Getting that fire of motivation is important to help put goals for the new year within reach

By Kaye Spector

Plain Dealer Health and Medical Reporter

Why is it that every January, people are eager to make a change, but by Valentine's Day, the urge has evaporated?

It's not unusual for Jazzercise classes, for example, to double in size after Jan. 1. "They usually come after the first of the year because everybody feels that finally, this is the year we are going to do it," says Judy Saletel, a Jazzercise instructor in Mentor for 23 years.

But after six weeks, most people's drive to change is gone, along with any hope to get in shape, slim down, stop puffing on cigarettes or change bad habits.

What can you do to keep the fires of motivation lit?

Psychologist Jeffrey Janata, division chief, psychology, at University Hospitals Case Medical Center, offers some perspective.

In general, motivation can either be positively or negatively reinforced: We go toward the positive -- such as fitting into a fabulous dress for your class reunion -- and away from the negative -- like hating how your thighs look.

What seems to predict success in behavior change is the immediacy of that reinforcement, Janata says.

"If the reward or punishment is coming right now, we're more likely to be motivated than if it's in the distant future," he says.

That's why your goal of a significant weight loss by June is trumped by the New Year's Eve buffet table: Good-tasting food is an immediate reward.

So the trick, Janata says, is to turn those long-term goals into smaller, short-term goals with either immediate consequences or positive reinforcement.

week and be disappointed with a one-pound loss -- even though that's a completely reasonable amount to lose in seven days.

Rather than quit, "focus on the one pound to get there, not on the 30," Janata says. "Make your [short-term] goal to lose a pound a week with reasonable calorie intake and exercise. It's the immediacy that counts for most people."

With that overall approach in mind, Janata offers these six strategies that can keep you moving toward your objective:

Set attainable goals

The first and most important step -- and it might be worthwhile to get some professional advice on what is realistic.

Weight loss and fitness are two classic examples where people often set high goals, then give up after being unable, predictably, to achieve them in an impossibly short time.

"Most people, when they join a fitness center, they want it now. We say, 'Let's just stretch this out for the entire year,' " says Rich Zatta, fitness and personal training manager at Mandel JCC. "We don't want you to feel so overburdened that you don't come back."

About 80 percent of newcomers to the JCC who meet with a professional, set specific goals and have a custom program become longtime users and achieve their results, Zatta says.

"Shape" your behavior Many parents and, yes, animal trainers are familiar with this technique. It rewards attempts, even if they are not right on the mark initially. The idea is that your continued efforts will hone your habits until you achieve your goal.

Say you want to work out every day. Your initial action should be to simply get yourself to the gym, even if you don't do much once there. After you reliably achieve that baby step, then you can further shape your habit by focusing on your workout -- which you also could break down into smaller goals.

The important thing is that lots of little changes can eventually add up to something bigger.

"If our goal is to reduce portion size, we don't want to only give ourselves credit if we get to the nutrition size," Janata says. "If we cut back only a little bit, that's a good thing."

Reward yourself

When you achieve a short-term objective, reinforce that victory with a goodie -- particularly if the behavior you're trying to eliminate, like overeating, is something you enjoy.

Important: The reward should be as valued as the behavior you're trying to abolish.

"We must be careful not to eliminate pleasure without introducing an alternative," Janata says. "That treat is a way of maintaining the same level of reward/pleasure."

Monitor yourself

We engage in much behavior, like overeating, automatically.

Using this technique, you try to pin down and understand the conditions under which you engage in the behavior you're trying to eliminate: When do I tend to light up? In the car? After a meal? When I'm drinking beer?

Once you've figured out your cues and habits, "Now you can set up a plan to overcome the obstacles," Janata says.

Monitoring also leads to insight into internal and external cues, which helps us to change behavior.

And then there's the "reactive effect" -- we can change our behavior merely by becoming aware of exactly how many cookies we are eating at the party, rather than mindlessly munching away.

"Just the act of writing it down, merely the act of paying attention, will accomplish some behavior change," Janata says. "After a while, it takes on a rewarding context."

Disrupt learning chains

Typically, our actions have triggers, either internal, such as thoughts or emotions, or external, such as times of day.

A sample chain: Boredom as a trigger to overeat, which causes you to gain weight.

Find ways to create a new association to that triggering event that will result in a healthier response: When you're bored, go for a walk instead of eating, which will help you to lose weight. Shape in the new association and then reinforce it with rewards.

Proximity of distress

One way to motivate yourself is to use stress: Stay focused on the behavior you are trying to eliminate -- especially if it makes you feel bad.

So put that unattractive photo of you in a bathing suit on your refrigerator door to remind you of why you want to slim down. Or tape stories about lung cancer around your favorite smoking spot.

"If we put it out of our minds, we won't change behavior," Janata says. "If we know that stress is one of the things motivating people to actions, then one tool is to keep stress fresh. Then you are more likely to finish your pills, go to the gym or lose those last five pounds."

Need to de-stress? Turn off the technology and tune out

By Kaye Spector

Plain Dealer Health & Medical Reporter

Feel the need to de-stress? Try turning off your CrackBerry for a few days -- or even a few hours.

Yes, technology is great, but laptops and smart phones are turning many of us into giant knots of stress, says Dr. Ned Hallowell, a psychiatrist, former Harvard professor and author of 16 books, including "CrazyBusy: Overstretched, Overbooked and About to Snap!"

