time to be well - cleveland clinic full-time in a busy office, didn’t ... pediatrics, pediatric...

Time to Be Well

Family Checkupclevelandclinic.org/fhc

Bridget Rini, a single mother of three working full-time in a busy office, didn’t have time to be sick.

But after a year of “not feeling right,” Bridget scheduled a physical with Nancy Sobecks, MD, at the Independence Family Health Center. She told Dr. Sobecks that she was tired all the time, and despite exercising regularly and participating in Weight Watchers®, she had gained nearly 15 pounds.

“Dr. Sobecks was so thorough. She took her time with the exam and she listened to me,” says Bridget. Dr. Sobecks said that her symptoms suggested underactive thyroid (hypothyroidism). The thyroid, a butterfly-shaped gland weighing about an ounce, is located in the front of the neck below the Adam’s apple. Disorders in the tiny hormone-producing gland are extremely common, affecting more than 20 million Americans.

Dr. Sobecks felt an abnormal nodule when she examined Bridget’s neck, and sent her for an ultrasound that revealed a significant mass. She referred Bridget to Joseph Scharpf, MD, in Cleveland Clinic’s Head & Neck Institute.

Most thyroid growths are benign. Dr. Scharpf started with a needle biopsy, which didn’t provide a definitive answer. He then removed the mass and one lobe of Bridget’s thyroid. But when a biopsy revealed cancer, he proceeded with a complete thyroidectomy.

“Learning that I had cancer was very overwhelming,” says Bridget. “But if I had to get that news, I was glad it came from

Dr. Scharpf. He was compassionate and told me that thyroid cancer is one of the most treatable cancers, with a five-year survival rate of more than 90 percent.”

Innovative approachBridget’s surgery was followed by treatment with radioactive iodine to destroy any remaining tissue. She was one of the first patients to benefit from an investigational treatment that avoids several days of drugs to remove thyroid hormone, a procedure that can lead to significant physical and emotional discomfort. The new treatment relies on just two doses of recombinant human thyroid-stimulating hormone (rh-TSH) before the radioactive iodine is administered.

“I’ve heard the horror stories from people who had to go through gradual withdrawal of TSH, and I was so glad I could avoid that,” says Bridget.

Back to normalNow under the care of Jennifer Wojtowicz, DO, an endocri-nologist at Cleveland Clinic Independence, Bridget has lost 19 pounds and says she feels “amazing!” More importantly, she is cancer-free.

Her advice: “Listen to your body. When it tells you something is wrong, find a doctor who will listen too.” ◆

n To find a primary care physician or specialist at a Cleveland Clinic Family Health Center near you, call 888.MED.WELL (633.9355) or browse our online directory of physicians at clevelandclinic.org/fhc.

Summer 2010 Strongsville Family Health and Surgery Center; Broadview Heights,

Brunswick, Independence and Wooster Family Health Centers

South Side Family Health CentersImaging Services Near YouRadiology appointments can typically be scheduled at your earliest convenience at our family health centers, and results are read within 24 hours by board-certified radiologists

Cleveland Clinic Broadview Heights: CT, mammography, ultrasound and general diagnostic radiology

Cleveland Clinic Brunswick: MRI, ultrasound, mammography and general diagnostic radiology

Cleveland Clinic Independence: CT, ultrasound, mammography, bone-density testing, echocardiography and stress echo, cardiac stress testing, endoscopy, upper and lower GI studies, genitourinary imaging, and general adult and pediatric radiology

Cleveland Clinic Strongsville: CT, MRI, ultrasound, low-dose mammog-raphy, bone-density testing, echocardiography and stress echo, cardiac stress testing, upper and lower GI studies, genitourinary imaging, and general adult and pediatric radiology

Cleveland Clinic Wooster: CT, MRI, mammography, screening mammography, bone-density testing, and general adult and pediatric radiology

Resources for YouNurse on CallTo speak with a registered nurse about any health concerns, contact our 24-hour Nurse on Call or simply call your Cleveland Clinic Family Health Center office after hours and you’ll be automatically connected to Nurse on Call — 216.444.1234 or 800.801.2273.

Make Bill Payments Online All Cleveland Clinic facilities now have a secure online “Quick Pay” option. Use any Internet browser to go to myaccount.clevelandclinic.org and choose “Make a quick payment online.”

Health Information Resource CenterContact a health educator who can provide you with written health information on a diagnosis, treatment or procedure. Health educators are available Monday through Friday, 8 a.m. to 5 p.m. — 216.444.3771 or 800.223.2273 ext. 43771.

