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Fall 2011

As summer comes to an end, many of us are making the adjustment back to a well-orchestrated routine of work, school, household chores and social events. With so much to organize and juggle, it’s often easiest to put our health on the back burner. Let the changing of the season be your reminder to book any necessary health appointments and an excuse to add some variety to your life by embracing the best of what the season has to offer. This fall, unwind from a busy day with a relaxing walk to enjoy the colourful leaves, spice up your meals by adding seasonal fruits and vegetables such as apples, pumpkins, beets and sweet potatoes to your diet, and take advantage of cooler temperatures to go outside for a run or hike.


Five Years and Going Strong

At Cleveland Clinic, we believe in celebrating milestones, especially ones that improve the lives of others. This fall, we will be celebrating the fifth anniversary of Cleveland Clinic Canada. Since 2006, we have helped more than 10,000 Canadians improve their health and quality of life through our Executive Health, Sports Health and Wellness programs. We continue to find that more and more individuals are taking proactive roles in their health and embracing our model of care – a model that is based on creating an environment where the patient is at the centre of a multi-disciplinary care team. We customize care to our patients’ medical history, lifestyle and goals, and empower patients with education and tools to modify their behaviours so that they can live healthier lives. We would like to thank our patients, client partners, talented staff and the clinical community for their support throughout the past five years and we look forward to continuing to work together to improve the health of Canadians.


A Tradition of Excellence

Cleveland Clinic continues a tradition of excellence as one of America's top four hospitals, and one which offers the best cardiac care, according to U.S.News & World Report's 2011-12 Best Hospitals rankings. For the 17th consecutive year, Cleveland Clinic's heart program was ranked number one in the United States. Among Cleveland Clinic’s highly ranked programs, nine placed in the top five and four – heart, gastroenterology, kidney disorders and urology – placed among the top two.


Dr. Roizen’s Top Tips to Live a Healthy Life

Cleveland Clinic’s Chief Wellness Officer, Dr. Michael Roizen, spoke to a full house at the Economic Club of Canada on Tuesday, September 13, 2011. As a wellness expert and New York Times best-selling author, Dr. Roizen explained that aging is a controllable process and there are hundreds of steps we can take to help us live our lives to the fullest.

Here are some of his top tips for changes that you can make today to start living your healthiest life:

Eat healthy: A diet rich in fruits, vegetables, fish and whole-grain foods offers protection against chronic lung diseases as well as many other aging-related diseases and problems. Avoid trans fat, saturated fat, high-fructose syrups such as corn, refined sugars and refined carbohydrates.

Get moving: There's no better way to improve your heart health and feel an adrenaline rush than by working up a good sweat. Aim for at least 10,000 steps a day and add resistance training and cardio to your exercise plan.

De-stress: When you're tense, tasks become more painful and difficult. So take a deep breath. Tackle large projects by breaking them into more manageable pieces and make sure to track your accomplishments.

Prioritize sleep: Sleep is more than simply a period of rest. In fact, it ranks right up there with diet and exercise in terms of being vital for your health and well-being. People who sleep well are less likely to become obese and are more resistant to colds and upper respiratory infections.

Quit smoking: Smoking ages you. Your skin suffers, your lungs become congested, and you simply don't breathe as well. Also, stay away from smokers: Spending one hour in the presence of secondhand smoke is the equivalent of smoking four cigarettes.

Have a laugh: Seriously. A good laugh helps stimulate the immune system, and humour has a valuable effect on your memory.


Our Clinical Family is Growing

In an effort to meet the demand and deliver the best patient care possible, we continue to add to our team of talented clinicians. Please welcome the newest members of our Cleveland Clinic Canada family:

Dr. Yako Merogi, DC, is a talented new Chiropractor in the Sports Health department at Cleveland Clinic Canada. Committed to ongoing learning and staying abreast of the latest innovations in chiropractic care, Dr. Merogi has an Honours Degree in Kinesiology and Health Science from York University in Toronto and earned his Doctor of Chiropractic degree from the New York Chiropractic College. He is also certified to provide Active Release Technique (A.R.T.) therapies for the spine and upper and lower extremities as well as contemporary medical acupuncture and kinesiological taping.

Priya Shah, RN(EC), NP-PHC, BScN, brings a wealth of knowledge and experience to our Executive Health Program in her role as a Nurse Practitioner. In addition to being formally trained as a nurse, Ms. Shah received additional medical education and experience at McMaster University. As a Nurse Practitioner, Ms. Shah is able to order and interpret diagnostic tests, communicate diagnoses, prescribe medication and perform specific procedures and will be a great clinical resource for our urgent care patients. Prior to joining Cleveland Clinic Canada, Ms. Shah worked at the Scarborough Academic Family Health Team and at the Intensive Care Unit at St. Michael’s Hospital.


