CLEVELAND CLINICWestlake Family Health CenterLakewood Family Health Center

CheckupHealth Information from the

Family Health Center Closest to You

F A M I L Y Spring/Summer 2003

Play it SafeThis Summer!

ummer’s breezes entice motorcyclists to the

open road, beckon boaters and swimmers to lakes

and rivers, and prompt plans for backyard fun.

Cleveland Clinic family health center physicians

hope you’ll enjoy summer by putting safety first.

That wind in your hair may feel great,

but... please wear a helmet! Motorcyclists who cruise

at speeds of just 25 mph can sustain low-impact head

injuries that severely damage the brain. This can lead to

personality changes, coma, disability or death. After 40,

your brain is even more vulnerable to injury, especially

if you take aspirin or other blood thinners to protect

against heart attack or stroke.

Scooters and skateboards: rolling out new

guidelines... The American Academy of Pediatrics rec-

ommends scooters for kids 8 and up, and skateboards for

kids under 10 only if supervised. Scooters have created

a surge in ER visits. In the first nine months of 2001,

84,000 kids were treated in ERs for scooter injuries. Insist

on helmets to prevent head injuries, and encourage wrist-

and kneepads to prevent fractures. Steer skateboarders

toward skate parks with smooth surfaces, far from traffic.

A healthy respect for the water... Water safety

is important for the whole family. Drowning is the second

leading cause of death among children; toddlers and

teens are at greatest risk. Keep an eye on toddlers, even in

wading pools. CPR training for everyone — even your

sitter — can ease your mind. Out on the lake, always wear

your life jacket; have kids wear them dockside, too. Bring

your trusty ship-to-shore radio when venturing out on the

water. Tell a friend where you’re headed — and when

you’ll return. On Ohio rivers, watch for low-head dams,

signaling sudden drop-offs; carry your canoe or kayak

around them to safety.

Backyard trampolines: accidents waiting to

happen... If your kids love the trampoline, schedule

supervised sessions with a gymnastics instructor. The

American Academy of Pediatrics recommends that home

trampolines be banned, noting the 140 percent spike in

trampoline-related injuries between 1990 and 1996, when

83,000 trampoline accidents required an ER visit. Thirty

percent involved fractures, and often hospitalization and

surgery. In rare cases, spinal cord injuries occurred. So

make sure your kids keep their heads up — and their feet

on the ground. And enjoy your summer!

SOur family medicine andinternal medicine specialistsnow offer Open AccessFor appointments within 24hours, call 440/899-5555

Open MRI available

For appointments with our

family health center specialists,

call the Cleveland Clinic

Appointment Center between

7 a.m. and 11 p.m., 365 days a

year, at 216/444-2273 or

800/223-2273.

Kid’s KornerKid’s Korner

Sports Physicals:Summer Is the TimePractice for fall high school sports typically begins

in August. Be sure to schedule a pre-participation

evaluation for your athlete beforehand. Now’s the

perfect time to make an appointment.

Ohio High School Athletic Association regula-

tions require participation forms for athletes in

grades 9 through 12 to be completed and signed

by a physician, the participant, and a parent or

guardian before the first practice. Ohio law per-

mits an M.D., D.O., chiropractor, physician’s

assistant or advanced nurse practitioner to per-

form physicals.

High schoolers should also have comprehen-

sive regular exams by their primary care physician

to assess their overall health.

For appointments at Westlake with John R.

Sanderson, D.O., or pediatrician colleagues, or

family medicine specialists, call 440/899-5555.

For appointments with pediatrician Ruthanne

Muniak, M.D., at Lakewood, call 216/521-4400.

Healthy Summer EatingAS SUMMER APPROACHES, many of us want to

shed pounds along with layers of clothing. According

to the American Dietetic Association, the popular

high-protein, low-carbohydrate diets suggest that

carbohydrates are “bad for you” and make you gain

weight. But high-protein, low-carbohydrate diets

tend to be low in calcium, fiber and nutrients that

protect against heart disease and cancer.

Dieters who eat more total calories and get less

physical activity will wind up gaining weight. Our

nutrition specialists recommend foregoing fad diets.

Instead, adopt healthy weight management tech-

niques. Eat fewer fast foods, measure portion sizes,

and increase your intake of fruits, vegetables and

foods low in fat and high in whole grains. Eat fewer

calories than you burn, and increase your physical

activity.

Variety and moderation are key, as are total calo-

ries. Eat fewer calories and/or get more exercise, and

you’ll lose weight.

