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Health AdvantageHEALTH NEWS FOR OUR FRIENDS AROUND THE WORLD | SUMMER 2008

ALSO INSIDE

CLEVELAND CLINIC EXTENDS AHEALING HAND INTERNATIONALLY

[ I N T H I S I S S U E ]

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Cleveland Clinic Employees Travel to Change Lives

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Kuwaiti Girl Overcomes Facial Deformity

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The Point of Acupuncture: Needling the Body to Heal

ALSO IN THIS ISSUE

4 Around Cleveland Clinic

Our Latest News

5 Health Essentials

Colorectal Cancer

9 eCleveland Clinic

Cleveland Clinic’s online programs advance patient care

11 Examining the Headlines

Autism

12 Cleveland Clinic in Florida

Targeted Spinal Surgery

13 Questions and Answers

High-Fructose Corn Syrup

14 Special Feature

Information from the Nation’s No. 1 Heart Center

20 Global Patient Services

Information for Our Friends Around the World

Health AdvantageSUMMER 2008

Cleveland Clinic is a nonprofit multispecialty academic medical center. Founded in 1921, it is dedicated to providing quality specialized care and includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education division and a research institute. Cleveland Clinic Health Advantage is published by Cleveland Clinic. The infor-mation in this publication should not be relied upon as medical advice. It is not intended to replace a physician’s medical assessment

and medical judgment.

© The Cleveland Clinic Foundation 2008

Christine Harrell Managing Editor Chip VallerianoArt Director Samiya Khan Marketing To be added to the email or mailing list, visit clevelandclinic.org/HA. Click on Health Advantage News-letter. Email your comments to [email protected].

Cleveland Clinic is committed to stewardship of the world’s natural resources.

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On the cover: Isador Lieberman, MD, left, and Mark Kayanja, MD, right, performed 11 surgeries on patients with severe spine trauma while in Uganda in March 2007.

Cert no. BV-COC-070401

Health Advantage | Spring 2008 1

“It hurt all the time,” she recalls. “I had to just cradle it.”

She went to see doctors in her hometown of Wheeling, W.Va., as well as Pittsburgh, but they offered her little hope. “They said they could only x it into a straight position but that I still wouldn’t be able to move it. At least with it bent, I could use it to dry my hair and work on my crafts.”

Then one day, while searching online, she came across informa-tion about elbow replacement surgery at Cleveland Clinic. She was so excited that she asked her primary care doctor for a referral right away.

She drove the three hours to Cleveland to see Orthopaedic Surgeon Jeffrey Lawton, MD, who told her the surgery is not for everyone; in fact, he said he does not recommend it to about 80 percent of the people who ask about it.

“Most people who have arthritis in their elbows are not good candidates for elbow replacement because they want to do too much with it, like throwing a softball or playing golf. Elbow

When Kathryn Woods was 19, her elbow “froze” into a

bent position, and stayed that way for the next 35 years.

She is not sure about the original reason, but she knows

that the rheumatoid arthritis with which she was later

diagnosed played a role.

[ PAT I E N T E X P E R I E N C E ]

Elbow Replacement Surgery Restores Mobility After 35 Years

(Continued on page 2)


replacements are limited by the relatively smaller bones of the forearm, so they don’t tolerate as much stress as hip or knee replacements,” Dr. Lawton says.

“Mrs. Woods was a good candidate because she only wanted pain relief and a return of functional motion,” he continues.

“She wanted to be able to do things like lift a coffee cup and put on her earrings. Patients who overexert their replacement elbows risk loosening the implants and fracturing the bones, but I thought that wouldn’t happen to her.”

Mrs. Woods, who had the surgery last June and a few months later completed postoperative physical and occupational therapy, is thrilled with her results.

“It is so amazing,” she says. “I can’t lift anything over 5 to 10 pounds for the rest of my life, but I can move my arm again! I have a full range of motion and flexibility and love not having to ask for help with so many things now. It’s the best thing I ever did.”

2 800.884.9551 | 001.631.439.1578 | clevelandclinic.org/HA

ELBOW REPLACEMENT SURGERY

Elbow replacement surgery, also known as total elbow

arthroplasty, can help restore comfort and function to

patients who experience pain daily.

• Elbow replacement is best for active people who agree not to overuse

the elbow after surgery, avoiding such activities as hammering, heavy

lifting or roller blading, but who are interested in more modest rewards,

like the ability to sleep on that arm or brush their hair.

• People who most often have the surgery are those with severe deterio-

ration due to osteoarthritis, rheumatoid arthritis or traumatic arthritis

in one or both elbows. Patients who have had a severely broken bone

near the elbow or who have a tumor or severely damaged tissues in the

elbow also may be good candidates.

• Generally, patients must have tried at least six months of other treat-

ment, such as medication or physical or occupational therapy, without

success.

THE PROCEDURE

• The two-hour procedure is performed under general or nerve block anes-

thesia.

• The surgeon begins by making an incision of about 6 inches along the

inside of the arm or the back of the elbow to begin insertion of the arti-

ficial elbow, which has two parts. The humeral part replaces the lower

end of the upper arm bone also known as the humerus. The ulnar part

replaces the elbow part of the large bone of the forearm.

• Some bone is removed and the surgeon also may remove any tissues

near the elbow that could stop movement of the new joint. A canal

in the middle of the bones is hollowed out using a special tool to make

space for the implant and the new joint is inserted. Next, the final

components are cemented into the bones and the incision is closed.

The arm is placed in a dressing and splint.

(Continued from page 1)

KATHRYN WOODS



AFTER THE SURGERY

• Patients stay in the hospital for 3 or 4 days. A splint may be

used after surgery to help stabilize the elbow. Pain is man-

aged by injected medications at first, but most patients are

able to move to oral pain medications in a day or two.

• Physical therapy, starting with gentle flexing exercises, is

started. Patients can usually go home once they are comfort-

able and have a good range of passive motion. For a month

or so, the arm may be less useful than it was before surgery;

however, using it for gentle activities is encouraged. Usually,

patients are advised to lift nothing heavier than a cup of cof-

fee for six weeks.

• The patient will need help with activities such as driving,

shopping, bathing, cooking and others for several weeks. The

patient should never again lift more than five pounds with the

arm, even when fully recovered, which can take up to a year.

• Continued strengthening exercises are essential. Patients can

often perform these exercises at home after a few training

sessions with a physical therapist.

GETTING STARTED

• Talk to your rheumatologist or primary care doctor if you think

you might be a candidate for elbow replacement surgery.

• Because just a few thousand of these procedures are per-

formed in the United States each year, many people have to

travel to find an experienced elbow arthroplasty surgeon. Total

elbow replacement arthroplasty is usually performed in a ma-

jor medical center that has surgical teams as well as nurses

and physical therapists that specialize in this type of surgery.

To learn more about elbow replacement or to schedule an

appointment with a Cleveland Clinic orthopaedic surgeon,

please call 800.884.9551. If calling outside of the United

States, call 001.631.439.1578.


Our Latest NEWS

INTRODUCING THE FUTURE OF HEALTHCARE

Innovative new buildings improve patient access, experience

This fall, Cleveland Clinic is opening the Sydell and Arnold Miller Family Pavilion and the Glickman Tower. These buildings, which represent the largest construction and philanthropy project in Cleveland Clinic history, embody the pioneering spirit and com-mitment to quality that define Cleveland Clinic. These structures are a tangible expression of institutes, our new model of care that organizes patient services by organ and disease.

At 1 million square feet, the Miller Family Pavilion is the coun-try’s largest single-use facility for heart and vascular care. The 12-story Glickman Tower, new home to the Glickman Urological & Kidney Institute, is the tallest building on Cleveland Clinic’s main campus. Both will help us improve patient experience by increasing our capacity and by consolidating services, so patients can stay in one location for their care.

