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Update _ Summer 2013


Comprehensive Pediatric Care Coming to Medina Hospital

Cleveland Clinic Children's is going where there is patient need. As many young families move to Medina and the surrounding communities, Cleveland Clinic Children’s is providing them with access to its full spectrum of pediatric services, from childhood immunizations to the most complex procedures, including transplants.

In 2012, Cleveland Clinic Children’s provided care to more than 800,000 children, from newborns to adolescents to young adults. With this expansion into Medina, Cleveland Clinic Children’s will bring its expert pediatric care to more than 40 locations throughout Northern Ohio.

“People come to Cleveland Clinic for their healthcare needs from all over the world,” says Giovanni Piedimonte, MD, Chairman of Cleveland Clinic Children’s. “Now, Cleveland Clinic Children’s is extremely excited to be bringing the highest quality of pediatric care close to home for the Medina community. This means we will be able to provide the full continuum of care throughout the lifespan of residents who live in Medina and its surrounding communities.”

Cleveland Clinic Children’s prides itself on providing quality, comprehensive care in a timely fashion, many times offering short wait times to see the doctor, including same-day appointments (when available).

Medina’s New Pediatric Offices

Two office suites with 5,000 square feet of space have been renovated on the third floor of the Medical Office Building. Medina Hospital will serve as the South hub for pediatric care with Hillcrest Hospital serving as the East Side hub and Fairview Hospital on the city’s West Side. Cleveland Clinic Children's physicians in Medina will provide general pediatric care, as well as a wide range of specialty services, including allergy/immunology, cardiology, endocrinology, gastroenterology, pulmonology and rheumatology services.

The new pediatric offices feature a large and comfortable waiting area for patients and families and six exam rooms for seeing young patients. Being located on the site with Medina Hospital also allows for ready access to hospital care, emergency services and laboratory work as well as critical care transport to Cleveland Clinic’s main campus or Fairview Hospital in the event of an extreme emergency. In 2014, pediatric infusion suites will be opened in the Medical Office Building alongside the current adult infusion suites.

About Medina Hospital

Located on Route 18 (East Washington Street), the main corridor to the Medina community, Medina Hospital is a 116-bed acute-care facility that has been serving the healthcare needs of a growing Medina County since 1944. In August 2009, the hospital affiliated with Cleveland Clinic and today it is the southernmost community hospital in the health system.

With the growing family population in Medina, each year more than 900 moms choose to deliver their babies at the Family Birthing Center at Medina Hospital where Cleveland Clinic Children's specialized neonatology services are now available 24 hours a day. 

“We are so happy to be bringing pediatric care to families in and around Medina,” says Alec Kulik, administrator for Cleveland Clinic Children’s. “This will allow children to access world class, ‘kids first’ care without having to leave their community.”


New Clinic Works with Families to Curb Childhood Obesity

The Centers for Disease Control and Prevention estimate that more than 30 percent of our nation’s youth are overweight or obese, which represents almost a tripling of the problem in the last three decades. Cleveland Clinic Children’s new Be Well Kids Clinic is focused on helping children and adolescents in dealing with the complex issues surrounding unhealthy weight.

Cleveland Clinic Children’s Be Well Kids Clinic, led by Pediatrician Sara Lappe, MD, and Gastroenterologist Naim Alkhouri, MD, offers a comprehensive approach in evaluating and treating young individuals with weight management problems. It is a multi-disciplinary clinic for the evaluation and management of pediatric obesity, and the diagnosis of obesity-related conditions.

“We know that the issues surrounding unhealthy weight in children are complex,” says Dr. Lappe. “A child’s genetics, nutritional intake, emotions, and home and school environments all play a role. Our team of experts has knowledge in each of these areas and can provide long-term help and individualized plans for youth struggling with weight issues.”

The Be Well Kids Clinic works to create an individualized treatment plan to help each child achieve his or her goals. For the best chance at long-term success, it is important to start as early as possible when weight becomes an issue. The team sees patients ages 2 to 20 with a body mass index (BMI) in the 85th percentile and higher who are interested in lifestyle changes.

Dr. Lappe says these are the five signs that a child is getting too heavy:

  • Difficulty keeping up with other kids during play
  • Aches and pains when moving
  • Snoring at night
  • Depression or anxiety (acting nervous, sad or moody)
  • Darkening of skin around the neck (acanthosis nigricans)

The program offers comprehensive care – including individual medical appointments combined with group sessions on behavior modification, nutrition and exercise. Medical care is coordinated by pediatric providers with expertise in childhood obesity. Children will be referred to a variety of pediatric medical subspecialists -- such as pediatric endocrinologists, pediatric gastroenterologists, and pediatric cardiologists—as needed.