With such devices making us available 24 hours a day, we lose control of our lives, Hallowell says. That ratchets up stress, making us distracted, impulsive, restless and hyperactive.

In fact, Hallowell believes that many of us, who are living overloaded lives through technology, show symptoms of attention deficit hyperactivity disorder.

"When you become crazy busy, you become distracted, you become impulsive, you become restless and hyperactive," he says.

Hallowell recently spoke to Cleveland Clinic employees about how to manage the chaos of modern life. Bottom line: Put on the brakes. And reconstruct the boundaries that technology has broken down.

That means no texting while the family is having dinner. No cell-phone calls while driving. And no obsessive e-mail checking when you have a few minutes of downtime.

Hallowell tells the story of one patient who asked if it was weird that her husband set his BlackBerry down next to them when they made love. Hallowell says he didn't know which was more odd: that the husband felt the need to have his phone nearby at such an intimate moment or that the wife was unsure whether it was appropriate.

"Good people, smart people, enthusiastic people, talented people become victims of their own enthusiasm . . . [and] their own desire to serve. You don't have to be," Hallowell says. "This is the grand seduction of modern life."

His advice is to choose three things every day to accomplish. Then focus laserlike on getting them done. Resist the distractions of interruptions such as visitors, e-mail and phone calls as much as possible.

"As you make yourself too available, you don't have time to think," he says. "Ask someone where they do their best thinking. Rarely do they say 'at work.' You think when you have a block of uninterrupted time. If you're like most people, it's not very often."

Studies show that nearly 20 minutes of every hour at work is spent dealing with interruptions.

"The more you allow yourself to have the world have at you, the more vulnerable you become to stress," Hallowell says. "You're running ragged and overcommitted, plus you're unhappy, plus you'll get sick."

You may have to have a talk with your boss if you're expected to always be available, Hallowell says. But start off with the affirmation that you both have the same goal -- you doing the best work possible. Then say there's a price to pay for being available 24 hours a day -- is it worth what you have to give up healthwise? Most bosses will say no, Hallowell says.

"Run your day knowing your priorities and what you need to get done. Create boundaries according to your desires," he says. "It's up to you to decide what matters."

Registered nurses in high demand as well-paying field continues to grow

By Kaye Spector

Plain Dealer Health and Medical Reporter

 

What's the prescription to recession-proof your employability? Get a nursing degree.

As baby boomers age and the need for health care grows, and with the nationwide nurse shortage, registered nurse jobs are projected to increase nationally by 500,000 by 2016, according to the federal Bureau of Labor Statistics. The bureau counted about 2.5 million RNs across the country in May.

Nursing is a good choice, too, for wages.

Not counting doctors and dentists, nursing salaries typically are among the highest in any large occupational field. Average annual RN wages are $65,130.

Although the job pays well, the nursing shortage is going to get worse, predicts Gingy Harshey-Meade, chief executive officer of Ohio Nurses Association.

The national RN shortage is expected to grow from 8 percent in 2009 to 12 percent in 2010 and to 29 percent by 2020, says the U.S. Department of Health and Human Services.

That's equal to having more than 808,000 too few RNs by 2020.

The problem isn't a lack of people wanting to go into nursing. Rather, it's the lack of nursing educators.

A university teaching job typically pays significantly less than a position in a hospital. So -- particularly when economic times are tough -- many nurses with the advanced education necessary to teach choose to keep working in hospitals.

With the average age of those teaching in nursing programs now 55, the need for educators becomes even more acute in the face of anticipated retirements.

A recent survey by the American Association of Colleges of Nursing found that 62.8 percent of all responding nursing schools had faculty vacancies that they needed to fill, translating into an overall 7.6 percent faculty vacancy rate.

"Salary in higher education is a more pervasive issue and one that can't be solved for a given profession," says Patricia Underwood, associate dean for academic programs and associate professor at Frances Payne Bolton School of Nursing at Case Western Reserve University.

Tuition is another obstacle to luring nurses into becoming educators.

CWRU this year received a large federal grant for student loans that covers tuition and obligates students to pay back only 15 percent if they take nursing-educator courses and work as a nurse faculty member for four years.

This fall's federal stimulus funding broadened the eligibility pool from doctoral students to master's students. CWRU also offers nursing-education fellowships.

"If we are going to address the larger issue of the nursing shortage, we have to address, first and foremost, the faculty shortage," Underwood says. "Starting more programs is not the answer. We have to increase the capacity of existing programs."

The field of pharmacy -- the other high-paying health care occupation, aside from doctors and dentists -- has a little different story.

Pharmacists earn an average of $104,260 a year, says the Bureau of Labor Statistics. But growth in jobs will be much smaller, with projections for 2016 only 30,000 more than this year. The bureau counted 266,000 U.S. pharmacists in May.

More pharmacy schools have opened in the past decade, increasing from 80 to 110, reports the American Association of Colleges of Pharmacy. The number of colleges in Ohio alone doubled from four to eight in the past eight years or so.

"The combination of having more pharmacy schools mixed with more female pharmacists coming back into the job market -- now we're beginning to see the shortage decline," says Ernest Boyd, executive director of the Ohio Pharmacists Association.

"For the moment, pharmacists are paid well in the jobs that they have."

Few studies back promises made by makers of so-called 'functional footwear'

By Kaye Spector

Health and Medical Reporter, The Plain Dealer

It sounds so easy.

