HEALTH Focus Center for Digestive Health

DIGESTIVE HEALTH Michael Kirsch, MD, FACP Q: Why Can’t My Doctor Diagnose My Condition?

A: Making a correct diagnosis of your digestive symptoms can be very challenging. This is because for many of your symptoms, we simply do not have an accurate diagnostic test to nail it down. This is true for many medical specialties where physicians must use their knowledge and judgement. For example, doctors have become skilled in diagnosing migraine headaches, even though x-rays or CAT scans of the head on these patients would be normal.

Irritable bowel syndrome (IBS) falls right into this category – a real disease without supportive diagnostic tests available.

Consider how IBS contrasts with other conditions and symptoms from a gastroenterologist’s point of view. Heartburn or GERD: We have excellent tests to help us diagnose the presence and severity of this disease.

Appendicitis: In addition to the physician’s personal assessment of the patient, we have accurate imaging studies that can confirm our suspicion

Gallbladder Attacks: Our diagnostic tests for gallbladder disease are so accurate, that it is unheard of that they are not performed when gallstones or gallbladder issues are suspected. I doubt that any surgeon would remove a gallbladder unless diagnostic testing was not performed first.

Rectal Bleeding: When a patient comes to us with this symptom, nearly always we will provide a specific explanation because we have great tools available to do so.

Irritable Bowel Syndrome: A mysterious but extremely common illness when patients complain of abdominal pain, bloating, nausea, diarrhea and constipation. It’s the most common condition that GI physicians like us see in our office. But, there is no test for it. How, then, do we make this diagnosis? If you think you may have IBS, come and see us. We can help.

For your convenience, you may request an appointment on our website www.cdhohio.com.

34940 Ridge Rd. #B Willoughby, OH 44094 (440) 953-1899 www.cdhwilloughby.com

INSURANCE Laura Mutsko Agent, CSA and Certified Healthcare Reform Specialist Q: I’m getting a lot of phone calls. Some sound official, but I am pretty sure they are scams. Your thoughts?

A: One thing you can count on . . . there is no shortage of scammers out there who are always looking for new ways to separate you from your money. Here are a couple of the latest scams making the rounds.

Offering Help with New Medicare Cards

Do not believe anyone who contacts you to help ‘change out’ your Medicare card to one with a new number. These scammers are looking to get a hold of your Medicare number which is your social security number. Your new Medicare card will be mailed to you automatically. Medicare does not need your personal information in order to issue you a new card. Medicare will not call or visit you uninvited and there is no charge for the new card. In addition, Medicare will never threaten you with a loss of your benefits if you don’t share your personal information or talk to their representative.

If you are contacted by anyone who uses these tactics pretending to be from Medicare, hang up or close your door. Immediately call Medicare at 1-800-MEDICARE (1-800-633-4227) to report them.

Email phishing scams

Scammers know many of us are catching on to their schemes. So, their newest tactic is to disguise themselves as legitimate organizations.

Here’s how it works. Your caller id or email message may show they are from the IRS, your local utility company or a local hospital. They will ask you for personal information so they can update your records. They may even provide you with a phony phone number to call to verify they are legitimate. If you do not comply, they may threaten to turn off your heat or have you arrested. Don’t fall for their scare tactics. Look up the phone number yourself and call the organization they say they represent. Or ask them to send their information to you in the mail. You can also ask for their contact information and report them to the police.

If you think you are being scammed, don’t be embarrassed to talk about it. Contact your insurance agent, bank, credit card company or the police and explain what has happened. There are people ready to assist you if you ask for help.

Got questions on life, health, Medicare Advantage Plans and Medicare Supplements? Call or email me. I will help you find a plan that works for you. My email is Lmutsko@mutskoinsurance.com or call 440-255-5700.

Laura Mutsko Mutsko Insurance Services, LLC

6982 Spinach Drive, Mentor, OH 44060 440-255-5700 www.mutskoinsurance.com

MENTAL HEALTH AND SUBSTANCE ABUSE CARE Rakesh Ranjan, MD Q: Have you Ever Been Conned?

A: I often have individuals come into my office with various stories of being a victim of a con artist. I believe it is important that everyone recognizes the signs of a con artist.