Patients will have faster access to Cleveland Clinic cardiac and urological services. For details, please visit meetthebuildings.com.

ARCHBISHOP DESMOND TUTU ATTENDS LECTURES

BY CLEVELAND CLINIC PHYSICIANS

Derek Raghavan, MD, Chairman of the Taussig Cancer Institute, was the course convenor and a lecturer, along with Andrew

Stephenson, MD, of the Glickman Urological & Kidney Institute, at a Multidisciplinary Cancer Management Course in Cape Town, South Africa, in April, where special guest Archbishop Desmond Tutu was in attendance. Archbishop Tutu is known for his work opposing the former South African system of apartheid and peacefully working towards racial equality.

The American Society of Clinical Oncology and the South African Society of Medical Oncology jointly sponsored the course, which focused on improving the level of cancer care globally as well as focusing on cancer management in the most common disease sites and systems.

CLEVELAND CLINIC NURSES RECEIVE HIGHEST AWARD

Cleveland Clinic has again achieved Magnet status, the top national award for nursing excellence. Magnet status, bestowed by the American Nurses Credentialing Committee, is recognized nationally as the gold standard for patient care and provides healthcare consumers with a benchmark to measure quality of nursing care.

AIRCRAFT EXPAND REACH OF CLEVELAND CLINIC

CRITICAL CARE TEAMS WORLDWIDE

Cleveland Clinic is able to go to new lengths to transport highly complex patients, including those who are critically ill, with the addition of two medical transport jets. The aircraft went into service on July 1 and are able to reach Cleveland Clinic patients in need wherever they are, even overseas. In the first four weeks of service, the team traveled to six states and three continents. Critical Care Transport Team constellation is customized based on the needs of the individual patient and can serve infants, children and adults. Sophisticated communications allows for in-flight interaction with the referring doctor as well as any specialty at Cleveland Clinic. These dedicated jets join our fleet of critical care transportation vehicles, which includes mobile intensive care units and helicopters.

For more information, visit clevelandclinic.org/cct.

[ A R O U N D C L E V E L A N D C L I N I C ]

From left: Derek Raghavan, MD (Chairman, Taussig Cancer Institute), Daniel Vorobiof, MD (Oncologist, Johannesburg, South Africa), Archbishop Desmond Tutu, Bryan Burmeister (Chair, Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia), Prof. Raymond Abratt (Univer-sity of Cape Town, Chair of Radiation Oncology), Andrew Stephenson, MD (Cleveland Clinic Glickman Urological & Kidney Institute), Joan Schiller, MD (Chair of Medical Oncology & Deputy Director, UT Southwestern Cancer Center, Dallas).

Health Advantage | Summer 2008 5

While most Americans don’t have any risk factors for colorectal cancer, there are certain subgroups of individuals who are at an increased risk for polyps and cancer and for whom the impor-tance of screening is especially heightened.

THE BIGGEST RISK FACTORS TO CONSIDER INCLUDE:

SMOKING- The Physician’s Health Study found smoking to be one of the most reliable predictors in the development of colorectal cancer. Heavy smokers who have had more than 20 pack-years have 2 to 3 times the risk of developing colorectal adenomas (precancerous polyps) than nonsmokers. A pack year measures lifetime smoking by multiplying the number of packs smoked each day by the number of years of smoking.

OBESITY – Studies show that obese individuals may have twice the risk of developing adenomas. A high body mass index (BMI) comes with an increased risk of colon cancer in both men and women.

FAMILY HISTORY of pre-cancerous polyps or colorectal cancer – A family history of relatives may increase the risk of polyps or cancer by two- to threefold; the younger the age of the relative that was affected, the greater the number of relatives or the more closely related the relative, the higher the risk.

RACE – Black men and women have the highest prevalence of colorectal cancer, followed by Caucasians and then other ethnic groups.

RECOMMENDATIONS FOR COLON HEALTH

National data still remind us colorectal cancer screening in Americans is underutilized, with less than 50 percent of the eli-gible population reporting undergoing colorectal cancer screen-ing according to the interval recommended by the Multi-Society Task Force on Colorectal Cancer.

A colonoscopy is the preferred method of screening for colorec-tal cancer. Everyone should begin to be examined at the age of 50 and continue to get colonoscopies every 10 years. Blacks and those who are obese or heavy smokers should consider being screened at age 45 because of the higher incidence of colorectal cancer. Other options for screening include a yearly stool test for blood (Fecal Immunochemical Test - FIT) and/or a flexible sigmoidoscopy every five years.

ONGOING CLINICAL INVESTIGATIONS

Studies involving colorectal polyp prevention are being con-ducted by Carol Burke, MD, Department of Gastroenterology and Hepatology. Some of the studies are based around individu-als with familial adenomatous polyposis (FAP), which is a rare disease that provides a good model for the effects of treatments in patients with sporadic colorectal adenomas.

Along with the Ohio State University and the United States Department of Agriculture, Dr. Burke is studying freeze-dried black raspberries as nutriceuticals in the regression of colorectal polyps in adults with FAP. Nutriceuticals are extracts of foods that provide medical or health benefits.

In conjunction with the National Cancer Institute and MD Anderson, Dr. Burke is one of the co-investigators in a study of the effect of the combination of Celebrex®, a chemopreventive drug, and difluoromethylornithine (DFMO) on colorectal polyps in adults with FAP. The researchers also conducted a worldwide trial with Pfizer on children with FAP assessing the effect of Celebrex® versus placebo on the prevention of colorectal polyps.

To make an appointment with a physician in the Cleveland Clinic Digestive Disease Institute, call 800.884.9551. If calling from outside the United States, call 001.631.439.1578.

[ H E A LT H E S S E N T I A L S ]

Colorectal Cancer WHAT YOU NEED TO KNOW

FOR BETTER HEALTH

Although colorectal cancer is the second most common type of cancer in men and women in the United States, fortunately it is also one of the most preventable types. Screening is essential to detecting and/or removing col-orectal polyps before they turn into cancer or to catching the cancer early. If caught in its early stages, cancer of the colon and rectum is curable in more than 90 percent of patients.


[ M E D W I S H ]

Dr. Diaz registers a patient.

CLEVELAND CLINIC GYNECOLOGIST

BATTLES CERVICAL CANCER IN PERU

As a founding member of the Inter-national Cervical Cancer Foundation (INCCA), Maria Lina Diaz, MD, has helped pave the way for a healthier and brighter future for thousands of women in Peru. INCCA is an international, non-pro t organization dedicated to reducing cervical cancer morbidity and mortality through patient care and education. Head of the Section of Ambulatory Gynecology at Cleveland Clinic in Florida, Dr. Diaz is part of a cooperative effort of medical professionals from many disciplines bat-tling cervical cancer, the No.1 cause of cancer-related deaths among women in a majority of developing countries.

Dr. Diaz embarked on her rst medical mission to Peru in May 2005. She was one of 45 medical specialists from ve countries to launch the initial humanitar-ian program in Cusco, Peru. That year 90 nurses were provided with free training in Pap smear techniques.

“This dedicated group of nurses subse-quently performed Pap smears on over 8,000 women, many of whom received cervical cancer screening for the rst time during the campaign,” explained Dr. Diaz. “This was a monumental achieve-ment in women’s healthcare for the region.”

The next year Dr. Diaz returned with the INCCA team to provide care for the women in the city of Cusco as well as the outlying town of Urcos. In addition to providing free screenings and teach-ing Pap smear techniques, Dr. Diaz also helped to surgically treat underprivileged women identi ed with signi cant precan-cerous cervical disease.

