CLEVELAND CLINIC

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!

S

Lorain Family Health andSurgery Center

Elyria Family Health Center

High-field MRI, 4-sliceCT scans now available

Same-day DEXA andmammography offeredCall 440/204-7400

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 KornerRemote Friendships:Wave of the Future?With the popularity of high-speed Internet service ex-

ploding, kids can become so engrossed in online

“gaming” that friendships become more “remote”

than real. They meet in cyberspace for role-playing

games, chess or cards, and chat through instant-

messaging or on the phone as they play.

Communicating online can help overcome social

barriers for shy or awkward kids. But they miss the

subtleties of voice, gesture and expression that come

with face-to-face interaction. Messages are sent and

received differently in person, which teaches kids

how to communicate with empathy as adults.

To encourage “face time” with friends as well as

physical activity, Cleveland Clinic pediatricians and

family medicine specialists suggest limiting kids’

combined Internet, videogame and TV time to an

hour or so a day. Young computer buffs can be en-

couraged to teach older, isolated relatives how to use

e-mail or play cards online.

Peanut Allergies: Cause for ConcernFrom potato chips to hot chocolate, many foods are

processed with peanut products. Experts say that may

be why peanut allergies — lifelong in 80 percent of

cases — are so common, and the leading cause of

fatal or near-fatal food reactions.

A promising genetically engineered drug made

headlines in March when early studies showed it pre-

vented allergic reactions to peanut flour. However, it

has not yet been commercially developed.

So avoiding peanuts — and foods processed or

flavored with them (sometimes labeled as “natural”

flavors) — remains a must.

Check the ingredients of every snack and meal

for children; if ingredients aren’t labeled, pass on the

dish. Be wary in restaurants — traces of peanut

products may be found in oil, pans or utensils used

to prepare “peanut-free” dishes. Warn children

against sharing food, especially at school. Some chil-

dren can develop reactions by touching those who’ve

just eaten peanut butter, or toys or play equipment

they’ve handled.

Reactions range from itching in the mouth and

throat, to airway closure within minutes. Keep self-

injectable epinephrine and a liquid antihistamine

on hand, and be sure that teachers and child

care providers know how to handle an emergency.

Allergist Amy Chuang, M.D., treats children at

Lorain; call 440/204-7400 for appointments.

To schedule appointments with Lorain pedia-tricians (left to right) Robert Weiss, M.D.,Vaishali Flask, M.D., and Rami Boutros, M.D.,call 440/204-7400.

Guarding Against West Nile VirusMosquitoes — once mere annoyances — now pose a threat due to West Nile

virus, which can infect mosquitoes, birds, horses and people. Last summer, eleven

of 211 Cuyahoga County residents with infections died.

Typically, West Nile virus causes no symptoms, the Centers for Disease Control

and Prevention reports. In 20 percent of cases, mild fever, headache, body aches,

skin rash and swollen lymph glands develop. In one of 150 cases, severe illness

ranges from headache, high fever and stiff neck to stupor, coma, convulsions and

paralysis.

West Nile virus doesn’t appear to spread from animals to people, or directly from

person to person. In rare instances, it has been transmitted through breast milk and

organ transplantation, but risks are slight, experts say.

Meanwhile, protect yourself with insect repellent containing DEET (N, N-diethyl-

meta-toluamide) on skin and clothing outdoors, and wear long-sleeved shirts and

pants. Stay inside at dawn, dusk and early evening, when mosquitoes are hungriest.

And eliminate standing water (mosquito breeding grounds) from your yard.Internal medicine specialists and pediatricians are available to discuss your con-

cerns at Lorain; call 440/204-7400. To consult Elyria internists, call 440/366-8822.

AGE-RELATED MACULAR DEGENERATION(AMD) — a major cause of vision loss among older

Americans — is caused by deterioration of the mac-

ula, that part of the retina providing sharp, central

vision. Options for patients are limited, although

Cleveland Clinic Cole Eye Institute researchers con-

tinue to explore root causes and new treatments.

However, a national study suggesting that nutri-

tion plays a role in prevention has prompted many

ophthalmologists to recommend a high-dose combi-

nation of antioxidants and zinc for some patients. If

you have intermediate to advanced AMD, ask your

doctor if this combination of supplements might

help you: 500 mg of Vitamin C ■ 400 IU of Vitamin

E ■ 15 mg of beta-carotene ■ 80 mg of zinc as

zinc oxide ■ 2 mg of copper as cupric oxide.

These vitamins and minerals slowed disease pro-

gression by 19 to 25 percent among study patients at

intermediate or high risk of advanced AMD. They did

not affect early AMD or restore lost vision. But they

aren’t recommended for those who smoke or recently

quit, due to slightly higher rates of lung cancer.

Richard Wyszynski, M.D., is a retinal specialist

at Lakeland Eye Surgeons and Consultants. For

appointments, call 440/988-4040.

When Aging Vision Dims

CRP: New Clue to HeartAttack, Stroke RiskTHE 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 with Lorain internal medicine

specialist Walid Saber, M.D., who has a special

interest in cardiology, call 440/204-7400.

Sathya Reddy, M.D., specializes in geriatricmedicine at Cleveland Clinic Lorain.

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 hearing

evaluations with Lorain otolaryngologist George

Ozbardacki, M.D., and audiologist Sharon Jones,

M.A., CCC-A, call 440/204-7400.

What’sThatNoise?

Arthritis Not aForegone Conclusionfor Aging Backs

MILLIONS OF OLDER AMERICANS ACCEPTBACK PAIN as an inevitable part of aging, along

with arthritis. But neither condition comes naturally

with age. However, arthritis — particularly

osteoarthritis — is a common cause of back pain,

according to the Arthritis Foundation, and can occur

anywhere along the spine.

