- Top-ranked hospital in South Florida
- Getting to the Bottom of Your Digestive Troubles
- Thyroid: A Small Gland with a Powerful Punch
- Heart Attack: What WOMEN Need to Know
- Kidney Stones – Common but Treatable
- Enhance Your Memory with Brain Games
- Q&A: Ready for a run? There’s much to know before you go
#1 in Miami-Ft. Lauderdale Metro Area
Cleveland Clinic Florida has claimed the top spot, ranking #1 in the Miami-Ft. Lauderdale metro area, according to U.S. News & World Report’s Best Hospital rankings.
U.S. News & World Report recently released its annual ranking of Best Hospitals and Cleveland Clinic Florida has claimed the top spot, ranking #1 in the Miami-Fort Lauderdale metro area for 2016-2017. The annual survey ranks 70 hospitals in the local metropolitan area, which includes Miami-Dade, Broward and Palm Beach counties.
Overall, Cleveland Clinic Florida ranked 5th among 263 hospitals in Florida, moving up four spots from the previous year.
Cleveland Clinic Florida’s Gastroenterology and GI surgery program ranked #49 in the nation. Geriatrics and Orthopaedics were also designated high performing in the region.
Cleveland Clinic Florida also achieved the highest rating possible for the following five procedures and conditions:
- Chronic Obstructive Pulmonary Disease (COPD)
- Colon Cancer Surgery
- Heart Failure
- Hip Replacement
- Knee Replacement
A complete list of newly ranked hospitals is available online at health.usnews.com/best-hospitals.
Anyone who has suffered digestive problems knows that symptoms can range from mild to severe pain and bloating to diarrhea or constipation, none of which sounds like much fun. But in truth a lot more could actually be going on. It’s important to find out as early as possible, because some issues can lead to more serious, chronic illnesses if left untreated.
Your digestive system is a complex and extensive part of the body. It starts at your mouth, down your esophagus to your stomach, small intestine, colon, rectum, and ends at your anus. It’s responsible for helping your body absorb essential nutrients and then getting rid of the waste, which are very important functions. So, if you continue to suffer from digestive disturbances, it’s probably time to make an appointment with your doctor. Not only will you be more comfortable once you’ve gotten to the source of the issue, more importantly, early diagnosis and treatment can reduce damage to your esophagus and GI tract.
Today, gastroenterologists are using advanced technology that make diagnosis and treatment of digestive disorders much more palatable. For example, endoscopic ultrasound (EUS) is an important tool that allows doctors to see your internal organs very clearly. EUS provides very high resolution images, because it does not have to go through barriers such as skin and bone, as compared to surface ultrasound.
According to Cleveland Clinic Florida gastroenterologist Ronnie Pimentel, MD, “the EUS procedure is typically performed in an outpatient setting, and usually takes close to 45 minutes.” He adds that “patients do not experience discomfort during the procedure, and are able to go home the same day.”
EUS is very useful in helping physicians evaluate cancers or other tumors of the stomach, esophagus, pancreas, colon, liver, gall bladder, digestive tract and rectum, as well as to plan the most effective treatment strategies. It can even provide good images of smaller masses that may not be detected using other technology. And, preliminary results are available immediately, allowing for timely staging and treatment of gastrointestinal cancers.
How An Endoscopic Ultrasound Works
EUS is much like a regular endoscopy procedure in that a probe is inserted down the esophagus and into the stomach. The difference, however, is that the probe’s tip has an ultrasound camera on it that provides a very clear view of the stomach and nearby organs.
By getting so close to the organs, EUS allows doctors to take a biopsy through the stomach wall, by removing a small amount of tissue for testing. Getting a biopsy this way is more comfortable for patients than a traditional needle biopsy through the skin, and more critical is the fact that it reduces the risk of “seeding,” or spreading the tumor through the skin or to other parts of the body.
Dr. Pimentel states that, “another important use for EUS is to perform nerve blocks for severe pain in cancer patients. We also can insert markers (known as fiducials) to guide future radiation treatments so that they target only the tumor, not the healthy tissue around it.”
In addition, EUS is sometimes used to help find answers for patients with abdominal pain that doctors have been unable to explain.
Suffering from unexplained fatigue, irritability, weight gain or loss? If so, you have plenty of company. These common complaints can be symptoms of a myriad of conditions, including disorders of the thyroid, a butterfly-shaped endocrine gland. So how do you know whether or not to be concerned?
How Common Are Thyroid Disorders?
According to the American Thyroid Association, approximately 20 million Americans will develop a thyroid disorder. With about one in eight women developing a thyroid disorder during their lifetime, they are much more likely than men to be affected.
