a.m. to 11 p.m., Monday through Friday at 216/444-CARE (2273) or 800/

2 Lifestyle Changes Yield Results, Study Shows A RECENT OUTCOMES STUDY conducted by Cleveland Clinic Family Health Center registered dietitians showed that through lifestyle interventions, individuals with high cholesterol lowered their LDL (bad) cholesterol by 22 percent without additional drug therapy. Following the guidelines from the National Cholesterol Education Program, 41 adults (ages 32 to 75) saw their LDL ( bad ) cholesterol drop an average of 22 percent. Participants received counseling on lifestyle changes, including limiting dietary cholesterol to 200mg or less/day, limiting total daily fat to 30 percent or less of caloric intake, and increasing fiber (whole grains, beans, fruits and vegetables) and physical activity. Recent national data from the Centers for Disease Control and Prevention states that 60 percent of people with high cholesterol levels did not know they were high. If your doctor determines your cholesterol is elevated and suggests a change in eating habits, ask for a referral to a registered dietitian. Internist Baljit Bal, M.D., who specializes in preventive medicine and obesity, and nutritionist Peggy Zeller, R.D., L.D., can help you determine if you need to make some lifestyle changes. Get your Game On THE DEFINITION OF A WEEKEND WARRIOR is someone who is not a professional athlete (i.e., gets paid for playing a sport), but someone who plays hard at a sport and enjoys working on improving his/her performance. Whether it is a recreational soccer team, a sand volleyball league or golfing on the weekends, you love the sport and want to continue injury-free. If this description fits you, you might be interested in programs offered at the Cleveland Clinic Sports Health and Orthopaedic Rehabilitation Center at the Beachwood Mandel Jewish Community Center (JCC). The JCC offers sports-specific performance improvement programs, such as the Throw Right Program for baseball, Golf Rehabilitation Plus and the Optimal Running Performance Program. Strength and conditioning specialists can design personalized exercise and conditioning programs for your specific sport goals, in addition to preventing injuries. If you do get injured, our specialists can help with the treatment and rehab to get you back out there. For more information about any of these programs, call 216/ Saving Saving your Breath your Breath Loutfi Aboussouan, M.D., is new to Cleveland Clinic Beachwood. He specializes in general pulmonary medicine, neuromuscular diseases, sleep medicine and longterm ventilator care. Call 216/ IF YOU SMOKE AND CAN T COMPLETE A LONG SENTENCE IN ONE BREATH or laugh without coughing, it s wise to see a doctor. These are signs of chronic obstructive pulmonary disease (COPD), along with rapid breathing, shortness of breath, chronic cough, chest tightness, increased airway congestion and frequent throat-clearing. The American Lung Association reports that 80 to 90 percent of people with COPD are smokers. COPD, a leading cause of hospitalization, disability and death in the United States, arises from chronic bronchitis or emphysema. Each obstructs the airways differently. But the end result is the same: a slow deterioration in lung function that limits physical activity, interferes with sleep, and can trigger headache, irritability and impaired mental function. If you have COPD and smoke, the most important thing to do is quit. Avoiding secondhand smoke, dust, air pollution, work-related fumes and exposure to respiratory infections is also key. Visit your doctor often; treatment with fast- and long-acting bronchodilators can open up narrowed or clogged airways. Antibiotics and oxygen therapy may help as well. Pulmonary rehabilitation programs will improve your physical endurance. A medically supervised diet and exercise program, pneumonia vaccination and a yearly flu shot are recommended. Call 216/ or visit us on the Web at clevelandclinic.org/fhc