Watch the Power of Prevention

Are you or someone you love in need of a head-to-toe physical? Hear from our patients and physicians about how our Executive Health program can help you improve your health and your overall quality of life.


New Urgent Care Clinician, Same Great Patient Care

As an Executive Health patient, you benefit from a five hour medical evaluation in our state of the art facility as well as the use of our urgent care service for 12 months following your evaluation. We are continually told by our patients that our urgent care service is invaluable, so we are happy to announce that we had added a new clinician to run this service. Ms. Priya Shah, a qualified Nurse Practitioner, will dedicate her time solely to caring for our urgent care patients.

As a Nurse Practitioner, Ms. Shah is able to order and interpret diagnostic tests, communicate diagnoses, prescribe medication and perform specific procedures. Prior to joining Cleveland Clinic Canada, Ms. Shah was a primary care provider at the Scarborough Academic Family Health Team and also worked in the Intensive Care Unit at St. Michael's hospital.

As a reminder, the urgent care service is available for Executive Health patients who experience a non-emergency medical issue such as a sore throat, flu or ear infection that can be addressed in one clinic visit. Patients experiencing such issues will be able to call and discuss their symptoms with the Nurse Practitioner. Ms. Shah will be able to schedule necessary appointments for the same day or next day. Appointments are available on Monday, Wednesday, Thursday and Friday. To make an urgent care appointment with Ms. Shah, please call our clinic at 416.507.6600.

Please note that our Executive Health program is not intended to replace the role of your family physician, it simply meant to complement it with an in-depth annual exam that is focused on preventing disease and giving you the tools and support you need to make positive changes in your health. We encourage all of our patients to maintain their relationship with their family medicine physician. This continuity of care is critical for our patients so that all of their clinical needs are met, now and in the future.


Cancer Screening Saves Lives

We all have reasons for avoiding our annual check up or not seeing a physician when we suspect a problem. But the simple fact is that routine screenings will not only offer you peace of mind; they can also save your life. During September and October, the Canadian Cancer Society is working hard to raise awareness about men’s and women’s cancers, in particular colorectal, breast, cervical, prostate, testicular and skin cancer.

Below are some general screening guidelines to help you take control of your health.

Colon Cancer Screening

Many people dread the idea of having their colon checked, but keep in mind that 90% of colon cancer cases can be successfully treated if detected early.

What you can do:

  • Beginning at age 50, or earlier if you have a family history of the disease or are considered to be at high risk, you should start getting screened for colon cancer. Screening methods may include a colonoscopy or a fecal occult blood test. Talk with your family physician about what the right option is for you.

Breast Cancer Screening (for Women)

It is important for women to maintain an awareness of how their breasts normally look and feel and to monitor any changes. This awareness, along with regular mammograms, is essential in the early detection of breast cancer.

What you can do:

  • During your annual check up, ask your family physician to perform a physical breast examination.
  • Beginning at age 50, or earlier if you have a family history of breast cancer or are considered to be at high risk, you should start having regular mammograms. Talk with your family physician about what is right for you.

Cervical Cancer Screening and HPV Vaccination (for Women)

The pap smear is the most commonly used method of screening for cervical cancer, and it can detect the presence of risk indicators such as the human papillomavirus (HPV). HPV is a sexually transmitted infection, and in order to provide the best possible protection, the HPV vaccine should be administered to women before they become sexually active. In women, HPV can cause cervical cancer.

What you can do:

  • If you are 18 years of age or older and/or sexually active, you should have an annual pap smear test. Frequency of testing may need to increase or decrease depending on your risk factors.
  • Speak with your family physician to see if the HPV vaccine is right for you.

Prostate Cancer Screening (for Men)

The Canadian Cancer Society reports that, on average, 11 Canadian men die of prostate cancer every day. Screening can help detect prostate cancer early, often before symptoms become evident.

What you can do:

  • Beginning at age 50, or earlier if you have a family history of prostate cancer or are considered to be at high risk, talk with your family physician about your prostate.

Testicular Cancer Screening (for Men)

When testicular cancer is detected and treated early, the chances of successful treatment are very good. Being aware of your body and getting regular medical check ups are the best ways to detect testicular cancer early. Most testicular cancers are first detected by the patient.

What you can do:

  • Beginning at 15 years of age, all males should be aware of how their testicles normally look and feel and report any changes to their family physician.
  • If you have a family history of testicular cancer, you should talk to your family physician about a personal plan for screening which may include regular physical exams.

