Spring 2012

At Cleveland Clinic Canada, we believe that your health is the best investment you can make. Healthy living, like financial planning, is about making smart choices today so that you can enjoy the benefits tomorrow. Of course to invest wisely it is important to be well informed about available options and how they can benefit you. The goal of this quarterly e-newsletter to keep you up to date on relevant health news, share tips to help you live a healthier life and explain how we can help. We hope you find this information helpful. If you have any suggestions or recommendations, feel free to let us know at ccfca@ccf.org

Executive Health Program: New and Improved

Over the past few years, our patients have told us that there are two improvements they would like to see in the Executive Health Program: same-day test results and more specialists onsite. We are happy to announce that those improvements are now in place.

Lab results available the same day

Earlier this year, Mount Sinai Hospital, a top academic health sciences centre in Toronto, began providing all medical lab services for Cleveland Clinic Canada. Now all patients can meet with their Executive Health physicians at the end of the day to review available lab results and determine if any specialist referrals are required. This same-day physician wrap-up provides timely feedback and review of test results, and eliminates the need for our patients to return to our clinic for a follow-up appointment.

18 onsite specialists

To ensure our patients receive the highest-quality care, we continue to build an all-star team of clinicians. We now have 18 specialists onsite providing expertise in anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, orthopaedics, urology, neurology, respirology and sports medicine.

Dermatology is Now Available for New Patients

Do you have a mole that should be checked out or dry skin that just won’t go away?

Starting this May, we have expanded our dermatology clinic hours to allow for new patients with referrals. In the past this service has only been available to Executive Health patients. This service is ideal for those who have a medical concern or condition involving their skin, hair or nails. Please note that dermatologist appointments at our clinic are covered by OHIP, require a physician referral and are available only for adults.

Cosmetic dermatology procedures, including injections and dermal fillers, are available for a fee and do not require a physician referral. If you would like to book an appointment, please call 416.507.6783 or fax a referral to 416.507.6650

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Osteopathic Medicine is Now Available

Are you suffering from back pain? Do you have a sports injury? Are you seeking relief from migraines? If you answered yes to any of these questions, osteopathy may be right for you. Osteopathic medicine is a non-invasive manual therapy that focuses on total body health by treating and strengthening the musculoskeletal framework, which includes the joints, muscles and spine, as well as the body's nervous, circulatory and lymphatic systems.

Osteopaths use a broad range of gentle hands-on techniques, including soft tissue stretching, deep tactile pressure and mobilization or adjustment of joints, to treat a variety of conditions. These techniques involve minimal pain, increase mobility and improve your overall health.

Osteopathic treatment is intended to promote and restore the body's ability to heal itself. Osteopaths don’t simply concentrate on treating the problem area, but use techniques intended to balance all the systems of the body and promote overall good health and wellbeing.

Meet Luke Fuller, Osteopath

Luke Fuller, MHSc (Osteo), MPhysio, an accomplished and internationally renowned osteopath, recently joined our Sports Health Team at Cleveland Clinic Canada.

Over the years, Luke has acquired an extensive knowledge of methods and approaches to treating a wide variety of sports-related and chronic injuries. He also has extensive expertise in enhancing performance and has almost a decade of experience treating world-class athletes.

When he is not treating patients at our clinic, Luke travels worldwide with the Association of Tennis Professionals (ATP) World Tour treating elite athletes, and has also consulted with the Ladies European Tour in golf. He recently returned from the 2012 Monte-Carlo Rolex Masters Tennis tournament, which was won by World No. 2 Rafael Nadal. “It was an amazing tournament and a tremendous thrill to work with these athletes again,” said Luke.

His treatment philosophy is simple. “I work on variety of sports injuries at Cleveland Clinic Canada. It’s just as important for the parent of three kids or the busy executive as it is for the elite athlete to maintain a healthy body and I am here to help them do that.”

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Dr. Tim and Team Canada Hit the Ice in the Czech Republic

If you are a hockey fan, you probably know that in April the 2012 World Under-18 Hockey Championships took place in the Czech Republic. But did you know that our very own Dr. Tim Rindlisbacher (aka Dr. Tim) was on hand as Team Canada’s sports medicine physician?

Over the past three years, Dr. Tim has worked closely with Hockey Canada. In his role as team physician, he examines each player invited to the selection camp to identify injuries and issues and decides whether or not he is healthy enough to compete. If any problem is identified, he works toward a resolution as quickly as possible.

For those who don’t know much about hockey, the World Under-18 Hockey Championships is an annual event organized by the International Ice Hockey Federation for the top under-18 hockey players from around the world. This tournament has become one of the most popular and prestigious sports events of the year, and has launched the NHL careers of many players. This year the tournament was held in Brno, Czech Republic and Team Canada won the bronze medal in overtime. Way to go, Canada and Dr. Tim!