All you have to do is put on a pair of shoes, and by simply going about your daily business -- grocery shopping, standing in line at the bank or picking up the dry cleaning -- you get great-looking legs.

That's the promise of "functional footwear" such as MBTs, FitFlops, Reebok's EasyTone sneakers and Skechers' Shape Up shoes.

The manufacturers claim that instability built into the shoes makes it harder to maintain balance and stand erect, forcing the wearer to use and develop muscles that aren't engaged with regular shoes. The footwear also is supposed to reduce stress on the joints and the back.

MBTs, the granddaddy of functional shoes, are made by Switzerland-based Masai Group International Ltd. and have been available in the United States since 2005.

This year, Reebok and Skechers came out with their own less-expensive versions, promising shapelier calves and a tighter rear end without the wearer going anywhere near a gym.

(MBTs cost from $240 to $390, while Reebok and Skechers cost around $100.)

So are the claims all marketing? Or do they work?

In theory, they could work, says Dr. Amanda Weiss Kelly, director of pediatric sports medicine at Rainbow Babies & Children's Hospitals.

But there are few rigorous, peer-reviewed scientific studies to prove it, she says.

One such study shows the MBTs can improve function and reduce knee and lower back pain for patients with knee osteoarthritis.

"For someone with arthritis, these shoes might be worth a try," Weiss Kelly says. "Some research supports this. But you have to be up and moving."

Another showed that developmentally delayed children with motor difficulties who wore the MBTs for two hours a day improved their balance.

"Theoretically speaking, by activating different muscles, you could end up firming and toning the muscles," Weiss Kelly says. "But nobody has done a controlled medical study on it."

The most important thing the shoes might do, Weiss Kelly says, is encourage their owners to walk more.

"Wearing these while sitting at a desk is not going to expand your calorie expenditure," she says. "I don't care what kind of shoes you wear, you have to exercise. I would just be thrilled if we could get people up and walking."

With nod from FDA, stevia finds sweet success in market for 'natural' products

By Kaye Spector

Health and Medical Reporter, The Plain Dealer

Wary of the pink, blue and yellow packets to sweeten your coffee, but trying to avoid the white and brown stuff too?

Check out the newest sweetener on the block, stevia extract.

Leaves from the stevia plant, an herb native to South America and Central America, have been used as a sweetener for centuries. But stevia extract could not be sold as a sweetener in the United States until late last year. That's when the U.S. Food and Drug Administration declared a highly purified extract of the herb, called rebaudioside A, safe for use in foods and beverages.

The Plain DealerStevia, a natural substitute for sugar that is an extract of a plant native to Central and South America. is shown here in powder and plant form. The FDA had been hesitant to approve stevia, in part because an early study showed that some forms of the extract had negative health effects under certain conditions when consumed in large quantities.

With the nod from the FDA, a barrage of products featuring the zero-calorie sweetener hit the U.S. store shelves this year, aimed at those who want to consume less sugar but avoid made-in-the-lab artificial sweeteners.

The big players in the stevia market are food producers Cargill Inc. and Merisant Co. Both make stevia-based tabletop sweeteners, and both have partnerships with soft-drink manufacturers.

Coca-Cola is sweetening its Sprite Green and Odwalla juice drinks with Cargill's Truvia, while Pepsi is adding Merisant's PureVia to its SoBe Lifewater fruit-flavored water.

The rush to market is coming from consumers' hunger for "natural" goods, says Valerie Myers, medical nutrition therapist at Kaiser Permanente in Bedford.

Labeling for both tabletop sweeteners prominently features green plants and the word "natural."

Consumers "like to hear that, rather than it's an amino acid or it's a chemical," Myers says. "We're in a 'green' state right now."

With many health experts blaming sugar-sweetened beverages, at least in part, for the U.S. obesity epidemic, stevia-based beverages might be a good choice for someone trying to cut calories or sugar, says registered dietitian Tammy Randall, director of education at the Diabetes Association of Greater Cleveland. A 12-ounce can of soda has about 150 calories and up to 10 teaspoons of sugar.

Stevia has seen success in other countries. In Japan, where stevia has been used since the 1970s, it accounts for 40 percent of the sweetener market.

Until the FDA's recent approval, stevia could be sold only as a dietary supplement and could not be labeled as a sweetener or added to food products. Stevia remained unknown to most consumers and relegated to health food stores.

As far as Randall is concerned, one calorie-free sweetener --natural or not -- is as good as another. It all comes down to individual taste, she says.

"Many people are leaning toward stevia because of the older myths about sweeteners," she says. "Pretty much all of those have been debunked. They're all pretty safe. Some of it is more personal preference and philosophy rather than a health decision."

But that "all-natural" label on your packet of stevia sweetener might be subject to interpretation.

Stevia extract is up to 300 times sweeter than sugar. So manufacturers mix the extract with other ingredients, like dextrose, to "fill the envelope," Randall says. Truvia and Pure- Via both contain sugar alcohol and other sweeteners, in addition to rebaudioside A.

The display rooms at the American Dietetic Association's recent nutrition conference in Denver were jammed with stevia-sweetened products, Randall says.

Myers also thinks stevia sweeteners could be a good choice for people trying to control their sugar intake. She has grown the herb in her own garden to sweeten her tea.