Skin Cancer Screening

Skin cancer is the most commonly diagnosed cancer in Canada. Canadians can reduce their exposure to the risk of this disease by performing skin self-exams and protecting their skin from sun-related damage.

What you can do:

  • Perform skin self-exams using a full-length mirror and hand mirror monthly after bathing. Familiarize yourself with any moles, blemishes or birthmarks on your body, and if they change in size, colour or shape, or if you develop a sore that does not heal, see your family physician.
  • During your annual check up, ask your family physician to examine your entire body for abnormalities or changes in skin lesions or moles that could be a sign of skin cancer. Your family physician will refer you to a specialist if necessary.

The above are general guidelines that can help Canadians take control of their health. Please note that these guidelines are intended for healthy adults. Your medical and lifestyle requirements may be different because of your medical and family history. Ask your family physician what is right for you.


How to Fuel Your Run with a Healthy Diet

Exercise is good for you, but if you do not eat enough to fuel that exercise, you may be putting your health at risk. Jennifer Brenton from OptiMYz magazine interviewed Nicole Springle, Registered Dietitian and Sports Nutritionist at Cleveland Clinic Canada.

What do runners need to know about nutrition to run well and stay healthy overall?

Without a good training diet, your race day nutrition isn’t going to make much of a difference. I see too many runners concerned about what to eat the day before a race, without taking the time to invest in a healthy diet leading up the event. Here are my top nutrition and hydration tips to ensure that a runner’s training diet prepares them properly for the best race they can run:

Nutrition

  1. Eat a diet rich in healthy carbohydrates. Runners need the energy provided by carbohydrate-rich foods. Examples of good carbohydrate choices are fruits, vegetables, whole wheat and multigrain breads, cereals, pastas, and rice. Consume about 60% of your calories from carbohydrates, while limiting refined sugars like white breads, pastas, rice, and foods high in added sugar as much as possible.
  2. Eat plenty of fruits and vegetables. We’ve all heard this before, but the fact is that there is no other food out there that provides the same health benefit. They are also good carbohydrate sources and contribute fibre to your diet. Finally, as a runner, the anti-oxidant qualities of fruits and vegetables can help repair some of the damage that your body incurs during training. As a rule, aim for at least two or three servings of fruit and four or more servings of vegetables per day.
  3. Get enough protein, including red meats, poultry, fish, most dairy products (not ice cream, cream cheese, sour cream, or butter), nuts, peanuts, peanut butter, beans, soy and tofu, and other legumes (lentils, chick peas, etc.). Eat about 20% of your calories from protein, or 0.8 to 1.0g of protein per kg of your body weight per day. For example, a 70kg male would require approximately 56-70g of protein. If you training steadily throughout the year, four to five days per week, your protein needs could increase to 1.5 g/kg/day or more.
  4. Eat frequent, small meals, and combine protein and carbohydrates for lasting energy. Instead of three large meals, eat five or six small meals and snacks per day. Try not to go for any longer than four hours without eating; otherwise, your blood sugar will drop and you could start to feel tired and cranky and have sugar cravings. Eat every two to three hours. Try this: Breakfast, snack, lunch, snack, dinner, and then an optional snack in the evening. By combining a protein source with carbohydrates at each meal and snack, you will help your energy last longer.

Hydration

  1. Hydration is essential to your success as a runner. Once you are thirsty, you are already dehydrated. You’ll need to “think to drink,” so bring a water bottle with you every day.
  2. Drink eight glasses of non-caffeinated fluids per day, not including water you take in during or immediately after your run.
  3. Drink during your run or during any intense physical activity. If you’re exercising longer than 20 minutes, you’ll need to start drinking water to make sure you don’t start to fatigue, slow down, and dehydrate.
  4. Aim to pee clear. You know you’re drinking enough water if your urine is consistently clear throughout the day — except first thing in the morning.

Ask an Expert: Jennifer Sygo, RD

What are some healthy breakfast and lunch options for my kids?

It's back-to-school time, and that means another year of battles around what to feed your kids for breakfast and lunch. Here are some easy, healthy and tasty breakfast and lunch options to make the battle a win-win for everyone.

Healthy Breakfast Options

Kids who do eat something before school tend to be a healthier weight, are more likely to meet nutritional needs, have better recall and perform better on tests than those who do not. (And a note to parents: The same applies to you at work — yes, you will actually perform better on the job if you nosh on something before your morning meeting.) So, by ensuring that your son or daughter has a bite before hopping on the bus, you’re setting them on the right dietary path for the day.