For appointments with registered, licenseddietitians at Westlake, call 440/899-5555.

MANY people temporarily

experience tinnitus (ringing,

buzzing, whistling, hissing

or rushing noises) in their ears or head. For more

than 12 million people, it’s a persistent problem. For

some, it interferes with the demands of everyday life.

If you have tinnitus, Cleveland Clinic family

health center otolaryngologists can rule out health-

related conditions causing the problem. Our audiol-

ogists can then do a thorough hearing evaluation.

Together, they can determine whether you are a

candidate for the Tinnitus Management Clinic at

Cleveland Clinic main campus.

While there is no universal cure, certain mea-

sures provide relief. Tinnitus rehabilitation plans

may include sound therapy and/or noise generators,

biofeedback and behavior modification. For evalua-

tions by Westlake otolaryngologists Edward Fine,

M.D., Ph.D., Richard Freeman, M.D., Ph.D., or

Peter Koltai, M.D., and audiologist Lorraine Lom-

bardo, M.A., CCC-A, please call 440/899-5555.

What’sThatNoise?

When Carpal Tunnel SyndromeInterferes With Work

Plastic surgeon Warren Hammert, M.D.,sees patients with hand and upper extremityproblems at Westlake; for appointments,call 440/899-5555.

CARPAL TUNNEL SYNDROME can make keyboarding, operating a cash register and working on

an assembly line difficult. Swollen tissues in the carpal tunnel at the base of the palm put pressure on

the median nerve, causing pain, tingling, numbness in the fingers, weakness in the thumb, and a

tendency to drop things.

Initial treatment usually involves splinting to restrict movement and allow swelling to subside;

anti-inflammatory medication may be prescribed. If these measures do not help, outpatient surgery

may be recommended.

While repeated use of the hands or wrists at

work does not cause carpal tunnel syndrome,

certain factors increase your risks for it:

■ age (50s and 60s)

■ female gender, especially during pregnancy

and around menopause

■ concurrent illness

■ obesity

■ poor physical condition

■ smoking

To decrease pain at work, keep wrists straight

and minimize repeated flexing, extending or

twisting, and rest your hands periodically.

Meanwhile, address risk factors you can control:

Give up smoking, increase physical activity and lose weight, if necessary.

THE MYSTERIOUS molecule CRP (C-reactive

protein) may be as much of a “smoking gun” for

artery disease as cholesterol, experts believe. An

elevated CRP level indicates inflammation and was

traditionally associated with arthritis. Now it’s linked

to inflammation of the arteries as well. The result

can be instability and rupture of a plaque, the cause

of heart attacks and strokes.

The American Heart Association (AHA) recom-

mends CRP testing for people whose age, blood pres-

sure, cholesterol level, family history or habits put

them at risk for heart disease within10 years.

Cleveland Clinic family health center cardiolo-

gists believe the simple, inexpensive blood test could

supplement cholesterol screening by estimating risk

in those without symptoms of heart disease. The AHA

considers screening unnecessary for people at very

low risk of heart disease; researchers have not proved

that lowering CRP reduces risk.

Presently, everyone with high CRP levels should

begin aggressive preventive measures, including

cholesterol-lowering medication, healthier eating,

exercising and — especially — giving up smoking.

For appointments at Westlake with cardiologists

Caroline Casserly, M.D., Lon Castle, M.D., or

Robert W. Reynolds, M.D., call 440/899-5555.

CRP: New Clue to HeartAttack, Stroke Risk

Bouncing Back After Heart AttackIf you’ve had a heart attack, heart surgery or

both, cardiac rehabilitation is probably in your

future. A comprehensive recovery and educa-

tion program can help you and your family: ■

understand heart disease and risks ■ adopt

good exercise and eating habits ■ shop wisely

for food ■ manage weight better ■ reduce

stress ■ make lasting behavior changes for a

healthier lifestyle.

Counseling can be done individually or in a

group setting with family members.

Patients are closely monitored during the

exercise-based program, which runs three days

a week for eight to 12 weeks. Monitoring is

less intensive afterward as patients continue

rehabilitation — ideally, at a hospital-based

program.

During exercise rehabilitation, you will be

hooked up to an EKG machine as a cardiologist

or primary care physician looks for unsuspect-

ed changes in heart rate or rhythm that may

signal problems. The cardiologist will monitor

stress testing on the treadmill. You may also

exercise on a stationary bike, rowing machine

or with weights.

Since you need a physician referral for car-

diac rehabilitation, most insurance companies

cover this service.

