HEALTH Focus

DIGESTIVE HEALTH Franjo Vladic, MD Q: Are My Heartburn Medicines Safe?

A: Several times each week, patients see me, armed with newspaper articles, with concerns about their heartburn medicines. They have read that these medicines can lead to osteoporosis, Alzheimer’s disease, kidney disease and other serious medical illness. Who would want to take medicine for simple heartburn if this might lead to dialysis or dementia? Here’s how I counsel these worried patients. Of course, we all know that information is power. However, misinformation takes that power away. The news articles and web postings on the risks of Proton Pump Inhibitors, known as PPI’s, are exaggerated and misleading. If you are now taking a heartburn or GERD medication, chances are you are taking one of these PPI medicines. Believe me, I’ve read my share of PPI doomsday warnings. If this information was actually true, then I wouldn’t take PPIs either. But, they are not true. These medicines are safe and the risks of serious side-effects are extremely low. Many of my patients must take them indefinitely, and I tell them that they should do so with confidence that they are safe. Obviously, no drug is 100% safe and there may be unknown risks of medicines, particularly those that must be taken chronically. If any medicine is prescribed, the following three statements should be true. • The medicine is absolutely necessary. • The lowest effective dosage has been prescribed.

• There is no superior alternative to the drug. If you want an explanation why the press accounts are misleading, come and see me in the office and I will explain it all. Accurate information is real power. Center for Digestive Health 34940 Ridge Rd. #B Willoughby, OH 44094 (440) 953-1899 www.cdhwilloughby.com

INSURANCE Laura Mutsko Agent, CSA and Certified Healthcare Reform Specialist Q: Do you have any updates on the use of “observation status” by hospitals?

A: While some progress has been made by Congress regarding what Medicare terms “observation status,” some issues remain.

To clarify, “observation status” is the classification patients are given before they are formally admitted to the hospital. It provides doctors with time to decide whether to admit a patient as an inpatient or discharge them. You can be classified as “observation status” regardless of whether you are in the emergency room, having outpatient surgery or staying in a regular hospital room. While you are under “observation status,” you remain an outpatient.

Problems arise because observation status affects how much you pay for hospital services (like X-rays, drugs, and lab tests). It can also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay. For a patient who meets Medicare’s three-day inpatient hospital stay requirement and qualifies for Part A coverage, Medicare will pay for 100 percent of their skilled nursing care for the first 20 days and then all but $167.50-per-day co-insurance for days 21-100. Important note: Under Medicare rules, the days spent as an outpatient under observation status do not count toward the three-day hospital stay requirement. In March, 2017, Congress enacted a law requiring hospitals to inform patients both orally and in writing within 36 hours that they are in the hospital “under observation.” However, patients and their families are often under stress and do not realize the financial implications of this classification. A number of bills have been introduced in Congress over the past several years that would require Medicare to count the time a Medicare patient spends in observation status toward the three-day inpatient requirement to qualify for coverage of skilled nursing care.

There are no clear cut solutions. At this time, there is no process for appealing observation status. Many patients who find themselves in this situation ask their personal physician to intercede and try and get a patient’s status changed. Others pay out of pocket for their rehabilitation. Many simply go without the skilled nursing care.

If you have questions concerning life, health, Medicare Supplement Insurance, Medicare Advantage plans or other insurance questions, please contact me at 440-255-5700 or Lmutsko@mutskoinsurance.com. I will help you get the best coverage to meet your needs. 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: Will My Front Teeth Really Look Big?

A: I thought of this question as I met a new patient this week. He had a set of dentures that were on their last legs. They had broken over the years and had a number of repairs to try and patch them together. None of that phased me as I see that a lot. What made an impression on me was how much tooth showed when he smiled. The upper front teeth were enormous. First of all the teeth were very long. Secondly, when he smiled the entire tooth was visible as well as a fair amount of pink denture base above the teeth. This gentleman was in his 60’s and that look was not at all natural. We sometimes see that on a very young patient but time takes it toll on the height of teeth. Dentures or crowns on front teeth should reflect a natural look on a person. They should be in consonance with their facial features and general appearance. A person’s chronological age will affect the size of his teeth. Denture teeth that were made when someone was in their 40’s do not look natural for someone who is twenty or thirty years older.

Front teeth have definite shapes and sizes to create a “natural smile.” They are not all the same length..they are not all the same width..and of course they are not bright white. All of that just spells phony when one looks at it. I strive to have a natural and comfortable look on the dentures that we make. The very front teeth are the largest and widest of the upper six teeth. They are taller than the tooth that is next to them and definitely wider than that tooth. They do not all line up in a row. The four front teeth as a group are relatively flat looking, whereas the cuspid or “eye tooth” has a large mid-section. These subtle difference make our smiles look, for lack of a better word, natural and pleasing.

