YOUR LINK TO HEALTHY LIVING IN NORTHEAST OHIO HEART … · Power your body’s engine for life: 7 tips from the nation’s No. 1 heart program HEART MECHANICS PLUS Health ESSENTIALS

Power your body’s engine for life: 7 tips from the nation’sNo. 1 heart program

HEART MECHANICS

PLUS

HealthE S S E N T I A L SYOUR LINK TO HEALTHY LIVING IN NORTHEAST OHIO

E A S T E R N C U Y A H O G A , G E A U G A , L A K E A N D N O R T H E R N S U M M I T C O U N T I E SF A L L 2 0 1 3

QUIZ:TEST YOUR STRESS IQSEE PAGE 18

Banish Back Painpage 14

Learn Your Diabetes ABCs

page 10

Compassionate Care for Kidspage 17

DOWNLOAD a free recipe for delicious Winter Vegetable Soup. page 9

page 8

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SOURCES: CLEVELAND CLINIC TOBACCO TREATMENT CENTER, THE AMERICAN HEART ASSOCIATION

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Features

5 Tips for Choosing a Rehabilitation Facility Ask the right questions to get the information you need.

6 Convenient Orthopaedic Services Hillcrest Hospital expands to better care for you.

7 Healthcare Reform Must-Knows Do you know what’s changing and why?

8 7 Smart Steps to a Healthy Heart Recommendations from the nation’s No. 1 heart program.

10 Learning the ABCs of DiabetesEducation and support are helping people with diabetes.

12 Walk-In, World-Class Express Care Fast medical help near you.

14 Banishing Back Pain Learn the keys for reducing chronic back pain.

16 Pain Solutions Living with chronic pain? It’s time to see a doctor.

17 Caring for Kids Child life specialists help put hospitalized children at ease.

Depar tments

3 News & Events

18 Pop Quiz

19 My Story

EDITORSAdrienne Russ Annette Thompson

This publication is for informational 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. Always consult fi rst with your physician about anything related to your personal health.

Health Essentials is published three times a year for The Cleveland Clinic Foundation, 9500 Euclid Ave., AC311, Cleveland, OH 44195. Volume 2, Number 2E.

Brian Harte, MD, is now President of Hillcrest Hospital. He has been with Cleveland Clinic for nine years—including as President of South Pointe Hospital and Chief Operating Offi cer at Hillcrest. For the past fi ve years, he served as Medical Director for Cleveland Clinic’s Department of Business Intelligence within Medical Operations. Dr. Harte is board-certifi ed in Internal Medicine. He’ll continue to see patients at Hillcrest, where he has been on the medical staff since 2006.

Robert Juhasz, DO, is now President of South Pointe Hospital. Dr. Juhasz has been with Cleveland Clinic for 15 years, most recently as medical director for Willoughby Hills Family Health Center. Dr. Juhasz also serves as Associate Dean for the Ohio University Heritage College of Osteopathic Medicine, Cleveland Clinic Extension Campus. He has led the search for the new dean and is working with the architectural and design teams for the new medical school to be located on the South Pointe campus, focused on increasing the number of primary care physicians in our community.

Brian Harte, MDPresident, Hillcrest Hospital

Robert Juhasz, DOPresident, South Pointe Hospital

NEW HOSPITAL LEADERSHIPHillcrest and South Pointe hospitals welcomed new presidents in September

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BRINGING FUN BACK TO THE FEASTING SEASON Get tips for making the holidays more festive and less stressful, and take a by-the-numbers look at this time of the year. Download our free tipsheet at clevelandclinic.org/healthessentials.clevelandclinic.org/healthessentials

’Tis the Season for Stress?For many, the holidays are a mixed blessing because of the added

stress (think: extra gatherings, shopping, cooking and hosting).Here’s how American adults rate this merrymaking season:Here’s how American adults rate this merrymaking season:

46%46%JOYOUSJOYOUS

12%UNSURE

42%STRESSED

2 C L E V E L A N D C L I N I C . O R G / H E A LT H E S S E N T I A L S

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NEWS & EVENTS Q&A

Certifi ed genetic counselors Jessica Moline, MS, CGC, and Allison Schreiber, MS, CGC, from Cleveland Clinic’s Center for Personalized Genetic Healthcare in the Genomic Medicine Institute, provide an overview of what they and their colleagues do.

Q: What do genetic counselors do?We help patients and families understand genetics and genetic dis-orders. We assess the chance of disease occurrence or recurrence and talk with patients and families about options in disease management and family planning. We provide education, facilitate gene testing and help with prevention and resources. In brief, we offer genetic counseling to promote informed choices and adaptation to the risk or condition.

Q: When should I consider genetic testing?You may want to consult with us if you have a family history of a recurring condition; a known genetic condition (e.g., Huntington’s disease, muscular dystrophy, thrombophilia, hemochromato-sis, Lynch syndrome); or a genetic mutation carrier in the family (e.g., sickle cell anemia, cystic fi brosis, Tay-Sachs disease). Another reason is to learn about recurrence risk for future pregnancies. You should only accept gene testing recommendations from a genetics professional, such as a genetic counselor.

Q: What should I expect at an appointment?You need to bring detailed family health information with you. Your appointment length will vary depending on the issue. If genetic testing is recommended, blood usually can be drawn the same day.

Q: Does insurance cover it?Many insurance companies will cover genetic counseling, but be sure to check your policy specifi cally.

Q: Why is it becoming more prevalent?Advances in our understanding of genetics is allowing us to provide this type of preventive care. And when famous people like actress Angelina Jolie go through genetic testing and surgery (as she did for the BRCA1 gene mutation for breast and ovarian cancer), it increases awareness.

REASONS TO QUIT SMOKING

SOURCES: CLEVELAND CLINIC TOBACCO TREATMENT CENTER; THE AMERICAN HEART ASSOCIATION

Your body begins to repair itself almost immediately after you smoke your last cigarette; your risk of heart attack drops within 24 hours of quitting smoking.

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SCHEDULE A CONSULTATIONTo make an appointment with a genetic counselor or learn more, go to my.clevelandclinic.org/genomics-genetics.

