CJN.ORG | CLEVELAND JEWISH NEWS | 33
SEPTEMBER 9, 2016
HEALTH
Read more health news at cjn.org/health
Never too little and never too late for exercise
T
DR. DANIEL FLEKSHER
he Summer Olympics have come and gone, it is already past Labor Day and cooler weather is certainly just around the corner, and yet, for many, those extra pounds we were planning to lose or that body we were hoping to achieve never quite came to fruition.
I consider this a “dangerous” time because I often hear patients start talking about “next year” in regard to getting the exercise they need. Some of it is motivation; a lot of it is the perception that proper exercise can only be done outdoors. Obviously, from my perspective as a doctor and a strong advocate for regular exercise, this perspective is troubling, and I have spent much time trying to find ways to motivate my patients as well as realistic means and planning to perform the right type and amount of exercise. Living in Cleveland, we can’t afford to be workout warriors for less than half the year, waiting for the right weather. Fortunately, the belief that exercise is only worthwhile if performed for hours
at a time is easily shattered. Numerous studies have been done and continue to be done looking at the minimum amount of time needed to see a health benefit from exercise. It seems that almost any amount of exercise will benefit one’s health with increased benefit coming from increased exercise. In general, I recommend getting into a routine of exercising regularly, experiencing the numerous health benefits including improved sleep and clearer cognition, far above and beyond any specific time prescriptions. More than anything, I try to find ways around the “all or nothing” personality by setting the bar low initially and letting the benefits of exercise sell themselves.
While I frequently hear that the weather is not conducive to walking or that going to the gym takes too much time, in reality, an invigorating exercise routine can be performed in one’s home without any equipment at all. There is now a plethora of apps that can be downloaded to one’s smartphone with exercise routines ranging from casual five-minute workouts to intense 25- to 30-minute challenges. Set goals and utilize rewards. Have a favorite TV show? Try to get your workout in before the show starts or choose a workout and do some short intense bursts during commercials and stretch and work on balance while the show is on. Finally, don’t ignore the core. The core muscles of the body refer to the musculature of the back, abdomen and pelvic region and are crucial to balance and stability. Back pain is one of the
most common reasons for acute doctor visits, but may be preventable simply by keeping the core strong. Exercises can be found online, but generally consist of crunches/sit-ups, back bends, and planks. So don’t wait for the “perfect” time. Make your time “perfect” by choosing to fill it with all of the things that are important to you. Start now, have fun, get a friend or significant other involved so you can motivate and feed off of each other. If you have any health conditions or are unsure whether or not you are healthy enough to start an exercise program, make sure to see your doctor first.
Dr. Daniel Fleksher is an internist with University Hospitals’ Beachwood Internal Medicine Associates. Follow Daniel @DrFleksher on
Lack of primary care physician can lead to nightmare DR. IRA TAUB itaub@chmca.org
I
n my recurring nightmare, it is a beautiful August afternoon and I am seeing a well-dressed student who just wants to play freshman soccer. I sift through a short stack of photocopied medical records and spot a onepage referral, signed by someone I do not recognize, that says “irregular heart rhythm – needs clearance for sports.” After a few minutes spent interviewing and examining him, it is abundantly clear that nothing is wrong with his heart. I give him the good news and he thanks me graciously.
