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The Dash Diet

The Dash Diet (Dietary Approaches to Stop Hypertension) is a clinically-proven diet to prevent and treat hypertension and is promoted by the NIH (National Institute of Health).

The diet is low in sodium, high in fiber, high in nutrients that help lower blood pressure (calcium, potassium and magnesium), and low in saturated fat and cholesterol. The diet emphasizes the intake of fruits, vegetables, whole grain products, fat-free or low fat milk and dairy products, fish, poultry, nuts and beans. It is limited in sweets, sugar-sweetened foods and beverages, processed foods, red meats, and added fats.

The diet offers other benefits such as reducing the risk for getting heart disease because along with lowering blood pressure can reduce the LDL cholesterol; both are contributors for heart disease. It is most effective when followed along with other lifestyle changes; getting regular exercise, attaining a healthy weight and cutting down on alcohol. The NIH has published a manual that offers meal samples and menus based on different calorie levels. Talk to your dietitian or doctor to make sure this dietary plan is appropriate for you.

1200 Calorie Menu Sample

Breakfast
  • ½ cup of dry oatmeal
  • 1-8 oz cup of skim milk
  • 1 medium apple with skin
Lunch

Chicken Salad made with the following:

  • Cup of Arugula
  • 3 oz. of grilled chicken strips
  • 1/3 cup of red grapes cut in halves
  • 1 Tbs. of crushed almonds
  • Low calorie spray dressing
  • 1/2 cup of cooked quinoa
Snack
  • 6 oz Greek plain yogurt
  • ½ cup Mixed berries
  • 2 Tbs. unsweetened granola
Dinner
  • 4 oz of grilled fish
  • ½ cup brown rice
  • 1 cup broccoli
Snack
  • 1 low fat string cheese
  • 10 Multigrain crackers

Nutritional Analysis: Calories: 1210 calories, Protein: 103 grams, Carbs: 137 grams, Total fat: 27 grams, Saturated Fat: 5 grams, Cholesterol: 170 grams, Sodium: 1043 mg.

Recipes

Un-fried fish with Yogurt Tartar Sauce
  • Un-fried Fish
  • ¼ cup Corn meal White enriched bolted with wheat flour, added, self-rising
  • 16 oz of Catfish
  • Cooking spray
  • 1 tsp dried thyme
  • 1 tsp dried basil
  • ½ tsp garlic powder
  • ¼ tsp black pepper and 1/2 tsp paprika

Makes 4 servings

Directions: Preheat oven to 400 degrees. Spray vegetable oil over a baking sheet to coat it. Combine cornmeal, thyme and basil on a plate and mix well. Sprinkle garlic powder and pepper on fish. Coat fish with cornmeal mixture Dust each fillet with paprika. Coat fish with cooking spray. Place fish on baking sheet and place sheet on the bottom shelf of the oven. Bake for 20 minutes. Then reduce heat to 350 degrees and continue to bake until crust is golden and fish flakes with a fork. Enjoy it with the yogurt tartar sauce

Tartar sauce with Greek Yogurt
  • 1 cup Greek Plain yogurt
  • 1 Tbs sweet pickle relish
  • 1 Tbs Mince onion
  • Juice of 1 lemon
  • Salt and Pepper to taste
  • Makes 8 servings

Directions: mix together all the ingredients and season to taste with salt and pepper.

Tomato Barley Salad with Feta
  • 1/4 cup olive oil
  • 4 red, ripe tomatoes
  • 5 oz of cooked barley
  • 2 oz of low fat feta cheese
  • 1 garlic clove
  • 2 Tbs minced chives
  • 2 tbsp of fresh chopped basil and 1 tbsp grated lemon zest

Makes 4 servings

Seed and quarter tomatoes. Chop garlic cloves. In a large bowl combine tomatoes and barley. In a small bowl combine oil, herbs and lemon zest. Pour over tomatoes and barley and toss. Sprinkle with feta cheese.

Nutritional Analysis: Calories: 361 Protein:24 grams Carbs: 23.5 grams Total fat: 12 grams Saturated Fat: 5 grams Cholesterol: 65.8 grams Sodium: 563 mg.

