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Spring 2013

At Cleveland Clinic Florida, it’s our goal to keep you informed on the latest news in healthcare.

Now celebrating our 25th anniversary, Cleveland Clinic Florida has grown to become a fully integrated academic medical center with locations in Weston, West Palm Beach, and coming soon to Palm Beach Gardens and Parkland.

eHealthLines - Spring 2013

Spring Recipes

Strawberry-Ricotta with Angel Cake

  • 4 cups of strawberry
  • ½ cup low fat ricotta cheese
  • 4 -1oz- slices of angel food cake
  • 1 Tbsp of orange peel
  • ½ tsp Almond extract
  • 1 tsp of lemon juice
  • 4 tsp of brown sugar

Stir together ricotta cheese, 3 teaspoons of sugar, grated orange peel, and almond extract in a small bowl. Cover and refrigerate. Place strawberries, 1 teaspoon of sugar and lemon juice in a serving bowl and stir to blend. Let stand covered at room temperature until ready to serve. To serve, crumble 1 slice of angel food cake on bottom of a dessert dish, and spoon over a layer of berries and a layer of ricotta mixture.

Makes 4 Servings

Nutritional Information per Serving:
  • Calories: 189 calories Sodium: 317 mg Protein: 18 g
  • Saturated Fat: 3.48 Total Fat: 5.6 g Dietary Fiber: 1.5 g
  • Carbohydrates: 18 g Cholesterol: 28 mg

Asparagus Salad with Shallot-Mustard Vinaigrette

  • 1 lbs Asparagus, raw
  • 2 Tbsp Olive Oil
  • 1 Clove of garlic, raw
  • 1 Tbsp red wine vinegar
  • ½ tsp of Dijon Mustard
  • 2 Tbsp of shallot, raw
  • 1 dash of table salt
  • ¼ tsp of black pepper, ground

Wash and trim asparagus and place in a baking dish. Add 1 tablespoon olive oil and garlic clove that has been bruised with the side of a knife, and toss to coat. Roast asparagus at 400 degrees until tender-crisp, 12 to 15 minutes, stirring once. Remove from oven and let stand at room temperature until ready to serve. Whisk together remaining ingredients: 1 tablespoon olive oil with vinegar, mustard, and shallots. Season to taste with salt and pepper. Pour over asparagus and toss to coat.

Makes 4 Servings

Nutritional Information per Serving:
  • Calories: 91 calories Sodium: 12 mg Protein: 3 g
  • Saturated Fat: 0.2 Total Fat: 0.5 g Dietary Fiber: 2 g
  • Carbohydrates: 5 Cholesterol: 0 mg
Innovative Care for Colon Cancer

Innovative Care for Colon Cancer

Colorectal cancers—tumors of the large intestine or rectum—are the third leading cause of cancer-related deaths in the United States. But improved testing and treatment have brought great improvements. “Many colon cancers are completely treatable—and beatable—through surgical treatment, chemotherapy and radiation,” said Cleveland Clinic Florida colorectal surgeon David Maron, MD.

There are now more than 1 million survivors of colorectal cancer in the U.S., according to the American Cancer Society. One of them is Hallock Martin, an Episcopal priest from West Palm Beach. It all started with “some strange stuff going on,” he said. He was having testicular pain, so he visited a local urologist. Then he decided to seek a second opinion at Cleveland Clinic Florida. There the doctors looked at his blood work results, which immediately raised a red flag. “It was clear I was losing blood somehow,” Martin recalled. “That same day I got an appointment with a hematologist at Cleveland Clinic Florida and we began the process.”

A colonoscopy uncovered the source of the trouble: a tumor in the large intestine. Within a few weeks, Dr. Maron had removed the tumor and Martin was on the road to recovery. “My surgery was on January 23, 2012, and by the end of the following month, I was shooting a commercial for colon cancer awareness month,” Martin says. “By December the same year, my oncologist pronounced me cancer-free.”

Cleveland Clinic Florida has been on the cutting edge of technology for the past 25 years, said Dr. Maron. “Our colorectal team has pioneered innovations that are now considered “gold standard” for care around the world. About 85 percent of our colon cancer cases are done minimally invasive, whether robotically assisted or through regular laparoscopy.”