But she worries that artificial sweeteners merely encourage America's sweet tooth. She'd like to see us all eat fewer sweet things in general.

"There's a time and a use for artificial sweeteners," Myers says. "It's just heightening our desire for sugar."

Scrubs made by Mom add soft touch to Rainbow ER

By Kaye Spector
Health and Medical Reporter, The Plain Dealer 

You can buy scrubs at lots of places: uniform stores, discount stores, on the Web.

But nurses at Rainbow Babies & Children's Hospital have a source for custom-made, child-friendly scrub tops: Dorothy Riedel.

Riedel, who lives in South Euclid, is the mother of Rainbow emergency-room nurse Kristine Vehar.

Riedel began sewing and selling holiday and seasonal-themed scrubs to the Rainbow ER nurses about five years ago, after the ones she made for her daughter generated admiration from Vehar's co-workers and the question: Will your mom make me one?

So now there's a plastic tub in the Rainbow ER nurses' lounge, piled high with fabric. Nurses pick out the fabric, pay $15, and receive their custom-made scrub top in a few weeks. Riedel charges $25 for two, or $10 if the nurse supplies the fabric.

Riedel estimates she's made about 400 scrub tops over the years for the Rainbow nurses. She recently filled orders for 19 tops with holiday prints, such as snowmen or Peanuts characters.

Riedel thinks the kid-friendly prints help the ER's scared children connect with their caregivers.

"When a child is in the ER, there's a lot of strangers in there with them. If they see a nurse with a Charlie Brown top on, they'll feel more relaxed," Riedel says. "It gives me pleasure to do that."

My daughter, my co-author

When Dr. Tommaso Falcone decided to include a section about nutrition in the second edition of his book on infertility, he only had to look across the dining room table for help.

The chairman of the Cleveland Clinic's Ob/Gyn & Women's Health Institute turned to his daughter, Tanya Falcone, a graduate student in nutrition and dietetics at Kent State University.

Father and daughter spent about a year going through the concepts for the book. Then the young woman wrote a chapter on nutrition and supplied menus for the appendices.

Falcone says he learned a little bit about his daughter as the two worked together.

"She is the type of person who has her own ideas," about the medical part of the book, Falcone says. When he would raise questions about some of her ideas, "she was quite firm."

Falcone describes his book, "The Cleveland Clinic Guide to Infertility," as an expanded version of information he would tell patients during their first office consultation.

Nutrition is "a very important part of fertility enhancement," he says, particularly because excessive weight is one of the four main causes of infertility. Eating well also is something the patient has direct control over, he says.

"With most other things, I am controlling the most intimate aspects of their lives," Falcone says. "This is something that they can do."

Tell me about it

It's National Hospice Awareness Month, and Hospice of the Western Reserve is marking the observance by telling stories about hospice and inviting others to share their own.

Every day in November, the hospice is posting a new story on its Web site.

There, you also can download brochures about hospice's services and planning for end-of-life, and find links to information about advocacy at the state and national levels.

The hospice stories reflect the experiences of the staff and volunteers.

Like the story about an information-services worker who spent half a workday and a Friday night to help a dying patient set up Skype, an Internet communication service that allowed the patient to talk to his loved ones all over the country. It was the young patient's final wish.

To read the stories -- or tell one of your own -- go to the Web site and click on the large brown box at the bottom of the page.

Hospitals in the news

High-profile patients who have been treated at Cleveland's big hospitals have been grabbing the national television spotlight in recent weeks.

On Nov. 11, talk-show host Oprah Winfrey broadcast her interview with Charla Nash, the Connecticut woman hospitalized at the Cleveland Clinic after being mauled by a chimp. Nash arrived at the Clinic in February, three days after a friend's 200-pound chimp tore off much of her face and hands.

That same day, ABC's Nightline program broadcast a story reported at University Hospitals Case Medical Center on adults developing serious cases of H1N1, or swine, flu.

On Nov. 13, ABC's 20/20 featured a story on Johanna Orozco, the Cleveland teen who was shot in the face by her ex-boyfriend, with video and interviews of the trauma doctors who treated her at MetroHealth Medical Center.

Doctors concerned about obesity irked by physician group's grant from Coca-Cola

Dr. Caldwell Esselstyn Jr.

 By Kaye Spector

Health and Medical Writer, The Plain Dealer

CLEVELAND -- Caldwell B. Esselstyn Jr., the longtime Cleveland Clinic surgeon who lectures around the world and counsels people regarding the health benefits of a plant-based diet, was among 22 U.S. scientists and physicians who recently signed an open letter of opposition to the American Academy of Family Physicians.

Their beef? The AAFP announced in October that it accepted a six-figure grant from the Coca-Cola Co. to create content about beverages and sweeteners for the academy's consumer Web site, FamilyDoctor.org.

The AAFP said its first-ever "consumer alliance" would enable the academy to develop educational materials and "incorporate the products [consumers] love into a balanced diet and a healthy lifestyle." The new content is expected to launch in January.

The partnership created a stir among some physicians, nutritionists and health experts. Many saw the arrangement as a threat to the 62-year-old academy's commitment to science and family medicine.

Among the critics, in addition to Esselstyn's group, are the Center for Science in the Public Interest and nutrition authority Marion Nestle.

Soda and other sweetened beverages are the No. 1 source of added sugars in the U.S. diet, the American Heart Association says, and many health experts blame the drinks, at least in part, for the soaring U.S. obesity rate. A 12-ounce can of soda can contain up to 10 teaspoons of sugar.