Check Out Our Brand-New WebsiteSee what’s new on the redesigned Health Essentials online at clevelandclinic.org/healthessentials.

40%Patients at Cleveland Clinic’s Tobacco Treatment Center achieved quit rates of 40 percent vs. 5 percent for those without treatment.

It’s never too late to kick the habit. Even smokers who quit in their late 60s may add as many as four years to their life expectancy.

YEARS FOUR 440

Cigarette smoking is the largest preventable cause of premature death in the country, accounting for more than 440,000 deaths every year.

THOUSAND

Genetic Counseling

Cleveland Clinic Pharmacy Opening in IndependenceA new pharmacy opens in December at Independence Family Health Center, making it convenient for patients to fi ll their prescriptions. Cleveland Clinic operates several outpatient pharmacies at health system locations, and each of our pharmacists and technicians is committed to putting our patients fi rst. Our focus is on delivering quick and accurate prescription services while educating patients about the importance of their medication therapy.

For a complete list of Cleveland Clinic pharmacies, go to clevelandclinic.org/pharmacy.

NEW HOSPITAL LEADERSHIPHillcrest and South Pointe hospitals welcomed new presidents in September

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’Tis the Season for Stress?

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Make a Difference as a VolunteerVolunteers are an important part of our healthcare teams at Euclid, Hillcrest, Marymount and South Pointe hospitals. They provide personal touches that patients and their families need, appreciate and remember. Volunteering is a wonderful opportunity to help others and develop new skills. Volunteers perform a variety of jobs in our hospitals, including delivering fl owers and gifts, assisting at hospital information desks, transporting patients, and working in various hospital departments.

If you are interested in becoming a volunteer at one of our hospitals, please contact the Volunteer Department:

Euclid Hospital: 216.692.8880Hillcrest Hospital: 440.312.4631Marymount Hospital: 216.587.8131South Pointe Hospital: 216.491.6303

RECORD YOUR FAMILY HEALTH HISTORY—WITH OUR HELPFamily health history refers to health information about you and your close relatives. Having a family member with a disease suggests that you may have a higher chance of developing that disease than someone without a similar family history. It does not mean that you will defi nitely develop the disease. Factors that may contribute to disease include:

Genes Lifestyle Environment

How can I learn about my family health history?The best way to learn about your family history is to ask questions, talk at family gatherings, draw a family tree and record health information. If possible, look at death certifi cates and family medical records. MyFamily® can help you record your family’s health history.

What is MyFamily?MyFamily, a custom-built software tool, selects applicable MyChart® enrollees who have upcoming well-check appointments. If that includes you, you’ll be asked to

participate in a “pre-visit” information-gathering process. You’ll be asked about the health history of your parents, grandparents and children. The online collection system is easy to use and saves you time at your appointment. You can save your work and return later to fi nd answers or gather additional family information.

MyFamily is available at select Cleveland Clinic locations, including main campus and Beachwood Family Health and Surgery Center. The Solon Family Health Center has the largest concentration of users, with all primary care physicians currently using MyFamily.

CELEBRATION OF LIGHTSThursday, Dec. 5, 7 p.m.This annual event, sponsored by the Hillcrest Hospital Auxiliary, is dedicated to family members, friends and loved ones who have passed away; it also recognizes and celebrates cancer survivorship. Proceeds benefi t the Hillcrest Hospital Cancer Center. For more information, call 440.312.4631.

Medical Care on New Year’s DayCleveland Clinic Express Care will be open on New Year’s Day (Wednesday, Jan. 1) from 8 a.m. until noon at the following locations: Beachwood, Independence, Stephanie Tubbs Jones and Willoughby Hills family health centers. Express Care at the Madison Medical Offi ce Building will be open from 10 a.m. until 2 p.m.

Individuals 14 years of age and older can get walk-in medical attention for common health problems like cold and fl u symptoms, rashes, ear and throat infections, and seasonal allergies—no appointment necessary. Those under 18 need a parent or legal guardian present. For more information, visit clevelandclinic.org/expresscare.

Cleveland Clinic Urgent Care in Bainbridge will be open on New Year’s Day from 9 a.m. until 1 p.m. Urgent care provides care for minor illnesses, fever, minor burns, minor lacerations, stomach fl u and more. For more information, visit clevelandclinic.org/urgentcare.

DietPhysical activity

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Finding the right rehabilitation facility may seem chal-lenging. “There are many factors to consider when choos-ing a facility,” says Yana Shumyatcher, MD, a Physical

Medicine and Rehabilitation specialist at Cleveland Clinic Rehabilitation Hospital at Euclid Hospital. “Asking the right questions can help.”

Cleveland Clinic Rehabilitation Hospital at Euclid Hospital provides rehabilitation services specifi cally for individuals who have suffered a stroke, a traumatic injury or a severe ill-ness. See how it measures up with answers to these 10 impor-tant questions:

1Does it offer programs specifi c to your needs?Our physicians prescribe therapies for rehabilitation

after stroke, brain injury, Parkinson’s disease, amputa-tion, orthopaedic surgery, cardiac rehabilitation and organ transplantation.

2 Is 24-hour care provided and how qualifi ed is the staff?Around-the-clock physician coverage is provided. Our

nursing staff includes registered nurses certifi ed in rehabili-tation nursing and experienced in acute care.

Answers to these 10 questions provide the information you need

Tips for Choosing a Rehab Facility

START REHABBINGTo learn about Cleveland Clinic Rehabilitation Hospitals at main campus, Euclid and Lakewood hospitals go to clevelandclinic.org/rehab. For more information about rehabilitation services at Cleveland Clinic Rehabilitation Hospital at Euclid Hospital, call 216.692.8668.Hospital,

3How are treatment plans developed?

Physicians and nurses work with physical, occupational, speech/lan-guage and recreational therapists, psychologists and social workers to develop patient treatment plans.

4How often is therapy provided?Patients receive a minimum

three hours of therapy daily, fi ve days a week, as required for licensed reha-bilitation facilities.

5 What supplemental services are offered?Programming in horticulture, art, music, relaxation,

cooking, pet therapy, balance/coordination and stroke exer-cise is available, as well as support groups.