“As a member of the global community, I feel compelled to bring my resources and energies to bear for the betterment of underserved women worldwide,” said Dr. Diaz. “I am thankful that Cleveland Clinic has been so supportive of this endeavor.”

In May 2007, Dr. Diaz was instrumental in organizing the now annual mission to Cusco and helped secure valuable resources consisting of medical equip-ment and supplies. These went toward the establishment of a dedicated medical clinic in Cusco, which acts as the home base for all future INCCA missions to the region.

As part of this year’s mission team returning to Cusco, Dr. Diaz took on the added role of program director of the

INCCA Cervical Cancer Conference, the rst annual continuing medical educa-tion course for volunteer physicians and nurses.

“It is imperative that visiting staff take back what they learn to their communi-ties, so that women everywhere have a chance to live a life free of cervical cancer,” added Dr. Diaz.

ABOUT MEDWISH INTERNATIONAL

MedWish is a Cleveland-based, nonpro t organization that provides reusable medical supplies to devel-oping countries. Cleveland Clinic has been supporting the organiza-tion for 15 years by donating medi-cal supplies, providing warehouse space and encouraging employees to volunteer their time.

Supplies ranging from syringes and sutures, to wastebaskets and wheel-chairs, must eventually be discarded by area healthcare providers, but instead MedWish donates those supplies to countries in need. Along with serving the need for supplies in developing countries, MedWish also reduces waste and promotes sustainability.

For more information, visit MedWish-International.org.

Cleveland Clinic’s international medical charity work and support for MedWish International have global impact.

Serving the Underserved: Cleveland Clinic Employees Travel to Change Lives


[ M E D W I S H ]

Adversity comes in many shapes and sizes, from the congenital defects and traumatic injuries that deform spines to the lack of electricity and sterile water that impede care for patients in some re-gions of the world. A medical team from Cleveland Clinic in Florida faced these very adversities while on a spine surgery mission in Uganda in February.

Led by Isador Lieberman, MD, Chairman of the Medical, Interventional and Surgi-cal Spine Center at Cleveland Clinic in Florida, the 2008 mission was his third. Dr. Lieberman tried to prepare the team for the substandard medical conditions and poverty that would make their impor-

more challenging.

“Regardless of the obstacles we face in providing care, we can never lose sight of the obstacles that our patients face every day,” Dr. Lieberman said. “The life-altering work we do on these missions

Working through Health Volunteers Over-seas and the Scoliosis Research Society, the Cleveland Clinic team included spine surgeons Selvon St. Clair, MD, and MarkKayanja, MD, internal medicine and infectious disease specialist, Harriet Kay-anja, MD, operating room nurse Adam

Suprapaneni. Originally from Uganda, it was Dr. Mark Kayanja who convinced Dr. Lieberman that the medical mission could make a difference in his homeland.

During the two-week mission this year, they operated on 18 patients, working from the Mulago Hospital and the MengoHospital in Kampala, as well as the Katalemwa Cheshire Children’s Hospital. They treated patients with a broad range of conditions including major spinal deformities, congenital birth defects, and infections, such as tuberculosis of the spine.

In addition, the Cleveland Clinic team brought much needed equipment and medical supplies to the local facilities. Cleveland Clinic indirectly supports the group’s medical missions through the

goods to MedWish International, which

then distributes the supplies to countries like Uganda.

“[Developing countries] are so short of supplies, and what they do have is reused hundreds or thousands of times,”

hand the difference that organizations like MedWish make.”

The group also provided medical educa-tion and training to the Ugandan staff. Drs. Lieberman and Kayanja continue to consult with three local surgeons in Uganda via a Web site and conduct patient follow-up.

“Though we didn’t accomplish all that we wanted, we left Uganda reminded of the resilience of the human spirit,” com-mented Dr. Lieberman.

Cleveland Clinic in Florida Surgeon Leads Medical Mission in Uganda

Dr. Lieberman examines a patient.

At MedWish International’s warehouse, located in Cleveland, items such as old wheelchairs are collected, sorted and shipped to healthcare facilities in developing countries.


[ M E D W I S H ]

Situations like this abound in Honduras, the second poorest country in Central America and one of the poorest in the Western Hemisphere. Millions of citizens are unable to afford the most essential ne-cessities of life – food, clean water, shelter and basic medical care.

Cleveland Clinic employees Russell Ray-mond, DO, Cardiovascular Medicine, and Brian Smith, Director of Strategic Project Development, turned their attention to Honduras after a devastating hurricane in 1998, volunteering to help through separate organizations.

Dr. Raymond and his four brothers, three of whom are physicians, volunteered their talents through the Salvation Army. Their group, which has expanded to 35 volunteers – including Cleveland Clinic employees Ann Biery, RN, BSN, John Lampe, MD, and Philip Cusumano, MD – returns each February. Smith’s volunteer group, organized through his church, initially assisted with reconstruction and now provides healthcare. After 12 mis-sion trips, he says, “there still is so much to be done, and we have roots there.”

PROVIDING MEDICAL CARE AND

SCREENINGS

After volunteers from Dr. Raymond’s group arrive in Honduras, their goal is to see as many patients as possible, usually about 500 each day. On Dr. Raymond’s most recent mission, he met a 23-year-old mother of five who walked four miles just to see “the doctors from America.”

Ongoing Volunteerism in Honduras

Fifty-day-old Yeison Ponce’s chances of surviving past his first birthday were stark. He suffered from a life-threatening congenital heart defect and didn’t have access to the care he needed in his native country of Honduras.

During his mission trips, Smith helps build homes and facilities, and serves as part of medical brigades, or networks of medical professionals and volunteers who travel to underserved villages in developing countries. The group provides immunizations as well as basic health screenings.

Although most of the volunteers who travel with Dr. Raymond and Smith don’t speak Spanish, they communicate with patients by pointing and smiling. “Smil-ing is a universal language. People all over the world appreciate a helping hand, and in Honduras, the smiles and hugs are unconditional,” Biery says.

DONATIONS OF VITAMINS, MEDICATION,

EQUIPMENT

In many cases, Honduran patients can’t afford even basic hygiene and medi-cal products, which is why Smith and Dr. Raymond rely on supplies donated by Cleveland Clinic’s Pharmacy Depart-ment. On Dr. Raymond’s most recent trip, volunteers brought 40 suitcases filled with medicines such as skin creams, pain relievers and antibiotics to Honduras. Additionally, as part of Dr. Raymond’s commitment, each of his patients receives a 60-day supply of vitamins, and each child receives an anti-parasitic. “To them, vitamins are like gold,” Dr. Raymond says.

MedWish International also provides expired-but-usable medical supplies to the volunteer medical missions in Honduras.

BRINGING CHILDREN TO CLEVELAND

For seriously ill children like Yeison, Smith and Dr. Raymond arrange for surgery in Cleveland. Because there are few trained surgeons in Honduras, Smith says, the majority of children who suffer from severe medical conditions don’t re-ceive any type of care. Yet with logistical help from local Honduran organizations, more than 30 children have traveled to Cleveland Clinic for cardiac surgery.

Yeison is one of this program’s most re-cent success stories. He was discharged from Cleveland Clinic and returned to Honduras with his family. But it’s important to remember, Smith says, that there are millions of adults and children around the world who also need our help.

“Honduras is only one country,” Smith says. “There’s the entire continent of Africa, Haiti, India and so many others that need our help. As Cleveland Clinic continues to expand internationally, it’s important that we remember to help not only our patients, but members of our local and global communities who are so desperately in need.”