Ask The Expert – Pancreatic Cancer: Not a Death Sentence

About 37,000 people in the United States will be diagnosed this year with pancreatic cancer, reports the American Cancer Society, and 91 percent will die of the disease, making it one of the deadliest cancers. According to Conrad H. Simpfendorfer, MD, a specialist in the treatment of liver, bile duct and pancreatic cancers at Cleveland Clinic in Florida, a diagnosis of pancreatic cancer, however, is not a death sentence. He answers these important questions about pancreatic cancer.

Why is pancreatic cancer so deadly?

Symptoms of pancreatic cancer are often subtle until the cancer has reached an advanced stage. Only about 10 percent of cancers appear to be contained within the pancreas when they are found. Once the cancer has moved from the pancreas to other parts of the body, or metastasized, it is much harder to treat. Another factor is that too few patients are referred for a surgical consultation, and surgery offers the only chance of a cure.

What are the treatment options?

Surgery, radiation therapy, and chemotherapy are the three main types of treatment for cancer of the pancreas. Depending on the stage of the cancer, some or all of these treatments may be combined.

When is surgery appropriate?

Potentially curative surgery to remove the cancer is recommended for cancer that has not spread outside the pancreas. Palliative surgery may be performed in more advanced cases to relieve symptoms or to prevent complications caused by the cancer. In both situations, there are advanced minimally invasive treatment options available.

If you have been diagnosed with pancreatic cancer and would like to schedule a consultation with Dr. Simpfendorfer at Cleveland Clinic or would like a second opinion on a recommended treatment plan, please call 800.639.DOCTOR, or visit www.clevelandclinicflorida.org for more information.

Small Surgery for Skin Cancer with Big Results: Mohs Micrographic Surgery at Cleveland Clinic Florida

Skin cancer is the most common cancer and one of the most curable. When it comes to skin cancers of the head and neck, there is no better treatment than Mohs micrographic surgery. It is most often used to treat basal cell and squamous cell carcinomas, and it is also recommended for reoccurring skin cancers.

Tamara Lior, M.D., is head of the Section of Mohs and Laser Surgery at Cleveland Clinic Florida's Department of Dermatology. A member of the American College of Mohs Micrographic Surgery and Cutaneous Oncology, Dr. Lior is fellowship-trained in Mohs surgery. As a result, she is able to precisely identify skin cancers, remove them with minimal damage to healthy tissue, and reconstruct the wound.

Mohs surgery involves the layer-by-layer removal of skin that contains cancer cells. It allows for the selective removal of the skin cancer while preserving the surrounding tissue to minimize scarring and cosmetic defects. It also offers the highest chance for the complete removal of the cancer, the most important measurement of the procedure's success. Mohs surgery has the highest cure rate of all treatments for basal cell and squamous cell skin cancer, exceeding 97 percent.

Patients come from near and far to Cleveland Clinic for the treatment of skin cancer. Gustavo Staebler, a 58-year-old resident of Guatemala City, Guatemala, was diagnosed with skin cancer on his nose and neck. He was referred to Dr. Lior earlier this year because the procedure is not available in Guatemala.

"I couldn't have received better treatment anywhere else," says Mr. Staebler. “Dr. Lior explained the procedure so well, and I’m very happy with the quick recovery and the results."

Skin Cancer Prevention and Detection

"When detected early, skin cancer is very curable," Dr. Lior explains. "And because skin cancer is readily seen and easy to diagnose, it's vital to have your skin checked from head-to-toe by a trained dermatologist on a yearly basis." Although only a physician like Dr. Lior can conclusively diagnose skin cancer, there are warning signs you should be aware of. "If you notice a mole with asymmetry, border irregularities, color variations or diameter greater than the size of a pencil eraser, it's imperative to get it checked out as soon as possible," Dr. Lior explains.