The thyroid gland is located at the base of your neck. It only weighs about 10-30 grams, but it has a very big job to do. Some of the most common thyroid disorders are related to the levels of hormones that it produces. Although small in size, the thyroid packs a mighty powerful punch, as these hormones affect the entire body, including heart and lung function, muscle and nerve function as well as metabolism.
Often symptoms of thyroid imbalance can masquerade as other problems, such as depression, insomnia, menopause, as well as other issues. Since many of these symptoms are extremely common, people suffering from thyroid conditions frequently go undiagnosed.
Dr. Metzger explains, “Undiagnosed thyroid disease is a major concern, as it can result in a higher risk for other serious conditions, such as cardiovascular disease or infertility.”
Types of Thyroid Disorders
Hyperthyroidism (overactive gland)
Patients with hyperthyroidism may experience the following symptoms:
- racing heart
- excessive sweating
- heat intolerance
- thinning of the hair
- weight loss
- irregular periods
These symptoms may accompany a goiter or an enlargement of the thyroid gland.
Hypothyroidism (underactive gland)
Symptoms of an underactive thyroid, or hypothyroidism, include:
- slowing of body function
- slower thinking
- muscle weakness
- abnormal periods
- slowing of the metabolism leading to moderate weight gain
Some patients also have goiters. However, many patients with hypothyroidism do not have symptoms, so screening with a blood test is important.
Thyroid Growths (nodules or cancer)
Most nodules (lumps in the thyroid) are painless, so they usually are discovered by a doctor during a routine physical exam. Larger nodules can sometimes be noticed by the patient, since they may cause difficulty swallowing, breathing, or hoarseness. In rare cases, nodules may cause hyperthyroidism.
Patients with thyroid cancer may not experience any symptoms at all. The cancer is typically found as a lump or nodule on examination of the neck, or when an imaging test such as an ultrasound, CT scan or MRI is performed for an unrelated condition. In rare cases, thyroid cancer will cause pain, difficulty swallowing or hoarseness. As with other thyroid disorders women are much more likely than men to develop thyroid cancer.
There are different types of surgical procedures and techniques that can be considered, based on the diagnosis. The standard treatment for thyroid cancer is surgical removal of the entire thyroid (total thyroidectomy).
“The determining factor for most appropriate procedure depends upon whether the lymph nodes need to be removed,” says Dr. Metzger. “In some cases, the lymph nodes directly behind or underneath the thyroid will need to be removed, if the cancer has spread. In a small subset of patients, we may also have to remove the lymph nodes on the side of the neck.”
The average length of an incision for typical thyroid cancer surgery is approximately two inches. “The length of the incision depends on the size of the thyroid,” states Dr. Metzger. “We’re very conscious that these types of surgeries may result in scarring, so we do what we can cosmetically to prevent the visibility.”
Many patients will not need additional treatments after total thyroidectomy for thyroid cancer; however, some may need radioactive iodine therapy. For this treatment, a patient swallows capsules or a liquid containing a small dose of radioactive iodine, which travels through the bloodstream and destroys thyroid cancer cells.
The good news is thyroid disorders can often be easily treated with medication. However, in some cases, hormone replacement, radioactive iodine treatment, other targeted therapy or surgery may be necessary. Most types of thyroid cancer can be completely removed with surgery, and survival rates are quite high.
“Discuss the options with your doctor to decide what the best treatment plan will be for you, based on your diagnosis and a number of other factors,” suggests Dr. Metzger.
We always associate chest pain with heart attacks, and for good reason, but it’s not the whole story, especially for women. While chest pain is the most common symptom of a heart attack, women can have symptoms that aren’t related to chest pain at all. They need to be on the lookout for other, subtler symptoms.
Also, we need to dig deeper into the symptom of chest pain for both men and women as it relates to heart attacks. It is seldom as dramatic as you might think, and it can feel like pressure or heart burn that comes on over time.
Like many women, you’re probably busy most of the time. You may take care of a family, run a household, work outside the home and care for aging parents. You are probably also tired a lot of the time. Most likely this is normal.
But you should pay attention to fatigue if it is new or dramatic. Here’s what to watch out for:
- you are suddenly worn out after your typical exercise routine
- you aren’t exerting yourself, but have fatigue or a “heavy” chest
- simple activity like making the bed, walking to the bathroom or shopping makes you excessively tired
- although you feel exceptionally tired, you also experience sleep disturbance
Sweating and/or shortness of breath
As women age, a lack of exercise and gradual weight gain cause issues like shortness of breath. Hot flashes are a common complaint for many women during menopause.
