HEALTH Focus

OPHTHALMOLOGY Gregory Eippert, MD

Q: What is the difference between being visually impaired (or having low vision) and being legally blind? A: The terms visually impaired and low vision are often used interchangeably and encompass a great range of visual abilities and disabilities from mild to severe. Visually impaired/low vision is defined as permanently reduced vision, visual acuity of 20/70 or worse, that cannot be corrected with regular eyeglasses, contact lenses, medications, or surgery and that affects a person’s ability to perform their usual daily activities. Low vision may be the result of a birth defect, injury, stroke, age, or the complication/progression of an eye disease such as macular degeneration or glaucoma.

Legal blindness is a classification developed by the U.S. government to determine eligibility for vocational training, rehabilitation, schooling, disability benefits, low vision devices, and tax exemption programs. A legally blind person is anyone whose vision cannot be corrected to better than 20/200 in the best eye or who has a visual field of 20 degrees or less. Visual field refers to what one can see to the sides, above, and below when looking straight ahead and without moving their head. The normal visual field range is 190 degrees.

Few people today are totally without sight. In the United States, it is estimated that 85% of all individuals with eye disorders have some remaining sight and approximately 15% are totally blind. Most visually impaired people have some usable vision and, with the help of low vision aids, can make the best use of that vision.

Given these definitions and parameters for visual impairment and legal blindness, there are a number of variances and variables. For instance, it is possible to be legally blind in one eye and visually impaired in the other. And, it is possible to have good visual acuity and a decreased visual field and vice versa. When it comes to the assessment of visual impairment and legal blindness, it is helpful to remember that visual acuity is not the only indicator for these conditions but the visual field and person’s functionality with everyday tasks must also be considered.

Measuring a person’s vision to determine the level of visual impairment is important for many reasons: from prescribing eyeglasses and other optical or low vision devices, to determining benefits for which one might be eligible, to safety concerns and issuing driver’s licenses, and to helping the individual with a visual impairment improve their quality of life as much as possible. Gregory Eippert, MD 9485 Mentor Ave., #110, Mentor 44060 440-255-1115 www.opivision.com

PLASTIC SURGERY Paul Vanek, MD, FACS

Q: I hate my double chin… does Kybella really work? A: Yes! Kybella was approved by the FDA in 2015. Designed to be an alternative to liposuction or surgery, it uses a synthetic version of deoxycholic acid to destroy fat cells. In our digestive tract, deoxycholic acid is a naturally occurring molecule that aids in the breakdown and absorption of dietary fat. When a trained health professional injects Kybella into subcutaneous fat, it can break down fat in targeted locations. Over a period of several weeks, both the dissolved fat and deoxycholic acid get cleared into the lymphatic and circulatory systems, and excreted as waste. Best of all, once destroyed, these cells can no longer store or accumulate fat, so further treatment is not expected once patients reach a desired aesthetic goal.

The most common application for Kybella is to improve the appearance and profile of moderate to severe fat below the chin. The medical term for this is “submental fat,” which you and many people call a “double chin.” Many people feel that this condition makes them look older or heavier than they actually are. It can develop for some people even if they eat well and exercise. Kybella is the first and only FDA-approved prescription medication that can treat this condition, and avoid surgery. Results are typically noticeable in only a few weeks.

During a 15 to 20-minute treatment, patients receive multiple small injections under the chin. Treatments are one month apart, with the total quantity dependent on the amount of fat that a patient wants to remove to achieve their desired profile, with a maximum of six treatments. Dr. Paul Vanek M.D., F.A.C.S. Vanek Plastic Surgery 9485 Mentor Ave #100 Mentor, OH 44060 440-205-5750 www.MentorPlasticSurgery.com Accepting new patients for non-intrusive and surgical cosmetic and reconstructive solutions

AUDIOLOGY Robert J. Otto Au.D.