6Do caregivers assist with discharge and insurance questions?

Each patient’s assigned social worker or case manager will help coordinate services needed at home and will help verify insurance benefi ts.

7 Is family participation encouraged?A partnership involving the patient, family and medical

providers is essential to maximizing every opportunity for recovery. Family members are encouraged to observe therapy, participate in key meetings and learn how to assist in the care of the patient.

8Are outpatient physician and therapy services offered?Comprehensive services, including outpatient therapy

and home care, are provided through access to more than 650 rehabilitation professionals in Northeast Ohio.

9 Is access to patient electronic medical records provided?

Each patient’s rehabilitation team can access his or her medi-cal history, medication lists, radiology and laboratory results, and treatment status electronically.

10Do patients have on-site access to other specialists?The full range of medical and surgical subspecialists,

therapists and physiatrists is available.

Yana Shumyatcher, MDPhysical Medicine and Rehabilitation specialist

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During the past two years, Cleveland Clinic’s Orthopaedic & Rheumatalogic Institute has been adding to its orthopaedic services at Hillcrest

Hospital by increasing the number of specialists, expanding the physical space, and increasing the days and times that services are offered.

“In the past, we offered limited orthopaedic care,” says Richard D. Parker, MD, Chairman of Cleveland Clinic’s Orthopaedic Department. “But now, thanks to our expansion, patients can see a Cleveland Clinic orthopaedic specialist, have surgery and receive follow-up care—all right here at Hillcrest Hospital. Outpatient rehabilitation services are also available on the Hillcrest campus.”

FULL SERVICESMusculoskeletal care offered at Hillcrest now includes:

Arthritis and osteoporosis treatmentJoint replacement and reconstructionHip and knee careHand, wrist, elbow and shoulder careOrthopaedic trauma services

All these services are available in one convenient location in a 3,200-square-foot, newly renovated orthopaedic suite on the third fl oor of the Hillcrest Hospital Atrium.

The Institute also includes rheumatology, which is on the fourth fl oor of the Atrium. “These improvements have enabled us to increase the days we offer both orthopaedic and rheumatologic services,” Dr. Parker notes.

Cleveland Clinic orthopaedic physicians and rheuma-tologists at Hillcrest provide highly specialized treatment for bones, joints, muscles and tendons. They are assisted by a specialty-trained clinical team. The team works together to give each patient the best possible and most appropriate care.

MEET THE TEAMCleveland Clinic’s orthopaedic physicians and rheumatolo-gists at Hillcrest include:

Robert Anschuetz, MD—medical orthopaedics, including the hip, knee and shoulder Damien Billow, MD—orthopaedic trauma, including nonunion and malunion fractures Michael Bloomfi eld, MD—hip and knee replacement and reconstruction Scott Burg, DO— rheumatologic conditions, including arthritis, osteoporosis and lupus; golf-related injuries Robert Hampton, DO—hip and knee replacement; knee and shoulder arthroscopy; fracture care Steve Maschke, MD—hand, wrist, elbow and periph-eral nerve surgery Bernard Stulberg, MD—hip and knee replacement and reconstruction

These physicians are dedicated to healing patients and enhancing their quality of life.

CONVENIENT ORTHOPAEDIC SERVICESHillcrest Hospital expands to better care for your bones, muscles and joints

Bernard Stulberg, MD, works with a patient after a joint replacement surgery.

CALL TODAY FOR AN APPOINTMENTTo schedule an appointment with a Cleveland Clinic orthopaedic or rheumatology physician at Hillcrest Hospital or another convenient Cleveland-area location, call 216.444.2606. For more information about Cleveland Clinic’s Orthopaedic & Rheumatalogic Institute, go to clevelandclinic.org/ortho.go to


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The 2010 Affordable Care Act can seem overwhelming and even a little confusing. But here’s the main point: Healthcare is being revamped to help Americans

have more access to quality care while reining in runaway healthcare costs. (See “Why Is U.S. Healthcare So Expensive?” at clevelandclinic.org/health-reform.)

While details are still being ironed out, there are some important things you should know about healthcare reform, taking effect in 2014.

EVERYBODY WILL NEED TO HAVE HEALTH INSURANCEIf you don’t have health insurance, Medicare or Medicaid today, you’ll need to buy an insurance policy on your own or pay a penalty. Online healthcare exchanges will make it easy to shop for policies. And more people will qualify for Medicaid—if state law allows it. (When this was printed, Ohio had not yet passed a law to allow this change.)

“The more people who have access to healthcare, the healthier people will be,” says Daniel Sullivan, MD, Medical Director of Cleveland Clinic’s Solon Family Health Center.

Today, people without health insurance tend to put off going to the doctor or having routine care that could help prevent them from getting sick. Their healthcare often starts in the emergency room, sometimes late in their illness, requir-ing more expensive treatments.

“Being treated in the ER for a minor earache can cost you just short of $1,000,” Dr. Sullivan says. “Going to the doctor’s offi ce is much less expensive. If we can reduce the number of uninsured people using the ER for routine care, we can con-tribute to a signifi cant reduction in healthcare costs. People with access to care cost less to care for and ultimately have better health outcomes.”

WELLNESS AND PREVENTION WILL BE MORE IMPORTANT THAN EVERLiving healthier is the best way to reduce medical costs as well as manage the infl ux of newly insured patients. So, healthcare organizations like Cleveland Clinic will continue to do more to inspire patients to stay well and take an active role in their health.

“Our focus is shifting from ‘sick’ care to ‘health’ care,” Dr. Sullivan says. “That may include getting more people out to walk in the Metroparks or take lessons in low-fat cook-ing. There is great value in those things—not just in treating

someone after they’ve had a heart attack, but preventing a heart attack in the fi rst place.”

Healthcare reform is a work in prog-ress, but the changes will be good for everyone, Dr. Sullivan believes.

“Providing more people with access to healthcare will result in a healthier population and ultimately reduce the cost of care by reducing the burden of disease,” he says.

What You Need to Know About Healthcare ReformThe overhaul of U.S. healthcare is already underway. Do you know what’s changing and why?