Cleveland Clinic Cancer Answer LineTo speak with a Taussig Cancer Institute nurse about symptoms or concerns, call our Cancer Answer Line, Monday through Friday, 8 a.m. to 4:30 p.m. — 216.444.7923 or 866.223.8100.

Heart and Vascular Institute Resource Nurse Ask our resource nurses about any heart condition or about how to find the right specialist, get a second opinion or make an appointment, Monday through Friday, 8:30 a.m. to 4 p.m. — 216.445.9288 or 866.289.6911.

Stay Informed the Easy WayYou’ll get the latest healthcare news for free when Cleveland Clinic enewsletters — including eFamily Checkup — are delivered to you electronically. To sign up, visit clevelandclinic.org/newsletters and select the enewsletters you’d like to receive. It’s that easy.

Broadview HeightsCleveland Clinic Independence at Marymount Medical Center2001 East Royalton Road Broadview Heights, OH 44147

Appointments: 216.986.4000 or 800.544.6333

Hours: Monday – Friday, 8 a.m. – 4:30 p.m.

BrunswickCleveland Clinic Brunswick Family Health Center3574 Center Road Brunswick, OH 44212

Appointments: 330.225.8886 or 800.231.7567

Hours: Monday – Thursday, 8 a.m. – 8 p.m. Friday, 8 a.m. – 5 p.m. Saturday, 8 a.m. – noon

IndependenceCleveland Clinic Independence Family Health Center5001 Rockside Road, Crown Centre II Independence, OH 44131

Appointments: 216.986.4000 or 800.544.6333


Cleveland Clinic Cancer Center at Independence6100 W. Creek Road Independence, OH 44131

Appointments: 216.524.7979 (Medical Oncology) 216.447.9747 (Radiation Oncology)

MedinaMedina Medical Offices970 East Washington Street Medina, OH 44256

Appointments: 330.721.5700

Primary Care Hours: Wednesday & Thursday, 8 a.m. – 4:30 p.m.

Orthopaedics Hours: Monday – Friday, 8 a.m. – 5 p.m.

StrongsvilleCleveland Clinic Strongsville Family Health and Surgery Center16761 SouthPark Center Strongsville, OH 44136

Appointments: 440.878.2500 or 800.239.1098


Cleveland Clinic Strongsville PharmacyHours: Monday and Thursday, 9 a.m. – 8 p.m. Tuesday, Wednesday and Friday, 9:30 a.m. – 5:30 p.m.

Pharmacist: 440.878.3100

Strongsville Outpatient Surgery CenterState-of-the-art outpatient surgery in a convenient community setting. For information, visit clevelandclinic.org/asc.

Appointments: 440.878.3400 or 800.239.1098

Cleveland Clinic Cancer Center at StrongsvilleAppointments: 440.878.2500 (Medical Oncology)

WoosterFor appointments at any Cleveland Clinic Wooster facility, call 330.287.4500 or 800.451.9870

Cleveland Clinic Wooster Family Health Center1740 Cleveland Road Wooster, OH 44691

(Neurology, Primary Care, Sports Health, Nutrition Services, Pediatrics, Pediatric Neurology, Pediatric Cardiology and Psychology)

Internal Medicine Hours: Monday – Friday, 8 a.m. – 5 p.m. Saturday, 8:30 a.m. – noon

Family Medicine Hours: Monday – Friday, 8 a.m. – 5 p.m. Saturday, 8 a.m. – noon

Pediatrics Hours: Monday – Saturday, 8:30 a.m. – 5 p.m.

Cleveland Clinic Wooster Women’s Health Center1739 Cleveland Road Wooster, OH 44691

Appointments: 330.287.4930

(Ob/Gyn Care, Perinatology and Psychology)

Hours: Monday – Friday, 8 a.m. – 5 p.m.

Cleveland Clinic Wooster Specialty Center721 E. Milltown Road Wooster, OH 44691

(Allergy/Immunology, Cardiology, Cardiac Rehabilitation, Dermatol-ogy, Endocrinology, Gastroenterol-ogy, General Surgery, Orthopae-dics, Physical Therapy, Podiatry, Urology and our Cancer Center – Hematology/Oncology plus Radiation Oncology)

Hours: Monday – Friday, 8 a.m. – 5 p.m.