Q: Immunize Your Hearing? A: Some health conditions that endanger your hearing and overall health are unavoidable, but others can be prevented. One of the best preventative steps is making sure all of your vaccinations are still effective, and getting boosters or new vaccinations as recommended by your primary care physician. The following are some common diseases that could put your hearing at risk and the vaccinations available to prevent them. As always, consult your physician for more detailed, personalized information and recommendations. Pneumonia (pneumococcal disease)

Pneumococcal disease comes in many forms and can affect more than your lungs. More than half of middle ear infections are the result of pneumococcus bacteria, and severe forms of the disease can cause permanent hearing loss. The pneumococcal conjugate vaccine protects against 13 forms of pneumococcal bacterial infection. The PCV13 vaccine is effective for adults 65 years and older, or adults under 65 with weakened immune systems. A different vaccine, PPSV23, protects against 23 forms of the bacteria and is intended for all adults 65 years or older deemed at higher risk of pneumococcal bacterial infection. Meningitis

The bacterial form of this disease has been associated with hearing loss due to inflammation damaging the cochlear nerve that conducts sound from the ear to the brain for processing. Two kinds of meningitis vaccines are currently recommended by the Center for Disease Control (CDC) to protect at-risk adults against meningitis: • Meningococcal conjugate • Serogroup B Ask your physician about getting vaccinated to find out if you are in a group deemed “at-risk” of contracting meningitis. These groups include (but are not limited to) those planning to travel overseas, entering the military, or diagnosed with an immune deficiency. Measles/Mumps/Rubella

Measles can lead to several complications, including ear infections resulting in partial or complete hearing loss. Women who contract rubella (also known as “German measles”) in the early stages of pregnancy can pass the virus to the fetus, leading to birth defects that include deafness. A mumps viral infection can damage the cochlea (inner ear) and cause hearing loss or complete deafness in one or both ears. Whooping Cough (pertussis)

Irreversible hearing loss is among the potential complications from whooping cough. You should have received your first DTaP (diphtheria, tetanus, and pertussis) vaccine as part of a five-dose schedule administered again at ages two, four, six, and 15. A booster is available for adolescents and adults called Tdap (Tetanus, diphtheria, and pertussis) for anyone who didn’t get it as a preteen or teen. Expectant mothers should also receive a Tdap dose between 27 to 36 weeks of pregnancy. Even adults who received DTaP and Tdap vaccinations and boosters on schedule should receive a tetanus and diphtheria (Td) vaccine every ten years. Chicken pox (varicella zoster)

The chicken pox virus can damage hearing in children and adults. Older adults who had chicken pox in their youth may lose their hearing if the virus reactivates as shingles or as Ramsay Hunt syndrome. Two doses of the varicella vaccine are recommended for children, adolescents, and adults. Consult your medical history or ask your physician if you received a combination vaccine for measles,

mumps, rubella and varicella (MMRV) between the ages of 12 months and 12 years old. The shingles vaccine (brand name Zostavax®) is recommended if you’re over 60 regardless of whether you know for certain you had chicken pox or not. A surprisingly large number of people contract chicken pox at some point in their lives without ever realizing it. Flu (influenza)

Any temporary hearing loss due to influenza is usually the result of congestion and will go away once you recover. However, in some cases the virus attacks your ears directly, resulting in sudden and sometimes permanent hearing loss. Unlike the other vaccine options described above there are multiple seasonal flus, including H1N1 (i.e., “Swine” flu), H3N2 (i.e., “Dog” flu), and more. Each year the CDC calculates which flu viruses are likeliest and recommends appropriate vaccines based on that data. They generally suggest everyone six months or older receive a flu vaccine at the beginning of every flu season (starting in the fall through winter). Robert J. Otto Au.D. Earmark Audiology, LLC Mentor Medical Campus 9485 Mentor Ave. Mentor 44060 440-255-1800 www.earmarkaudiology.com

INSURANCE Laura Mutsko Agent, CSA and Certified Healthcare Reform Specialist

Q: What can I do to make the most of my health insurance before the end of the year?

A: Fall is a good time to take a look at where you stand with your health insurance benefits. There are some benefits you will lose if you do not use them before the end of the year. Here are a few tips to help you make the most of your insurance. Dental Benefits

Maxing out benefits is especially important when it comes to dental coverage. Most Medicare Advantage plans with dental coverage as well as other dental plans often provide a set amount of coverage that goes away if it is not used. For example, if you don’t get that second cleaning in December, it doesn’t mean you can get three cleanings the following year. The problem arises when dentist get booked as everyone tries to use up their benefits before they lose them. If you have benefits remaining, schedule your appointment for routine exam and cleaning now, before the end-of-the-year demand for appointments begins. Vision, Hearing and Podiatry Benefits

Check whether your insurance covers vision, hearing and/or podiatry care. You may be covered for an exam or a set number of visits each year. If you are in the market for any of these services, contact your insurer for a list of their preferred providers and ask what insurance savings you are eligible to receive annually. Don’t leave these benefits on the table. Medicare Plans