STAY IN THE KNOWLearn more about healthcare reform in “Why Is U.S. Healthcare So Expensive?” at clevelandclinic.org/health-reform.

Daniel Sullivan, MDMedical Director, Cleveland Clinic’s Solon Family Health Center

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Your heart is like a classic car. With proper care, you can keep it running well for a long time. So rev up your engine by putting this advice from Cleveland Clinic experts to work for your health.

1 FUEL RIGHT. We actually have the power to fi ght heart dis-ease with our diets. Just as a car runs best on the right blend of gasoline, we run best when we make the right food choices.

It turns out that fresh produce is the best fuel for our hearts. So reach for fruits and veggies like bell peppers, dark leafy greens and berries—their deeper colors pack the most nutrient power. Round out your meals with more fi sh, whole grains, nuts, beans and olive oil. These foods are mainstays of the Mediterranean diet, which is known to reduce heart disease risk.


1 FUEL RIGHT.ease with our diets. Just as a car runs best on the right blend of gasoline, we run best when we make the right food choices.


YOUR HEART:AN OWNER’S MANUAL

Doctors from the nation’s No. 1 heart program* share 7 tips for running your body’s engine for life

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of gasoline, we run best when we make the right food choices. It turns out that fresh produce is the best fuel for our hearts. So reach for fruits and veggies like bell peppers, dark leafy greens and berries—their deeper colors pack the most nutrient power. Round out your meals with more fi sh, whole grains, nuts, beans and olive oil. These foods are mainstays of the Mediterranean diet, which is known to reduce heart disease risk.

of gasoline, we run best when we make the right food choices. It turns out that fresh produce is the best fuel for our hearts. So reach for fruits and veggies like bell peppers, dark leafy greens and berries—their deeper colors pack the most nutrient power. Round out your meals with more fi sh, whole grains, nuts, beans and olive oil. These foods are mainstays of the Mediterranean diet, which is known to reduce heart disease risk.

meals with more fi sh, whole grains, nuts, beans and olive oil. These foods are mainstays of the Mediterranean diet, which is known to reduce heart disease risk.

*U.S. News & World Report has ranked Cleveland Clinic the No. 1 heart program in the U.S. every year since 1995.

8 C L E V E L A N D C L I N I C . O R G / H E A LT H E S S E N T I A L S C L E V E L A N D C L I N I C . O R G / H E A LT H E S S E N T I A L S C L E V E L A N D C L I N I C . O R G / H E A LT H E S S E N T I A L S C L E V E L A N D C L I N I C . O R G / H E A LT H E S S E N T I A L S C L E V E L A N D C L I N I C . O R G / H E A LT H E S S E N T I A L S

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1 FUEL RIGHT. We actually have the power to fi ght heart dis-ease with our diets. Just as a car runs best on the right blend of gasoline, we run best when we make the right food choices.

It turns out that fresh produce is the best fuel for our hearts. So reach for fruits and veggies like bell peppers, dark leafy greens and berries—their deeper colors pack the most nutrient power. Round out your meals with more fi sh, whole grains, nuts, beans and olive oil. These foods are mainstays of the Mediterranean diet, which is known to reduce heart disease risk.

Eating healthfully also helps to prevent diabetes, which harms the heart and body in so many ways. This means maintaining a healthy body weight and limiting processed foods, simple carbo-hydrates, sugar and saturated fat.

2 GET MOVING. A sedentary human body, like a sedentary car, will deteriorate over time. Start small and take a 15-minute walk during your lunch break or simply park farther away

from the door at your offi ce or the store. Enjoy moving and monitor your progress.

Mark Angel, MD, a cardiovascular medicine specialist at Cleveland Clinic’s Richard E. Jacobs Health Center, says the eventual goal is to get 40 to 45 minutes of exercise fi ve to six days a week. Need motivation? Schedule regular exercise dates with a partner or a friend. Or adopt a dog, and you’ll be walking twice a day, Dr. Angel says. Once you start moving, you will feel more ener-getic, sleep better and think more clearly.

3 KEEP A “WELL-OILED MACHINE.” This means reining in stress. Vladimir Vekstein, MD, Director of the Cardiac Catheterization Lab at Hillcrest Hospital, says, “Stress plays

a huge role in developing heart disease and other health issues. Controlling stress by whatever means you can is important. That could be exercise, meditation or reading a good book.” (Download a guided relaxation podcast at clevelandclinic.org/healthessentials.)

One easy way to alleviate stress is to laugh out loud. It immedi-ately increases blood fl ow just like aerobic exercise or cholesterol-lowering drugs do. There is some thought that laughing on a regular basis can even reduce your risk for a heart attack.

4 TRACK YOUR NUMBERS. You monitor your tire pressure and gas levels, right? Certain measurements can clue you in to your heart’s health, too. Have your blood pressure and

cholesterol levels checked at least once a year. Blood pressure should be 120/80 or less. “Even low levels of high blood pressure are associated with a higher risk of heart disease,” says Steven Nissen, MD, Chairman of Cardiovascular Medicine at Cleveland Clinic. If your num-bers are too high, talk to your physician. Cholesterol should be below 100 for LDL cholesterol; HDL should be above 45 for women and 40 for men. Diet and exercise can help improve your cholesterol levels, alone or in combination with drugs called statins.

5 AVOID “DANGER ZONES.” “Smoking literally doubles your risk of heart disease, and you don’t want to wait until you have a heart attack to decide to stop,” Dr. Nissen says. Nicotine

patches or gums, or a medication called varenicline (Chantix®), can help you quit. (Go to clevelandclinic.org and search “Smoking Cessation.”)

6 USE THE RIGHT TOOLS. “In areas like Seattle where the whole population is getting trained in CPR, survival rates have gone up in a major way,” Dr. Nissen says. Sign up for

FUEL UP WITH HEART-HEALTHY COMFORT FOODWarm up your body this season with this new twist on Winter Vegetable Soup. Download the recipe at clevelandclinic.org/healthessentials.clevelandclinic.org/healthessentials

a class. Also, know where automated external defi brillators (AEDs) are in your offi ce and in public buildings. The devices can restore the heart’s rhythm during cardiac arrest even faster than CPR.