But these symptoms can signal a heart problem when they happen in certain situations:
- sudden sweating or shortness of breath without exertion
- breathlessness that continues to worsen over time after exertion
- shortness of breath that worsens when lying down and improves when propping up
- “stress” sweat (cold, clammy feeling) when there is no real cause for stress
- sweating or shortness of breath accompanied by other symptoms such as chest pain or fatigue
Neck, jaw, back pain
As intricate as our body’s systems are, they are very adept at giving signals when there is something wrong. When there is a problem with the heart, it triggers nerves in that area, but you sometimes feel pain elsewhere.
Pain in the jaw, back or arms may signal a heart condition, especially if the origin is hard to pinpoint (for example there is no specific muscle or joint that aches). Also, if the discomfort begins or worsens when you are exerting yourself, and then stops when you quit exercising, you should get it checked out.
Here are some other signs to look out for:
- women, in particular, can have pain in either arm — not just the left one like many men
- pain in the lower or upper back often starts in the chest and spreads to these areas
- the pain is sometimes sudden, not due to physical exertion, and can wake you up at night
- you may feel pain that is specific to the left, lower side of the jaw
What to do if you notice symptoms
Women often say they noticed some of these three warning signs weeks or a month before a heart attack.
The sooner you report a problem, the better the chances are of catching an issue before it becomes a full-blown heart attack. If you experience any of these symptoms, take note and visit your doctor as quickly as possible.
When you see your doctor:
- bring a list of your symptoms and when they are occurring
- let him or her know about any related family history
- talk about stress or anything going on in your life that might contribute to a problem
Your doctor likely will listen to your symptoms and check your pulse and blood pressure. He or she may order blood work, which will show whether your heart is damaged.
Your doctor also may use an electrocardiogram (ECG) to tell whether the electrical activity of your heart is normal, or an echocardiogram (echo) to view images of the heart to see if damage has occurred, or a cardiac stress test to detect if there is significant blockage in the blood vessels around your heart.
All this is important in identifying any problems and taking steps to intervene before a possible heart attack.
When to call 911
Get help right away if you have chest pain or discomfort along with any of these symptoms, especially if they last longer than five minutes:
- pain or discomfort in other areas of the upper body, including the arms, left shoulder, back, neck, jaw, or stomach
- difficulty breathing or shortness of breath
- sweating or “cold sweat”
- fullness, indigestion, or choking feeling (may feel like heartburn)
- nausea or vomiting
- light-headedness, dizziness, extreme weakness or anxiety
- rapid or irregular heart beats
Kidney stones, a very common disorder of the urinary tract, are small masses of crystals that form in the kidneys. Urine normally contains chemicals that prevent the crystals from forming, but some people with kidney stones have a chemical abnormality of blood or urine that contributes to the tendency for stones to form. There are also other factors that may contribute to the formation of stones.
Symptoms to watch for
The most common symptoms of kidney stones are back pain radiating to the abdomen or groin, blood in the urine, pain when urinating, and often nausea and vomiting. If you notice these symptoms it’s time to seek medical attention. Kidney stones are rarely diagnosed in advance, and the pain is often severe enough to end up in the emergency room. Once in the ER, diagnostic tests, such as a CT scan, X-rays or ultrasound can then be done.
According to Nicolas Muruve, MD, a Cleveland Clinic Florida urologist, specializing in kidney stones, “about half a million people visit the ER every year as a result of kidney stones.” Dr. Muruve treats patients with kidney stones as well as other urologic disorders.
If kidney stones become problematic, there are a variety of treatment options. In the event of a kidney stone attack, there are medications that can help stones pass naturally. Most kidney stones don't require surgical intervention and removal. However, when kidney stones don't pass on their own, they can be extremely painful.
“There are several safe, minimally invasive procedures offered to treat smaller stones, such as shock wave lithotripsy (SWL),” states Dr. Muruve. SWL is a relatively non-invasive procedure that uses targeted shock waves to break stones into tiny pieces that are passed naturally in the urine. The procedure takes approximately one hour, and patients can generally go home a few hours after the treatment.
When stones are larger, typically more than 2 cm (the size of a marble), there are other procedures that can be done. Your doctor may recommend a percutaneous nephrolithotomy (PCNL). PCNL is a procedure that involves entering the kidney through a small incision in the back. Once the surgeon gets to the kidney, a nephroscope (a miniature fiber-optic camera) and other small instruments are utilized to locate and remove the kidney stones. Dr. Muruve states, “We have advanced the PCNL procedure, which can now be offered in an outpatient setting 70% of the time.”
Preventing future stones
The majority of kidney stones, depending on their size and location, can be removed with minimally invasive techniques. A chemical analysis can be done once the stones have been removed, to determine which types of stones you have. Most kidney stones are calcium based, but they can also be made of other substances, such as uric acid or cysteine. It’s important to know what is causing the stones, so that you can take steps to prevent them from recurring.