The Be Well Kids Clinic is staffed by a pediatrician, a nurse practitioner, a gastroenterologist, a nutritionist, a psychologist and an exercise physiologist. Together, they do a thorough evaluation of the patient, which includes a medical evaluation, family history, patient history and diet habits.

First, the team determines if there are any complications related to the child’s obesity; if so they involve other subspecialists as needed. Family involvement is critical. The team approaches the families with what is called motivational interviewing.

Referrals to the clinic are welcome from primary care pediatricians and subspecialists who feel that their patients would benefit from a multi-disciplinary approach. The team also welcomes self-referrals from parents who are concerned about their child’s weight and are ready to make healthy changes.

For more information, or to make a referral to the Be Well Kids Clinic, please call 216.448.6000.


New Community Pediatric Infusion Centers Are Closer to Home

More than a few children have told Steven Spalding, MD, that they don’t feel like they are sick when they have their infusions in the comfort of Cleveland Clinic’s new community infusion suites.

In the new pediatric infusion centers, patients sit in chairs rather than lying on beds. The centers have glass walls that offer natural light and look out onto wooded landscapes. If the children prefer other distractions, they can watch big-screen TVs or play with a tablet computer while talking to kids in nearby chairs.

“Our aim in opening these infusion centers in the community was to bring full-service Cleveland Clinic Children’s services to families closer to home rather than requiring all families to come to the pediatric infusion center at our main campus location,” explains Dr. Spalding, Head of the Center for Pediatric Rheumatology at Cleveland Clinic Children’s.

Infusions are offered for children with chronic rheumatologic or gastroenterologic conditions requiring infusible therapies such as biologic agents or methylprednisolone (see table). Infusions are given at the Avon and main campus locations on Mondays, Wednesdays and Fridays and at the Twinsburg location on Thursdays.

Pediatric infusion therapy offerings

For gastroenterologic conditions:

  • Infliximab (Remicade®) — Main campus, Avon, Twinsburg

For rheumatologic conditions:

  • Abatacept (Orencia®) — Main campus, Avon, Twinsburg
  • Infliximab (Remicade®) — Main campus, Avon, Twinsburg
  • IV immunoglobulin — Main campus
  • Methylprednisolone — Main campus, Avon, Twinsburg
  • Rituximab (Rituxan®) — Main campus
  • Tocilizumab (Actemra®) — Main campus, Avon, Twinsburg
Setting a new course

Dr. Spalding is aware of no other children’s hospital that offers infusion centers as a primary service in the community, outside of its main hospital location.

“This is a unique service that sets us apart nationally in the commitment we’ve made to improving access for families while offering the exact same quality of care and level of service as on our main campus,” he says.

That level of service includes accessibility to other pediatric medical services, such as imaging, bone density measurement and blood testing, at the same convenient community location. Free parking and on-site dining options at the Avon and Twinsburg health centers also help minimize family stress and expense, especially since infusions can last up to six hours.

Dr. Spalding sees community pediatric infusion centers proliferating with the coming wave of infusible biologic therapies.

“A large number of infusible drugs are in the development pipeline for all kinds of chronic conditions, from asthma to endocrinologic conditions to neurologic diseases,” he notes. “Ready access to infusion centers is going to greatly improve the care of children with these conditions by bringing them cutting-edge therapies closer to home.”

For more information, or to make a referral to Gastroenterology or Rheumatology, please call 216.444.9000.


Pediatric Endocrine Clinics Focus on Turner Syndrome and PCOS

Young patients with Turner syndrome and polycystic ovarian syndrome (PCOS) need specialized care. Cleveland Clinic Children’s has clinics dedicated to both of these conditions.

Care for Turner Syndrome

The Turner Together Clinic opened in December 2012 under the direction of B. Michelle Schweiger, DO, and Nouhad Raissouni, MD. It is for girls with diagnosed Turner syndrome. The earlier patients are referred, the better so that complications can be prevented and care can be optimized.

Specialists at the clinic provide multidisciplinary/interdisciplinary care that includes endocrinology, cardiology, ENT, behavioral medicine, adolescent gynecology, genetics and nutritional therapy.