7 PAY ATTENTION TO “WARNING LIGHTS.” If you have a family history of heart disease, it’s even more important to make these lifestyle changes. Your risk of cardiovascular

disease increases if immediate family members have the disease—especially if male relatives were younger than 55, or female relatives were younger than 65, when diagnosed.

Your heart is an amazing engine. Follow this owner’s manual and you will be amazed at how much better you can feel.

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LAUGHTER IS GOOD FOR YOUR HEART. IT REDUCES STRESS

AND IMMEDIATELY INCREASES BLOOD FLOW, SIMILAR TO

AEROBIC EXERCISE.

Heart Attack Warning SignsIf you have these symptoms, call 911 right away:

Chest pain radiating to the left, right or both arms

Chest pressure or tightness

Shortness of breath

Sweating

Women, older people and people with diabetes sometimes experience other warning signs:

Sudden loss of consciousness

Shortness of breath with exertion

Unexplained fatigue

Cold sweats

Pain in the jaw, shoulder, abdomen or back

Dizziness

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Free education and support are helping people live well with diabetes

ABCS


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LEARNING THE

OF DIABETES

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Being diagnosed with diabetes can be a diffi cult experience. Patients often feel overwhelmed, uncertain and fearful about the impact of the disease on the rest of their lives.

Cleveland Clinic offers numerous options throughout the region to help patients with diabetes learn how to improve their health. These include classes with certifi ed diabetes educators, one-on-one appointments with nurses and registered dietitians, and activities such as support groups and health fairs.

Diabetes education and management services are offered on the East Side at:

Euclid, Hillcrest, Marymount and South Pointe hospitalsCleveland Clinic main campus Beachwood, Independence, Solon and Twinsburg family health centersSagamore Hills Medical CenterStephanie Tubbs Jones Health Center in East Cleveland

TEACHING PATIENTS TO MANAGE DIABETESSouth Pointe Hospital and the Stephanie Tubbs Jones Health Center offer four-session classes for patients and their families. These are fairly typical of the offerings at all Cleveland Clinic locations.

Session 1—The main topic is healthy eating, including how to count carbohydrates and read food labels. Students learn about the types of diabetes and the importance of exercise, as well as how to use a blood glucose meter and record the readings.

Session 2—Attendees learn how to detect patterns in blood glu-cose readings and analyze what makes levels fl uctuate (high or low), such as skipping a meal or eating too many carbohydrates in a sit-ting. Other topics include portion control, ways to make good selec-tions when dining out, and how to manage diabetes when sick with an unrelated illness, such as the fl u.

“We play an interactive game in which we present a symptom, such as being suddenly weak or sweaty. Patients guess whether the symptom is of blood sugar being too high or too low,” says Lynne Timko, RN, who has been a Certifi ed Diabetes Educator at South Pointe Hospital for 33 years. “It is very eye-opening for them.”

Session 3—This class covers the possible long-term complications of diabetes, such as vision or foot problems, and ways to prevent them. A dietitian shares tips on modifying recipes to fi t diabetic guidelines. Individual counseling on weight loss is available.

Session 4—Graduation! Patients celebrate success in meeting the personal goals set at the beginning of the class and chart a course for even more success in the future.

Throughout the classes, patients can share their feelings about having diabetes. “It is so empowering for them to see that they are not the only ones going through these emotions,” Ms. Timko says.

IT DOESN’T END THEREThe diabetes education staff notifi es each patient’s primary care physician once the class is completed.

“Ongoing diabetes self-management support, provided by follow-up phone calls, support groups and annual review classes, helps patients keep current with the latest information on diabetes,” Ms. Timko says.

One student who recently completed the class, Gloria Mhoon, 66, of Hudson, was referred by her physician, Jane D’Isa-Smith, DO, because she was having trouble managing her blood sugar levels.

“I learned I was eating too many carbs and fried foods. My sugar was spiking over 600 every afternoon and early evening. Also, I wasn’t sleeping at night,” Miss Mhoon says. “They taught me to make better choices, and now my sugar is back to normal. I feel 100 percent better. It’s due to the nurses, doctors and dietitians here. I am very appreciative.”

INSULIN CLINICAnother Cleveland Clinic program to help patients with diabetes is the insulin clinic at The Lennon Diabetes Center at Stephanie Tubbs Jones Health Center. This clinic, which opened in 2012, helps patients manage their insulin.

“The number of patient visits can range from a few to 20 or more, depending on individual needs and level of diabetes con-trol,” says Sue Cotey, RN, Diabetes Program Coordinator. “Some patients are referred to start insulin therapy. Others have had suc-cess with lifestyle changes and we assist them in decreasing the amount of insulin they take, or stopping it completely, under the direction of the physician.”

REACHING OUT TO THE COMMUNITYSouth Pointe Hospital holds a diabetes health fair each November. This year it will be from 1 to 4 p.m. Friday, Nov. 8, in South Pointe Hospital’s B building main lobby and auditorium.

The event features expert speakers, cooking demonstrations, exercise instruction, health screenings and more. Six patients who have excelled in meeting goals related to their diabetes in the past year will be honored as Patient Champions, which helps to inspire others. Typically about 400 people attend.

SIGN UP FOR A CLASSTo register for diabetes education services at any Cleveland Clinic location, please call toll-free 866.721.0070. To learn more, visit clevelandclinic.org/diabetesclasses. For more information about diabetes and its warning signs, go to clevelandclinic.org/diabetes.go to

Certifi ed Diabetes Educators Lynne Timko, RN (center), and Ellen Trifi letti, RD, LD (right), help Gloria Mhoon learn to manage her diabetes.

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Walk-In, World-Class ExprEss CarEFast, convenient care for minor medical

conditions—seven days a week!

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Cleveland clinic is dedicated to making it easier for people to get convienent care when they need it. We’re determined to ensure that you are able to see a health professional the same day—and we’re doing that through Express care.

We Want to Prevent ‘sCenarIo a’Darleen Smith’s pain and burning was bad, but not that bad. It was prob-ably just another urinary tract infection. She scheduled an office visit with her physician for the next day and figured she could wait it out by drinking lots of water and cranberry juice. The next morning, she woke up with a raging fever and nausea. If only she had gone to Express Care, she could have started treatment sooner.