The tumor removal procedure itself is the same, whatever surgical method is used, Dr. Maron noted. “The benefit of minimally invasive approaches is in the recovery,” he said. “It allows patients to experience a shorter recovery with significantly less pain, smaller incisions and, in many cases, better clinical outcomes.”

Cleveland Clinic Florida colorectal surgeons also perform robotically assisted procedures, which offers “better visualization and better ability for the surgeon to work in confined spaces,” Dr. Maron said.

“Our model is optimal for patients with cancer,” he said. “All our physicians are located in one building. If a patient with colon cancer needs to see a radiologist or gastroenterologist, they’re just footsteps down the hallway. It’s also much easier for all the specialists to discuss treatment plans that are unique to each patient.” This team effort allows for the best outcome in patient care.

“That kind of teamwork is often considered the future of medicine,” Hallock Martin said. “But at Cleveland Clinic Florida, it’s the way medicine is practiced everyday. I was very much impressed.”

Treating Movement Disorders with a “Pacemaker” for the Brain

Treating Movement Disorders with a “Pacemaker” for the Brain

A pacemaker gets misfiring hearts back in rhythm. A newer technology known as deep brain stimulation (DBS) can do the same thing for the brain. For several years, Cleveland Clinic Florida has been using DBS to help patients with movement disorders such as Parkinson’s disease, essential tremor and dystonia.

“The treatment for these conditions starts with medication,” said Cleveland Clinic neurosurgeon Badih Adada, MD. “But when the side effects grow too severe, or the medicine stops being effective, we start thinking about surgical procedures.”

Cleveland Clinic has been a leader in developing DBS treatment, Dr. Adada said. “We implant electrodes deep inside the brain in order to control abnormal movements,” he explained. Wires run from the electrodes to a small device, similar to a pacemaker, that is implanted under the skin near the collarbone. It continuously sends electrical pulses to the brain, stopping the faulty signals that cause tremors and other movement disorders.

Patients are awake under mild sedation for the procedure, because surgeons need to ensure that the electrodes are controlling the patient’s abnormal movement, Dr. Adada said. Patients stay overnight in the hospital, but recovery is generally rapid, he added.

“Once the device is implanted, patients follow up with a neurologist specializing in movement disorders to adjust their medications and program the device,” Dr. Adada said. “The results are often dramatic. For patients with severe tremors, it’s practically a cure; often their tremor is completely gone. For patients with Parkinson’s, we usually see marked improvement in symptoms and a decrease in the need for medication.”

Physicians at Cleveland Clinic have a great deal of experience in DBS treatment, having done these procedures for more than a decade, Dr. Adada said. But Cleveland Clinic is also a pioneer in adding new technologies, such as highly accurate intraoperative imaging machines that allow physicians to place the electrodes with even more precision. “You need to have the electrodes in a specific spot, within a millimeter,” says Dr. Adada. “This allows us to do that even better.”

What truly sets Cleveland Clinic Weston apart is its team approach, Dr. Adada added. “For DBS, you need to have a neurologist specializing in movement disorders, a neuroradiologist, an anesthesiology team and a neurosurgeon with expertise in the procedure,” said Dr. Adada. “All those elements are in place here.”

Microbiota Fecal Transplant

New Type of Transplant Stops Superbugs

Its name is Clostridium difficile, and that second part of the name, from the Latin word for “difficult,” is especially apt. Better known to doctors as C. diff, this superbug often appears in nursing homes and hospitals. It causes severe diarrhea and intestinal disease — enough to kill more than 14,000 Americans each year, according to the Centers for Disease Control and Prevention.

Like all bacterial infections, C. diff is treated with antibiotics. For many patients, the drugs do their job effectively. But some patients can’t seem to get rid of the invading bacteria. The patients suffer from repeated infections that can be embarrassing, uncomfortable and even life threatening.

