Online Health Chat with Jamie Starkey, LAc

October 22, 2014

Description

For more than 3,500 years, acupuncture has been providing relief to people around the world. Originally developed and practiced in China, this soothing therapy is today embraced by all patients who seek to alleviate symptoms caused by ailments that range from arthritis to migraines to the aftereffects of chemotherapy. It has even been proven effective in helping people stop smoking. Take this opportunity to join us as our acupuncture expert discusses the treatment, what to expect and its benefits.

Acupuncture draws on the belief that an energy called Qi (pronounced “chee”) circulates throughout our bodies, from the tops of our head to the soles of our feet. When we experience good health, this energy flows unobstructed along pathways in the body called meridians. Each meridian is believed to be connected to a specific organ system, and when an energy flow is disrupted by a disease or an injury, illness or pain occurs. Acupuncture is then used to balance the flow of Qi and stimulate the body’s natural ability to heal.

Acupuncture treatments involve placing hair-thin needles of varying lengths into certain areas of the skin. The number of slender needles – as few as three, as many as 20 – and the length of time they are kept in place depends on the ailment being treated. During the treatment, the needles may be twirled, warmed or electrically energized to intensify healing effects.

Many acupuncture points are near nerves. When stimulated, the point sends a message along the nerve to the brain and spinal cord. This then causes the release of serotonin, dopamine and endorphins – chemicals our own bodies produce that alter or eliminate the message of pain being delivered to the brain. The release of these “feel-good” mood-regulating chemicals makes people feel better physically and emotionally. And when someone’s emotional outlook improves, their quality of life improves.

Clinical studies have shown that acupuncture bolsters the body’s nervous and endocrine (glandular) systems, and has an anti-inflammatory effect. Acupuncture decreases the inflammation associated with different diseases and relieves muscle spasms and strain.

The World Health Organization endorses acupuncture, and clinical studies have shown it to be a beneficial treatment for many conditions, including:

  • Chronic pain: migraines, neck and back pain, tendonitis, sciatica, carpal tunnel syndrome, fibromyalgia and rheumatoid arthritis
  • Digestive disorders: irritable bowel syndrome, colitis, gastritis and constipation
  • Urinary and reproductive disorders: menstrual cramps, irregular or heavy periods, infertility and menopausal symptoms
  • Psychological and emotional disorders: depression, anxiety, stress and insomnia
  • Symptom management for adverse reactions to chemotherapy and radiation, including fatigue, generalized pain, dry mouth, peripheral neuropathy, nausea and vomiting
  • Seasonal allergies
  • High blood pressure
  • Addictions to nicotine, alcohol and drugs
  • Overweight or obesity, when coupled with diet and exercise (Acupuncture is not a magic bullet for weight loss, but can help curb appetite)

About the Speaker

Jamie Starkey, LAc, is the lead acupuncturist at Cleveland Clinic’s Center for Integrative Medicine. She earned a Bachelor’s degree in biology from the University of Toledo and a Master’s-level degree in acupuncture from the American Institute of Alternative Medicine. She further enhanced her clinical training by completing a clinical internship at Guang AnMen Hospital in Beijing China, Acupuncture and Moxibustion Outpatient Department, an affiliate of the China Academy of Traditional Chinese Medicine. She is a Diplomate of Acupuncture, National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), and holds her acupuncture license from the Ohio State Medical Board. Additionally, she is a Level II Reiki Practitioner. Jamie served as the secretary of the Ohio Association of Acupuncture and Oriental Medicine (OAAOM) from December 2006 to December 2008 and has been a member of the Ohio Association of Acupuncture and Oriental Medicine (OAAOM) from December 2005 to the present.

Jamie offers acupuncture here at Cleveland Clinic with a focus on women’s health, oncology, acute/chronic pain management, stress-related disorders and acupuncture clinical research. “I take great pride in being a clinician of Traditional Chinese Medicine. I strive to help patients discover the ability their body has to heal itself when properly supported and brought back into a balanced state of health and wellness.”


Let’s Chat About Acupuncture and Chinese Medicine

Moderator: Welcome to our chat: Answers on Acupuncture and Chinese Medicine with Cleveland Clinic lead acupuncturist Jamie Starkey, LAc. Jamie, thank you for taking the time to be with us to share your expertise and answer our questions.


The Acupuncture Experience

amp7282: Hello. Is it better to be treated for one issue at a time? How effective is acupuncture for eating issues? How many times a week do you recommend going? How long does it typically take for a person to recover? How effective is acupuncture for depression? How many times a week do you recommend going? How long does it typically take for a person to recover?

Jamie_Starkey,_LAc: Hello. Thank you for your questions. Patients generally come in with one or two primary complaints. In the first visit appointment, the acupuncturist will usually review the main complaint(s) in great detail and will also review a lengthy intake form, which is used to help in the diagnostic process. We look at the whole pattern of symptom presentation, not just each individual complaint. More times than not, we end up treating more than one issue at once, and it is also common for patients to report side benefits that are improvements noted in addition to their main complaint.

In my opinion, the primary treatment for an eating disorder should be some form of psychotherapy, and nutritional/medical issues should also be closely monitored by a physician. In my clinical experience, I have found acupuncture to be more effective in a supportive role for patients suffering from eating disorders. It can be quite useful to help engage in the relaxation response, calm anxiety, etc.