Practice Sun Safety

  • Apply 1 ounce of SPF 30 or above every day
  • Choose sunscreens with active ingredients of zinc, titanium, mexoryl and avobenzone
  • Wear a broad-rimmed hat and sunglasses
  • Avoid undue sun exposure during peak sunlight
  • Reapply sunscreen regularly
  • Refrain from using tanning beds
  • Get a complete skin cancer screening every year
Ask The Expert – March is Colon Cancer Awareness Month: Act Now to Prevent Colon Cancer
Steven D. Wexner. MD - FACS, FRCS, FRCS(ed) – Cleveland Clinic Florida, Chair of Colorectal Surgery

Preventing colon cancer may be easier than you think. Most cases of colon cancer can be prevented by having a screening colonoscopy. Colon cancer is one of few diseases where normal body tissue - in this case, polyps - actually turns deadly. Removing nonmalignant polyps during a colonoscopy procedure may prevent colon cancer from developing. Colon cancer is one of the most prevalent cancers in the US. It is also an equal opportunity destroyer, oblivious to gender, race or income. People at increased risk for colon cancer include those with one or more immediate relatives with the disease, an inherited tendency to form polyps, a long history of ulcerative colitis, or a history of breast or uterine cancer. However, they are in the minority. The disease occurs most often in those who least expect it.

According to Steven Wexner, MD, chief academic officer and chair of Colorectal Surgery at Cleveland Clinic Florida, "Colonoscopy is considered the gold standard test for detecting and eliminating polyps. Other tests are simply less effective."

  • Sigmoidoscopy: Only checks the lower portion of the colon.
  • Hemoccult test: Detects blood in the stool, but is often inaccurate, giving false negative reports to at least 50% of patients with colon cancer and false positive reports to many patients who do not have the disease. A positive barium enema requires a colonoscopy follow up.
  • Virtual colonoscopy: Might be a substitute some day, but is now unaffordable. For this reason, it is now recommended by every major gastrointestinal society that both men and women have a screening colonoscopy at age 50. Anyone at increased risk should be screened by age 40 - earlier in some cases. The need for future screening tests is determined by the findings at the first screening as well as the patient’s risk factors. Some symptoms of colon cancer include blood in the stool and pain the lower abdomen. More than half of all people diagnosed with colon cancer have no symptoms at all, so it is simply not wise to wait for the appearance of symptoms. Do yourself a favor and schedule a colonoscopy today. It just might save your life.

Cleveland Clinic Florida's Digestive Disease team is comprised of colorectal surgeons, gastroenterologists, general surgeons and other specialists. They work collaboratively, in order to provide the most accurate diagnosis and individualized treatment plans for conditions such as colon cancer, irritable bowel syndrome, Crohn's and Colitis, liver and pancreatic cancers, as well as many others. This team effort allows for the best outcome in patient care.

Ask The Expert – March is Colon Cancer Awareness Month: Prevention is Key
Lester Rosen, MD – Cleveland Clinic Colorectal Surgeon

Colon cancer is the second most common cause of cancer death in the United States. Approximately one out of every 18 people will develop colorectal cancer in their lifetime. Find out what you should know about colon cancer – Lester Rosen, MD, Cleveland Clinic colorectal surgeon, shares some important facts.

Is colorectal cancer preventable?

When colon cancer is found at an advanced stage, the chance of cure is much less than when it is detected early. Fortunately, colon cancer is preventable by having regular checks of the colon called screenings. Colon cancer can be formed within a growing polyp, and colonoscopic removal of a "young" polyp without cancer prevents colorectal cancer, while colonoscopic removal of a polyp with early cancer can be curative. Flexible sigmoidoscopy is recommended every five years with annual hemoccult.

All patients should read their colonoscopy report to ensure that their bowel preparation was acceptable, and their exam was complete to the end of the colon called the Cecum. Colonoscopy is the best test available, however, polyps can be missed in various clinical situations. Even if cancer is found, it is curable in over 90% of patients, if caught early. Most polyps and curable cancers do not produce symptoms. Therefore, do not wait for symptoms to develop, see your doctor for colon checks on a regular basis while you are feeling well.

Who is at risk of colorectal cancer?

We are all at risk of developing colorectal cancer. Over 75% of patients who get colorectal cancer have no identifiable risk factors. However, some patients either have a personal history of colorectal polyps or cancer, ulcerative or Crohn's colitis, or a strong family history of colon cancer. These patients are at moderate to high risk. The risk is particularly strong if the first degree relative with cancer was less than age 50.

Symptoms of colon cancer include a change in bowel habits, abdominal pain, rectal bleeding or anemia. Patients with symptoms should have an examination of the whole colon called colonoscopy. Also, a risk factor is age greater than 50. For this reason, people with no symptoms or any of the risk factors should be screened for colorectal cancer starting at age 50.