Cleveland Clinic employees (from left) Laura Sweeney, RN, Armand Lucas, MD, Jennifer Brainard, MD, and Brian Smith are surrounded by children while on a medical brigade in the rural Honduran village of San Matias.


But all of this clicking must connect to eCleveland Clinic to take advantage of these outstanding benefits. Cleveland Clinic offers a full suite of online health management tools that ultimately enhance patient care. They include:

MYCONSULT

eclevelandclinic.org/myconsult

MyConsult Online Medical Second Opinion program is a sophis-ticated, Web-based extension of Cleveland Clinic’s 80-plus-year role as one of America’s most respected referral institutions. The secure, online program provides remote second medical opinions from Cleveland Clinic physicians for more than 1,000 life-threatening and life-altering diagnoses.

Using a secure Internet site, patients send their medical infor-mation to Cleveland Clinic’s nationally recognized specialists who provide comprehensive medical reports within two weeks. The online medical second opinions include treatment options or alternatives and recommendations regarding future therapeutic considerations.

In addition to second opinions for medical conditions, MyCon-sult offers nutrition counseling and international pre-adoption consultations. The nutrition counseling services are provided by Cleveland Clinic Heart & Vascular Institute registered dietitians who develop personalized, comprehensive nutrition programs based on the unique needs of each individual.

Comprehensive pre-adoption consultations are conducted by a board-certified pediatrician who specializes in international adoption and who helps adoptive parents as they prepare to welcome a child from a foreign country into their lives.

DRCONNECT

eclevelandclinic.org/drconnect

DrConnect is a complimentary service for referring physicians that allows them to follow their patient’s treatment progress while at Cleveland Clinic. By providing physicians with real-time information about their patient’s treatment progress, DrConnect is propelling physicians into the future of healthcare, a world in which their patients’ detailed medical information is always just a click away.

MYCHART

eclevelandclinic.org/mychartinfo

This free program enables Cleveland Clinic patients to actively manage their healthcare any time of the day or night via the Internet. With MyChart, patients can go online to view portions of their medical record.

Unlike other personal health record services, which only allow users to view medical records, MyChart is interactive, enabling its more than 65,000 users to renew prescriptions, schedule or cancel doctor appointments, view lab test results as soon as they are available and access reliable healthcare information.

In addition, authorized caregivers can use MyChart Caregiver to manage the healthcare of minor children or dependent adults for whom the caregiver is legally responsible.

Patients can sign up for MyChart at their Cleveland Clinic physician’s office or online at clevelandclinic.org/mychartinfo. MyChart is secure, which means you, and only you, can access your account. The information is encrypted, which means it is stored in such a way that it can only be unscrambled after you enter the correct password.

[ e C L E V E L A N D C L I N I C ]

Cleveland Clinic’s Online Programs Advance Patient Care

How can a patient in Montana who is unable to travel get a second opinion from an internationally renowned heart center? By clicking a computer mouse. How can a doctor attending a seminar in Phoenix review the electronic medical record of a patient he referred to a specialist at Cleveland Clinic? By clicking a computer mouse. How can individuals anxious about their health check lab test results at 2 a.m. on a Sunday? Yes, by clicking a computer mouse.



By September 2007, Nabil Al Najdi hadn’t been home to Kuwait to see two of his daughters or his son in more than 12 months. Although he missed his home and his family, he and his wife, Hanna Malek, had traveled thousands of miles to Cleveland, to hand their daughter’s care over to Cleveland Clinic specialists.

Mariam Al Najdi, 11 years old, had undergone four facial reconstruction surgeries to correct deformities of the nose and lip she has dealt with since birth. Her doctors have done all they can for her at this stage of her growth. She will likely be back for final treatment when she turns 15.

Mariam was born with a cleft lip and palate. When she was 3 months old, surgeons in Kuwait closed the outside of her upper lip. Her doctors advised her parents that there was no more that could be done at that time, and that she would need additional surgeries as she grew and developed.

At the recommendation of her doctor in Kuwait, Mariam and her parents made their first trip to Cleveland Clinic in 2001, when Mariam was 5 years old. They chose Cleveland Clinic, according to Mr. Al Najdi, because of the “huge difference in medicine and technology here as opposed to other parts of the world.” Mariam was placed under the care of Frank Papay, MD, Chairman of the Dermatology & Plastic Surgery Institute.

Dr. Papay performed all of Mariam’s surgeries in 2001, 2004, and when she came back again in 2007. Cleveland Clinic pediatric endocrinologists also helped to correct her growth hormone deficiency, a condition com-monly associated with cleft lip and palate.

Cleft lip and palate can interfere with normal activities and take a toll on a person’s self-esteem. When left untreated, the deformity causes those who have it to have difficulty communicating. They are sometimes even shunned from society, says Dr. Papay, who has done mission work in South America and Mexico to treat children with cleft palate.

To schedule an appointment with a specialist in the Dermatology & Plastic Surgery Institute, call 800.884.9551. If calling from outside the United States, call 001.631.439.1578.

Overcoming Facial DeformityFAMILY TRAVELS FROM KUWAIT SEVERAL TIMES FOR GIRL’S TREATMENT

WHAT IS CLEFT LIP AND PALATE?

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing. The malformations occur when there is not enough tissue in the mouth or lip area, and the tis-sue that is available does not join together properly.

Cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth) and/or the soft palate (the soft back portion of the roof of the mouth).

WHAT CAUSES A CLEFT LIP AND

CLEFT PALATE?

In most cases, the cause is not known and these conditions cannot be prevented. Most scientists believe clefts are due to a combina-tion of genetic and environmental factors. The condition also may occur as a result of exposure to viruses, chemicals or medications while the baby is in the womb.

Although treatment may extend over several years and require several surgeries, most children affected by this condition can achieve normal appearance, speech and eating.

For more information on this condition, visit clevelandclinic.org/health.


Thomas Frazier, PhD, of the Center for Pediatric Behavioral Health, addresses that question and gives us the latest re-search on autism, a neurological disorder that affects children’s brain development and impairs social interaction and com-munication skills.

Health Advantage: What is behind the dramatic rise in autism cases?

Thomas Frazier: The latest Centers for Disease Control estimates suggest that one in every 150 children exhibit some form of autism spectrum disorder. The main reason the number of cases has grown is increased awareness. Symptoms of autism are being diagnosed earlier, and pediatricians now catch milder cases that were totally missed before. In the past, those children were often just described as unusual, quirky, obsessive or socially awkward.

Health Advantage: What causes autism?

Thomas Frazier: The exact cause is un-known in most cases. In some cases, it is due to a genetic mutation like Fragile X or Angelman’s Syndrome. One recent theory is that autism spectrum disorders result from one or more spontaneous muta-tions in the genetic code. A recent study has suggested that older fathers may be at risk for having children with autism. Perhaps because as men get older, there’s

more likelihood their sperm have genetic mutations. Scientists are also looking at what’s called “mirror neuron systems” – the neurobiological systems we use to interpret other people’s actions, thoughts and feelings. Children with autism have significant difficulty imitating behaviors, which seems to suggest their mirror neurons aren’t working. There’s also been a lot of talk about environmental compo-nents contributing to autism, and while the environment likely does contribute, at least in some cases, there’s not a lot of evidence showing in what ways the environment matters.

Health Advantage: Are childhood vaccines dangerous?

Thomas Frazier: Data suggest vaccinations play very little – if any – role in autism. Vaccines are given at 18-24 months, but cognitive difficulties associated with au-tism often present themselves well before that, although parents may not have yet picked up those signs. With the exception of children with specific metabolic disor-ders, there is no evidence that vaccines cause or contribute to the symptoms of autism.

Health Advantage: At what age do autism symptoms present themselves?