The trouble in these patients is not so much the C. diff, but the makeup of the patient’s own normal gut bacteria, explains Cleveland Clinic gastroenterologist Allison Schneider, MD. “We all have a vast number of microbes in our guts,” she says. “There are more microbial cells in our bodies than human cells. But in some people, something about the native flora — the microbes in their intestines — prevents them from fully clearing out the C. diff infection,” she says.

Since February 2013, Cleveland Clinic Florida has been offering a powerful new treatment for C. diff infections. It’s known as the “microbiota fecal transplant,” and even though the name is off-putting, the results are very impressive, Dr. Schneider says. The procedure is much like a colonoscopy, she explains. It involves using purified bacteria from the stool of a donor — a relative or close friend — who has a “normal” collection of gut microbes.

“The people who do this have been suffering up to 10 bowel movements a day for months and even years,” Dr. Schneider says. “It can make people squeamish, but studies show that success rates are upwards of 90 percent.”

In a study recently published in the American Journal of Gastroenterology, 97 percent of patients surveyed said they would have another transplant, and more than half said they would choose the transplant over antibiotic treatment.

“With proper selection and screening, this procedure appears to be very safe,” Dr. Schneider notes. “And we’re just at the tip of the iceberg. There’s a good chance we will be using this for other disorders down the line, including irritable bowel syndrome and other infections.”

Valve Repair

Restoring Flow: Heart Valve Repair and Replacement

Your heart beats more than 100,000 times each day. That can put a particular strain on the heart valves, which control blood flow through the heart’s four chambers. “Valves can wear out for several different reasons,” says Cleveland Clinic interventional cardiologist Howard Bush, MD. “It can run in the family, for example, or it can be a symptom of age.”

In the United States, the most common mitral valve abnormality is prolapse, and the most common valve abnormality is aortic stenosis. The mitral valve separates the left atrium (the first stop for blood from the veins) and the left ventricle. If the mitral valve doesn’t close properly, blood can leak backward from the ventricle into the atrium.

The good news is that valve repair and replacement surgery is now highly advanced, says Cleveland Clinic Florida cardiovascular surgeon Edward Savage, MD. Newer minimally invasive options offer patients shorter hospital stays, quicker recovery and less scarring.

Cleveland Clinic Florida is a leading center for repair and replacement of heart valves, Dr. Savage notes. “This is still heart surgery. We still have to stop the heart. That’s one of the great advantages of Cleveland Clinic Florida — we do a lot of these surgeries and our staff is extremely experienced.”

But surgery is not always the answer, Dr. Savage emphasizes. “That’s another advantage of Cleveland Clinic,” he says. “We have patients coming here from all over, and each gets a thorough evaluation. And because all of our physicians are located in one building, we collaborate closely on our treatment plans.”

Late last year, Andrea DiRienzio experienced this approach firsthand. “I knew I had a congenital issue with my aorta valve,” she says. “My grandmother died of that in her late 40s, so I have it checked every year.” But even though DiRienzio stays active and eats right, she was having trouble breathing last fall. She went to her doctor and asked for a full heart workup; he told her the valve was narrow, but she could probably wait another two years.

But the problem only got worse. In early December, DiRienzio came to see Dr. Bush at Cleveland Clinic Florida for a second opinion. “The key to medicine is determining the right treatment for the right patient,” Dr. Bush says. Medications are appropriate for some patients; others benefit from new interventional procedures, he explains. For active patients like Andrea, surgical replacement or repair is often the right choice, he says.

In Andrea’s case, Dr. Bush’s evaluation revealed another worrying issue. “He found a blockage in my left anterior descending artery — what’s known as the ‘widow maker,’” Andrea says. “That could have gone at any time.” She immediately scheduled surgery with Dr. Savage, and a few weeks later, she had a new aortic valve — and two bypasses.

“I really feel like they saved my life,” Andrea says. “These heart issues could have killed me if they hadn’t caught them. My advice to anyone is, if you don’t feel right, get it checked out. And even if you’re told by your doctor that everything is fine, you should listen to your body, and get a second opinion. I’m so glad that I did, and now I feel fabulous. The physicians at Cleveland Clinic Florida really worked as a team and made sure I knew exactly what was going to happen. It was a great experience.”