Dentures, like anything else, can be made to last for a long time. However, the larger question is whether or not they should be used for a long time. First of all, a denture is porous and absorbs odors and bacteria to a point of saturation. This creates a very unsanitary situation in the mouth. Second of all, colors of teeth and size of teeth change as we get older. Bright white and large teeth are not appropriate for someone as they advance through middle age. These are reasons that I recommend that a denture be remade every 5-7 years. This way our denture stays “in style” Just as our faces and bodies change, our artificial teeth should adapt and change. After all this is the same thing that happens to people with natural teeth. They change in shape and in color. During the denture making process in our office, we spend a lot of time getting the front teeth to look appropriate for that particular person. Many times we use computers to aid us in picking the best size for our mouths. These teeth are always viewed by me and the patient when the teeth are in wax. This allows me to move the teeth in any direction at will. We may move them up or we may move them down. This allows us to see more or less of our teeth. To create a natural appearance, I may recommend turning a tooth ever so slightly. I may suggest a small space between certain teeth. This is all done to duplicate the works of what we often call nature.

It is important to see how the curve of the edges of your teeth looks against your upper and lower lip. Do we have a harmonious smile line ( a tracing of the teeth edges) or does it look out of place. I compare pictures of your old teeth and try to make a change for the better, in a very subtle fashion. I use digital photos and videos to help the patient see themselves as the rest of the world sees them. Denture making is a science blended into an art. It can’t be rushed and shouldn’t be hurried. After all you will be wearing these dentures for years. The least that should be done is spending an appropriate amount of time creating them.

If you think that it is time to make the move to a denture or to update your current denture, please call me. I will listen to you and do my best to help you. Please call me at 440.951.7856. I look forward to meeting you. 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

OPHTHALMOLOGY Gregory Eippert, MD Q: My eye doctor just started me on two different glaucoma drops to control my eye pressure (IOP). I was told to wait five minutes between drops. Why is this wait time necessary? Do the drops have any side effects?

A: For those diagnosed with glaucoma, prescription eye drops is often the initial plan of treatment. These eye drops can help maintain one’s intraocular pressure (IOP) at a healthy level and are an important part of the treatment routine for many people. When using multiple eye drops, there are two considerations. First, eye drops are absorbed only while in direct contact with the surface of the eye. The longer the drops stay in place until absorbed by the eye, the better the efficacy. This can be achieved by keeping your eyes closed for 2-3 minutes without blinking after instilling the eye drops. Second, when taking multiple drops, wait at least five minutes between drops. This time period will allow for maximum absorption of each drop and prevent it from being washed out by the next drop. Since the eye can only hold one drop of liquid at a time until it is absorbed, it is only necessary to use one drop of the medicine and using more than one drop at a time will result in the excess drop trickling down your face. Remember to close the bottle each time after instilling drops as an open bottle can become more easily contaminated. For contact lens wearers, remove contacts prior to instilling glaucoma eye drops. Your contacts may be reinserted after 15 minutes after the last eye drop.

Like all medications, glaucoma eye drops may have possible side effects that vary per individual and may include stinging or momentary irritation when instilling; red, irritated eyes afterwards; dryness; or an allergic reaction such as lid swelling, pain, or blurry vision. One way to help with a stinging/burning sensation or dryness is to use artificial tears before you instill the glaucoma drops, then wait five minutes before instilling your glaucoma drops. At bedtime, over-the-counter gels or ointments may be used that can help soothe your eyes overnight. If you use gel or ointment however, use your glaucoma drops first, wait five minutes, and then instill the gel or ointment as the last medication as they inhibit drop absorption due to their ‘thick’ composition. Work closely with your eye doctor to understand the purpose and goals of your treatment plan including the purpose of the eye drops, proper dosage, possible side effects, and a target IOP. In most cases, medicines used to treat glaucoma must be continued daily for the rest of your life. Follow-up as recommended with your eye doctor to evaluate the effectiveness of your treatment plan and pursue other treatment options if necessary. Gregory Eippert, MD 9485 Mentor Ave., #110, Mentor 44060 440-255-1115 www.opivision.com

PLASTIC SURGERY Paul Vanek, MD, FACS Q: My Belly Button is disgusting! Can you fix it?

A: I cannot tell from your question what you precisely don’t like about it, but navel area surgery is one of the hottest trends in cosmetic surgery. Some women want it done after the effects of pregnancy, and both men and women may want excess skin removed in this area after weight loss. Others simply don’t like how their belly button looks.

Except for bikinis around the pool, the navel area has been typically hidden. But it is not uncommon today to see women wear yoga pants or leggings with short tops and sports bras, leaving their navels exposed. Accordingly, tightening the stomach and midriff area is now the focus of many fitness programs, for which we also have treatments and procedures.

Most surgeries in the navel area are of two types, umbilicoplasty, which changes the shape and size of the crevice to make it larger or smaller, or umbilical hernia repair, which changes an “outie” into an “innie”.

It is a rather simple procedure to reduce the size of a person’s navel, by removing extra belly button skin and tightening the bordering abdominal skin. It gets more complicated to increase the size of the belly button because I need to remove some of the surrounding abdominal skin and then gently stretch the belly button tissue to reach the enlarged border caused by removing the skin. Now that you have this information, I suggest you call my office for a personal consultation and I will help you determine if this is right for 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