3 Cancer News: Is a clinical trial right for me? Kids korner Supplements: Not for Young Athletes Adolescent athletes should consult a physician before taking any nutritional supplements. The American Dietetic Association warns that using natural ergogenic aids to boost athletic performance may be unhealthy for teens. Young athletes seek out natural supplements to increase strength, size and energy. The protein supplement creatine is popular among sprinters and weightlifters to build muscle and increase hustle. However, its long-term safety record, its true effect on athletic performance, and its influence on adolescent growth and development are largely unknown. Teens may take extra vitamins and minerals to boost performance, but megadoses have adverse side effects. And downing energy drinks or bars containing natural stimulants like caffeine and ephedrine can cause palpitations, arrhythmias and serious circulatory problems. Health professionals recommend that teens take nutritional supplements only when medically necessary. A daily multivitamin, a healthy diet and a proper exercise program are all that growing athletes need for maximum performance. Beachwood pediatricians Joseph Lock, M.D., Steven Wexberg, M.D., and Conrad Foley, M.D., see children for all their health needs. CANCER CLINICAL TRIALS, ALSO CALLED RESEARCH STUDIES, are what might be called the training camp of modern medicine, where treatments (including drugs, devices and therapies) are tested for safety and efficacy before going for approval by the FDA. The ultimate goal of the research is to find better ways to treat cancer. Advantages to participation include the possibility of receiving a new treatment before it is publicly available; providing researchers with critical information needed to further the knowledge of, and progress against, cancer; and the possibility of decreased treatment costs. With any new treatment, there are possible risks as well as benefits. Patients will be informed of any known possible side effects or risks. For patient protection, an Institutional Review Board monitors trials to make sure they are safe, meaningful, and ethically designed and conducted. Patients of the Cleveland Clinic Family Health Centers have access to clinical trials sponsored by the National Cancer Institute at the Cleveland Clinic Taussig Cancer Center. To learn more about clinical trials, call Vinit Makkar, M.D., or Gary Schnur, M.D., at 216/ Questions to ask before participating in a clinical trial: What is the purpose of the clinical trial? What does the clinical trial involve? How long will it last? How could the clinical trial affect my daily life? What side effects can I expect? Total Body CT Scan: Who Should Get One? TOTAL BODY CT SCANS HAVE BEEN PROMOTED RECENTLY as a new diagnostic technique, using computer tomography, or noninvasive imaging, to screen for potential problems and disease, such as lung cancer, heart disease or abdominal abnormalities before symptoms even appear. Useful as a preventive and diagnostic tool, the scan takes less than five minutes, and approximately one hour later, a board-certified radiologist will go over your results with you. While screenings and preventive medicine are crucial to health care, a total body CT scan is not for everyone. It is best for individuals over the age of 45 who are at high risk of developing heart disease, lung disorders or abdominal diseases. A family history of these conditions, increased age, smoking, and high cholesterol and blood pressure are all factors to consider. Total body CT scanning requires education and follow-up with a physician. A doctor should be actively involved with a patient when he or she is deciding whether to have one. For more information or to make an appointment with a physician to discuss total body CT scan, call 216/

4 Cleveland Clinic Family Health Centers on the Web Appointments Cleveland Clinic Beachwood Cedar Road Beachwood, OH / or 800/ Monday through Thursday: 8 a.m. to 8 p.m. Friday: 8 a.m. to 5 p.m. Saturday: 8 a.m. to noon Cleveland Clinic and Hillcrest Hospital Rehabilitation and Sports Health (Mandel Jewish Community Center) S. Woodland Road Beachwood, OH / Monday through Thursday: 7:30 a.m. to 7 p.m. Friday: 8:30 a.m. to 5 p.m. Cleveland Clinic Cancer Care Center at Beachwood To see our medical oncologists about cancer diagnosis or treatment, please call 216/ To speak with a nurse about cancer symptoms or concerns, Monday through Friday from 8:30 a.m. to 4:30 p.m., please call the Cleveland Clinic Cancer Answer Line: 216/ or 800/ Cleveland Clinic Beachwood Outpatient Surgery Center Cedar Road Beachwood, Ohio / The Cleveland Clinic Beachwood Surgery Center offers state-of-the-art outpatient surgical care in a convenient community setting. Our staff is committed to ensuring patients comfort and satisfaction. Outpatient procedures are performed in seven sophisticated operating suites. After spending a limited time in the postoperative care area, patients are discharged to complete their recovery in the privacy and comfort of home. CLEVELAND CLINIC Nurse on Call To speak with a nurse, 8 a.m. to 11 p.m., five days a week, about your adult and pediatric health concerns, call 216/ / Other Family Health Centers Brunswick 330/ Chagrin Falls 440/ Creston 330/ Elyria 440/ Independence 216/ Lakewood 216/ Cleveland Clinic Family Checkup is published by the Division of Marketing to provide up-to-date health information and news about Cleveland Clinic Family Health Center services. The information contained in Cleveland Clinic Family Checkup is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician s medical assessment and medical judgment. Editor: Jennifer Moseley Art Director: Barbara Ludwig Coleman Photographer: Tom Merce Lorain 440/ Solon 440/ Strongsville 440/ Westlake 440/ Willoughby Hills 440/ Wooster 330/ Call 216/ or visit us on the Web at clevelandclinic.org/fhc