Thomas Frazier: Many times symptoms begin very early in life, sometimes shortly

after birth. Parents should look for any kind of developmental delay: for example, if a baby has trouble making eye contact. By around 12 months, a child should be able to use language to make simple re-quests, and string words together around 18 months. The key is whether the child using functional language and social com-munication, including non-verbal commu-nication, rather than just repeating what is heard on television.

Health Advantage: Can autism be cured?

Thomas Frazier: There is currently no cure for autism. However, if a child is diag-nosed with an autism spectrum disorder early in life, and behavioral treatment is initiated, then the possibility that the child will be able to be placed in a regular school is increased.

Health Advantage: How does a child’s autism affect his parents?

Thomas Frazier: It is important for parents to seek support from family, friends and other parents of children with autism. It is very easy for parents to become de-pressed or paralyzed by the news regard-ing their child’s condition. There are two good websites for parents of autistic children: autismspeaks.org and ianproject.org.

In the 1960s, autism was diagnosed in one in every 2,000-2,500 children. In the 1970s, it rose to one in every 10,000 children. Today, experts estimate that one in 166 children have an autism disorder. Why has the number grown so high? Is it due to vaccines, environmental toxins – or something else?

Thomas Frazier, PhD

[ E X A M I N I N G T H E H E A D L I N E S ]

AutismWHY HAS THE NUMBER GROWN SO HIGH?


[ C L E V E L A N D C L I N I C I N F L O R I D A ]

For more than 20 years, Mrs. Warren, now 71, lived with progressively worsening back and leg pain, seeking an array of treatments with only limited success. With her mobility severely limited, she turned to the Medical, Interventional and Surgical Spine Center at Cleveland Clinic in Florida.

An initial evaluation, in December of 2007, confirmed that Mrs. Warren suffered from degenerative spondylolisthesis, a condition that occurs when one vertebra slips forward over another, ultimately leading to pain and disability. In Mrs. Warren’s case, the severity of the condition also led to spinal stenosis, a narrowing of the spinal canal. This places pressure on the nerves that travel through the spinal column, which can cause pain, numbness, tingling and heaviness in the legs.

Mrs. Warren was referred to Isador H. Lieber-man, MD, a spine surgeon and Chairman of the Medical, Interventional and Surgical Spine Center. After a careful review of the risks and benefits of surgical treatment, surgery was elected as the best option to al-leviate the symptoms of pain and immobility.

“Degenerative spondylolisthesis and spinal stenosis are structural problems, and while medication, therapy and exercise may help to improve symptoms, serious cases often require a structural solution, and that means surgery,” said Dr. Lieberman. “When a pa-tient is unable to walk and is suffering severe pain, surgery is frequently the best hope.”

For Mrs. Warren, the decision to undergo surgical treatment was difficult but ultimately clear. “At the time that I came to Cleveland Clinic in Florida, I could not stand or walk,

and I could not see my friends or leave my residence,” said Mrs. Warren, who spends her winters with her husband in Hollywood, Florida. “I was in excruciating pain, and that was no way to live, so I knew that surgery was the right approach.”

Dr. Lieberman was able to identify the areas where disc slippage and compression originated and where surgical repair was necessary. “Over the last 20 years, since Mrs. Warren first began experiencing back pain, techniques for locating and surgically treat-ing areas of compression in the vertebrae have advanced at a tremendous rate,” Dr. Lieberman explained. “Today we are able to minimize damage to surrounding tissues dur-ing surgery by limiting the invasive nature of the procedure. That means better results and quicker recovery times for our patients.”

In February, Mrs. Warren underwent surgery to decompress the nerves and fuse tar-geted vertebrae. The day after surgery, she was walking again, and today her progress continues.

“Surgery at Cleveland Clinic literally gave me back my life, and I truly believe that I am a walking miracle,” said Mrs. Warren. “My friends see me and they cannot believe that I am the same person who could once barely stand up. I tell them that half the battle is finding the best doctor, and that is what I have done with Dr. Lieberman.”

Both Dr. Lieberman and Mrs. Warren agree that after additional therapy and time, a game of tennis may be in the cards for Mrs. Warren.

Targeted Spinal SurgeryGETS STANDING OVATION FROM TORONTO PATIENT

Nancy Warren of Toronto, Canada, was an avid tennis player until chronic pain resulting from a degenerative spinal condition forced her to give up the sport she loved.

[ Q U E S T I O N S & A N S W E R S ]

Melissa Ohlson, MS, RD, LD, a registered dietitian and Nutrition Projects Coordinator of Preventive Cardiology and Rehabilitation at Cleveland Clinic, looks at obesity and diabetes, and answers questions about a potential cause.

WHY SINGLE OUT ONE FOOD INGREDIENT?

Although it is almost certain there is no single cause for obesity and diabetes, some research-ers have begun pointing the nger at speci c foods and food ingredients. One such ingredient stands out at the top of their list: high-fructose corn syrup (HFCS). HFCS is produced by processing corn starch to yield glucose and fructose (sugar molecules). HFCS has the same sweetness and taste as an equal amount of sugar (sucrose), but is the preferred sweetener because it costs less to manufacture and has a longer shelf life.

HOW PREVALENT IS HIGH-FRUCTOSE

CORN SYRUP IN THE AVERAGE DIET?

Over the past 30 years, HFCS in the food sup-ply jumped from less than 1 percent to over 40 percent, and now stands as the leading caloric sweetener added to foods and beverages. HFCS can be found in soft drinks and other beverages, and it is used to sweeten jams, condiments, breakfast cereals, baked goods, candy confections and prepared desserts. In an American Journal of Clinical Nutrition review, a conservative estimate of the consumption of HFCS indicates a daily average of 132 calories for all Americans over age 2.

AREN’T ALL SUGARS THE SAME?

Some researchers say the increased use of HFCS in the United States parallels the rapid increase in obesity experienced over the past few decades. Fructose is absorbed differently than other sugars, and doesn’t register in the body metabolically the same way glucose does. In other words, the body’s hunger signals do not respond. This suggests that consuming a lot of fructose over time could lead to weight gain.

Fructose consumption has been shown to induce insulin resistance, impaired glucose tolerance and hyperinsulinemia, all risk factors in the development of type 2 diabetes.

While it may seem logical to blame HFCS for playing a role in the obesity epidemic, there is still a lack of solid evidence in the opinion of some researchers.

WHAT’S YOUR ADVICE TO READERS?

First, ll your diet with nutrient-rich, lower-cal-orie fresh fruits, vegetables and whole grains. Second, regardless of the source, keep in mind “calories in and calories out.” Although weight control is more complex than that, even a small switch from one to two cans of soft drinks per day to water can make a difference. Only when we make these positive changes in our diets will the obesity and diabetes rates in this country begin to fall.

Obesity and diabetes plague our nation at an epidemic rate,

affecting nearly one-third of American adults and 16 percent of

children. While there is a clear association between increased body

weight and risk of developing type 2 diabetes, the cause of this

obesity crisis remains uncertain. Researchers are now looking to

different aspects of our diets for answers.Melissa Ohlson, MS, RD, LD

High-Fructose Corn Syrup:COULD ONE FOOD INGREDIENT BE BLAMED FOR OBESITY AND DIABETES?



“That was not what I wanted to hear,” says the 48-year-old architect from Florida, now living in South Carolina.

In 2007, Mr. Laconis experi-enced atrial fibrillation, a heart rhythm disorder. The a-fib was controlled with medica-tion; however, surgery was needed to repair the mitral valve prolapse.

After a referral from his cardiologist and some Internet research, Mr. Laconis and his wife, Lexie, determined that the Cleveland Clinic Heart & Vascular Institute had the most experience and the best outcomes. Best of all, it offered robotically assisted minimally invasive valve repair for certain cases.