Chagrin Fallsand Urgent Care

Lakewood

Independence

Strongsville

Brunswick

Westlake

Lorain

Elyria

Avon

Avon Lake

Lorain County

Cuyahoga County

Summit County

MedinaCounty

Lake County

PortageCounty

GeaugaCounty

Wooster

Beachwood

Solon

Willoughby Hills

Sports Health on Chardon Road

(Wayne County)

Lake Erie

Cleveland Clinic

Sports Healthat JCC

TwinsburgBroadview Heights

There’s a Family Health Center Near YouAvon ..................................440.899.5555

Avon Lake ...........................440.930.6800

Beachwood ........................ 216.839.3000

Broadview Heights .............. 216.986.4000

Brunswick ..........................330.225.8886

Chagrin Falls ......................440.893.9393

Elyria ..................................440.366.9444

Independence ..................... 216.986.4000

Lakewood ........................... 216.521.4400

Lorain ................................440.204.7400

Solon ................................. 440.519.6800

Sports Health on Chardon Road .....................440.516.5400

Sports Health at the JCC ...... 216.378.6240

Strongsville .........................440.878.2500

Twinsburg ............................330.888.4000

Westlake ............................440.899.5555

Willoughby Hills ..................440.943.2500

Wooster ............................. 330.287.4500

Family Health and Surgery Center

Family Health Center /Specialty Center

Assess and modify your lifestyleIdentifying and avoiding triggers of a migraine may be enough to ward off attacks. That’s why Cleveland Clinic head-ache experts urge patients to keep a daily diary noting such variables as diet, sleep schedule, travel plans and stress levels. Behavior modification may reduce or eliminate attacks.

Take a deep breathCleveland Clinic physicians encour-age migraine patients to manage stress through alternative approaches such as biofeedback, relaxation techniques, guided imagery and yoga. Physical therapy can reduce tension and strengthen muscles in the neck and shoulders, where migraine pain commonly spreads.

Exercise is another staple — but not during an attack, when it worsens pain. Adequate sleep is a must, but don’t push

it: Oversleeping on weekends may induce a headache. Patients trying to catch up on lost sleep during the week are advised to get up at the usual time on weekends and take a nap later if they feel tired.

Medicate if you mustWhen migraines are frequent or disabling, medication is essential. Preventive medi-cines come in dozens of varieties, from natural supplements like vitamin B2, magnesium and coenzyme Q10, to drugs originally developed for other conditions, including antidepressants, anticonvulsants and blood pressure medications. These can be taken daily to reduce the incidence and severity of migraines.

Preventive drugs often are combined with abortive or rescue medications, which are migraine-specific. Taken at the onset of a headache, they can stop it from becoming full-blown. ◆

If you suffer from headaches, Cleveland Clinic specialists can address your concerns:

Primary Care

n Dhia Aldoori, MD, Brunswick, Medina (pictured)

n Jeffery Kontak, MD, Brunswick, Strongsville

n Mini Spoorthi Velagapalli, MD, Independence

Neurology

n Mohammad Alsharabati, MD, Brunswick, Strongsville

Beat the Pain oF MIgRAINE

From drugs to deep breathing, doctors have an arsenal of weapons for fighting migraine headaches. While no surefire cure exists, most patients respond to treatment, often with a combination of therapies. Some possible headache triggers, such as weather changes, are uncontrollable. Even so, changing what you can control is preferable to taking medication.

Talk to a Cleveland Clinic Children's Hospital pediatrician if you are concerned about plantar warts.

n Dana C. Schmidt. MD, Wooster (pictured)

n Genevive Falconi, MD, Brunswick

n Diana R. Wasserman, MD, Independence

n Gary Williams, MD, Strongsville

Tread Lightly With Plantar Warts

Running around barefoot is a rite of summer. But like ants showing up to spoil the picnic, plantar warts can make an unwelcome and uncomfortable appearance on your kids’ feet.

Plantar warts resemble a cauliflower under the skin, with tiny black dots in their centers. They typically develop beneath pressure points such as the ball of the foot or the heel. Plantar warts differ from calluses in that they are painful when pinched.

Plantar warts are caused by the human papillomavirus (HPV). The virus gets in through tiny cuts and breaks in the skin, infecting the outer layer. Plantar warts may not appear for several weeks or months after infection. Pressure from walking around pushes the wart inward and a layer of hard skin can form over the wart. Left untreated, plantar warts can enlarge, spread from one location to another or develop into clusters. Eventually, they can become quite painful.

Slippery When WetThe virus that causes plantar warts thrives on wet surfaces such as shower floors, locker rooms and public swimming areas. Remind your kids to wear flip-flops in public places and never to share socks or shoes.