Then I turn to his mother and say, “I want to talk to you about the episode of chest tightness from a few weeks ago. This has nothing to do with his heart, but problems like asthma and anxiety are common at his age. Have you ever discussed that with his doctor?” She shakes her head. I also noticed that he winced when I touched his right shoulder. Does his doctor know that the injury from spring soccer still hurts? Blank stares from both of them. I sigh, print out a sports clearance letter (which he clutches like a prize) and wish him luck during the upcoming school year. I console myself with the thought that I can still pass along my concerns to his physician. As I sit down in front of his electronic medical record,
a little corner of the screen flashes “No PCP” – no primary care provider. There are many real-world versions of this child – a good student from a middleclass family who has not seen his own pediatrician in several years. He is basically healthy, and when the need arises for a sports physical, he simply goes to the local pharmacy chain. His parents can count on little or no wait time, a predictable cost for the visit and someone behind the desk who, although he doesn’t know him from a hole in the wall, wears a well-starched white coat. A 15-minute visit there is more than enough time to ask a few scripted questions, perform a cursory physical exam and refer to a specialist if anything seems out of line. In his case, the “irregular heart rhythm” which necessitates
an expensive and time-consuming visit to the pediatric cardiologist is actually a normal physical finding. In a good primary care, pediatrics or family medicine practice, the heart exam would not have been flagged as abnormal, and the more concerning issues, like an injury that will not heal, would likely have gotten appropriate attention. Why would a kid from a family that can afford nice clothes and fancy athletic shoes not see his regular doctor? A short study recently published in the journal JAMA Pediatrics shows that, while well over 90 percent of children have a primary care doctor, there are significant financial barriers to seeing that doctor that tend to hit middle-class families hardest. That study demonstrates that out-ofpocket annual costs for children with private health insurance have risen about 20 percent over the past 10 years. Many companies have moved their employees to high-deductible health plans, which have lower premiums but require more costs of care to be borne by the patient. In a recent survey administered by the American Academy of Pediatrics,
pediatricians report that 20 percent of families now forego preventive care visits and over 50 percent have reduced follow-up visits. It is easy to understand the appeal of a service that is quick, convenient and probably won’t cost more than $75. Good primary care, like good bridge design, is seldom noticed when it is functioning well. However, when care is fragmented and the continuity of the physician-patient relationship is disrupted, problems will eventually happen. Potentially life-threatening illnesses will be diagnosed later than they should be, perhaps too late. Children with developmental and educational delays will not receive the intervention that they need. Non-problems will prompt expensive and wasteful diagnostic testing, while real problems fester. When it comes to primary care, children deserve better than 15 minutes in the back of a drugstore.
Dr. Ira Taub is a pediatric cardiologist for Akron Children’s Hospital Heart Center who sees patients in multiple locations throughout Northeast Ohio.
34 | CLEVELAND JEWISH NEWS | CJN.ORG
Medworks clinic to be held Oct. 1
Medworks will host a medical clinic from 8 a.m. to 2 p.m. Oct. 1. Free medical exams and women’s health exams will be provided. The clinic will take place at MetroHealth Cleveland Heights Medical Offices, 10 Severance Circle in Cleveland Heights. For more information, call 216-231-5350 or email info@medworksusa.org.
SEPTEMBER 9, 2016
Arthritis expo in Akron Sept. 14
The South Arthritis Expo is set for 9 a.m. to noon Sept. 14 at Cleveland Clinic Akron General Health & Wellness Center-Bath, 4125 Medina Road in Akron. Doors open at 8:30 so visitors can view exhibits. Co-sponsored by the Arthritis Foundation and the clinic, the free event aims to present the latest news about arthritis, the nation’s leading cause of disability. More than 50 million Americans, including 300,000 children, live with arthritis. In Ohio, 2.6 million are affected. Topics to be covered include information about different types of arthritis, joint replacement, physical therapy and foot problems.
HEALTH
Weils to offer health series
The Weils, a Montefiore senior living community, will host a three-part community health series this fall. The series kicks off from 1:30 to 3 p.m. Sept. 15 with “The Aging Eye.” Lisa Cellura, manager of community engagement for the Cleveland Sight Center, will discuss how to deal with common vision challenges for older adults. Ben Rossi, founder and director of physical wellness for InMotion, will discuss “Living with Movement Disorders” from 1:30 to 3 p.m. Oct. 20. The series concludes from 1:30 to 3 p.m. Nov. 17 with “Eat, Treat and Move Your Feet: Tips to enjoy the holidays when you have diabetes.” In honor of National Diabetes Awareness Month, Rose Ann Chiurazzi, a certified diabetes educator and nutritionist for the Diabetes Partnership of Cleveland, will provide tips on which foods can be enjoyed and which should be limited in order to keep diabetes in check. Each program is free and open to the community. The Weils is at 16695 Chillicothe Road in Bainbridge Township. For more information or to RSVP, contact Ivy Kopit at 440-996-0504 or ikopit@theweils.org.
Lake Health revives home visit tradition
Lake Health has begun offering in-home primary care through its Lake Health House Calls program. Lake Health House Calls is designed to address the needs of the elderly and people with a debilitating condition who may have trouble getting to a doctor’s appointment. The goal of these house calls, explained Michele Pirc, director of Advanced Practice Providers at Lake Health, is to reduce hospital readmissions and improve patient outcomes, according to a Lake Health news release. “Because we’re able to spend a significant amount of time with patients at their homes, including assisted living and long-term care facilities, we can deliver a level of care not possible in an office setting,” Pirc said. “Depending on a patient’s needs, we can provide everything from prescribing medications and removing stitches to ensuring they understand their treatment plans and discharge instructions.” For more information about Lake Health House Calls, call 440-255-5571.