After sending his medical records electronically to Cleve-land Clinic to see if he was eli-gible for the robotic procedure, Mr. Laconis received a nod from cardiac surgeon A. Marc Gillinov, MD. “I felt pumped

up and ready to go,” says Mr. Laconis, who also participated in an online chat with Dr. Gillinov.

Less than a month later, Mr. Laconis underwent robotic mitral valve repair. By the following week, he was out of the hospital, back in his hotel, and making plans to visit the Rock and Roll Hall of Fame and Museum before heading home.

“We have only great things to say about Cleveland Clinic,” says Mrs. Laconis. “We were confident we were getting the best care possible.”

To schedule an appointment with a specialist in the Heart & Vascular Institute, call 800.884.9551. If calling from outside the United States, call 001.631.439.1578.

[ F R O M A M E R I C A’ S N O. 1 H E A R T C E N T E R ]

Architect “Pumped” for Heart Repair

At first, it was only a heart murmur. But it was enough to keep Robert Laconis out of the Naval Reserves. A cardiologist later diagnosed the murmur as a severely leaking mitral valve caused by mitral valve prolapse. Once hoping for a future in the Navy, Mr. Laconis was now looking at heart failure.

Q &A : Robots and Heart Surgery

Our cardiac surgeons answer the most frequently asked questions about robotic heart surgery.

WHAT IS ROBOTICALLY ASSISTED HEART SURGERY?

It’s a minimally invasive procedure in which a heart surgeon uses robotic technology to perform certain complex heart operations.

DOES A ROBOT PERFORM THE SURGEON’S WORK?

No, the surgeon controls the movement of robotic “arms” that grasp and place instruments wherever the surgeon directs them. The robotic arm’s “wrist” movements mimic those of the surgeon. However, they may be more precise than the surgeon’s natural hand and wrist movements. The surgeon is in full control of the robotic arms during the en-tire operation, so there is no chance of random movement.

WHAT HAPPENS DURING ROBOTIC SURGERY?

In robotically assisted heart surgery, endoscopic instru-ments attached to robotic arms are placed into the body through three small incisions between the ribs. A tiny camera is placed through another incision.

The heart surgeon sits at a computer console and views the heart clearly through two lenses that provide depth percep-tion. Foot pedals allow the surgeon to control the view, and zoom in and out. The surgeon manipulates the robotic arms, which have motion sensors attached to their wrists to communicate their movements throughout surgery.

WHAT ARE THE ADVANTAGES?

This approach offers many advantages over standard sur-gery, including:

• a shorter recovery and faster return to daily activities • smaller incisions and minimal scarring • less trauma to tissues, and less pain as a result • a shorter hospital stay (three to five days, versus five

to seven days) • less need for pain medications • decrease in bleeding (and less need for transfusion)



“Wrong,” says Cleveland Clinic cardiologist Arman Askari, MD. “Thin isn’t necessarily synonymous with healthy.”

Carrying too many pounds does put a stress on your heart, causing it to work harder to carry and nourish that excess weight. “While it’s true that being overweight is a risk factor for heart disease, weight is only a small part of the picture,” Dr. Askari explains.

Sometimes, being thin carries a false sense of security. “Thin people may be more prone to lead active, healthy lifestyles, but I’ve also seen all types of people – from a 39-year-old smoker or a buff, pro beach volleyball player – come in with heart attacks,” he says. “Coronary artery disease doesn’t discriminate fat or thin, male or female.”

THE BIGGER PICTURE

When trying to live a heart-healthy lifestyle, it’s important to begin with a more comprehensive look at all the risk factors for heart disease, or conditions that increase a person’s risk of developing heart disease.

Thin People Can Have Heart Disease, TooYou’re not overweight. So, heart disease is no threat. Right?

“It’s important to know that some risk factors cannot be changed while others can be modified or treated,” Dr. Askari says. “The more risk factors you have, the more likely you are to develop heart disease.”

KNOW THE BASICS

The following are heart disease risk factors beyond your control:

INCREASING AGE – Heart disease becomes more likely as you get older. About 85 percent of people who die of heart disease are 65 or older.

MALE GENDER – Men have a greater risk of heart attack than women.

MENOPAUSE – After menopause, a woman’s risk of heart dis-ease increases and approaches the level of a man’s.

FAMILY HISTORY – Your risk of heart disease increases if your parents, brothers, sisters or children have the disease.

RACE – The risk of cardiovascular disease is higher in Blacks, Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This increased risk is partly due to higher rates of high blood pressure, obesity and diabetes in these populations.



WHAT YOU CAN DO

Not all risk factors, however, are set in stone. “Focus on those factors that you can change,” advises Dr. Askari:

STOP SMOKING – Smoking is the most preventable risk factor for heart disease. Eliminate the use of all tobacco products, and stay away from other’s smoke.

LOWER YOUR TOTAL CHOLESTEROL, LDL (BAD) CHOLES-

TEROL AND TRIGLYCERIDE LEVELS – It is recommended to have your cholesterol level checked as early as age 20, or earlier if you have a family history of high cholesterol. The cholesterol profile includes an evaluation of total cholesterol, HDL, LDL and triglyceride levels. Your healthcare provider can tell you how often to have your cholesterol tested.

RAISE YOUR HDL (GOOD CHOLESTEROL) – HDL cholesterol takes the LDL (bad) cholesterol away from the arteries and back to the liver where it can be passed out of the body. High levels of HDL seem to protect against cardiovascular disease.

LOWER HIGH BLOOD PRESSURE – High blood pressure increases the workload of the heart and kidneys, increasing the risk of heart attack, heart failure, stroke and kidney disease.

CONTROL DIABETES – People with diabetes, especially women, have a higher risk of heart disease because diabetes increases other risk factors, such as high cholesterol, LDL and triglycerides; lower HDL; and high blood pressure.

MAINTAIN A HEALTHY BODY WEIGHT – While being thin isn’t a panacea, research has shown that being overweight contributes to the onset of cardiovascular disease. That makes it important that you achieve and maintain a desirable weight.

EXERCISE - The heart is like any other muscle – it needs a workout to stay strong and healthy. Exercising helps improve how well the heart pumps blood through your body. Aim for moderate exercise 30 minutes a day, on most days.

FOLLOW A HEART-HEALTHY DIET - Whether you’re aiming to prevent heart disease or trying to prevent further heart damage, following a “traditional Mediterranean diet” has been shown to have a heart-protective effect. Aim for a diet rich in fruits, vegetables, legumes and whole grains. Your diet should include fish, nuts and low-fat dairy. Also, choose vegetable oils rich in monounsaturated fats and low in saturated fats and avoid products that contain hydrogenated and partially hydrogenated vegetable oils.

LAST BUT NOT LEAST

While not traditional risk factors, the following are thought to contribute to overall risk for heart disease:

INDIVIDUAL RESPONSE TO STRESS - Some researchers have noted a relationship between cardiovascular disease risk and stress. This is because stress can raise blood pressure, which is a risk factor for heart disease, Dr. Askari explains. Try manag-ing stress by practicing relaxation techniques, guided imagery, massage, Tai Chi or yoga; learning time management skills; and setting realistic goals.

DRINKING TOO MUCH ALCOHOL - Research has shown that those who have one to two drinks per day (4 oz. of wine, 12 oz. of beer, or 1½ oz. of 80-proof spirits) may have less risk, but too much alcohol is linked to high triglycerides, irregular heart beats, obesity and cancer. Too much alcohol can lead to increased blood pressure, heart failure and stroke, and is detri-mental to your heart because it damages the myocardium.