We Want to ensure the Care In ‘sCenarIo B’ Brenda Jones had seen that red blistery rash before—the last time she acci-dentally touched poison ivy. She called her doctor Friday morning, but his first open appointment wasn’t until Monday morning. Her itching seemed almost unbearable. So, instead of waiting until Monday, Ms. Jones drove to the Willoughby Hills Family Health Center Express Care, where she got medical care—and relief—right away.

cold and flu symptomsconjunctivitis (pinkeye)Ear and throat infectionsMinor bumps and cutsseasonal allergies


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We’ve opened numerous Express Care clinics across the East Side so that it’s easier for you to get care close to home. Express Care locations make getting medical care faster. While Emergency and Urgent Care locations typically see patients with serious and severe conditions, Express Cares see patients with more common, minor illnesses and injuries such as:

WALK-IN, WORLD-CLASS EXPRESS CARE

DOWNLOAD THIS FREE APP Scan this code to get Cleveland Clinic’s new Today app for your iPad. Tap “Appointments” for help comparing Express Care, Urgent Care and Emergency Departments, and choosing the right location for you. Get a quick tour of the app on YouTube at clevelandclinic.org/todayapptour.

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Cleveland Clinic is dedicated to making it easier for people to get convienent care when they need it. We’re determined to ensure that you are able to see a health professional the same day—and we’re doing that through Express Care.

WE WANT TO PREVENT ‘SCENARIO A’Darleen Smith’s pain and burning was bad, but not that bad. It was prob-ably just another urinary tract infection. She scheduled an offi ce visit with her physician for the next day and fi gured she could wait it out by drinking lots of water and cranberry juice. The next morning, she woke up with a raging fever and nausea. If only she had gone to Express Care, she could have started treatment sooner.

WE WANT TO ENSURE THE CARE IN ‘SCENARIO B’ Brenda Jones had seen that red blistery rash before—the last time she acci-dentally touched poison ivy. She called her doctor Friday morning, but his fi rst open appointment wasn’t until Monday morning. Her itching seemed almost unbearable. So, instead of waiting until Monday, Ms. Jones drove to the Willoughby Hills Family Health Center Express Care, where she got medical care—and relief—right away.

Cold and fl u symptomsConjunctivitis (pinkeye)Ear and throat infectionsMinor bumps and cutsSeasonal allergies

Simple sprains and strainsSinus infectionsSkin rashesUpper respiratory infectionsUrinary tract infections

EVENING AND WEEKEND HOURS No appointments are necessary. Just walk in and see a nurse practitioner or a physician assistant for prompt, Cleveland Clinic quality treatment. If you need advanced care, you’re in the right place to be referred to a Cleveland Clinic specialist.

“We always urge patients to see their primary care physician when possible. They know you best,” says Theresa Lash-Ritter, MD, Director of Urgent and Express Care Clinics. “But if they’re not available when you are, there’s Express Care. Locations are open seven days a week, including evenings.”

It’s another way Cleveland Clinic is helping patients get same-day appointments, she notes.

WHAT ABOUT COST?The cost of a visit to Express Care is the same as a regular offi ce visit with your physician. Most insurance plans are accepted. Payment, including copay, is required at time of service.

Theresa Lash-Ritter, MDDirector, Urgent and Express Care Clinics

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Express Care Near YouThese Express Care locations on Cleveland’s East Side treat patients age 14 and older, unless otherwise noted:

Beachwood Family Health and Surgery CenterMonday–Friday, 1–9 p.m.Saturday and Sunday, 8 a.m.–4 p.m.

Independence Family Health CenterMonday–Friday, 5–9 p.m.Saturday and Sunday, 8 a.m.–4 p.m.

Madison Medical Offi ce Building*Monday–Friday, 8 a.m.–9 p.m.Saturday, 9 a.m.–4 p.m.Sunday, 11 a.m.–4 p.m.

Mentor Medical Offi ce BuildingMonday, Wednesday and Friday, 5–9 p.m.Saturday, 8 a.m.–4 p.m.

Stephanie Tubbs Jones Health CenterMonday–Friday, 1–9 p.m.Saturday and Sunday, 8 a.m.–4 p.m.

Willoughby Hills Family Health CenterMonday–Friday, 1–9 p.m.Saturday and Sunday, 8 a.m.–4 p.m.

Hours subject to change. For holiday hours and more locations throughout Northeast Ohio, go to clevelandclinic.org/expresscare.

*All ages treated here.

Where Should You Go?

Emergency Departments treat critical conditions that require immediate attention (as well as minor illnesses and injuries). Urgent Care locations treat conditions that require care within 24 hours to avoid further complications. Express Care locations treat common, minor conditions.

For lists of illnesses and injuries treated at each location, see “Choosing the Appropriate Level of Care” at clevelandclinic.org/expresscare.

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Robin Jackson fi rst experienced lower back pain a few years ago. At the time, she was taking medication for high cholesterol levels and dealing with signifi cant stress. Her physician suggested she have back surgery,

but Mrs. Jackson was not ready to take such a drastic step. In 2010, she had her fi rst appointment with Teresa Dews, MD,

Vice Chair, Department of Pain Management, and Medical Director of Cleveland Clinic’s Pain Management Center at Hillcrest Hospital.

Mrs. Jackson was diagnosed with sci-atica, typically the result of an irritated nerve in the spinal column. In her case, she had chronic pain originating in her lower back, traveling down her left leg and into her foot.

TEMPORARY RELIEFDr. Dews treated Mrs. Jackson with epi-dural steroid injections, which are used to treat other types of pain as well.

“Steroids are a strong anti-infl am-matory agent—injecting them close to a nerve helps to temporarily reduce back and leg pain,” Dr. Dews explains.

In February 2013, the pain was back with a vengeance. “My stress level was extremely high, and the pain was so bad, it felt like a charley horse gone nuclear,” Mrs. Jackson says. “I had to call the paramedics to take me for help, because I could not stand—I had actually learned to crawl again.”