If you have not yet had your annual Medicare physical, make an appointment for it now. Your physician will update any immunizations and order any tests and screenings you need. If you have already met your deductible for 2017, your share of the costs will be minimal. ANOC

Before the end of September, you will receive your Medicare Advantage Plan’s Annual Notice of Change or ANOC. The ANOC outlines all changes you will see in your plan for the following year including changes in cost, coverage, network providers and pharmacies. If you find significant changes and would like to look at plans offering more comprehensive coverage, please call me at 440-255-5700 or email me at Lmutsko@mutskoinsurance.com. We will schedule an appointment to discuss your needs once Medicare’s Open Enrollment begins on October 15. For most of us, the time between November 1 and January 1 is an extremely busy period. Why not check these items off your list of things-to-do now, before the end of the year rush. Laura Mutsko Mutsko Insurance Services, LLC 6982 Spinach Drive, Mentor, OH 44060 440-255-5700 www.mutskoinsurance.com

DENTAL CARE Jeffrey Gross, DDS, FAGD

Q: How Long Should My Teeth Last? A: That’s a great question. Those of you who are regular readers probably know the answer to that. So let me put that aside for right now and ask you a question. “How Long Will You Last”? I don’t what to appear morbid, but of course it is a legitimate question. In the Global Burden of Disease 2015 Study, dietary factors were the biggest cause of death in the U.S. That’s right! In the richest and most prosperous country the biggest cause of death was the way we eat.

In fact, according to a 2013 report from the Union of Concerned Scientists, an organization that has been around since 1969, increasing our consumption of fruits and vegetables could save more than 100,000 lives and $17 billion in health care costs from heart disease each year. Foods that age us are typically acidic. We in the United States can call these fun foods. They are fun and appealing because we have made them the main foods in our diet. Sugary foods and refined grains, processed foods, and red meat. All of these foods are showing up in association with many diseases. Our biggest epidemic...the epidemic of plenty has resulted in too many people being too obese. In fact the medical community has called obesity a disease in and off itself. Following along the same lines, heart disease and diabetes with their associated problems have changed happy and productive lives to a treadmill of doctor and hospital visits. Daily pills are the norm, not the exception. We can’t stop aging, but we can control to an extent the quality of life as we age. This has been shown in many societies around the world who age much differently than we do.

Dr. Michael Gregor, a leading physician who emphasizes nutrition as the best medicine, echoes this sentiment. He discusses and recommends plants and fruit to stave off many diseases. Many plants have an anti-platelet effect on our system. Platelets cause the blood to become sticky and clot. Clots in our arteries cause heart attacks and strokes. This is one of the reasons that many of my patients take a baby aspirin daily. This reduces the platelet activity and makes the blood “thinner”. Isn’t it amazing that plants will do this also, without any possible stomach issues as are those associated with aspirin. Strawberries and other berries will lower activated platelets. These activated platelets are loaded with inflammatory chemicals. So just with eating more fruits and vegetables we can potentially reduce or limit many debilitating disease that are associated with the epidemic of plenty.

Now we know the answer to our initial question. Your teeth should last your entire life. The reason is very obvious. If we want to live a long and vital life, we need to have a diet that is plant centric. The majority of our plates should be filled with whole grains, vegetables, legumes, nuts and berries. To consume these teeth, we need strong and healthy teeth. First of all this type of diet eliminates most foods that really attack our teeth via their associated stickiness. These sticky foods attract a load of bacteria and the acid that they produce. That’s a fast track to dental cavities. Noninflammatory foods allow our bodies to have greater resistance to disease in general. This translates into healthy gums and strong supporting bone. Grinding efficiently and chewing these fiber filled foods properly requires healthy teeth and gums. In the event that a tooth is broken, it needs to be fixed. In the event a tooth is lost, it needs to be replaced. Our mouth can be a very efficient machine if we take care of it properly. Unfortunately, many people take care of other machines in their lives better than their mouths. Not only is this disastrous for our oral health, it is detrimental to our general health.

If it has been a while since you had your teeth checked and evaluated to ascertain their level of health, don’t hesitate to call me. I can be reached at 440.951.7856. Megan will answer the phone and point you in the right direction.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine. The Healthy Smile 34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, Ohio 44118 216-371-2333 www.jeffreygrossdds.com