  • Whole grain cereal with 1% or 2% milk and a sliced banana, sprinkled with slivered almonds.
  • Oatmeal (preferably slower cooking or steel-cut) and/or quinoa with cinnamon, a dash of maple syrup, fresh or frozen berries, and a sprinkling of ground flax, hemp or chia seeds.
  • 1% or 2% cottage cheese with fresh or frozen blueberries and a slice of whole-grain bread or toast.
  • Peanut or almond butter on whole-grain bread or toast with a piece of fresh fruit.
  • 1-2 scrambled eggs with diced avocado and tomato on a whole wheat pita.
  • Trail mix made with cashews or walnuts, pumpkin seeds, dried cranberries or raisins, and dried sugar-free cereal (make it in batches and divide it up).
  • Smoothie made from plain yoghourt, milk or soy beverage, frozen berries, ½ of a banana.

Healthy Lunch Options

While cafeteria lunches are one way to feed a child, a homemade meal is, in many ways, your best choice. At the very least, it allows your child to enjoy his or her favourite foods; better yet, it allows them to be involved in the meal preparation process. If possible, emphasize fresh and whole foods more often, while limiting highly processed foods with long ingredient lists; for example, if the choice is between an apple and a granola bar, choose the apple.

  • Sandwich made with deli meat (try nitrate-free varieties like Maple Leaf Natural Selections) on whole-grain bread or wrap with avocado, tomato, and lettuce, a piece of fruit, and two small or one medium oatmeal cookie.
  • Lentil soup and a whole-grain roll with carrot and celery sticks and banana bread made from whole wheat flour.
  • 1-2 hard-boiled eggs (made the night before), 1/2-1 cup edamame or bean or chickpea salad (mix a can of chickpeas with a can of corn and diced carrots and green peppers, drizzled with olive oil and balsamic vinegar),and a side of cantaloupe, watermelon and/or honeydew melon.
  • Cheese and whole-grain crackers with cherry tomatoes, a piece of fresh fruit and a yoghourt.
  • Leftover grilled chicken on a whole-grain wrap with lettuce, tomato and grated cheese and an apple on the side.
  • Mini can of flavoured tuna and flatbread crackers, mixed veggies with hummus and ginger snaps for dessert.

Guilt-free Recipes

Pumpkin Ravioli in a Wild Mushroom-Ginger Broth

Ravioli filled with this savory mousse will delight your family and friends. The pumpkin says that fall has arrived and luckily for us, canned pumpkin puree is always available. Use a mélange of wild mushrooms in the broth. We like thinly sliced cremini, shiitakes, chanterelles and morels. Because some of these are hard to find, we buy dried and reconstitute them. You can use other winter squashes or sweet potatoes for the filling.

Ingredients

Ravioli

  • Refrigerated butter-flavored cooking spray
  • 1 shallot, minced
  • 3/4 cup pumpkin puree
  • 1/4 cup egg substitute
  • 2 tablespoons reduced-fat ricotta cheese
  • 2 teaspoons minced fresh sage
  • 1/8 teaspoon ground nutmeg
  • Freshly ground pepper
  • 32 won ton wrappers (3.5-inch square), defrosted if frozen
  • Kosher salt

Wild Mushroom-Ginger Broth

  • 3 cups fat-free, reduced-sodium chicken broth
  • 1 ounce dried wild mushrooms, rehydrated (see Note)
  • 1/2 pound assorted wild mushrooms, thinly sliced
  • 2 teaspoons grated fresh ginger
  • 1 garlic clove, crushed
  • 2 scallions, white parts and 3 inches of the green, thinly sliced

Directions

  1. Coat a nonstick skillet with cooking spray. Saute the shallot over medium heat until wilted, about 5 minutes. Remove from heat. In a bowl, combine the pumpkin puree, egg substitute, ricotta cheese, sage and nutmeg. Stir in the shallot and pepper. Set aside.
  2. Place 8 won tons on the counter and put 1 tablespoon of the pumpkin mousse in the middle of each. Wet the edges of the won ton and place another on top, pressing all around the edges to seal securely. Leave square or cut with a floured glass to make a circle, again making sure that each ravioli is sealed. Place on wax paper and cover with a clean kitchen towel. Place another 8 won tons on the counter and repeat the process. If not cooking immediately, transfer to a cookie sheet, cover and refrigerate.
  3. To make the broth, combine the chicken broth, rehydrated and fresh mushrooms, ginger and garlic in a saucepan, bring to a boil, then simmer for 10 minutes. Set aside and keep warm.
  4. To cook the ravioli, bring a large pot of lightly salted water to a boil. Reduce to a simmer. Slide in half of the ravioli one at a time and stir gently. Poach for 2 to 3 minutes, until the ravioli rise to the top of the pot. Remove with a slotted spoon and cook the remainder of the ravioli.
  5. While the ravioli are cooking, bring the ginger broth back to a simmer.
  6. To serve, place 4 ravioli in each of 4 shallow soup bowls. Ladle ¾ cup broth into each soup bowl. Top with a quarter of the mushrooms and garnish with sliced scallions. Serve immediately.