PAIN-FREE AT LASTThis time, in addition to sciatica, Dr. Dews diagnosed Mrs. Jackson with a disk herniation with some nerve compression.

Treatment in the form of three epidural steroid injections, each done in the Pain Management Center two weeks apart, pro-vided signifi cant relief, with an immediate reduction in the level of pain after just the fi rst injection. “Robin underwent a very dra-matic transformation for a very common condition,” says Dr. Dews.

BANISHING BACK PAINAppropriate treatment and a positive attitude are key to reducing chronic back pain

Teresa Dews, MDVice Chair, Department of Pain Management; Medical Director, Cleveland Clinic’s Pain Management Center at Hillcrest Hospital

Robin Jackson is back on her feet after a combina-tion of nonsurgical treatment at Cleveland Clinic’s Pain Management Center at Hillcrest Hospital and physical therapy.


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“She is very typical of the type of patient we want to see, treat appro-priately, and help return to their active daily lives.”

But Mrs. Jackson’s success did not result from medical treatment alone. According to Dr. Dews, the ultimate goal of interventional treatment like epidural steroid injections is to provide the patient with enough relief to get past the pain so they are able to engage in other healthy behaviors.

Dr. Dews adds, “Robin is the perfect patient, willing to do what-ever is necessary to make a combination of medical treatment, physical rehabilitation and exercise work.”

Just one day after her fi rst injection, Mrs. Jackson participated in a yoga class offered at her workplace. She continues to do yoga two times each week; takes only over-the-counter pain medication on occasion; and uses care when bending over, tying her shoes, and picking things up.

She is excited about again being able to wear high heels, stating, “To celebrate my 53rd birthday, I decided to treat myself to some shoe shopping—much to my husband’s dismay!”

Tips for Keeping Your Back HealthyAt some point in their lives, eight out of 10 Americans will suffer from back pain. While it is not possible to prevent all back pain or injury, here are some things you can do to keep your back healthy:

Eat a healthy, well-balanced diet to keep your bones and muscles strong. Maintain a healthy weight. Excess weight puts added stress on the structures of the lower back. Exercise regularly, including stretching, to keep your joints fl exible and your back and abdominal muscles strong. Choose activities and sports, such as swimming and biking, that do not place your lower back at risk of injury. Use good body mechanics when sitting, standing and lifting. Try to keep your

back straight and your shoulders back. When sitting, keep your knees bent and your feet fl at on the fl oor. Don’t over-reach, and avoid twisting movements. When lifting, bend your knees and use your strong leg muscles to help balance the load. Maintain good posture. If you start to feel sore or stiff, change your posture and modify your body mechanics. Your body will warn you, using pain as a signal, when your mechanics are improperly aligned. Practice safety measures to help prevent falls, such as wearing shoes that fi t properly and keeping stairs and walkways free of clutter. Don’t smoke. Tobacco interferes with blood fl ow to the spine.

BANISHING BACK PAINAppropriate treatment and a positive attitude are key to reducing chronic back pain

WE CAN HELPDr. Dews sees patients at Hillcrest Hospital and Chagrin Falls Family Health Center. To schedule an appointment with Dr. Dews or another Cleveland Clinic Pain Management Center physician, call 216.444.PAIN (7246). For more information, visit clevelandclinic.org/painmanagement.

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Involvement of a pain psychologistPhysical therapy Injection procedures using steroids or nerve blocks Ongoing monitoring and follow-up

With his background in physi-cal medicine and rehabilitation, Dr. Leizman also treats those with sports-related injuries.

“For every patient, the goal is to diagnose the problem, to restore and optimize function, and to decrease pain,” he says. “Every patient also provides an oppor-tunity to address lifestyle choices. If someone who’s overweight and inactive comes in with a sprained ankle, I try to educate them about healthy eating and exercise with the goal of helping them ward off more problems in the future.”

Cleveland Clinic specialists focus on relieving your painPain Solutions

Daniel Leizman, MDPain Management Specialist

WE CAN HELPFor more information, visit clevelandclinic.org/painmanagement. To make an appointment with Dr. Leizman or another Cleveland Clinic Pain Management Center physician, call 216.444.PAIN (7246).call

How long should you put up with arthritis or joint pain, an aching neck or back, or pain resulting from a surgery or injury? According to Daniel Leizman, MD,

a pain management specialist at Cleveland Clinic’s Pain Management Center at Hillcrest Hospital, pain is traditionally considered chronic if it lasts for more than three months. This includes pain that involves the spine or joints, cancer pain, nerve pain, unusual pain of the limbs, prolonged abdominal or pelvic pain, or pain after surgery.

“When an individual is experiencing pain for an extended period of time, or is under the care of a primary or specialty care physician and still experiencing pain, it’s time to seek help from a pain management specialist,” Dr. Leizman says. “It’s important to see a pain physician before resorting to taking narcotic medications for a long time or undergoing multiple injection procedures without knowing the cause of the pain.”

Dr. Leizman works with patients, primary care physicians and other specialists to establish an accurate diagnosis—determining what is causing the problem so he can accu-rately treat the problem. He then develops a multidisciplinary treatment plan, which may include:

Use of medicationsFurther diagnostic testingReferral to other specialists


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No matter how old we are, being a hospital patient can be unsettling. It’s often even more worrisome for children and young adults, who likely have not been

a patient since their delivery.At Hillcrest Hospital, certifi ed child life specialist Allison

Bahar, MA, CCLS, spends her days helping put young patients (from birth to age 18) at ease when they are being treated in the hospital’s pediatric emergency department, pediatric inpatient unit, radiology or outpatient surgery departments.

EASING WORRIES“Being in the hospital is scary; so much is unknown. Younger patients frequently ask me if there is a cat in the CT (computerized tomography) room, which is often referred to as a CAT scan,” Ms. Bahar says. “My job is to work with pediatric patients to help lower their anxiety and fear. I explain—in age-appropriate terms—or demonstrate exactly what they can expect in terms of a test, treatment, procedure or surgery.”