"The AAFP's Web site should be criticizing sugar-sweetened beverages in the strongest language and providing candid, objective advice about the health and safety questions related to diet drinks," the letter sent by Esselstyn's group says. "But with Coca-Cola providing the funding, the AAFP simply cannot do that."

Mid-career change to nursing a happy switch for disabled woman

By Kaye Spector

Health and Medical Reporter, The Plain Dealer

 

Carey Lewis was sitting in a graduate school preparatory class, an 11-year career behind her, when she decided she just didn't want to be a financial analyst anymore.

She turned back to the college's catalog and made a list of all the courses that appealed to her. They all were nursing classes. And so, while continuing to work full time, and with the support of her employer, Lewis enrolled in nursing school.

For anyone, the decision to move mid-career from a relatively sedate office job to a fast-paced profession with high physical and emotional demands is not one to be taken lightly. For Lewis, the decision had an added dimension: she lost part of her left forearm and her hand in a lawnmower accident when she was five years old.

Her disability has never been an issue. Lewis was a cheerleader in junior high, played trumpet in the school band and ran cross-country for the Strongsville High School team. She earned an accounting degree from Cleveland State University, and worked for nearly a decade in finance all over the country.

Like Lewis, more and more people with visible disabilities are entering the recession-proof nursing profession, says Donna Maheady, an RN and a Florida-based advocate for nurses with disabilities.

Nursing advocacy and professional organizations don't have a tally of the number of working nurses with disabilities -- a broad term that can range from hearing loss to multiple sclerosis. But they agree on one thing: admission to nursing school and finding a job can be difficult for those with a disability.

According to a study in the Journal of the Ohio Nursing Association, nurses with disabilities experience negative responses from their peers and employers.

Disabled nurses reported that their co-workers grumble about accommodations made for their disabilities, such as assignments or scheduling. The nurses also said that their employers don't want to make accommodations, or they insist that a disabled nurse perform a task in a way that is not mandatory, such as insisting a procedure be done while standing.

"Sometimes they are welcomed. Sometimes they are treated poorly. Sometimes they won't even have a chance at a job interview," says Maheady.

Lewis, now 35, says her admission interview at the Huron School of Nursing in East Cleveland went without mention of her disability, much to her surprise.

Nursing school, however, was tough. Lewis continued to work full-time, and there were many skills to learn. Lewis had to devise her own way of doing each task that required two hands.

She learned to start IVs, insert catheters and roll patients by watching other people closely, come up with an adaptation, then practice endlessly. She spent hours in the lab working on how to start an IV.

The simple act of putting on sterile gloves, which are required almost constantly, proved to be particularly nettlesome. On the advice of an instructor, she took a pair of gloves home and practiced putting them on over and over.

For actions requiring two hands, she often uses her left arm to steady things or hold them in place, while her right hand does the work. When she puts on sterile gloves, Lewis uses an extra-large pair. She pins the glove to her body with her left arm, then slides her hand inside.

One instructor told Lewis she'd never get through nursing school or find a job because of her disability. But when she aced her skills exam, the instructor admitted she was wrong -- and expressed her admiration.

Last spring, Lewis began working at the Cleveland Clinic. She joined the staff of H81, an internal medicine floor that's also a teaching unit. Most patients on H81 have been admitted from the emergency room with serious illness or injury, and the skills of newly minted nurses are quickly honed.

By law, Lewis' employer has to make accommodations for her disability. But so far, the Clinic has not had to, says Luann Capone, director of nursing quality.

"Carey has been similar to our other graduate nurses, doing a good job using the skills she went to school for," Capone says. "It might look different, but she's able to do it. She's figured this all out already."

On a recent day, Lewis sped about H81, a purple stethoscope around her neck and her long hair tied in a ponytail.

She cradled a thick pink-and-brown striped binder filled with policies, checklists and assessments in her truncated left arm. Her right hand handled everything else.

That day, Lewis had to start an IV in an older patient, with hard-to-find veins, "a difficult stick." It would be a challenge for any new nurse, and Lewis talked over what to do with her co-workers. She decided to ask a more-experienced nurse to start the IV if she was unsuccessful after a few attempts.

"Some things are just hard to do," she says. "It has nothing to do with being disabled."

Brigitte Folds, assistant nurse manager on H81, says that a few patients have expressed concern about having Lewis take care of them because of her disability. Other patients are too sick to notice. But most are welcoming, she says.

"They almost look at her as an inspiration, which I think is really cool," Folds says.

Swine flu vaccine clinic under way for pregnant women

By Kaye Spector
Health and Medical Reporter, The Plain Dealer

The county's first large-scale H1N1 flu vaccination clinic for pregnant
women got off the ground Thursday after the county Board of Health asked
for – and received – more than 1,000 injectable vaccines from three
local hospitals.
The county health board began contacting local hospitals, asking them
to share after injectable vaccines began trickling into Cuyahoga County
from the state last week.

The county's proposition: Give us some of your vaccine and we will
contact the 1,800 pregnant women who have either registered with the
Ohio Department of Health or contacted us, and we will administer the
vaccine.

County officials are eager to vaccinate pregnant women, who can only
receive injectable vaccine, as they have the highest H1N1 mortality
rates.