NOTE: To rehydrate dried mushrooms, soak the mushrooms in boiling water to cover for about 15 minutes, or until softened. Remove the mushrooms with a slotted spoon. Strain the soaking liquid through a coffee filter to remove sediment. Use in the recipe or reserve for another use.

DIETITIAN’S NOTE: Although this dish contains about 100 milligrams more sodium than we generally recommend at a meal, it is a good source of potassium, contains dietary fiber, and is low in total fat. Just make sure you monitor the sodium content in your other meals, and serve the ravioli with a side of fresh vegetables.

Makes 4 Servings

Per Serving:

  • 280 calories (5% calories from fat)
  • 1.5 g total fat (0 g saturated fat)
  • 13 g protein
  • 55 g carbohydrate
  • 4 g dietary fiber
  • 10 mg cholesterol
  • 700 mg sodium
  • 657 mg potassium

Crunchy Pumpkin Pie

This pie uses only a small amount of oil in the crust and skim milk in the filling to make it heart-healthy.

For the pie crust

  • 1 C quick cooking oats
  • 1/4 C whole wheat flour
  • 1/4 C ground almonds
  • 2 Tbsp brown sugar
  • 1/4 tsp salt
  • 3 Tbsp vegetable oil
  • 1 Tbsp water

For the pie filling

  • 1/4 C packed brown sugar
  • 1/2 tsp ground cinnamon
  • 1/4 tsp ground nutmeg
  • 1/4 tsp salt
  • 1 egg, beaten
  • 4 tsp vanilla
  • 1 C canned pumpkin
  • 2/3 C evaporated skim milk

Directions

  • Preheat oven to 425º F.
  • Mix oats, flour, almonds, sugar, and salt together in small mixing bowl.
  • Blend oil and water together in measuring cup with fork or small wire whisk until emulsified.
  • Add oil mixture to dry ingredients and mix well. If needed, add small amount of water to hold mixture together.
  • Press into a 9-inch pie pan and bake for 8 – 10 minutes, or until light brown.
  • Turn down oven to 350º F.
  • Mix sugar, cinnamon, nutmeg, and salt together in a bowl.
  • Add eggs and vanilla and mix to blend ingredients.
  • Add pumpkin and milk and stir to combine.
  • Pour into prepared pie shells.
  • Bake 45 minutes at 350º F or until knife inserted near center comes out clean.

Yield: 9 servings
Serving Size: 1/9 of a 9-inch pie

Each serving provides:

  • Calories: 177
  • Total fat: 8 g
  • Saturated fat: 1 g
  • Cholesterol: 24 mg
  • Sodium: 153 mg

In the News: Back-to-School Tips

Our Director of Psychology, Dr. Jacqueline Brunshaw shared some back-to-school tips with the National Post to help families ease back into the school year.


Will an Injury Keep You Off the Slopes this Winter?

Let our Sports Health team help you get back to the winter sports you enjoy most. An appointment with one of our Sports Medicine physicians is covered by OHIP and doesn’t require a referral. Call 416.507.6673 today to book an appointment with Dr. Tim Rindlisbacher or Dr. Julia Hamilton.


Protect Yourself and Your Family This Flu Season

It’s almost that time of year: When everywhere you turn, someone has the flu. Seasonal flu requires you to miss work, may cause life-threatening complications and is highly contagious. But there is one way to make sure you’re in the clear this year: Get vaccinated. Cleveland Clinic Canada offers free seasonal flu vaccines for our patients and their family to fight against flu season.

Take action this flu season. Get a seasonal influenza vaccine. Here’s what you need to know:

  1. Contact our clinic at 416.507.6600 in late October to book your appointment. It's free.
  2. This year’s influenza vaccine is the same as last year’s and protects against three strains of flu: influenza A and B, as well as H1N1. Although this year's influenza vaccine strains are unchanged, annual vaccination is recommended even for those who received the vaccine the previous season.
  3. Flu vaccines are safe. There has been no evidence of neurological or other problems linked with the vaccine. Read more about the seasonal flu and vaccine safety.