Screening Options include:

  • Fecal blood testing (FOBT) every year: This is a test on smears of stool. It can detect microscopic blood by a chemical reaction. The test is positive if any of six windows change to a blue color. If it is positive, a colonoscopy should be performed.
  • Flexible sigmoidoscopy every 5 years: This is a test where a physician passes a thin, flexible tube into the lower colon and examines the lining. It is done in addition to the yearly fecal occult blood testing. If an adenoma is found during the flexible sigmoidoscopy, a colonoscopy should be performed to remove the polyp and search for polyps higher in the colon. It is recommended that flexible sigmoidoscopy be combined with an annual FOBT.
  • Barium enema plus sigmoidoscopy: A barium enema is an x-ray. It is not accurate enough to check for colorectal polyps and can even miss cancers. It should not be used for colorectal cancer screening unless a colonoscopy cannot be performed. If it is used, it should be coupled with a flexible sigmoidoscopy to see the part of the lower colon that is not well seen on x-ray.
  • Colonoscopy every 10 years:

Colonoscopy is a test where a thin flexible tube is inserted into the complete colon. If the examination results are normal, this test is done every 10 years. Colonoscopy is the preferred colon cancer screening test. It is also the test of choice if patients have any symptoms that could be suggestive of colorectal cancer such as intestinal bleeding, unexplained abdominal pain or change in bowel habits. No additional FOBT or sigmoidoscopy should be done between colonoscopy examinations. If any polyps are seen during the exam, they should be removed and sent to the laboratory for analysis. If adenomas are found, generally follow up colonoscopy is performed in 3 to 5 years. Many patients with adenomas require lifelong colonoscopy at 3 to 5 year intervals.

Cleveland Clinic Florida’s Digestive Disease team is comprised of colorectal surgeons, gastroenterologists, general surgeons and other specialists. They work collaboratively, in order to provide the most accurate diagnosis and individualized treatment plans for conditions such as colon cancer, irritable bowel syndrome, Crohn's and Colitis, liver and pancreatic cancers, as well as many others. This team effort allows for the best outcome in patient care.

Understanding The Surgical Treatment of Breast Cancer

Each year over 200,000 women are diagnosed with breast cancer in the United States, it is the second most common cancer among women in the nation. For many women, it is the disease they fear most. But a diagnosis of breast cancer does not mean a death sentence. The good news is that more women than ever before are surviving. Thanks to earlier detection, new treatments and a better understanding of the disease, cancer patients have a greater chance for a positive outcome.

Breast surgeons Margaret Gilot, MD and Cassann Blake, MD are part of the team at Cleveland Clinic's Breast Cancer Program, which has been accredited by the National Accreditation Program for Breast Centers (NAPBC). This accreditation means the Center is qualified to offer the full spectrum of interdisciplinary care to patients with breast disease, including evaluation, treatment, and follow-up care.

Drs. Gilot and Blake meet with women every day facing a breast cancer diagnosis. They answer these important questions about the surgical treatment of breast cancer.

What is the difference between a lumpectomy and a mastectomy?

In a lumpectomy, the cancerous portion of the breast and a surrounding margin of normal tissue are removed. With a simple or total mastectomy, the entire breast is removed. Other types of mastectomy may include removal of the nipple, lymph nodes in the armpit, and chest wall muscles under the breast. Surgical treatments are recommended based on the size, location, or type of breast cancer.

What is a prophylactic mastectomy and when is it appropriate?

A prophylactic or preventive mastectomy is the removal of one or both breasts in hopes of preventing or reducing the risk of breast cancer from occurring or reoccurring. Some characteristics increase a woman's risk of developing breast cancer, such as a strong family history, genetic predisposition, or the discovery of abnormal cells in the breast's milk-producing glands. Risk factors need to be assessed carefully when considering a prophylactic mastectomy.

How are aesthetic results optimized in breast surgery?

Trained breast surgeons employ "oncoplastic" techniques to preserve or restore a breast's shape or appearance following a lumpectomy. If a woman chooses to have a mastectomy, she has the option to have immediate or delayed breast reconstruction with either an implant or natural tissue, usually from her abdomen. A woman considering reconstruction should discuss options with her breast surgeon and a plastic surgeon prior to her mastectomy. At Cleveland Clinic Florida, breast surgeons work collaboratively with plastic surgeons, to optimize patients’ breast surgery outcomes.

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