Sole SearchingIf your child is tender-footed, check the soles of both feet for signs of warts, such as:

• Small, fleshy or grainy bumps

• Hard, flat growths that have a rough surface

• Gray or brown bumps with black pinpoints

If you suspect your child has a plantar wart, don’t try to remove it at home. Plantar warts spread through direct contact. Visit a healthcare professional for diagnosis and treatment, which may include topical medications and pads, freezing (cryotherapy), or in stubborn cases, minor surgery. ◆

Kids Korner

4 Cleveland Clinic Family Checkup Summer 2010

Call for appointments with Cleveland Clinic Family Health Center primary care physicians and specialists at: Broadview Heights – 216.986.4000 Brunswick – 330.225.8886 | Independence – 216.986.4000 | Strongsville – 440.878.2500 | Wooster – 330.287.4500

Summer Vacation! Don’t Forget the…

If you’ll be spending time around the water with your children, play it safe. Drowning is the second-leading cause of death among children; toddlers and teens are at greatest risk. Never take your eyes off of a toddler near water, including wading pools. Out on the open water, always wear a life jacket and insist that children wear them dockside as well. CPR training for everyone — even your sitter — can ease your mind.

Dehydration can sneak up on you when you’re enjoying the outdoors. To avoid becoming dehydrated, you need to take in as much fluid as you lose. It’s easy to become overheated and forget to drink enough, but dehydration can lead to heat injury, ranging from mild heat cramps to heat exhaustion to potentially life-threatening heatstroke.

Whether you’re looking forward to romantic walks on the beach, hikes through the forest or rides at your favorite amusement park, you’ll need to treat your feet with care. All those months under cover have left your tender Cleveland feet vulnerable to cuts and blisters when they first see daylight. Pick a pair of sturdy athletic shoes that offer arch support.

Sneakers Water Bottle or Canteen Floaties

Visit a Cleveland Clinic International Travel Clinic or primary care physician for help in preparing for your trip.

n Tomas Gigena, MD, Brunswick, Medina (pictured)

n Kevin Hopkins, MD, Strongsville

n Ann Kelleher, DO, Independence

n Liza Dacio Talampas, MD, Wooster

Pack your prescription drugs in your carry-on luggage to ensure that you’ll have them on hand regardless of changing plans. And don’t forget a small bottle of pain reliever for unex-pected aches and pains during travel. An anti-inflammatory like ibuprofen or acetaminophen should do the trick. If you’re leaving the country, you increase your risk of illness by exposing yourself to diseases you wouldn’t encounter at home. A travel medicine specialist can offer recommendations.

Yes, you need your vitamin D. But after the first 15 minutes of unprotected tanning, it’s time to slather on the sunscreen. Any tan causes damage to your skin, including age-related effects such as wrinkles, brown spots and uneven pigmentation. More important, your risks for developing skin cancer increase when you tan. Cleveland Clinic dermatologists recommend SPF 45 or higher for trips to the beach and prolonged sun exposure, and daily SPF 30 for the face.

Sunscreen Medications & Vaccinations

clevelandclinic.org / fhc 5

A: Recent reports have drawn attention to a class of drugs called bisphosphonates (Fosamax, Actonel, Boniva and Reclast) commonly used to slow bone loss in post-

menopausal women. Some studies point to an increased risk of atypical thigh fractures in people using these drugs. The FDA has issued a statement saying that a preliminary review of the data does not show a clear connection between these drugs and fractures. A thorough study of any potential link is under way.

If you currently are taking these medications, don’t stop unless you are told to do so by a healthcare professional. Talk to your doctor if you develop new hip or thigh pain, or have any concerns about your medications, and report any side effects to your healthcare professional.

Preserve Bone MassOsteoporosis is a disease, and like many diseases, it is preventable. To preserve bone mass, avoid all tobacco products, limit alcohol intake, do weight-bearing exercises like walking, and get adequate amounts of calcium and vitamin D. Risks of bone fragility are

WOMEN ’ S HE ALTH

greatest after menopause, so supplement your diet with 1,200 mg of calcium and at least 400 to 800 international units (IU) of vitamin D starting at age 50. Most physicians recommend 1,000 IU per day in this part of the country, where exposure to sunlight is at a premium.

Begin bone-density screening at age 65, or sooner if you have risk factors such as a family history of osteoporosis, previous use of steroids or chemotherapy, smoking, or having already suffered a bone fracture. Screening every two to three years will detect any bone thinning. ◆

Q: I recently heard that osteoporosis drugs can actually increase the risk of fractures in older women. Should I stop taking this medication?