How con artists are able to con people

Con artists have an uncanny understanding of human psychology and they pick their victims very carefully. They have also cultivated over time a set of skills, which is utilized to earn the trust of unsuspecting victims. They tend to exude a lot of charm and confidence which make them very convincing. They also tend to victimize people who are more inclined to use others to achieve self-affirmations. Many of them have well-rehearsed lines and phrases which they utilize over and over again with different people. This is like their ‘tried and true’ trademark. They sound especially convincing because it makes themselves believe in their own lies.

How to spot a con artist

The basic principle of the con artistry and male/female relationship issues are rather similar. For example, many women look for ‘prince charming’ and that is exactly what most con artists pose to be. Therefore, my advice to all: judge a person by his/ her character not by skills. Skills can be learned/taught while character cannot be. Also, don’t judge a person by what he/she says, but what he/she does. What to do if you just discovered you’ve been conned

The most natural tendency is to blame yourself and think you are stupid, etc. but that is not going to help you. An inclination to trust people is a sign of good heartedness; however, trusting people blindly can be self-destructive. Learning from your past experiences, changings your behavior pattern, and valuing virtues over style are most critical.

What to do with if your family member/ friend is a con artist

The best approach a family member or a friend can take is to confront him/her directly. The con artists have a very complex set of psychological issues. These include narcissistic tendencies (insatiable ego), antisocial traits (includes lack of conscience) a deeply seated lack of self-esteem, strong urge to control others, etc. The only way to totally help a con artist is to get him/her psychological help from professionals. Many of them may not be conscientiously aware of the motivations for their behaviors.

Charak Center For Health and Wellness

12395 McCracken Rd. F Garfield Heights, OH 44125 www.charakcenter.org 1-855-424-2725 Ask about the CCHW Pharmacy that can fill all of your prescription needs! Pharmacy Phone: 216-504-3646 Pharmacy Fax: 866-277-0868

DENTAL CARE Jeffrey Gross, DDS, FAGD Q: I’m Confused. Which causes tooth decay... Sugar or Bacteria?

A: What a great question. Many people tend to mix up those two factors. That’s like asking which came first, the chicken or the egg. Some recent research just appeared in the dental literature which sheds some light on this important topic. This research came out of the University of Minnesota. Before I mention the research let’s talk about what causes problems in our mouth. Like anything in life, when something becomes very common, we don’t really see what it is or value it. It becomes its own entity and takes on it’s own name or identity. Cavities are a part of our lives. There are very few individuals who are cavity free. I’m not saying that this is impossible, but it is definitely not the norm. As a side note, I often see someone for years that does not have a problem with tooth decay, yet gum disease may do them in from a tooth perspective. I hope to devote a column to that in the future. Let me get back to our issue at hand.

Tooth decay is not some innocuous process that happens to us all. It is a very specific sequence of events that occurs under the right conditions. For the most part, we are in control of those events. We determine if all the various components of the event are there. It is under our control to allow the motions to procede. . . or not. We eat certain foods that we enjoy. Coincidentally, the bacteria in our mouths enjoy the same food. Since we were taught from the time that we were toddlers that sharing is a good thing, we decide to share this food with our mouth bacteria. They are grateful for the dinner, but are not well mannered. Their way of saying thank you is to leave behind a gift of acid. This acid attacks our teeth and causes a decaying or rotting of our teeth. In medicine, events or situations which disrupt the harmony of the body are called diseases. Tooth decay is a bacterial disease.

Now, let’s look at the research that I mentioned previously. This study said that bacteria that absorb and collect phosphate from saliva may be involved in the tooth decay process. Having a low level phosphate in the mouth can speed up the decay process. Patients who have impeded salivary flow, resulting in a dry mouth, also show higher levels of decay. Maybe this is due in part to low levels of phosphorus in the mouth due to lower amounts of saliva. In any event, the study showed that bacteria in dental plaque (I’ll explain what that is in a moment) will absorb phosphate and lower it’s concentration in the mouth. This phenomenon may promote tooth decay. Now what is dental plaque? Simply put, it is a collection of bacteria that forms a sticky mass or film on your teeth. Think of it as an apartment complex for the bacteria to take up residence. These are the guys that cause the problem.

Whether the problem is plaque eating sugars or leaching saliva, the fix, in part, is the same. If we can break up the colonies of bacteria, they will never produce acid to wreak havoc on our teeth. I hate to sound like a broken record, but the best way to prevent oral disease is to keep plaque off of our teeth. When it shows up, brush and floss to remove it. You could also starve the bacteria by eating less sugary foods, but changing diet is usually harder than keeping your teeth clean.