Tri-C care center reopens
“They encouraged me, but weren't too pushy. They would knock on the door every day and gently persuade me to go to rehab. Without a doubt, I will be back at the center after my knee replacement.”
Effective Care
- Melinda J. / Cleveland, Ohio
5625 Emerald Ridge Pkwy. Solon, Ohio 44139 . (440) 498-3000
The Community Health, Wellness and Preventative Care Center at the Metropolitan Campus of Cuyahoga Community College reopened Sept. 6. The center provides low-cost health care services to uninsured or underinsured adults while it gives Tri-C health career students opportunities to learn and train in a clinical setting. The center will be open from 2 to 5 p.m. Tuesdays and Thursdays through Nov. 17. The center is taffed by those studying to be medical assistants, physical therapy assistants, occupational therapy assistants and dietetic technicians. It is in Room 205 of the Health Careers and Science Building, 2900 Community College Ave. in Cleveland.
HEALTH
CJN.ORG | CLEVELAND JEWISH NEWS | 35
SEPTEMBER 9, 2016 ADVERTISEMENT
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Welcome Adrienna Jirik, MD Gastroenterology and Hepatology Dr. Jirik has joined Consultants in Gastroenterology in Cleveland Clinic’s Digestive Disease and Surgery Institute. She treats a range of digestive and liver disorders. Her special interests include: • • • • • • •
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Dr. Jirik sees patients in the Hillcrest Hospital Atrium Medical Building. To schedule an appointment with her, call 440.461.2550. To learn more about Consultants in Gastroenterology, visit clevelandclinic.org/CIG. Cleveland Clinic offers same-day appointments.
8/23/16 10:51 AM
36 | CLEVELAND JEWISH NEWS | CJN.ORG
SEPTEMBER 9, 2016
HEALTH
Logging MET minutes key to maximum health benefits MICHAEL F. ROIZEN
W
YouDocs@gmail.com
hat is the maximum health benefit from physical activity alone, discounting diet and the exercise you have to do to reach that maximum?
After examining 174 studies of the effect of physical activity on breast cancer, colon cancer, diabetes, heart disease and stroke, researchers involved in an article published by the University of Washington in Seattle discovered that maximum – you can reduce the likelihood of many cancers, heart disease and stroke by 25 percent by just doing physical activity (the odds drop 80 to 90 percent in three studies we have of people who did this physical activity, ate a Mediterranean diet in portions that kept their waist less than half their height, practiced routine stress management and avoided toxins like tobacco and excess alcohol). The minimum activity for maximum health benefits comes from about 4,200 metabolic equivalent of task, or MET, minutes a week, which translates to just 10,000 steps a day, 30 minutes of resistance training (moving weights against gravity) and 20 minutes three times a week of sweating activity. With that you get about 4,200 MET minutes a week, the amount that makes many cancers, heart disease and stroke 25
percent less likely. Metabolic equivalent task, the gauge researchers used to evaluate the benefits of kickin’ up your heels, is an approximate measure of how many calories are burned during any given activity. The World Health Organization recommends that adults get in a minimum of 600 MET minutes weekly, or about 30 minutes of moderate activity daily. The researchers also discovered that increasing your MET minutes from 600 to 3,600 a week reduces the risk of diabetes by an additional 19 percent, breast cancer by 14 percent, colon cancer by 21 percent, heart disease by 25 percent, and stroke by 26 percent. And you don’t have to spend six times as much time working out to hit 3,600 METS. You just have to get smart about it by choosing activities that have higher MET values and adding a bit more time. We’re particularly fond of a walking routine that incorporates interval training. We recommend puff-hard-can’t-talk effort with periods of recovery: Step up your walking pace for four minutes, then take it easy,
walking more slowly for three minutes. During your 30-to-60- minute walk, you can repeat this sequence at least two to three times . But while that’s substantial, we know you can do even more for even more lifeimproving results. In the study, the diseaserisk-reducing benefits of increased activity reached the maximum benefit near 4,200 MET minutes a week – about 10,000 steps (including 20 minutes of cardio activity you can get with interval walking) and 40 jumps a day, plus 30 minutes or more of resistance training, using light hand weights or stretch bands, every week. Eight thousand MET minutes give you only 2 percent more benefit than 4,200. You can start by writing yourself a prescription with these action steps: • Buy two pedometers so you’ll always have one; • Buy some great walking shoes; • Find a walking buddy. Start walking; • Start scheduling physical activity into your daily calendar. Do it – and keep doing it; • Start seeing if you are hitting the 10-thousand-a-day minimum for maximum
health. If not, increase walking by 10 minutes each week. Each day of the week should be 10 minutes or 5 percent more than the previous week’s average until you get to 10,000; • Buy a jump rope and start learning how to do 20 jumps every morning before you start your car; • Get up from your desk and walk for two minutes every hour. How can you step it up? Measure all your activities, including walking, stair climbing, vacuuming, gardening, running or cycling. Then do the math. For a complete MET chart, Google “NCI MET chart” (NCI is the National Cancer Institute). Add up your achievements. It may surprise you how much you do. By the end of the week, you’ll see just how great you feel.