See a Cleveland Clinic women’s health specialist to discuss recommendations.

n Pelin Batur, MD, Independence (pictured)

n Irene Dejak, MD, Strongsville

n Jennifer Poptic, MD, Brunswick

n Jill Schaeffer, MD, Wooster

Cleveland Clinic urologists offer a full range of services.

n John J. Malgieri, MD, Wooster (pictured)

n George Coseriu, MD, Strongsville

“Our fertility is a snapshot of our health,” says Edmund Sabanegh, MD, Director of Cleveland Clinic’s Center for Male Fertility. “Anything you do that’s bad will hurt your fertility.”

Using anabolic steroids, for example, is one of the “worst causes” of infertility, according to Dr. Sabanegh, as it shuts down sperm pro-duction. It can take six months to a year after stopping steroid use for sperm production to begin again.

To improve your fertility, try these tips:

1.Take antioxidant vitamins such as E and C, which can help prevent oxidative stress, a chemical reaction that damages sperm.

2. Quit smoking, because smoking, in particular, can damage DNA in sperm and lower the number of them and their motility

(swimming ability). Within three to six months after quitting smoking, sperm usually return to normal.

3. Stress is a big factor, although it’s not always possible to rid our lives of it. The best ways to handle stress, according to

Dr. Sabanegh, are to get regular exercise, follow a healthy diet and find fun ways to relax.

4 Steps to Boost Male Fertility Naturally

4. Keep your cell phone out of your pants pocket – even if you have a Bluetooth in your ear. Studies conducted at Cleveland

Clinic have shown that the radio frequency electromagnetic waves emitted by cell phones may increase oxidative stress and decrease sperm motility, contributing to decreased fertility.

Male infertility has a myriad of causes, including problems with the sperm (shape, structure, motility or number), varicocele (a varicose vein in the scrotum), an undescended testicle, deficient testosterone, erectile dysfunction, genetic defects or infections, among other things. ◆


Ooh Baby: Back Pain Is Common During PregnancyPregnancy is a miraculous journey, but it brings its own share of aches and pains. Sure, added weight changes posture, putting new strain on the muscles in the back. But did you know that hormonal changes during pregnancy actually loosen the joints and ligaments that attach your pelvic bones to your spine, further compromising your back?

Avoid the acheSimple strategies can greatly reduce back pain during pregnancy:

• Focus on your posture. Standing up straight will ease the strain on your back.

• Wear low-heeled (but not flat) shoes with good arch support.

• Avoid lifting heavy objects, and always squat down with your knees bent when picking things up instead of bending down at the waist.

• Don’t stand for long periods. If you need to be on your feet for any length of time, place one foot on a stool or box for support.

• Sit in a chair with good back support or place a small pillow behind your lower back. Place your feet on a footrest or stool whenever possible.

• Check that your bed is firm. If it’s not, put a board between the mattress and box spring to improve support.

• Sleep on your side with a pillow between your legs, or use a full body pillow for support.

• Exercise to keep fit. Regular activity will keep your back strong and may actually relieve back pain. Talk to your doctor for recommendations.

End in sightFortunately, very few women — only about 15 percent — report low back pain at the first postpartum visit. ◆

Discuss any pain during pregnancy with your ob-gyn to be sure it isn’t caused by an underlying condition.

n Jessica Lukowski, MD, Wooster (pictured)

n Natalie Bowersox, MD, Brunswick

n Deborah Clark, MD, Independence

n Sharon Sutherland, MD, Strongsville

Sciatica mythWomen often complain of sciatica during pregnancy. But while back pain associated with pregnancy can radiate to the buttocks and thighs, it’s rarely true sciatica, which is caused by a herniated or bulging disk in the lower spine. Only about 1 percent of pregnant women suffer from sciatica.

Cleveland Clinic experts say there are two common types of low back pain in pregnancy: lumbar pain and posterior pelvic pain.

Lumbar pain in the lower part of the back right above the waist is the same pain a non-pregnant person would feel after sitting in the car for too long or moving too many heavy boxes. It can radiate to your legs and usually is worse at the end of the day.

Posterior pelvic pain is more common in pregnant women, and is felt even lower in the body than is lumbar pain. Some women feel it deep in their buttocks or on the sides or backs of the thighs, or even over the pubic bones.