“Just remember, it’s not one thing – whether its weight, how much you exercise, or what you had for dinner last night – that determines your heart health,” Dr. Askari says. “It’s balancing a whole host of factors that make up the big picture.”

To schedule an appointment with a specialist in the Heart & Vascular Institute, call 800.884.9551. If calling from outside the United States, call 001.631.439.1578.

Just remember, it’s not one thing – whether it’s weight,

how much you exercise, or what you had for dinner last night –

that determines your heart health.



Cleveland Clinic researchers are investigating a replaceable heart valve that uses magnets, rather than stitches, to keep the valve in the proper place. This innovation could mean shorter surgeries, less time for patients on bypass machines, and a reduced risk of complications after re-operation to replace a prosthetic valve.

During the last 40 years, significant progress has been made in heart valve design and re-placement techniques. Replacement valves now can be expected to last 20 years. But failed valves require replacement surgery. In some cases, heart tissue can interfere with how well a replacement valve works by growing into it, a process called ingrowth.

Led by Kiyotaka Fukamachi, MD, PhD, of the Lerner Research Institute, the Cleveland Clinic team has developed a prototype with two parts: a base magnet and a magnetic ring attached to the replacement valve. Both magnetic pieces are encased in thin stain-less steel.

During the initial valve replacement surgery, traditional stitches are used to connect the base magnet to the heart tissue at the opening of the patient’s faulty natural valve. The magnetic ring with the new valve is then “mated” to the base magnet. The two magnets stay connected even under greater-than-normal pressure.

“The tight fit makes it unlikely that tissue ingrowth would occur and thus prevent the safe removal of the valve ring if it ever needed to be replaced again,” says Dr. Fukamachi. “And the coupling method has the potential for long-term durability.”

Dr. Fukamachi’s team also designed a spe-cial separation tool to detach the magnets if necessary. For example, if a patient needed another valve replacement, the surgical team would use the tool to separate the ring from the valve. A new valve would then be

“mated” quickly and easily to the existing base magnet.

Dr. Fukamachi reports that early clinical trials have been successful and anticipates this technique to be an improvement over traditional valve replacement surgery. “We’re working hard to reduce the length of surger-ies and the amount of time patients spend on heart bypass machines, particularly for our high-risk patients,” he says.

A Heart’s Attraction Innovative technology uses magnets instead of stitches

to keep heart valve in place

HEART-HEALTH

RESOURCES

Visit clevelandclinic.org/heartHA

for resources designed for your

heart health, including webchats,

online chats with a Heart &

Vascular Institute nurse, podcasts,

patient stories and more. Sign up

for our free eNewsletter, too.

18 800.884.9551 | 001.631.439.1578 | clevelandclinic.org/HA181818181888 88008000000 8888888.88884.9.94.94.94.95511 | 0011.63331 441.439.9.99.1515715715 8 | clecleve

Her supervisor called 9-1-1. It took the emergency room doc-tors hours to deduce that Ms. Jones had experienced an ocular migraine.

By the time she was 30, migraines were a regular part of her life. “Stress was a major cause,” she says. She was on a preventive medication for three or four years, and after that, she relied on over-the-counter medications whenever a migraine would are up.

In 2004, the migraines became so severe that Ms. Jones, a resident of Las Vegas, went to a headache clinic in Chicago and was put on a new medication. However, the medication caused severe constipation, ultimately triggering an anal ssure, or rectal tear. Spasming ensued in the levator ani muscle in the rectum, resulting in stabbing pain. Her doctor diagnosed the problem as levator syndrome.

Anal ssures are supposed to heal in time. But when time and traditional treatment didn’t help, Ms. Jones’s colorectal doctor referred her to Tim Rhudy, a licensed acupuncturist with Cleve-land Clinic’s Department of Pain Management.

While doing her intake, Mr. Rhudy asked the 51-year-old Jones where else she had pain, and she told him about her migraines. She said she couldn’t turn her head from side to side without pain. “He immediately said he could help with that,” she recalls.

“I felt like I had nothing to lose.”

STIMULATING PATHWAYS

Acupuncture is the stimulation of precise points on the body with hair-thin metal needles. These points, most of which are near nerves, fall along the body’s meridians — linear pathways throughout the body reminiscent of a subway system: the merid-ians are the subway lines; the points are the subway stations.

Different styles of acupuncture hail from many cultures. Mr. Rhudy practices a modern American style called Acupuncture Physical Medicine, or APM, as developed by Mark Seem, PhD. This potent style blends Western physical medicine techniques and classical Chinese acupuncture, incorporating trigger point therapy with acupuncture.

INVITING Qi

APM is a very tactile style of acupuncture. The acupuncturist palpates the body to nd active trigger points – hyper-irritated locations within muscles. “I rely on exploration with my hands and open dialogue with the patient to locate trigger points,” says Mr. Rhudy.

Hitting an active trigger point recreates the symptom in the patient. For example, the acupuncturist might palpate around the hip/buttocks area, causing the patient to feel pain moving down the leg.


The Point of Acupuncture: Needling the Body to Heal

Janet Jones was blind-sided by migraines. She was at work when, suddenly, she couldn’t see. Her vision became choppy and broken. Numbness crept through her left hand, up the side of her arm, and into the left side of her face. Just 20 years old at the time, she thought she was having a stroke.


She wanted to come back the next day, but Mr. Rhudy said treatments were too intense and that her body would continue to heal itself throughout the week. “He warned me that I would be sore and that the treatment might trigger a migraine – which it did, but it came and went quickly. He suggested I take a hot shower and go to bed,” she says.

Ms. Jones underwent two more acupuncture treatments in the next few weeks, which she believes cured the levator syndrome. When the anal fissure tore open again approximately nine months later, she immediately turned to acupuncture, receiving two more treatments.

“Acupuncture fixed it again,” she says. “I just passed the one year mark and haven’t had a problem since.”

RESTORING BALANCE

Acupuncturists consider themselves conduits for self-healing, navigating the body to unblock “holding patterns” in muscles and restore balance. “It’s prodding the body to remember what it feels like to not have these accumulated aches and pains,” Mr. Rhudy explains.

Many patients try acupuncture after exhausting their options with medical doctors. An acupuncturist is not a doctor, so it’s important that patients be thoroughly checked by a physician to confirm they don’t have an underlying disease or condition.

Some people use acupuncture solely to ease stress and tension. “Patients tell me they think more clearly or feel more relaxed or energized after a session,” says Mr. Rhudy.

Acupuncture is a discipline and requires commitment, whether short term or long term. And, arguably, a discipline that keeps the body and mind healthy is worth exploring. Just ask those who got their balance back.

“For me, acupuncture was phenomenal,” says Ms. Jones.


As trigger points are located, needles are inserted. The muscles either cramp and release immediately or yield a slow, dull, achy, distending sensation, like the “good” hurt after a massage. This represents the arrival of qi (pronounced “chee”), the Chinese word for vital energy or life force.

During her first treatment, Ms. Jones was told that her body would twitch as the acupuncture needles were inserted into trig-ger points. “Mr. Rhudy told me there was so much stress in my body, that it immediately reacted,” she says. He explained to her that the warm flow she felt was the release of qi.

“The sensation of the experience was indescribable,” recalls Ms. Jones. “There was beautiful music playing and warmth from the blanket that covers you once the needles are in. It puts you in a place where you are so relaxed and comfortable. I could feel the pain ebbing away, little by little…like the pain was going up those needles and out of my body.”

UNTYING MUSCULAR STRAIGHTJACKETS

APM is most effective when the source of dysfunction is myofascial — in the connective tissue that connects to body structures like muscles, organs and bones. “With this style of acupuncture, you’re seeking and untying muscular straightjack-ets,” says Mr. Rhudy.