5 Cleveland Clinic Beachwood Staff Profiles Daniel Alam, M.D., board-certified in otolaryngology and facial plastic and reconstructive surgery, graduated from the John Hopkins University School of Medicine in Baltimore. He completed a residency in head and neck surgery at the Harvard University School of Medicine in Boston, and a fellowship in facial plastic and reconstructive surgery at the University of California Medical Center in Los Angeles. Victor Erzurum, M.D., board-certified in vascular surgery, specializes in vascular and endovascular surgery including aortic aneurysms, carotid atherosclerosis, limb salvage surgery, angiography, balloon angioplasty and stenting, and minimally invasive surgical options. After graduating from the Northeastern Ohio Universities College of Medicine in Rootstown, Ohio, he completed a residency at Western Reserve Care System in Youngstown and a fellowship at Loyola University Medical Center, Foster G. McGaw Hospital in Illinois. For appointments, call 216/ Send me the following free information: Send completed coupon to: The Cleveland Clinic Foundation, P.O. Box 943, Wooster, OH Fact sheets: Balance Disorders (BPPV) Colonoscopy Diabetes Management or call toll-free: 800/ Name Street Address Age (optional) Brochures/Pamphlets: Brain Tumor Institute City/State/Zip Daytime Telephone Number Gamma Knife Center Pain Management Physical Medicine & Rehabilitation Skin Care Newsletters: Cancer Perspectives Competitive Edge (sports health) Pain Management Send me Family Checkup via Please add me to your Family Health Center mailing list Please remove me from your Family Health Center mailing list Please add my friend to your Family Health Center mailing list Name Street Address City/State/Zip Address Age (optional) Address Go to and click on Family Checkup newsletter to request this free information online. BW-204

6 Pregnancy After Miscarriage For most women who have had a miscarriage, the chances for future successful pregnancies are very good. But, according to the American College of Obstetricians and Gynecologists, about 1 percent of women may have repeated miscarriages (three or more, or two miscarriages in cases where women are older or higher risk). More than likely, one specific abnormality or underlying condition resulted in all three losses. Diagnosis and treatment of this condition can increase your chances of a successful pregnancy. If undetected or untreated, you may be at increased risk for a loss in a subsequent pregnancy. If you have had three or more miscarriages, talk to your physician about testing and treatment for a possible underlying cause. You should also discuss the timing of your next pregnancy. Some physicians recommend waiting up to three months before trying to conceive again. Your physician also may recommend treatment with progesterone, a hormone needed for implantation in the uterus. While treatment cannot totally guarantee a successful pregnancy, it can result in success rates approaching 85 percent for most women. Robert Kiwi, M.D., specializes in recurrent pregnancy loss, high-risk pregnancy, diabetes and pregnancy, and other medical problems in pregnancy. Women can make appointments at Cleveland Clinic Beachwood by calling 216/ (OB/GYN Specialties) or 216/ (Family and internal medicine) women s health Quit: Reduce your Risk for Stroke Women who smoke are at much higher risk for bleeding (hemorrhagic) strokes, but those who have quit can bring their risk back to normal, researchers have found. According to a report published in the online journal Stroke (December 2003), women who smoked 15 or more cigarettes a day were more than twice as likely to suffer this kind of stroke. And the more they smoke, the higher the risk. A bleeding stroke occurs when a weakened blood vessel in the brain ruptures. This type of stroke is the most serious. A previous study had established smoking as a risk factor for hemorrhagic stroke in men, but until now, the effect on a woman s risk hadn t been determined. About half a million Americans suffer from stroke each year. Often these strokes are preventable by making lifestyle changes, such as controlling high blood pressure and high cholesterol, and managing your diabetes and other heart conditions, as well as reducing cigarette and alcohol intake. Treatment for Female Incontinence Urinary incontinence the loss of bladder control is not a disease. Rather, it is a sign that a problem may exist. Regular leakage of urine can occur with certain movements, during pregnancy or times of stress. When leakage of urine becomes frequent or severe enough to become a social or hygienic problem, you should see your physician. Proper diagnosis and treatment may correct the problem and ease the symptoms of urinary incontinence. Diagnostic tests can be completed during an outpatient appointment and are not painful. Urinary incontinence almost always can be treated successfully, and in some cases without surgery. Many women regain control through physical therapy and exercise, biofeedback, behavioral therapy, medication or bladder control devices. Your physician may suggest surgery to alleviate incontinence only after other treatments have been tried. Advances in both laparoscopic and vaginal surgeries offer a quicker recovery, less postoperative pain and better results than traditional procedures. Ask your physician what is available for you. Neurosurgeon Samuel Tobias, M.D., is available for consultation on neurological disorders, such as stroke, at Cleveland Clinic Beachwood. THE CLEVELAND CLINIC FOUNDATION Family Checkup / W Euclid Avenue, Cleveland, OH NONPROFIT ORG. U.S. POSTAGE PAID CLEVELAND, OH PERMIT NO. 4184