Osteoarthritis causes the cartilage cushioning the

joints to wear away, allowing bones to rub against

each other. It causes mild to severe pain, restricted

movement and sometimes, numbness. Different fac-

tors set the stage for osteoarthritis:

■ excess weight or obesity putting pressure

on joints

■ sports or work injuries

■ cartilage defects occurring at birth

Seeing a doctor when back pain first develops

can prevent disability. A safe, effective management

plan may include physical therapy, anti-inflamma-

tory or pain medication, and nutrition advice to pro-

mote weight loss. Physical therapists can provide

exercises to keep the back limber and increase mus-

cle strength. Braces or supports for the spine, and

heat or cold for pain relief, can also be prescribed.

To schedule appointments with Sathya Reddy,M.D., or rheumatologist Robert McNutt, M.D.,at Lorain, call 440/204-7400.

CARPAL TUNNEL SYNDROME can make key-

boarding, operating a cash register and working on

an assembly line difficult. Swollen tissues in the car-

pal 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 tenden-

cy to drop things.

Initial treatment usually involves splinting to re-

strict movement and allow swelling to subside; anti-

inflammatory medication may be prescribed. If these

measures do not help, outpatient surgery may be rec-

ommended.

While repeated use of the hands or wrists at work

does not cause carpal tunnel syndrome, certain fac-

tors increase your risks for it:

■ age (50s and 60s)

When Carpal Tunnel SyndromeInterferes With Work

■ 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, in-

crease physical activity and lose weight, if necessary.

For appointments with Cleveland Clinic Lorain

hand and upper extremity surgeon David Shapiro,

M.D., who has a special interest in carpal tunnel

syndrome, call 440/985-3113. For appointments

with occupational medicine specialist Philippe G.

Berenger, M.D., call 440/204-7400.

Other Family Health Centers

Beachwood 216/839-3000

Brunswick 330/225-8886

Chagrin Falls 440/893-9393

Creston 330/435-5400

Independence 216/986-4000

Lakewood 216/521-4400

Solon 440/519-6800

Strongsville 440/878-2500

Westlake 440/899-5555

Willoughby Hills 440/943-2500

Wooster 330/287-4500

AppointmentsCleveland Clinic Lorain5700 Cooper Foster Park RoadLorain, OH 44053440/204-7400 or 800/272-2676

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

Friday: 8 a.m. to 5 p.m.

Saturday: 8 a.m. to noon

Cleveland Clinic Elyria1260 North Abbe RoadElyria, OH 44035440/366-8822

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

Friday: 8 a.m. to 5 p.m.

Saturday: 8 a.m. to noon

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

Cancer Answer LineTo speak with a nurse about any cancer

symptoms and concerns from 8:30 a.m. to

4:30 p.m., Monday through Friday, call

216/444-7923800/862-7798

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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Cleveland Clinic Elyria

Board-certified internal medicine special-

ist Monica E. Seo, M.D., graduated

from Case Western Reserve University and

completed her internal medicine residency

at University Hospitals of Cleveland. She is

experienced in emergency medical care.

For appointments, call 440/366-8822.

Cleveland Clinic Elyria

Philippe G. Berenger, M.D., board-

certified in internal medicine, has a specialty

interest in spine and musculoskeletal medi-

cine. He received his medical degree from

Faculte de Medicine d’Amiens in Amiens,

France, and came to The Cleveland Clinic for

his internal medicine residency. Dr. Berenger

received additional training in occupational

medicine at Rutgers University/Robert Wood

Johnson Medical School in New Jersey.

For appointments, call 440/204-7400.

Women’s Health

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THE CLEVELAND CLINICFOUNDATION

Screening vs. DiagnosticMammogramsBreast cancer is treated most effectively in its early

stages. 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

“screening” mammograms every one to two years

for women between 40 and 50, and annually for

women over 50, unless you have a family history of

breast cancer.

If you, your doctor, or the screening mammo-

gram detect a possible abnormality, a “diagnostic”

mammogram is your next step. Using the same

equipment as screening mammograms, it zeroes in

on the questionable area.

Board-certified Elyria internal medicinespecialist Wael Saber, M.D., specializesin cancer screening, hyperreactive air-way diseases, preventive cardiology andlipid disorders.

WARM WEATHER seems to bring runners out of

the woodwork. Running improves muscle mass, bal-

ance, strength and sleep, and reduces risks of heart

disease, stroke, colon cancer, osteoporosis, diabetes,

obesity and depression.

But the American Academy of Orthopaedic Sur-

geons reports that runners are prone to overuse

injuries such as stress fractures — often in the foot

or ankle. These occur when muscles become

fatigued and can’t absorb added shock, eventually

transferring stress to bone, causing a tiny crack.

To prevent overuse injuries: ■ stretch muscles

before and after running, to increase flexibility and

maintain range of motion ■ avoid hard, unforgiv-

ing terrain ■ begin strength training to improve

muscles’ ability to handle repetitive stress ■ replace

shoes every few months and ■ consider the amount

and intensity of your exercise; pushing too hard can

cause injury.

The keys are to listen to your body — it will tell

you if a running program is too vigorous — and

allow plenty of time for rest and recovery.

For appointments with Cleveland Clinic Lorainfoot and ankle specialist John E. Cann, D.P.M.,call 440/985-3113.

Run With Care

Women can make appointments at Cleveland Clinic Lorain by calling440/204-7400, and at Cleveland Clinic Elyria by calling 440/366-8822.