For information about cardiac rehabilita-tion at Westlake, call 440/899-5555.

IF SORES ON YOUR FEET or lower legs refuse to

heal completely, podiatrists and vascular specialists

can help you get back to normal. Stubborn foot and

leg wounds, sores or ulcers often result from poor cir-

culation, frequently affecting people with diabetes,

circulatory disorders or other medical problems.

After a thorough history and examination, doc-

tors will order X-rays, scans or noninvasive vascular

studies to help pinpoint the cause of your problem.

With this information, they can create a customized

treatment program designed to relieve pain and

speed healing, taking your health status and ability

to care for your wound into consideration.

Westlake podiatrist Robert Dushin, D.P.M.,specializes in diabetic foot care and generalpodiatry.

Help for Sores thatWon’t Heal

Treatment may involve:

■ antibiotics

■ anti-clotting medication

Guarding AgainstWest Nile VirusMosquitoes — once mere annoyances— now pose a threat due to West Nile virus,which can infect mosquitoes, birds, horsesand people. Last summer, eleven of 211Cuyahoga County residents with infectionsdied.

Typically, West Nile virus causes nosymptoms, the Centers for Disease Controland Prevention reports. In 20 percent of cas-es, mild fever, headache, body aches, skinrash and swollen lymph glands develop. Inone of 150 cases, severe illness ranges fromheadache, high fever and stiff neck to stupor,coma, convulsions and paralysis.

West Nile virus doesn’t appear to spreadfrom animals to people, or directly fromperson to person. In rare instances, it hasbeen transmitted through breast milk andorgan transplantation, but risks are slight,experts say.

Meanwhile, protect yourself with insectrepellent containing DEET (N, N-diethyl-meta-toluamide) on skin and clothing out-doors, and wear long-sleeved shirts andpants. Stay inside at dawn, dusk and earlyevening, when mosquitoes are hungriest.And eliminate standing water (mosquitobreeding grounds) from your yard.

Family or internal medicine specialistsand pediatricians are available to discussyour concerns at Westlake; call 440/899-5555. To consult Lakewood internists andpediatricians, call 216/521-4400.

■ new topical (surface) wound-care therapies

■ compression stockings

■ orthotics or prosthetics to improve function

and reduce areas of increased pressure

■ debridement (removal of dead or

callused tissue) overlying the sore

Education is key; you will be carefully instruct-

ed on how to care for your wound at home and

how to prevent it from recurring.

For appointments at Westlake, please call440/899-5555.

Other Family Health Centers

Beachwood 216/839-3000

Brunswick 330/225-8886

Chagrin Falls 440/893-9393

Creston 330/435-5400

Elyria 440/366-8822

Independence 216/986-4000

Lorain 440/204-7400

Solon 440/519-6800

Strongsville 440/878-2500

Willoughby Hills 440/943-2500

Wooster 330/287-4500

AppointmentsCleveland Clinic Westlake30033 Clemens RoadWestlake, OH 44145440/899-5555 or 800/599-7771

Monday through Thursday: 8 a.m. to 8 p.m.

Friday: 8 a.m. to 6 p.m.

Saturday: 8 a.m. to noon

Cleveland Clinic Lakewood16215 Madison AvenueLakewood, OH 44107216/521-4400 or 800/760-1513

Monday through Thursday: 8 a.m. to 8 p.m.

Friday: 8 a.m. to 6 p.m.

Saturday: 8 a.m. to noon

Cleveland Clinic Cancer Care Center atWestlakeTo see our medical oncologists about cancer

diagnosis or treatment, call

440/899-5555

To speak with a nurse about cancer symptoms or

concerns Monday through Friday, from 8:30 a.m. to

4:30 p.m., call the Cleveland Clinic Cancer Answer

Line:

216/444-7923 or 800/862-7798

www.clevelandclinic.org/fhcCleveland Clinic Family Health Centers on the Web

Visit our Web site for■ information and services for each

family health center

■ physician directories

■ community calendars

■ free health information

■ maps

■ Family Checkup newsletter

www.clevelandclinic.org/fhc

CLEVELAND CLINIC

Nurse on CallTo speak with a nurse, 8 a.m. to 11 p.m.,

Monday through Friday, about your adult and

pediatric health concerns, call

216/444-1234800/801-2273

Cleveland Clinic Family Checkup is published by theDivision of Marketing to provide up-to-date health infor-mation and news about Cleveland Clinic Family HealthCenter services. The information contained in ClevelandClinic Family Checkup is for educational purposes onlyand should not be relied upon as medical advice. It hasnot been designed to replace a physician’s medical assess-ment and medical judgment.