Pregnant women cannot receive the nasal mist form of vaccine because it
contains live virus.

About seventy-five percent of the 1,500 vaccines available at the
Thursday clinic came from MetroHealth Medical Center, the Cleveland
Clinic and Southwest General Health Center, said Terry Allen, the county
health commissioner.

MetroHealth gave nearly 900 doses, said chief medical officer Dr.
Alfred Connors.

While MetroHealth doctors are providing vaccinations to their patients
who qualify, the clinics are a faster way to get to patients than the
normal routes of contacting patients and scheduling appointments, he
said.

“What we're trying to do is get as many people vaccinated as quickly
as possible,” Connors said. “They had a mechanism to get that to
them quickly.”

He said he expected many of the women at the county's vaccination
clinic would be MetroHealth patients.

Nearly 550 pregnant women were vaccinated Thursday. Some children who
accompanied their mothers received the nasal mist vaccine.

“It doesn't make sense for healthy people to be coming to a
hospital,” Allen said. “This is a better way to serve a healthy
population and help them.”

A new shipment of vaccine is scheduled to arrive next week, Allen said.
He expects to be talking to hospitals again about sharing their
allotments.

“We don't want the vaccine to collect any dust,” Allen said. “We
want to get it out on the street as soon as possible.”

Health district officials will decide soon what priority group to
vaccinate, perhaps pregnant women again or children with chronic
illness.

“We're going to have to continue to broker vaccine available for use
in the community, particularly as we go forward,” Allen said. “It's
a federal asset that should be moved around.”

Northeast Ohio hospitals restricting visitors to curb spread of swine flu

By Kaye Spector Health and Medical Reporter, The Plain Dealer If you have flu symptoms or are younger than age 18, you won't be welcome as a visitor at a growing number of hospitals across Northeast Ohio. Hospitals are limiting who can walk through the door in an effort to stem the spread of H1N1, or swine flu. The Cleveland Clinic became the latest hospital on Monday to announce temporary restrictions: No one age 18 or younger or anyone with flu or flu-like symptoms should visit patients at its main campus in University Circle or its nine hospitals throughout the region. It is the first time the Clinic has imposed such restrictions, said Dr. Ian Glass, senior vice president, medical operations/regional quality. The limits were necessary because H1N1 accounts for the vast majority of flu cases in the community, and so far, its vaccine has been in limited supply, Glass said. H1N1 is particularly prevalent among young people, he said, prompting the age-related guidelines. "This is one of the easiest things we can do in terms of preventing disease," Glass said. Southwest General Health Center announced similar visitor restrictions Monday. Last week, the Akron-area hospitals, including Akron Children's Hospital, Akron General Medical Center and Medina General, put similar restrictions in place, as did Parma Community General Hospital. They joined University Hospitals Case Medical Center, which last spring began asking visitors of all ages with flulike symptoms to stay home and recently began restricting all children from certain high-risk floors. "We have not yet instituted any additional restrictions because we know it would be a hardship to families," UH spokesman George Stamatis said in an e-mail. UH may implement limits later if the situation warrants, he said. Officials at the hospitals with the new rules said that decisions about visits will be handled on a case-by-case basis for patients who are critically or terminally ill. "We talked about this and felt very strongly that there are always going to be mitigating circumstances," Glass said. "A heavy dose of common sense goes a long way toward helping the solution." Hospital personnel won't be accosting violators and sending them home. But they may ask visitors to don masks or not enter a room, said James Gosky, Akron General spokesman. "By and large, people understand and are very courteous," Gosky said. MetroHealth Medical Center has not instituted any new restrictions, but signs are posted throughout the hospital asking visitors with respiratory symptoms -- cough, sore throat, or runny nose -- to wear a mask.

Omega-3 fatty acids, fiber make chia seeds a healthy diet addition

By Kaye Spector
Health and Medical Reporter, The Plain Dealer

Most Americans of a certain age associate chia seeds with kitschy, sprout-covered terra-cotta figures.

But many well-known healthy-eating advocates -- including the Cleveland Clinic's Dr. Michael Roizen and Dr. Andrew Weil of the University of Arizona -- are saying it's a good idea to include the tiny black seed in your diet. Chia seeds are a good source of fiber and calcium, and -- important for vegetarians -- they contain omega-3 fatty acids, essential fats your body does not make but needs to function properly.

If you eat one seven-teaspoon serving of chia seeds every day, you can get a good deal -- 11 grams -- of the U.S. Department of Agriculture's recommended daily allowance of fiber. Compare that to a bowl of oatmeal, which has about 3 grams of fiber, or a slice of whole-wheat bread, which has about 5.

Adult women need 25 grams of fiber daily, while adult men need 38, the USDA says. Most people eat less than 10, says dietitian Tammy Randall. Sprinkling chia seeds on salads or yogurt could be a good choice for those struggling to meet the USDA fiber recommendations.

Jim Perko, executive chef for the Cleveland Clinic's Wellness Institute, uses chia seeds in the recipes he develops for students in his healthy-cooking classes.

Chia seeds soak up to five times their weight and volume in liquid, so Perko blends them into low-fat recipes, such as muffins and meatballs, in much the same way Mom used bread crumbs to make her meatloaf moist.

Perko also adds chia to thicken dressings, which -- because it clings more tenaciously -- lessens the amount of fat in coleslaws and salads. He'll also use chia rather than meat to add body and viscosity to his vegetarian chili.