Says Dr. Schweiger: “It’s best when kids with Turner syndrome have a coordinated group of specialists who work together and communicate with each other — and with the patient — as a team.”

Frequency of visits should be every three to four months for hour-long, one-on-one sessions followed by 20- to 30-minute shared medical appointments (SMAs).

Early intervention and prevention is the focus. Dr. Raissouni explains: “We are very highly focused on coordinated care and comprehensive developmental pediatrics that seek to minimize developmental delays and preserve reproductive function when possible.”

Referring physicians are sent clinical notes and lab results every time their patients are seen at the Turner Together Clinic. They are encouraged to share input and ideas. For information or appointments, call 216.444.7987. Dr. Schweiger also can be reached at schweim@ccf.or or 216.445.5158.

Care for PCOS

The PCOS Clinic also opened in December 2012 and it is directed by Nouhad Raissouni, MD. It is for girls and young women with a suspected or definitive diagnosis of polycystic ovarian syndrome (PCOS), and the earlier patients are referred, the greater the chance of preventing future complications.

The multidisciplinary/interdisciplinary care offered at PCOS includes pediatric and adolescent endocrinology, nutritional therapy, behavioral medicine and sports medicine. Patients visit for a one-on-one visit first and can follow up thereafter with shared medical appointments (SMAs). Its focus is on prevention, patient education, nutritional support, exercise and information sharing.

Dr. Raissouni works with the referring physician to confirm (or deny) a diagnosis of PCOS, as the syndrome is often over diagnosed. “We want to give the right name to the right condition, and if a patient has PCOS, to manage it accordingly,” she says. Once a PCOS diagnosis is confirmed, the referring physician is kept fully updated on the patient’s management in the PCOS Clinic.

For information or appointments, call 216.444.5437. Dr. Raissouni may be reached at raisson@ccf.org or 216.445.6351.


Who's New? Staff Spotlight

Sue Sreedhar, MD

Department: Critical Care Medicine
Specialty Interests: Critical care medicine
Location: Main campus
Phone: 216.444.5327
Email: sreedhs@ccf.org

Rishi Gupta, MD

Department: Gastroenterology
Specialty Interests: Gastroenterology
Location: Main campus, Twinsburg Family Health and Surgery Center
Phone: 216.444.3556
Email: guptar@ccf.org

Aron Flagg, MD

Department: Hematology/Oncology
Specialty Interests: Infectious complications of cancer chemotherapy, children with primary and secondary immune deficiencies, neutrophil disorders, and hematopoietic cell transplantation
Location: Main campus
Phone: 216.444.3866
Email: flagga@ccf.org

Keshava Gowda Narayana, MD

Department: Critical Care Medicine
Specialty Interests: Post-op cardiac patients, quality improvement, resident education, and patient simulation
Location: Main campus
Phone: 216.445.4806
Email: gowdak@ccf.org

Ahsan Moosa Naduvil Valappil, MD

Department: Neurology
Specialty Interests: Medically refractory epilepsy; autoimmune, genetic and metabolic disorders causing epilepsy; hemispherectomy; seizure like patterns in critically ill patients
Location: Main campus
Phone: 216.445.6746
Email: naduvia@ccf.org

Veena Tripathi Ahuja, MD

Department: Psychiatry and Psychology
Specialty Interests: Child and adolescent psychiatry
Location: Cleveland Clinic Children’s Hospital for Rehabilitation

Manish Aggarwal, MD

Department: Psychiatry and Psychology
Specialty Interests: Inpatient psychiatry, acute stabilization of mood disorders, psychotic disorders
Location: Fairview Hospital
Phone: 216.444.3814
Email: aggarwm2@ccf.org


CME from Children's

Live CME
Aug. 26-30, 2013

19th Annual Pediatric Board Review Symposium
Renaissance Cleveland Hotel, Cleveland, Ohio
Comprehensive review to prepare physicians for pediatric board certification or recertification. Program and registration at ccfcme.org/PedReview13.

Coming Spring 2014

Cleveland Clinic Children’s First Annual Pediatric Conference, to be held in Cleveland, Ohio. Details coming soon!

Free Virtual CME

The newest free online CME activities from Cleveland Clinic Children's include, “The Approach to Pediatric Patients with Recurrent Fevers.” This is an interactive case-based lesson in Cleveland Clinic’s popular Disease Management Clinical Decisions series.