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Making Sense of Medicine

Are you managing a chronic disease or condition? Trying to understand a diagnosis? Or do you just want to live a healthier life? Cleveland Clinic has developed a new website to help you make sense of the world of medicine. Health Essentials now gives you access to the latest health articles and videos in an easy-to-understand format.

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Unleashing your Fitness Potential

James Manson, CSEP, MSc, is the Director of Exercise Physiology at Cleveland Clinic Canada in Toronto

Have you ever wondered if the hours you spend at the gym every week are really improving your fitness? Or if you have what it takes to run a marathon?

Cardiovascular fitness can’t be assessed by looking in the mirror or gauging the tightness of your pants. It is measured by looking at the volume of oxygen you use while exercising at your maximum capacity. What this measures, in layman’s terms, is how efficiently your cardiovascular system – heart, lungs and muscles - works to deliver oxygen and create the energy you need to perform.

VO2 max testing is considered the gold standard in measuring your current aerobic fitness and is the most valid way to assess the capacity of your cardiovascular and respiratory systems and how they work together. This test reflects the capacity of the heart, lungs and blood to deliver oxygen to the working muscles during exercises that involve large muscle mass (running, biking, etc.). People who are fit have higher VO2 max scores, being able to work out longer and to process more oxygen for every kilogram of muscle than those with lower scores.

The VO2 max test usually involves an exercise test (on either a treadmill or a stationary bike) in which exercise intensity is incrementally increased while breathing is measured with a metered oxygen mask and heart rate is measured with a heart monitor. Your VO2 max is determined by identifying the specific point at which oxygen consumption plateaus even if exercise intensity increases. This test should be done in a clinical setting by a professional, such as an exercise physiologist, who has been trained and certified through the Canadian Society of Exercise Physiology or the American College of Sports Medicine.

The VO2 max score is an important clinical measure because it can be an accurate indicator of health-related fitness. Health-related fitness is a term referring to various health indicators, such as blood pressure, cholesterol, body composition and waist circumference that are positively affected by regular physical activity. The higher the VO2 score, the less risk of early mortality or serious illness. The average VO2 max score for a sedentary individual can range from 25 to 35 millilitres of oxygen per kilogram of body weight per minute (ml/kg/min), depending on age, gender and how long he or she has been sedentary. Elite athletes often score around 70 ml/kg/min. One of the highest recorded VO2 max test results (96 ml/kg/min) was that of a cross-country skier. Cyclist Lance Armstrong's VO2 max score was reported to be 85 ml/kg/min.

VO2 max test results are influenced by genetics but can often be improved through training. The two most effective ways to improve your VO2 max score are increasing your training time and intensity. Research also indicates that the less fit you are, the more you can increase your VO2 max score through training. In fact, novice exercisers have been able to increase VO2 max test results by 20% through proper training. Fit athletes have a harder time increasing their VO2 max scores, most likely because they are already so near their physical potential.

As a general rule of thumb, your VO2 max level can be raised by working out at an intensity that raises your heart rate to between 65%and 85% of its maximum for at least 20 minutes, three to five times a week. If you don’t know your maximum heart rate you can determine it by subtracting 220 minus your age. Please note that this formula only estimates your maximum heart rate. If you are interested in determining your specific maximum heart rate, you should consider the VO2 max test.

It is important to note that age and gender also affects VO2 scores. In general, VO2 max capacity is highest at age 20, and can decrease by nearly 30% by age 65. Also, because of differences in body size and composition, blood volume and hemoglobin content, a woman’s VO2 may be about 20% lower than a man’s max capacity.

To illustrate the effect VO2 max scores can have on a fitness plan, I have profiled two common scenarios.

A woman in her early 30s works out three times a week and has a VO2 score of 47, which is considered very good. She has run a few 10Ks over the past five years, but doesn’t consider herself a runner. Now she wants to run a marathon. Based on her superior VO2 max score and her lifestyle, the following fitness plan would be recommended:

  • Cardiovascular: three to five sessions per week at 75% to 80% of her maximum heart rate, with at least one long run during the week
  • Strength: two to three days per week of resistance training designed to support a high-intensity running program

It is important to note that while she has the VO2 max capacity to run a marathon now, she should ensure that structurally her body can handle the training.

A man in his late 40s works out sporadically and has a VO2 max score of 36, which is considered average. He used to run frequently in his 20s and early 30s but hasn’t done much in the last 10 years because of work and family. Trying to get back into shape, he now wants to challenge himself by running a marathon. Based on his average VO2 max score and his lifestyle, the following fitness plan would be recommended:

  • Cardiovascular: three to five sessions per week but at a lower intensity (60% to 65% of his maximum heart rate) and not for as long as the first example
  • Strength: two to three days per week of resistance training, with particular attention to recovery and over-training issues

Running a marathon at his age and fitness level would not be advised; he could cause more harm than benefit. A more realistic plan would be to run a series of smaller races, such as 5Ks and 10Ks, and perhaps try to work up to a half marathon. It is also important to take into account his family and work commitments and build a healthy exercise program that improves his fitness while allowing him to fulfill his other responsibilities. A realistic plan leads to long-term success.