"Chia not only thickens, but adds moisture. While it's doing all of that, it's adding omega-3 and healthy things," Perko said. "It's got outstanding culinary capabilities."

Chia can be a bit pricey, however. Heinen's sells chia seeds, packaged in a 1-pound plastic container, for about $11.

The local grocery chain began selling chia this year. Chris Foltz, Heinen's director of operations, says Heinen's sells about 20 pounds of chia per store per month.

More and more chia-based products are coming on the market, Soltz said. He recently evaluated a strawberry kiwi dressing and marinade that featured chia as an ingredient.

Chia seeds can also be found at the West Side Market, Nature's Bin and Whole Foods Market.

Patients flooding local ERs in fear they have swine flu

By Kaye Spector
Health and Medical Reporter, The Plain Dealer

Unnecessary fear over swine flu is clogging up area emergency rooms.

Three of Cleveland’s major hospitals - MetroHealth Medical
Center, University Hospitals Case Medical Center and the Cleveland
Clinic - said Tuesday they are seeing unprecedented numbers of people
coming into their ERs with flu symptoms.

The vast majority of these visits are unwarranted because the
cases are mild and don’t require emergency medical attention. After
being seen by a doctor, most patients are being told to go back home,
rest, drink fluids, take Tylenol and avoid contact with others.

The emergency room at MetroHealth has seen a record number of
people with flulike symptoms in recent days - from about 36 people a day
last week to 60 a day this week, said Dr. Charles Emerman, chairman of
the emergency medical department.

MetroHealth doctors say the spike is prompted by unwarranted
fear surrounding H1N1 flu, also called swine flu.

“I think people are really worried about this more than they
need to be,” said Dr. Jennifer Hanrahan, chairwoman of the
hospital’s infectious control committee. “Most people are going
to have a real mild illness. The best thing for these people to do is to
stay home.”

MetroHealth doctors made a public appeal Tuesday for flu
patients to come to the emergency department only if they have serious
symptoms. They stressed that for most people, the swine flu will be no
more dangerous than seasonal flu.

Patients with flu symptoms coming to the Clinic’s ER nearly
tripled over what the staff usually sees, from about 12 to about 30,
said Dr. Thomas Tallman. Most of the cases there too were mild, he said.

Rainbow Babies & Children’s Hospital, which is part of UH, is
seeing an overall increase in ER patients, from about 100 a day to 150 a
day; about half of those numbers are young flu patients.

The number of flu patients coming to Case Medical Center’s
emergency department also jumped in recent days, from the usual 30 a day
to nearly 50 a day. But UH says it is actually seeing more cases of
adults with severe flu symptoms and attributes it to underlying medical
conditions.

In recent days, several of the hospitals have created separate
areas within the ERs for people with flu symptoms to prevent spread of
the virus.

 MetroHealth had a roofed tent set up inside the ER, but took it
down after one day of operation after learning from Cleveland fire
officials that it violated the city fire code by blocking the water
sprinklers on the ceiling. Until the hospital comes up with another plan
to separate flu patients, staff members are handing out masks to people
with flu symptoms in the waiting room.

The Clinic created a separate room that patients enter directly
from the ER entrance. Tallman said he is working on plans to enlarge the
area because the number of patients is expected to increase.

In recent days, Rainbow also created a separate waiting room for its young
patients without flu symptoms. UH and Rainbow also are handing out
surgical masks to ER patients with flu symptoms.

New AHA guidelines for daily sugar levels aim to keep you and your heart healthy

By Kaye Spector
Health and Medical Reporter, The Plain Dealer

Americans are eating an average of just under a half cup of added sugar a day -- that's 22 teaspoons of the white stuff.

We're not talking about the naturally occurring sugar found in fruits or dairy products but rather the sweeteners and syrups added to foods during processing, preparation or at the dining table. Think soda and sweet tea. Processed foods such as instant oatmeal or breakfast cereal. Condiments including jam or maple syrup.

At a time when we're eating more sugar than ever, the American Heart Association recently said that lowering the amount we consume is essential to achieving and maintaining healthy weight, decreasing cardiovascular disease risk and meeting essential nutrient needs. The association published new guidelines this month.

For example, if you're an average adult woman eating around 1,800 calories a day, the association recommends no more than five teaspoons of added sugar a day. If you're an average adult man eating about 2,200 calories a day, the association advises a limit of nine teaspoons. The recommendations vary based on age and activity level.

"These are good benchmarks," says Brenda Walsh, a registered dietitian at University Hospitals. "Where we're at is way beyond what we should be."

What's wrong with making your life a little sweeter?

First of all, sugar has no nutritional value other than providing calories, and it displaces the more nutritious foods and beverages that we all should be consuming instead, Walsh says.

Second, high intake of added sugars can directly damage your health, says Dr. Leslie Cho, an interventional cardiologist with the Cleveland Clinic. The most significant way -- by creating obesity.

Obesity causes numerous chronic health conditions, including hypertension, diabetes and high cholesterol, which lead to heart attack and stroke, Cho says.

"Sugar is calories. An increase in calories is an increase in weight," she says. "It's really important to maintain a good body weight."

All things being equal, eating 50 more calories a day than you expend -- a mere three teaspoons of sugar -- could result in up to a five-pound weight gain over a year, according to the heart association.

High sugar intake also is associated with increased triglyceride levels, a known risk factor for coronary heart disease.