Talk to a health care professional if you have nagging sinus or cold symptoms:

Ear, Nose & Throat Specialists

n Cristina Cabrera-Muffly, MD, Independence (pictured)

n Steven Ball, MD, Strongsville

Family Medicine

n Marc Williams, MD, Brunswick, Medina

Ear candling is a centuries-old practice purported to extract earwax and other impurities with the help of smoke or a burning wick. Manufacturers of ear candling systems claim they work by creat-ing a slow vacuum that softens and pulls the old wax into the base of the candle. Researchers say that candling does not produce a vacuum, and if it did, it would have to be so powerful to pull sticky earwax from the canal that it would likely rupture the eardrum in the process. Candling poses several additional dangers, the most serious of which involve burning caused by the hot wax.

ExPERT ADVICE: For most people, earwax moves along the ear canal and eventually makes it to the outside, taking with it any accumulated dirt or other matter. For those who are prone to earwax buildup, compacted wax should only be removed by a phy-sician or other health professional using legitimate instruments.

A Heads-Up on Home Remedies

Many patients with chronic sinus symptoms from bacterial infec-tions, allergies and environmental irritants use nasal irrigation devices such as the Neti pot to relieve congestion, sinus pain and pressure. Research has found that nasal irrigation can be an effective way to relieve sinus symptoms, since the saltwater thins mucus to help flush it out of the nasal cavities. The process also helps prevent bacterial growth.

ExPERT ADVICE: Cleveland Clinic Ear, Nose & Throat special-ists caution sinus sufferers to see a physician if sinus symptoms continue for more than a week to 10 days and include facial pain, discolored drainage and dental pain. These symptoms signal infec-tion that may require treatment with antibiotics.

The company that produces Airborne, a dietary/herbal supplement once touted to ward off the common cold, recently agreed to pay $23.3 million to settle a class-action lawsuit brought against them for falsely claiming it prevented colds. The popular effervescent formula, created by a second-grade teacher, contains a blend of zinc; ginger; Echinacea; and 13 other vitamins, minerals and herbs.

ExPERT ADVICE: While Airborne won’t prevent a cold, some of its key ingredients have been shown to support the immune system, so taking it certainly won’t hurt you.

Everyone gets a sore throat from time to time. That’s because the pharynx, the tube that extends from the back of the mouth to the esophagus, can become inflamed from infection or common irritants like dry air. Gargling can moisten a scratchy throat and offer temporary relief. Dissolve ½ teaspoon salt in ½ cup warm water, and gargle every three to four hours to cut phlegm and reduce inflammation.

ExPERT ADVICE: If a sore throat lasts for more than three days and is accompanied by fever, see a healthcare professional to rule out streptococcus pyogenes (strep throat). Strep is a bacterial infection that, left untreated, can lead to rheumatic and scarlet fever.

Fact or Fiction:

✔ FACT

✔ FACT

Neti pots clear impurities from the sinuses.

✘ FICTION

✘ FICTION

Airborne® prevents colds.

Ear candles relieve sinus pressure and pain.

Gargling with saltwater relieves sore throats.


Vitamin D: Good for Your Bones, Good for Your Heart?

If you have concerns about your heart health, see a Cleveland Clinic cardiologist.

n Lawrence Jacobs, MD, Independence (pictured)

n Joel Godard, MD, Brunswick

n Kenneth E. Shafer, MD, Wooster

n Terrence Tulisiak, MD, Strongsville

It’s well-known that low levels of vitamin D can weaken bones. But recent studies are raising concerns that vitamin D deficiency also may trigger other serious health problems, such as increased risk of heart disease.

The Framingham Heart Study, which began in 1948 and followed 1,739 participants who had no cardiovascular disease, found that study participants with low vitamin D levels had twice the risk of a heart attack, heart failure and stroke over five years compared with those who had higher levels. What’s more, dozens of other observa-tional population studies have shown the same result.

More answers neededCleveland Clinic experts caution that these results don’t prove that vitamin D reduces heart disease risk. New studies, including one sponsored by the National Institutes of Health, will seek to provide a definitive answer.

Hedge your betsThe percentage of people with healthy vitamin D levels has dropped from 45 percent in 1994 to 23 percent in 2004, according to the National Health and Nutrition Examination Survey. The survey also found that seven out of 10 children have low vitamin D levels. The elderly, people with dark skin, those who live in northern climates and those who do not get much sun exposure or use sunscreen, also

may be more prone to vitamin D deficiency. While scientists work to uncover the facts, why not take a proactive stance on D?

Sunlight is the best source of vitamin D, and 15 minutes of strong sun exposure on unprotected skin is safe for most people to get a healthy dose of D. Unlike the sun, most food sources do not produce high levels of vitamin D, so it’s impossible to get enough vitamin D from eating foods.