“Staying adequately hydrated in order to maintain a urine output of at least two liters per day, and following a healthy diet that limits consumption of foods high in protein and salt can help prevent kidney stones,” says Dr. Muruve.
We have all forgotten things from time to time. As long as it does not occur on a frequent basis, the occasional misplaced keys or forgotten appointment should be considered normal. However, there are ways to enhance memory and keep your brain fit.
“Although memory may decline to some degree as you get older, significant memory loss is not an inevitable result of aging,” says Po-Heng Tsai, MD, Cleveland Clinic Florida neurologist. “Your brain has the ability to produce new brain cells, but it’s important to continuously use your brain, and challenge yourself in order to prevent memory loss,” according to Dr. Tsai.
In addition to maintaining a healthy lifestyle, research has demonstrated that incorporating certain daily activities has a favorable impact on brain health. Regardless of age, you can delay memory decline and encourage your brain to grow new, stronger connections by integrating brain games into your everyday activities. And, it’s important to change your brain fitness routine on a regular basis as well. In fact, one of the best things you can do is to keep your mind open to new possibilities.
Activities to improve your mind
Stimulate your brain with some word games or puzzles. The trick is to challenge yourself though, so if the puzzles are too easy for you, attempt more difficult ones that you’ve never done before. Here are some examples of memory puzzles to try:
- Crossword puzzles
- Brain teasers
- Codeword puzzles
Sharpen your short term memory
Write a word on a piece of paper and put it in an obvious location so you can refer to it later in the day. Turn it over so you cannot see the word and write the word, REMEMBER on the side you can see. Say the word to yourself several times, spell it, picture it and throughout the course of the day try and recall the word. Check the next day to see if you remembered it correctly.
Do this again periodically, eventually trying to recall a series of 2, 3 and eventually 4 words. Find different techniques to help you recall the words, such as by association. Once you learn the techniques that work for you, it’s likely you will start to apply them in your daily routine.
Keeping the mind active
“By challenging your brain on a regular basis, you will start to notice subtle memory improvements,” shares Dr. Tsai. By incorporating your favorite activities, the likelihood of continuing your brain fitness routine will increase. But, just remember that whether you enjoy reading, playing cards, doing puzzles or a word game, it’s also important to vary the activity and step away from the familiar. So, you also need to change it up a bit, or take it to the next level.
Create new brain enhancement activities
Sometimes it doesn’t take that much to break from your brain fitness routine. For example, if your current activities include puzzles or word games, try taking a look at the answers first, and then come back to the puzzle or word game later. Over a period of time it’s likely you will begin the learning process if it’s something that appeals to your interest for a new challenge. Remember it’s not about having to be totally correct. It’s about expanding your options over a period of time.
Think of how you feel when they change the layout in your grocery store. Most people moan and groan at the thought. What happens is that it takes you out of your automatic pilot and makes you think. That is what you are looking to accomplish. It may involve some new learning.
If you like to read, vary what you read. Read viewpoints from other sources and different types of books. Listen to an audio book on CD to encourage better listening skills. You can also try reading aloud for periods of time.
Make it social
Although pen and paper puzzles provide an enjoyable solitary exercise, board games can offer a fun, entertaining way to workout your brain. For example, games that focus on words, such as Scrabble and Boggle can help exercise your brain, as well as provide a social activity with others.
According to recent statistics, U.S. participation in running and jogging has grown 70% over the past decade. In 2015, it was estimated that over 60 million Americans were involved in the sport. The number of people running in non-traditional events like warrior and color runs has increased dramatically in the past five years.
Running properly is of utmost importance, regardless of whether you’ve been running for years or just getting started, or if you’re running just for recreation or are serious about the sport and have goals to break personal bests. And sometimes it requires some trial and error to figure out what will work best for you. We asked Farah Tejpar, MD, sports medicine specialist, to answer key questions about running, and how runners of all types can prepare.
Q. Is running good for everyone?
A. Running is a great way to boost your metabolism, burn calories and improve your cardiovascular health. But it’s important to run with proper technique and incorporate warm up and recovery exercises.
Q. Are there different types of runners?
A. Runners can fall into two groups:
- Endurance athletes who are always training for their next marathon or striving to improve their performance
- Weekend warriors who enjoy running for recreation and fitness
Q. What are typical running injuries?
A. Runners typically present with overuse injuries. Overuse injuries result from increased demand over time on the muscles, bones and tendons.
Q. Is running bad for your joints?
A. Running can help with weight maintenance and weight loss. This actually decreases the load on your joints and helps to prevent arthritis.
Q. How can a sports medicine specialist help?
A. During your appointment, a sports medicine physician will address structural and functional issues that can lead to injuries. These include your individual capabilities; such as muscle strength and flexibility, as well as external factors; such as environmental conditions, running surfaces and shoe wear.