After acupuncture, Ms. Jones was stunned to discover she could indeed turn her head left and right without any pain. “I hadn’t been able to do that in years,” she says.

BRIEF HISTORY OF ACUPUNCTURE

Acupuncture is one of the oldest and most commonly used

medical procedures in the world, originating in China more than

2,000 years ago. A key component of traditional Chinese medi-

cine, acupuncture views physical, mental, emotional and spiritual

health as a balance of yin (negative energy) and yang (positive

energy). When yin and yang are in balance, energy, or qi, flows

smoothly, and the body and mind are healthy. Acupuncture is

believed to restore order when imbalances occur.

One more modern theory is that acupuncture stimulates the

central nervous system to release chemicals to address the pa-

tient’s specific issue; for example, releasing endorphins to block

messages of pain from the brain.

Acupuncture became well-known and accepted in 1971 after

a prominent New York Times reporter, James Reston, wrote an

article about doctors in Beijing easing his post-operative pain

with needles.

DOES ACUPUNCTURE HURT?

Although experiences with acupuncture needling differ, treat-

ment is relatively painless because the needles are hair-thin

and solid. The needles stay in for up to 20 minutes.

Sensations in the muscles range from heaviness and numb-

ness to tingling and mild soreness — all signs the treatment

is working.

For an acupuncture appointment, please call 800.884.9551. If

calling from outside of the United States, call 001.631.439.1578.


services, please call 001.631.439.1578. You also can visit clevelandclinic.org/HA and click on “International Patients” or email your questions to [email protected].

HOTEL ACCOMMODATIONS ON THE CLEVELAND CLINIC CAMPUS

For reservations at The InterContinental Hotel and Bank of America Conference Center, The Cleveland Clinic Guesthouse, or The InterContinental Suites Hotel, call 216.707.4100 or toll-free 877.707.8999. Out-of-state patients from the United States may call 800.223.2273, ext. 55580. Patients outside of the United States may call 216.444.6404 for assistance.

GENERAL INFORMATION

For general information about Cleveland Clinic’s services, physicians and news, visit clevelandclinic.org/HA or call 800.884.9551. Patients outside of the United States may call 001.631.439.1578.

CLEVELAND CLINIC IN FLORIDA

For information about Cleveland Clinic in Florida located in Weston (near Ft. Lauderdale), visit clevelandclinic.org/florida.

CLEVELAND CLINIC CANADA

For information about Cleveland Clinic Canada, visit clevelandcliniccanada.com.

The National Center and the International Center, which make up Global Patient Services, provide facilitated access to ap-pointments and professional services. Like the concierge at a fine hotel, the trained, expert concierge staff of Global Patient Services is available to assist out-of-state and international pa-tients before, during and after their stay in Cleveland. Whether you need to be here for a day or a month, our staff will schedule appointments, arrange travel (with airline discounts when avail-able) and hotel accommodations, provide interpreters for all clinical appointments, accompany you to your medical appoint-ments, arrange any necessary transportation from your hotel, and direct you to restaurants, car rental and other services or activities that you or your family members may desire.

After you have returned home, our staff is available to help coordinate follow-up appointments, facilitate communications with your Cleveland Clinic physicians and answer any non-medical questions that you might have.

U.S. PATIENTS (OUTSIDE OF OHIO)

If you are from the United States but outside of Ohio and would like more information about the medical concierge service, please call 800.884.9551. You also can visit clevelandclinic.org/HA and click on “U.S. Patients” or email your questions to [email protected].

INTERNATIONAL PATIENTS

If you are a patient from outside the United States and would like more information about the International Center’s

Thousands of patients each year travel to Cleveland Clinic from every state in the nation and more than 80

countries around the world. Global Patient Services is a full-service department dedicated to meeting the needs

and requirements of both out-of-state and international patients who receive their care at Cleveland Clinic and

Cleveland Clinic in Florida.

GLOBAL Patient Services

[ G L O B A L PAT I E N T S E R V I C E S ]

U.S.News & World Report has ranked Cleveland Clinic one of the top 4 hospitals in America in 2008. For the 14th consecutive year,

Cleveland Clinic’s cardiac care has been ranked No. 1. Cleveland Clinic’s 2008 rankings for additional specialties are listed below.

Cleveland Clinic Named One of America’s Top Hospitals

Ranking

Heart & Heart Surgery 1

Urology 2

Gastrointestinal Disorders 2

Rheumatology 2

Orthopedics 3

Kidney Disease 4

Respiratory Disorders 5

Endocrinology 6

Neurology & Neurosurgery 6

Gynecology 8

Ear, Nose & Throat 11

Ophthalmology 11

Cancer 13

Geriatric Care 14

Psychiatry 22

*Rehabilitation was also a nationally ranked specialty.

clevelandclinic.org/usnews

9500 Euclid Avenue / AC311Cleveland, OH 44195

Cleveland Clinic teamed with James Beard Award-winning cookbook authors Bonnie Sanders Polin and Frances Towner Giedt to create a complete and easy-to-follow plan for preventing heart disease: Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook.

Polin and Giedt developed outstanding recipes that taste too good to be good for you (but are) ranging from Thai Swordfish in Red Curry Sauce to Grilled Chicken Breasts with Warm Balsamic Strawberries, Herbed Roasted Beef Tenderloin, and even New York-Style Cheesecake. A week’s worth of menus for each of the three caloric plans also has been included to take the guesswork out of eating from morning to night.

Backed by the reputation of Cleveland Clinic, this all-in-one guide provides instructions on an easy, enjoyable way for people to care for their hearts and live longer, healthier lives. The cookbook is available at select bookstores and online at randomhouse.com.

RECIPE CORNER

Warm Cannelloni Salad with Salmon and Citrus VinaigretteThis Italian-inspired salad is a quick workday meal for the entire family. Packed with fiber, potassium, and your daily allotment of omega-3 rich fats … this dish is an Italian-inspired winner!

D I R E C T I O N S

Place the rinsed beans in a salad bowl. Set aside.

Grill the salmon in a ridged skillet or over coals. When done, cool 5 minutes and divide into 4 sections.

Coat a nonstick skillet with cooking spray. Sauté the on-ion until opaque. Add the garlic and continue to sauté for 1 minute more. Stir into the reserved beans. Add the cucumber, red bell pepper, and mint to the beans. Toss the salad.

In a small bowl, whisk together the orange juice, zest, vinegar, olive oil, salt, if using, and pepper; toss with the salad. Place the lettuce cups on plates. Top with salad. Place the salmon alongside. Serve immediately.

P E R S E R V I N G : 320 calories (41% calories from fat), 14 g total fat (2.5 g saturated fat), 23 g protein, 23 g carbohydrate, 6 g dietary fiber, 45 mg cholesterol, 260 mg sodium, 620 mg potassium

I N G R E D I E N T S

One 15-ounce (425g) can cannelloni beans, rinsed well and well drained

One 12-ounce (340g) salmon fillet

Olive oil cooking spray

One medium red onion, thinly sliced

1 garlic clove, minced

½ English cucumber, thinly sliced

1 red bell pepper, seeded and chopped

2 tablespoons chopped fresh mint

4 lettuce cups

C I T R U S V I N A I G R E T T E

¼ cup (59ml) fresh orange juice

1 teaspoon grated orange rind

1 tablespoon white wine vinegar

2 tablespoons extra virgin olive oil3/8 teaspoon kosher salt, optional

Freshly ground pepper

MAKES 4 SERVINGS

From Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook

health aeagnadtv - cleveland clinic...inside of the arm or the back of the elbow to begin insertion...

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