Ms. Bahar uses her extensive training and a variety of tools to help young patients and their families prepare for and cope with both the medical and emotional aspects of being hospitalized. Modern technology in the form of an iPad

CARING FOR KIDSChild life specialists help put hospitalized boys, girls and their families at ease

provides virtually unlimited access to photos and videos that can help a child better understand a specifi c procedure. Other more basic tools—such as fabric dolls on which patients can draw, a bag of medical equipment and a wall-mount basket-ball hoop—help patients express themselves when they are unable or unwilling to talk, and can turn negative feelings into positive ones.

“The training and tools make my job easier, but the most important aspect of helping pediatric patients is the direct involvement of a parent or family member,” Ms. Bahar says. “I work with them not only to help them cope with the situa-tion, but also to provide the support their child needs.”

HELPING FAMILIES IN A LOCATION NEAR YOUChild life services are provided at no cost to pediatric patients and their families, and are currently offered at Hillcrest Hospital, Fairview Hospital and Cleveland Clinic Children’s main campus. For more information, go to clevelandclinic.org/childlife.information,

Certifi ed child life specialist Allison Bahar, MA, CCLS, spends time with a young patient.

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Do you know what chronic stress looks like, its negative health effects and how to deal with it?

Take this lighthearted multiple-choice quiz to find out.

1. Chronic stress is your body’s way of telling you to take better care of: a. Your kidsb. Your husbandc. Your dogd. Yourself

The correct answer is “d.” To get a handle on chronic stress, start taking care of YOU fi rst.

2. Stress has gone from acute to chronic when you:a. Feel uncharacteristically over-

whelmed by lifeb. Have regular mood swingsc. Have gained or lost weightd. Can’t sleepe. Get frequent headaches, stomach-

aches or back painf. Any of the above

The correct answer is “f.” Do any sound familiar?

3. An INEFFECTIVE way to cope with ongoing stress is: a. Eat healthy foodsb. Exercise regularlyc. Drink more wine or beer d. Get enough sleep

e. Write down how you’re feeling in a journal

The answer is “c.” Consuming alcohol actually will lead to more stress. It will tire you out and shorten your fuse. Try the ideas in “a,” “b,” “d,” and “e” instead!

4. Which statement is FALSE:a. Stress hormones hurt memory and

learningb. We should all learn to thrive on

stress, as it is part of modern lifec. Stress makes you more susceptible

to getting sickd. Men tend to respond to stress with

“fi ght or fl ight”e. Women often “tend and

befriend”—trying to take care of everyone’s needs

f. Stress is a risk factor for heart disease

The false statement is “b.” You should not learn to thrive on stress. Constant stress leads to reduced immune response and concentration and an increased risk for heart disease. When the body senses danger, it releases epi-nephrine, which makes the heart race, along with cortisol, which raises blood pressure and causes fl uid retention.

5. See your doctor for stress when:a. You are ready to jump off a cliffb. It interferes with your relation-

ships and responsibilities c. It interferes with your health d. You can’t handle high levels of

noisee. Your thoughts are mostly negative f. All of the above except “a”—don’t

wait that long!

The correct answer is “f.” Your doctor can help guide you toward appropriate treatment.

Test Your Stress IQStress hurts your heart. Are you doing all you can to minimize life’s stressors?

HOW MANY QUESTIONS DID YOU ANSWER CORRECTLY?4–5: Om-fabulous! You know how

to stress less. Be sure to applyyour knowledge and cut yourself some slack.

3: Whoa, Nellie! Take a moment to breathe. Look for ways to imple-ment the stress-reducing tips recommended here.

0–2: Time out! Slow down and take this stress advice to heart.

FREE PODCAST:UNWIND IN MINUTESListen to a guided relaxation podcast on your mobile device or computer. This routine will help you de-stress this holiday season —or at any time of the year. Go to clevelandclinic.org/healthessentials.clevelandclinic.org/healthessentials

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POP QUIZ


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An off-duty obstetrician/gynecologist shares his story of how he saved a heart attack victim

Lifesaving Knowledge

Elliot Philipson, MD, MBA

Empathy is the ability to understand and share in the feelings of another person. At Cleveland Clinic, we believe that empathy takes on a new dimension in a healthcare setting, where giving and receiving happens every day.

Cleveland Clinic set out to explore the meaning of empathy in a video that provides a lens into the lives of patients and caregivers.

Watch the Cleveland Clinic Empathy video that has had viewers around the world talking.

Just imagine if you could see a thought bubble above every person’s head. Go to Health Essentials online at clevelandclinic.org/healthessentials to watch the Empathy video today!

Empathy: The Human Connection in Patient Care

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MY STORY

Ron Reuben (left) and Dr. Elliot Philipson enjoy coffee and

conversation.

Earlier this year, while at Beachwood Family Health Center for an appointment, I went to the restroom in a remote part of the build-ing. I walked in and found a man lying on the fl oor. He looked pale,

and when I checked his pulse, there was none. I dashed down the hall to the ENT’s offi ce and had them call 911.

Back in the bathroom, I checked and determined that the man had not slipped and hit his head. I laid him on his back, ripped open his shirt and started CPR. After a couple of minutes, his color and pulse returned. He opened his eyes and quietly asked me to stop. While we waited for EMS to arrive, he told me his name was Ron Reuben and that he was 70 years old and there to see a doctor about dizziness.

When my colleagues heard this story, they said, “Wait a min-ute! You’re an ob/gyn, not a cardiologist.” This is true, but since my own heart attack, I’ve learned a lot about cardiology. Recently, an expert lectured on the importance of treating cardiac arrest victims with chest compressions fi rst—as opposed to opening the airway fi rst for breathing. This knowledge may have helped me save Mr. Reuben’s life.

A few days after the incident, I went to the hospital to visit Mr. Reuben, who had undergone heart surgery. When he learned who I was, he was very grateful and asked how he could thank me. Once he recovered, we met for a cup of coffee.

That wasn’t the fi rst time I used CPR. Once while traveling, a woman on the airplane needed to be resuscitated. In a perfect world, everyone would learn CPR. You never know when or where you could save someone’s life.

Dr. Philipson is Chair of Obstetrics and Gynecology at Hillcrest Hospital.

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