HEALTHFocus

Michael Kirsch, MD, FACP

Q:Colon Cancer Risk Factors…What Can We Control?

A:Colon cancer is one of the leading causes of cancer death in the United States. On average, your chances of developing colon cancer are 1 in 20, but your individual risk depends on several factors. At the end of this piece, I will provide BREAKING NEWS on this important issue. Colon Cancer Risk Factors Beyond Our Control • Age — Nine out of ten new cases of colon cancer develop in individuals over the age of 50. • Personal or Family History of Colon Cancer or Colon Polyps • History of Inflammatory Bowel Disease (IBD), such as Crohn’s Disease or Ulcerative Colitis • Inherited Syndromes — There are uncommon inherited conditions with very high colon cancer risk that need aggressive screening • Ethnic Background — African Americans have the highest colon cancer incidence and mortality rates in the United States. Colorectal Cancer Risk Factors We CAN Control • Being Overweight — If you struggle with weight, especially around your waistline, you are at higher risk for colon cancer. • Sedentary Lifestyle • Diet —Replace high-fat and processed foods with fresh fruits and vegetables, whole grains and lean proteins. • Smoking — Smokers have increased colon cancer risk along with lung cancer and other serious illnesses. • Heavy Alcohol Use BREAKING NEWS! The American Cancer Society has just announced that colon cancer screening should start at age 45, rather than age 50, as colon cancer in younger folks has become more common. Stay tuned! Our practice is absolutely committed to keeping your colon cancer-free.. I invite you to make an appointment at my office to discuss a plan of action. You have options. For your convenience you can request an appointment on our website www. cdhohio.com. Center for Digestive Health 34940 Ridge Rd. #B Willoughby, OH 44094 (440) 953-1899 www.cdhwilloughby.com

Gregory Eippert, MD

Q:Lately, I am noticing that my eyelids don’t close all the way. What is this condition called and what is the cause? Should I see my eye doctor?

A:What you are describing sounds like a condition called lagophthalmos in which the eyes do not fully close properly either during the day when blinking, or at night when sleeping. Proper eyelid closure and normal blink reflex are essential to maintain a healthy corneal surface and stable tear film. Each blink of the eye spreads a tear film over the eye and creates a continuous layer of moisture that helps flush out any irritants or foreign bodies and keeps our eye healthy. An inability to blink or close the eyes fully leaves the eye exposed to the elements and poses a risk of increased infection, dryness of the eyes and the corneal surface, and in more severe cases, corneal ulcers or exposure keratitis.

Lagophthalmos is the result of a malfunction of the facial nerves near the eye that can be caused by stroke, trauma, skin and eyelid conditions, complications of various eyelid surger- ies, obstructive sleep apnea, Bell’s Palsy, and thyroid disease among others. The condition of lagophthalmos leads to less frequent blinking, incomplete eye closure, and impairment of the nasolacrimal system that produces and drains away tears. Symptoms of this condition may include tearing, watery eyes, weak eyelids, foreign body sensation, dry and/ or red eyes particularly in the morning, and blurry vision.

For patients experiencing lagophthalmos, a visit to your eye doctor will be important to help determine the cause and treatment of your particular symptoms. When talking with your eye doctor, be prepared to provide a detailed history of your physical and eye health noting any recent trauma or surgery involving the head, face or eyelids; past infections with attention to occurrences of any herpes zoster infections; past or current symptoms of thyroid disease, stroke, or sleep apnea; recent eye surgeries; and other medical conditions. During the eye examination, your doctor will perform several assessments of your lagophthalmos including eye aperture, ocular motility, eyelid muscles, and a slit-lamp examination of the ocular surface and cornea. Treatment for lagophthalmos depends on the severity and expected duration of the condition and varies per individual needs. Treatment for mild to moderate cases may include preservative-free artificial tears several times daily to supplement loss of tear film; ophthalmic gel tears or ointments at bedtime and/ or during the day; wearing moisture goggles, an eye mask, or taping the eyelids at night when sleeping; or plugs used to block tear ducts to sustain moisture in the eye for longer periods of time. For In more severe cases, surgical intervention may be necessary and include treatments such as gold weights implantation in the eyelids, and specialized eyelid surgery. If you are diagnosed with and treated for lagophthalmos, make sure to followup with your eye doctor as frequently as recommended to help maintain the health of your eyes Gregory Eippert, MD 9485 Mentor Ave., #110, Mentor 44060 440-255-1115 www.opivision.com

Paul Vanek, MD, FACS

Q:When is the best time of year to have my plastic surgery?

A:This answer depends entirely on your personal lifestyle and I perform surgeries year-round. However, I have noticed that I usually perform the most surgical procedures from September through December. I believe this is due to two factors: it’s less busy for many people after a vacation and family-oriented summer season, and it’s just before the holidays, when many people want to look their best for parties and family gatherings. But other seasons may be better for you. You may want to make it part of your “New year, new you!” Many people lose weight with January diets and exercise programs, then have plastic surgery to cap off their transformation, and heal and be ready for next Summer’s activities – including hitting the beaches! Some patients use their summer vacations to schedule surgery and recovery away from work commitments. Others find Winter is their slowest time, so they schedule their vacations away from everyone, except their plastic surgeon. Heat and cold may also be a comfort factor for you, with the layers of clothing you wear to cover bandages or healing skin. This should be a topic you discuss with your plastic surgeon, especially how long you may need to miss work, or limit your activities. I work closely with my patients to choose a date that works for their life, but I want to mention that my office is celebrating a big event, and offering some month-long savings in September. Whatever you decide, just remember that the sooner you have your surgery, the sooner you can enjoy the “new you.” 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

Laura Mutsko Agent, CSA and Certified Healthcare Reform Specialist

Q:I have VA health care benefits, should I still sign up for Medicare when I turn 65? Should I get Medicare Part D Prescription Drug Coverage even if I get my prescriptions through the VA?