If your vitamin D levels are low, your physician may recommend that you take 1,000 to 2,000 international units (IUs) for several weeks. Patients with severe deficiency need 50,000 IU of vitamin D once a week for 12 weeks. When your vitamin D levels reach a normal level, your physician may suggest you consume a lower daily dose. ◆

What’s a hospitalist?A relatively new type of physician, hospitalists are general internists who dedicate their careers to studying and improving the safety and effectiveness of the care that takes place in the hospital. Because they spend all their time in the hospital, hospitalists are often much more familiar with the systems and functions required to take care of seriously ill patients. They are able to spend more time with each patient than are physicians making “rounds” of all their patients during lunch or on the way home from office hours.

Hospitalists communicate closely with each patient’s primary physician but handle care during time spent in the hospital. Cleveland Clinic employs hospitalists on the main campus and in several regional hospitals, and it has one of only eight hospital medicine training programs in the country. ◆

Ear candles relieve sinus pressure and pain.

Brian Harte, MD, Chairman of Hospital Medicine and Interim Chairman of the Medicine Institute



Strutting around in stilettos might not be a problem in your teens and 20s. But if you’re only looking at cute flats these days, you may be one of the more than 50 percent of American women who have bunions.

A bunion appears as a red bump or prominence at the base of the big toe on the inner side of the foot. But bunions are more than skin-deep. A bunion actually reflects a change in the anatomy of the foot over time. What starts as the big toe pointing toward the second toe ends up as a change in the actual alignment of the bones in the foot.

With at least six sets of muscles controlling each toe, it’s no wonder that cramming your feet into narrow, tight or high-heeled shoes can lead to pain.

To reduce your chances of developing bunions, keep these tips in mind:

• Choose footwear that conforms to the shape of your feet.

• Opt for shoes with wide insteps, broad toes and soft soles.

• Stay away from shoes that are short, tight or sharply pointed.

• Don’t wear heels higher than 2 ¼ inches.

• Never force your foot into a shoe that doesn’t fit.

See a Cleveland Clinic specialist if you have concerns about your feet.

Orthopaedic Surgery

n Kenneth Greene, MD, Brunswick (pictured)

Podiatry

n Allan Boike, DPM, Strongsville

n Nicholas Brown, DPM, Wooster

n Patrick McKee, DPM, Independence

If you’ve already developed bunions, try these nonsurgical approaches to relieve pain:

• Wear shoes that fit and have adequate toe room.

• Have your shoes professionally stretched.

• Use bunion pads or custom-made orthotics to cushion the area.

• Avoid activities that cause pain, such as being on your feet for long periods of time.

• Take over-the-counter pain relievers when necessary.

• Use ice to provide relief from inflammation and pain.

If nonsurgical treatment does not provide relief and you are having trouble walking or are in extreme pain, surgery may be necessary to return the big toe to its correct anatomical position. ◆

Function Beats Fashion in the Shoe Department



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Cleveland Clinic Family Checkup is published by the Division of Marketing and Communica-tions to provide up-to-date health information and news about Cleveland Clinic Family Health Center services. The information contained in Cleveland Clinic Family Checkup is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician’s medical assessment and medical judgment.

Editor: Marjie HeinesArt Director: Anne DragoPhotographers: Don Gerda, Tom MerceMarketing Manager: Melissa Phillips

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Allergies aren’t always to blame for burning, itching, gritty-feeling eyes. For an estimated 9 million Americans, the cause is dry eye, a condition in which the eyes don’t produce enough tears or the right quality of tears to keep the eyes lubricated and comfortable.

Combat burning, itching eyes and get year-round eye comfort with these tips:

1. Try artificial tears. The primary treat-ment for dry eye, artificial teardrops,

are available over the counter and may be water- or oil-based.

2. Add the right oil to your diet. Recent research shows that increasing your

intake of omega-3 fatty acids may act as a buffer against dry eye. Try foods like tuna, salmon, flax or hemp seeds, walnuts and canola oil, or take a standard-dose fish oil supplement.

3.Check your surroundings. If you leave the house feeling fine but arrive at a

destination with dry and itchy eyes, adjust the position of your car’s climate control vents away from your face. Forced heat and air conditioning decrease humidity. During weather extremes, run a cool mist humidi-fier in your bedroom.

4. Consider a prescription. When over-the-counter eye drops and home

remedies aren’t enough, prescription eye drops can help increase tear production, reduce eyelid inflammation or improve the quality of oil in tears.