children to protest being dropped off at school on the first day, and sometimes for several days. Anxiety disorders that regularly interfere with living – that keep children home from school, or get them sent home, for example – are also common. They affect perhaps one child in 20. Anxiety disorders often run in families. Genes have a lot to do with it, as does learning. Anxious parents teach their children to see the world as a dangerous place. By overprotecting, they also deny their children opportunities to face challenges and gain confidence. When parents regularly catastrophize, children learn to do the same. If children learn to be anxious, they can also learn to cope with anxieties. Let your child hear your own rational thought processes as you deal with uncertainty. Tell stories about children who faced scary things, like a dark forest or a new school. Let your child deal with the things that you know he can deal with. Limit over-exposure to the endless flow of television news about
disasters. For young children, images on TV can be very real, so a trauma far away can feel like it is happening right at home. Help your child to notice when he’s listening to his “worry voice” and to challenge those unrealistic fears. How many times has the house burned down (never); how often has the family moved without warning (never); when was the last time he saw a rhino outside of the zoo? Lots of children struggle with separation anxiety, especially in September. If your child has symptoms that are severe or persistent, or if you recognize these symptoms in yourself, seek help. Anxiety is very common, but also very treatable.
Dr. Michael Roizen writes about wellness for the Cleveland Jewish News. He is chief wellness officer and chair of the Wellness Institute at Cleveland Clinic. Follow him on @YoungDrMike.
September brings separation anxiety DR. ROBERT NEEDLMAN
F
rneedlman@metrohealth.org
or many children, September is the anxious month. With the return to school, forgotten fears rise up like ghosts under the full moon.
Will the teacher yell at me? Will I have friends? Who will eat lunch with me? Will I be able to go to the bathroom when I need to? Will I be smart enough, popular enough, good enough? Fears like these give many children headaches and stomach aches which are real, although bred in the imagination. Staying home “cures” the symptoms, but they tend to come back stronger the next morning. Another class of anxieties focuses not on what is ahead, but on what is being left behind. In separation anxiety, the unrealistic worries often circle around the parents: what if mom gets sick and I’m not there to help her? She could go out shopping and get lost coming home. The house could catch fire. What if my family moves? Worries that are best expressed with an excess of !! and ?? have a name in psychology: catastrophizing. (Fans of children’s literature might remember the beginning
of Roald Dahl’s classic, “James and the Giant Peach.” James’ parents were eaten by a rhinoceros!) Some children with separation anxiety feel sick; others act angry. When I hear about young children who are turning over desks or throwing chairs – actions that result in parents being called to pick them up – I wonder about separation anxiety. Getting sent home may seem like a punishment, but it’s actually a reward if it brings relief from intolerable fear. Children are almost never able to explain their motives in words, but they nonetheless learn to act out in outrageous ways in order to feel better. Anxiety is normal and necessary. Every child feels at least a little anxious sometimes. Anxiety is what makes the infant scan her mother’s face to see if the stranger is safe. It’s what makes the toddler who has just learned to run slow down and look around for his mom. It’s normal for young
Dr. Robert Needlman writes about pediatrics for the Cleveland Jewish News. He is a pediatrician and child development specialist at The MetroHealth System. He is the revising co-author of “Dr. Spock’s Baby and Child Care,” eighth and ninth editions, and is the author of “Dr. Spock’s Baby Basics.”