A:Please understand these are only general guidelines. Without knowing all the details of your personal situation, I am unable to provide more specific advice. The Veterans Administration encourages veterans to enroll in Medicare as soon as they are eligible. Having both types of coverage gives you more options for medical care. You will be able to go to a non-VA hospital or doctor if you need to do so or receive your care through VA providers.

If you put off enrolling in Medicare Part B until after your initial enrollment period, you will be subject to penalties once you do enroll. You will pay the higher monthly Medicare premium for the rest of your life. While you may have all the care you need now through the VA, keep in mind that benefits could be reduced in the future or you may move to an area where VA doctors and hospitals are not easily accessible.

Typically, veterans use the VA prescription drug benefits instead of Medicare Part D because the VA drug plan has lower out-of-pocket costs than Medicare Part D. But, consider enrolling in Medicare Prescription Drug coverage (Part D) if:

• Your prescriptions are not listed on the VA’s formulary or covered drugs list

• You take prescription drugs prescribed by non-VA physicians and fill the prescriptions at a local retail pharmacy

• You qualify for Medicare’s Extra Help program, and therefore Part D offers drug copayments lower than VA copayments

VA benefits are considered creditable coverage. This means enrollment in Prescription Drug coverage is permitted after your initial Medicare enrollment period without any penalties. To learn more about your VA benefits and Medicare enrollment choices you should contact the Department of Veterans Affairs. If you need help selecting a Medicare plan that works with your Veterans benefits please contact me. My email address is Lmutsko@gmail.com or call me at 440-255-5700 to set up an appointment to discuss your options. Laura Mutsko Mutsko Insurance Services, LLC 6982 Spinach Drive, Mentor, OH 44060 440-255-5700 www.mutskoinsurance.com

Jeffrey Gross, DDS, FAGD

Q:Should I Remove My Teeth or Save Them? (Part 2)

A:Last week we discussed one of two patients who had somewhat similar situations in their oral assessment. Both of these patients were faced with the decision of whether to keep or remove all of their teeth. Both of these patients did not want a completely removable solution. They were both looking for something that stays in the mouth and does not need to come out at night. If you remember, the first patient had gum disease and that is why she was seeking treatment. She saw the handwriting on the wall and knew that if she did not act, then a full denture was in her future. This was not where this patient wanted to go. Our second patient came to me missing her back teeth, but that’s not what brought her in initially. She came to me in pain. Her pain was all over her jaw and interfered with her daily routine. It wasn’t just an occasional ache. Over the counter pain relievers did not do the trick for her. She also told me that the rest of her teeth “are messed up.” The first thing that I had to deal with was getting her out of pain. Upon examination and after a lengthy discussion, I determined that her pain was not coming from her teeth. In fact, it was coming from her lack of teeth. She had joint pain coming from the hinge joint that connects the lower jaw to our heads. This joint is called the TemperoMandibular Joint. It is better known as the TMJ, probably because it is easier to say and medicine loves acronyms.

I treated her for this problem and she felt better almost immediately. Let me share with you that there is nothing more gratifying than getting a patient out of pain. This is one of the many reasons that I love practicing dentistry. Now we had to deal with the “messed up” teeth. As I said she had mostly front teeth. In addition to missing the back teeth, her front teeth are quite crowded and could be more attractive looking. She was totally aware of this and it bothered her. Her only chewing was on her front teeth. This forced her to throw her jaw forward to eat with any level of efficiency. This jutting of the jaw in a forward direction put an undue strain on her TMJ. This is why it was inflamed and irritated. This is the source of her discomfort. That is why I said previously her pain “was not from her teeth,” rather it was from her “lack of teeth.” Lack of back teeth to be specific. Lack of back chewing teeth to really nail down the source of the problem. We then turned our focus to her front teeth. They are all crowded and could use an improvement in alignment and general appearance. This did not apply to just one tooth. It applied to all of her teeth. So now our main question arises. Do we remove all of the remaining upper teeth and place permanent teeth on implants or do we save them. The way to save them in this case involves making crowns (caps) for her front teeth. They are both legitimate approaches. Unlike our patient from last week, active gum disease was not an issue. What became the point of discussion, became speed and age. Let’s deal with the second one first. This patient was relatively young and the thought of losing all of her teeth was not very appealing to her. If it was the only solution that would be a different story, but it was not. The other issue was time. She wanted to go from start to finish as quickly as possible with the teeth that are visible. She also wanted short appointments. All of these considerations make keeping her teeth the most appropriate choice for her. Of course, she will need something in the back of her mouth for proper chewing. This can be implants or some type of bridge. Our focus from the start was fixing her “messed up” teeth. So we see that the answer is oftentimes not the same for the similar situations on different people. I like to call this personalized dentistry, because it is fit to your mouth exactly. If you would like to explore what dentistry can offer you, please feel free to call Megan at 440.951.7856 and make an appointment. I look forward to generating a customized solution just for you. Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.