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Photographer: Tom Merce

Illustrations: Doreen Klimkiewicz

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Cleveland Clinic Westlake

Daniel Allan, M.D., board-certified in family

practice, provides comprehensive care for family

members of all ages. After earning his medical

degree from Case Western Reserve University, he

completed a family medicine residency at

Exempla Saint Joseph Hospital in Denver.

For appointments, call 440/899-5555.

Cleveland Clinic Lakewood

Ruthanne Muniak, M.D., board-certified in

pediatrics, has practiced general pediatrics for

26 years. She is a graduate of the Allegheny

University School of the Medical Sciences and

the Woman’s Medical College of Pennsylvania.

Dr. Muniak completed her postgraduate train-

ing at MetroHealth Medical Center in Cleveland.

For appointments, call 216/521-4400.

Women’s Health

NONPROFIT ORG.

U.S. POSTAGE PAID

CLEVELAND, OH

PERMIT NO. 4184Family Checkup / W149500 Euclid Avenue, Cleveland, OH 44195

THE CLEVELAND CLINICFOUNDATION

Detecting Breast CancerBreast cancer can be most effectively treated when

detected early in its development. Mammography,

together with regular breast exams by a health-care

professional and monthly breast self-exams, offer

women the best chance for early breast cancer

detection.

The American Cancer Society recommends that

women over age 20 perform breast self-exam every

month, five to seven days after the first day of a

menstrual period, or the first of the month for post-

menopausal women. It recommends “screening”

mammograms every one to two years if you are be-

tween 40 and 50, and annually if you over 50, unless

there is a family history of breast cancer.

If you, your doctor or a screening mammogram

detect a possible abnormality, a “diagnostic” mam-

mogram, which zeroes in on the questionable area,

is your next step.

Westlake’s Cancer Care Center offers both diag-

nostic mammography and treatment for breast can-

cer by medical oncologists Timothy Spiro, M.D.,

and Hamed Daw, M.D.

When’s the Best Timefor Her First GYN Exam?Cleveland Clinic family health center specialists rec-

ommend that a girl have her first gynecologic exam

when she:

■ develops abnormal bleeding or severe men-

strual cramps

■ approaches her 18th birthday or

■ considers becoming sexually active.

It’s easy to know that your daughter needs to see

a health care professional if she develops severe

cramps or is approaching 18. Knowing when she is

considering sexual activity is far more difficult.

However, statistics show sexual activity is common

before age 18, so attempt to keep the lines of com-

munication open.

If your daughter expresses an interest in seeing a

health care provider for a gynecological problem,

she may be anticipating sexual activity and want

protection. Encourage her to share any concerns or

problems with you, but do not discourage her from

seeing her doctor. If you accompany your daughter

to her appointment, expect to be excused for part of

the visit so she can speak freely with her health care

professional.

Women can make appointments atWestlake by calling 440/899-5555, andat Lakewood by calling 216/521-4400.

Adolescent GYN exams can be scheduledwith Westlake family medicine specialistLisa Marsh, M.D.

New Shared MedicalAppointments OfferedRESEARCH SHOWS a new health trend has mark-

edly increased patient satisfaction. In shared medical

appointments, patients gain much faster access to a

physician, with whom they can spend 90 minutes —

far more time than a traditional visit allows. They

also have the opportunity to share experiences with

other patients during the session.

Many Cleveland Clinic family health center pri-

mary care physicians, and some specialists, offer the

new option, called “Clinic Care Plus,” for patients

with certain health problems. In a shared appoint-

ment setting, patients see a physician for prevention,

treatment and follow-up. A behavioral health spe-

cialist is also on hand to address medical concerns.

Talk to your doctor to see if these sessions might be

appropriate for you.

When required, “Clinic Care Plus Physicals”

allow patients to receive a private physical as part of

their 90-minute shared medical appointment. Clinic

Care Plus Physicals can be scheduled sooner than

standard exams.

At Westlake, internist Derrick C. Cetin, D.O.,

will offer shared medical appointments addressing

weight management for those having medical

problems such as diabetes or hypertension with

behavioral health specialist Jean Forster, R.N. Inter-

nal medicine specialist Mary Walborn, M.D., will

offer Clinic Care Plus Physicals at Westlake.

Call 440/899-5555 to schedule an appointmentfor a Clinic Care Plus appointment or physical;for a free brochure, call 216/444-3178.