5. Ask if surgery is an option. It may be necessary to close the ducts that drain

tears from the surface of the eyes. This simple procedure is painless. ◆What Causes Dry Eye?

While dry eye can affect men and women at any age, it is most common in women after menopause. Causes of dry eye include:

n hormonal imbalance

n malfunction of the eye’s tear-flow system

n inflammation

n overexposure to air conditioning and/or heating

n environmental factors such as smoke or wind

n certain over-the-counter and prescription medications

n contact lenses or laser eye surgery

Dry Eye Is Nothing to Cry About

Visit a Cleveland Clinic eye care specialist for vision correction or treatment of dry eye and other eye problems:

Optometry

n Anna Milburn, OD, Brunswick (pictured)

n Tim Milburn, OD, Brunswick (pictured)

Ophthalmology

n Jonathan Eisengart, MD, Strongsville

n David Sholiton, MD, Independence


The Cleveland Clinic Foundation Family Checkup 9500 Euclid Avenue / AC311 Cleveland, OH 44195

10-FHC-008

South Side Bulletin Board

Free Community Health TalksWomen’s Health June 15, 6:30 – 8 p.m., Wooster Specialty Center

Digestive Health Sept. 8, 6:30 – 8 p.m., Independence

Heart Health Oct. 7, 6:30 – 8 p.m., Strongsville

Women's Health Oct. 20, 6:30 – 8 p.m., Brunswick

For information about other Health Talks or to make a reservation, call 216.444.3641 or 800.548.8502; or visit our website at clevelandclinic.org/healthtalks

Health Talks are subject to change.

Watch Us Grow Brunswick welcomes several new staff members: Gillian Culbertson, RD, Dietician; Kenneth Greene, MD, Orthopaedic Surgery; Robert Heyka, MD, Nephrology; and Sameh Yonan, MD, Pain Management.

Ob/Gyn and women’s health specialist Rebecca Bagley, MD; and pediatric sleep specialist Jyoti Krishna, MD, are now seeing patients in Independence.

Wendy Cunningham, PsyD, Pediatric Clinical Psychology, has joined the staff in Strongsville.

Wooster welcomes ophthalmologist Scott Stiener, MD.

Cleveland Clinic Staff in MedinaSeveral Cleveland Clinic staff members now see patients at the Medina Medical Office Building, next to Medina Hospital, including primary care physicians in Family Medicine and Internal Medicine, and specialists in Orthopaedics and Pain Management.

Tour de Solon Bike Ride Returns Take a scenic ride around the city of Solon during the second annual Tour de Solon, June 19. Hosted by the Solon Family Health Center, the event offers three courses of different lengths to accommodate riders of all skill levels. All courses begin and end at the Solon Family Health Center at 29800 Bainbridge Road in Solon. For more information or to register online, visit clevelandclinic.org/tourdesolon

“Living Well on Anticoagulation Therapy”An evening course taught by a team of experts with special knowledge about anti-coagulation therapy and management. This course will cover a number of items that will help you live safely and well while on anticoagulation therapy.

Monday, June 24 and Monday, Oct. 18, 6:30 – 8 p.m., Independence Family Health Center, Conference Room A. Register by calling 216.986.4000 or visit clevelandclinic.org/anticoagulation

Cleveland Clinic continues to expand and improve electronic medical records (EMRs) to provide faster, more efficient and accurate care as patient data is whisked through a highly secure network. Whether you are seen on our main campus, at one of our regional hospitals or at a family health center, your healthcare team has instant access to your medical record.

You can take an active role in your healthcare by signing up for MyChart. All you need is Internet access and an email account.

Learn more at clevelandclinic.org/mychartinfo.

MyChart: Your Personal Health Connection

While the Twinsburg Family Health and Surgery Center is under construction, Cleveland Clinic Twinsburg Medical Offices provide medical care to Twinsburg and surrounding communities. Several of Cleveland Clinic’s top-ranked specialty services, as well as primary care, are offered, including:

• Ophthalmology• Ob/Gyn• Women’s Health• General Surgery • Neurology

• Neurosurgery • Oncology • Pain Management• Rheumatology• Vascular Surgery

For more information about Twinsburg Medical Offices, located at 2365 Edison Boulevard, Suite 100, visit clevelandclinic.org/twinsburgcarenow or call 330.888.4000 to schedule an appointment.

Now Open: Cleveland Clinic Twinsburg Medical Offices

time to be well - cleveland clinic full-time in a busy office, didn’t ... pediatrics, pediatric...

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