No matter, how hard you work, some plaque may hang around. This is why a professional cleaning is so important. Now that you understand, what you are trying to do with the bacteria, the concept of a cleaning twice per year is kind of silly. Do I take a bath two times per year? Of course not! I am not suggesting weekly cleanings. What I am encouraging is cleanings customized to your mouth and life style. That could be as often as monthly or as infrequently as yearly. This is called personalized dentistry and something that I strive for my patients in my practice. Let us work together to reduce or eliminate oral problems. Let’s partner together to create a clean mouth. Call Megan at 440.951.7856 and take the first step down this path. 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

PLASTIC SURGERY Paul Vanek, MD, FACS Q: What Does It Mean That You Are “Double” Board Certified?

A: I have worked hard to become double board certified as both a general surgeon and plastic/reconstructive surgeon. Achieving even one board certification is a lengthy and rigorous process, involving many years of education and training. I completed my degree in Biochemistry at Haverford College where I was a Magill-Rhoades Scholar. I then completed my MD with Distinction in Research at University of Rochester.

My General Surgery certification is from The American College of Surgeons after completing a 5-year residency and demonstrating expertise to Board Examiners by passing written and oral exams. My second board certification from the American Board of Plastic Surgery came after a second residency in Plastic Surgery at University of Michigan. The American College of Plastic Surgery requires submission of one year of surgical cases as a precondition to their certification, an 8-hour written test, and a full day of oral board examination.

I recently successfully completed recertification in both General and Plastic Surgery specialties.

These require ongoing education and assessments, keeping up with the latest advancements, and demonstrating best practices relating to ethics, patient safety and communications.

Selecting a qualified plastic surgeon is critical. Board certification in plastic surgery, or as in my case, double board certification immediately verifies that your surgeon has the education, training, and experience to properly assess you and perform your surgery. My certifications prove to my patients that I am totally dedicated to know and do everything necessary to keep you safe and looking your absolute best.

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

OPHTHALMOLOGY Gregory Eippert, MD Q: Can you explain what cup-to-disc ratio is and how it is related to glaucoma?

A: Glaucoma is an eye disease that damages the optic nerve. The optic nerve carries information from the eye to the brain and is composed of millions of retinal fibers that bundle together and exit through the optic disc located at the back of the eye. When the optic nerve is damaged due to glaucoma in particular, you can slowly loose parts of your vision, usually peripheral vision first.

Cup-to-disc ratio, CDR, is a measurement used in ophthalmology and optometry to help describe the optic disc and aides in the assessment of glaucoma. The optic disc typically looks like an orange-pink donut with a pale center. The center portion is the cup. The CDR ratio compares the diameter of the cup portion with the diameter of the entire disc. Generally, a normal cup measures 1/3 the size of the optic disc. A cup-to-disc greater than 1/3 may imply glaucoma or other pathology.

In people with glaucoma damage, the cup becomes larger in comparison to the disc. This damage could occur due to increased eye pressure and/or loss of blood flow to the optic nerve, both of which can cause the optic nerve fibers to die off and change the cup-to-disc ratio. It is important to note that CDR by itself is not indicative of glaucoma nor is it a measurement of glaucomatous damage. There are people who have large cup-to-disc ratio because they were born that way and they do not have glaucoma.

If your eye doctor notices a larger than normal CDR or a change in your CDR measurement, you may be considered a glaucoma suspect. Depending on your particular case, including family history, the overall appearance of your optic nerve, and your exam (s), your doctor may conduct glaucoma testing including visual fields and OCT (ocular coherence tomography) photos of the optic nerve. Utilizing these periodic photos of the optic nerve, along with visual fields, other testing, and eye pressure measurements, the CDR can be monitored and assessed over time. All of these factors together help determine if glaucoma is present, requires treatment, and/or if treatment needs to be modified.

Glaucoma often progresses undetected until the optic nerve has been irreversibly damaged which can lead to varying degrees of permanent vision loss. While there is nothing you can do to prevent glaucoma, early detection and treatment can slow down its development or keep it from progressing.

Gregory Eippert, MD

9485 Mentor Ave., #110, Mentor 44060 440-255-1115 www.opivision.com