VO2 tests are often available at private health clinics for a fee. The fee usually covers the test and a personalized plan to improve your fitness based upon your goals and interests.

While a high VO2 max score may indicate your current fitness and potential, it’s not the only tool that should be kept in your fitness tool box. In addition to keeping your heart and lungs healthy, it is important to use strength training to build up your muscles and keep your bones strong, stick to a healthy diet to maintain energy and ensure that you set aside time to let your body rest and recover.

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    Brain Miscues May Be at Root of Eating Disorders

    Dr. Jacqueline Brunshaw is Director of Psychology, featured in National Post

    Have you ever wondered if someone you know might be suffering from an eating disorder? Some sobering facts on this serious but treatable condition: The number of new cases diagnosed each year is increasing, despite numerous campaigns to promote prevention; eating disorders have the highest mortality rate of any mental health disorder; for anorexia alone, approximately 10% of those diagnosed die, with organ failure and suicide as leading causes; about one in 100 women aged between 15 and 30 struggle with an eating disorder; and recovery rates are around 50%, with a relapse rate of 40% within one year of treatment.

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    A Healthy Taste of Spring

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    Supporting the Community

    President of Cleveland Clinic Canada puts his heart into it (again)

    In 2009 Mike Kessel, President and CEO, Cleveland Clinic Canada, first learned about the Becel Heart & Stroke Ride for Heart. Ride for Heart is the largest annual charity cycling event in Toronto, with over 13,000 cyclists participating in an exhilarating ride along the Don Valley Parkway on the first Sunday in June. The funds raised support the Heart & Stroke Foundation’s mission to eliminate heart disease and stroke and reduce their impact through the advancement and application of research and the promotion of healthy living.

    As someone who believes in the benefits of an active lifestyle and whose family has been impacted by heart disease, Mike was intrigued and wanted to learn how he could get involved. The first year, he rode 25 kilometres and enjoyed the experience so much that he challenged himself to increase his fundraising and mileage goals for 2010. As he prepared for the next event, he also accepted a position on the Heart & Stroke Foundation board. As a board member, he was committed to helping eliminate heart disease and stroke, and so he hit the ground running – or more accurately, biking.

    Mike quickly joined the Leaders with Heart team, captained by Colleen Johnston, Group Head, Finance, and Chief Financial Officer, TD Bank Group. The team consists of a group of committed riders from the Heart & Stroke Foundation board of directors. In keeping with his goal, Mike increased his fundraising and rode 50 kilometres in 2010 and 75 kilometres in 2011. Leaders With Heart has been the top fundraising team for the past two years, raising an incredible $152,040 in 2011. Mike has personally raised $7,240.

    Mike’s goal for 2012 is to get more people involved in this great event. His first recruit was his lovely wife, Julie! Several Cleveland Clinic Canada clinicians are also getting involved.

    This year, the Becel Heart &Stroke Ride for Heart will celebrate its 25th anniversary on Sunday, June 3, 2012. The ride begins at Exhibition Place, with three cycling routes to choose from – 25, 50 or 75 kilometres. With the goal of raising $5,000,000 in 2012, all riders are asked to fundraise a minimum of $100. If you raise $1,000 or more, you can join Mike – become a VIP (Very Important Philanthropist). As a VIP fundraiser, you play a key role in our mission to help Canadians live longer, fuller lives. You will receive special recognition and exclusive benefits before, during and after the ride.

    Be a part of something big! Join us on June 3 to support vital research and programs to help eliminate heart disease and stroke.

    For the love of art

    Cleveland Clinic Canada is proud to support the beloved McMichael Canadian Art Collection and its new fundraising event, Fashion as Art: EXPOSED! Attend this innovative event – to be held on Saturday, June 16, 2012 – and celebrate the fusion of art and fashion with some of Canada’s leading fashion designers, artists and celebrities.

    Hosted by well-known fashion personality Jeanne Beker, this exclusive event will feature thought-provoking art and the latest in haute couture. Fashionistas and art lovers alike will be treated to a glamorous evening of innovative design, gourmet cuisine and fabulous music. As part of the event, the Fashion Design Council of Canada will also highlight Canada’s Group of Seven Fashion Designers and showcase their artistic talents.

    With your generous support, the funds raised from this event will be used to advance the future of Canadian art through interactive educational programming and provocative exhibitions at the McMichael.

    Tickets are now on sale.

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    Congratulations to our Newest Author: Jennifer Sygo, RD

    The word “superfood” is everywhere these days, but which of the many hyped items should you really include in your diet? This e-book from the National Post offers clear, realistic advice from Ms. Sygo on foods ranging from quinoa to sardines, including what to eat and what to avoid at the grocery store.

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