Higher consumption of high-sugar beverages and foods also is associated with evidence of increased inflammation and oxidative stress, a term for damage to cells, tissues and organs caused by free radicals and other pro-oxidant molecules.

But Americans can't seem to get enough of the sweet stuff.

Americans' intake of added sugars increased from an average of about 16 teaspoons a day in 1977 to about 21 teaspoons by 1994, one study estimates.

That amount has remained high -- and has increased to 22 teaspoons a day among those 20 years and older -- estimates The National Cancer Institute, which looked at data from the 2001 to 2004 National Health and Nutrition Examination Survey.

The biggest culprits are soft drinks and other sugar-sweetened beverages, which are the No. 1 source of added sugars in the American diet, the heart association says. Per-person daily consumption of soft drinks increased 70 percent between 1970 and 2000, from 7.8 ounces to 13.2.

It's probably no coincidence that the usual drink size used to be 8 ounces. Now it's routinely 12 ounces and up -- including beverages like the 64-ounce Double Gulp fountain drink, Walsh says.

Most of Walsh's patients are trying to get their weight or diabetes under control. She says they usually are surprised to hear that a 12-ounce can of soda can contain up to 10 teaspoons of sugar. Many of them drink three sodas every day.

Others drink a gallon of juice every day. While juices contain natural sugars, rather than added sugar, they are high in calories, Walsh says. And "we don't feel full from them."

Better beverage choices are milk -- which provides nutrition -- or water, she says.

Artificial sweeteners do help some of Walsh's patients cut down their sugar intake.

"I'm fine with people using artificial sweeteners if it helps them achieve their goals," she says.

Walsh tells her patients to try fruit when craving a sweet: They get the sugar taste they crave, with the added benefits of nutrition, fiber and satiety.

Consumers may have a tough time avoiding added sugars in processed food. U.S. food labels provide information on total sugars per serving but do not distinguish between sugars that are naturally present in foods and sugars added to enhance taste or texture.

For example, flavored yogurt has about 10 grams of natural sugar and, usually, another 10 to 20 grams of added sugar, depending on the flavor.

Added sugars do, however, show up in the ingredient list. Walsh urges her patients to read them religiously and avoid foods where sugar is listed among the first five or so ingredients. (Manufacturers must list ingredients in order according to greatest weight by volume.)

The best way to avoid added sugar is to cut down on eating processed food, Walsh says. "The more processed a food is, the more sugar they need to add."

Also consider the whole product, not just a package claim such as "low-fat" or "no trans fat" when choosing processed foods. Another undesirable ingredient -- such as sugar -- might be amped up to improve taste.

Yes, that cracker might be made from whole grain, but if the second ingredient is sugar, you might want to pass, says Walsh.

When choosing food, Walsh says, step back and really consider what you're getting: Is it an invented product that is far, far away from its origin in nature? If so, that deep-fried snack made from extruded cornmeal and dusted with cheese-flavored powder might not be the best choice.

"My rule is, 'If Grandma doesn't recognize it, don't eat it,' " Walsh says.

Cho's guidelines for her patients: Be a "mindful eater" of the 200 or so food choices they make every day.

"You have to be responsible for whatever goes into your body," she says.

Cleveland Clinic summit names Top 10 medical innovations predicted for 2010

Jay Alberts, a biomedical engineer at the Cleveland Clinic, noticed his bicycling partners with Parkinson's had no symptoms after pedaling faster than they usually did on a tandem bike. Albert's subsequent research bore out his hunch, and the Clinic will recognize his work as one of the Top 10 medical innovations for 2010. (Plain Dealer photo by Chuck Crow).

 

By Kaye Spector
Health and Medical Reporter, The Plain Dealer 

 Sometimes innovation arrives on a bicycle.

That's how it came to biomedical engineer Jay Alberts, whose research into treating Parkinson's Disease symptoms is being recognized today by the Cleveland Clinic as one of the Top 10 medical innovations for 2010.

Alberts' research and the rest of the breakthrough devices and therapies will be announced at 11 a.m. at the Clinic's 2009 Medical Innovation Summit, which concludes this afternoon.

Alberts is a serious cyclist whose inspiration for treating Parkinson's came while participating in two, seven-day, 400-some-mile bike rides in Iowa to raise money for the disease, a neurological disorder that results in resting tremors, slowness of movement and limb rigidity.

In 2003, Alberts noticed that after the day's ride ended, his tandem partner, who has Parkinson's, stopped trembling enough to write clearly. After a 50-mile leg of the 2006 ride with a different partner, Alberts observed that the partner's symptoms were virtually gone.

When Alberts returned to Ohio, he decided to find out why. In a randomized, controlled study released about six months ago, he discovered that Parkinson's patients who rode with a trainer pedaling at 80 to 90 rpms -- a level beyond what they would choose on their own -- for an hour, three times a week showed 35 percent improvement in motor function.

Alberts' pedaling regimen lessens symptoms up to four weeks. He theorizes that the intervention might change brain function. The cycling also is empowering for patients, allowing them to actively manage their disease.

Alberts is now into a second study with Clinic collaborators Drs. Michael Phillips and Mark Lowe, and the initial results look promising.

All from a bike ride.

"To me, it's about always being aware of what's potentially out there," Alberts said. "It illustrates that as a scientist, we don't just find answers in the lab."