There have been mixed results in clinical trial data showing acupuncture’s effect on depression. Some studies have found acupuncture to be quite helpful, especially for those patients who may be resistant to drug therapy. I find acupuncture to be most effective when used in combination with drug therapy and psychotherapy. Patients may not be able to taper off of drugs altogether, but they may be able to decrease the amount of drugs needed. It is also important to pay close attention to diet and exercise when suffering from depression. Many integrative and functional medicine physicians will look closely to be sure you are not deficient in nutrients such as Vitamin D and also check for chromosomal abnormalities such as MTHFR mutations.

For any condition, I generally recommend a weekly consecutive dose of treatment, anywhere from three to five treatments to five to 10 treatments. Patient response is variable, so I will re-assess the condition after the entire course of treatment is complete. If therapeutic effect has been reached, then visits will be tapered to every two weeks, every three weeks, etc. Eventually, you come in on an as-needed basis. Some patients prefer to stick to a “maintenance” schedule, which, again, is variable dependent upon the individual patient’s needs.

nt014: Since I have multiple issues (such as migraines, frozen shoulder pain, plantar fasciitis, etc.) can this be addressed all at once or do you concentrate on one area at a time?

Jamie_Starkey,_LAc: While each acupuncturist is different, most treat multiple conditions at one time. The idea in Eastern medicine is to treat the whole person, so oftentimes, these individual symptoms are actually related in Chinese Medicine theory. We diagnose at the root level, so it is very common that main complaints resolve in addition to side benefits. Just from a superficial understanding of your issues, it appears very reasonable that all of these can be addressed during the same treatment session.

charlyfu: Is there anything we can do ourselves to extend the effects of the acupuncture treatment.

Jamie_Starkey,_LAc: Acupressure is a means to extend the effects of acupuncture for some conditions. I will oftentimes teach patients specific points to apply self-acupressure, or I will send them home with "ear seeds," which are tiny balls placed on very specific portions of the ear with adhesive tape. This is another application of acupressure. Common conditions that can be helped with acupressure include: fatigue, insomnia, pain, tobacco cessation, morning sickness/nausea and menstrual cramps. Talk to your acupuncturist about acupressure techniques that may be applicable to your condition.

Samadi: I had received acupuncture in 2011. The treatment was a mixture of ling ku plus da bai. During treatment, my diaphragm stopped functioning and I was unable to breath. The needles were removed before total loss of consciousness, but the resulting feeling was that of a cardiac event. The next day, I was found to have an ascending aortic aneurysm. I was told by two other acupuncturists that my system was extremely "revved up." This was evident by hypertension that I had never had before this treatment. My question is how long can the negative effects of an acupuncture treatment last, and have you ever heard of an acupuncture treatment creating an aneurysm? I also lost 20 pounds. within three weeks of this treatment.

Jamie_Starkey,_LAc: Thank you for your question, and I'm very sorry to hear about your experience. I have never heard of acupuncture "creating" an aneurysm, either empirically or in the published reports. It is more probable that the aneurysm was there prior to your acupuncture visit, and you were just asymptomatic. Fainting, while rare, is a reported side effect of acupuncture and something that we discuss with our patients in the consent process. While it's an extremely rare occurrence, the vasal vagal response can occur.

faride: Hi. What is the risk of having acupuncture while taking Xarelto®?

Jamie_Starkey,_LAc: Thank you for your question. I have many patients on anticoagulants who safely receive acupuncture treatment. There is no contraindication, as the bleeding induced by an acupuncture needle is minimal. The needles are incredibly thin (36 to 38 gauge – about the size of a strand of hair) and are solid. If there is any bleeding involved, it's literally the size of a pin prick and swabbed away. There is increased risk of bruising if you are on an anticoagulant, so that should be discussed by your acupuncturist.

sareptatj: I have a pacemaker. Would energizing the needles electrically cause any interference with the pacer?

Jamie_Starkey,_LAc: Excellent question. Electro-acupuncture is contraindicated in patients with a pacemaker. Your acupuncturist should be well versed in this and be able to modify the treatment accordingly.

Mr. Tibs: Will I experience improvement right away or does it take several weeks before I notice a benefit from acupuncture?

Jamie_Starkey,_LAc: There is a spectrum of response. I have patients who respond within one to three treatments, and then there are others who do not reach therapeutic effect until 10+ visits. There are many variables that factor into response, including the severity of the condition, underlying cause of condition, etc. I typically recommend eight to 10 consecutive weekly treatments as a full course. I will then stop and re-assess the patient's condition after the course is complete. The goal is to reach therapeutic effect and then begin tapering visits so that patients come in on an as-needed basis.

Pididle: Do I have to believe in acupuncture to get it to work?

Jamie_Starkey,_LAc: While there is certainly the power of the mind-body connection in terms of healing, you do not have to necessarily "believe" in acupuncture for it to work. We know through much rigorous scientific investigation that acupuncture influences the body in many different ways. It influences the nervous system, promotes a release of endorphins, which provides an analgesic effect, modulates the immune system, increases natural killer cell activity, suppresses the expression of cytokines to provide an anti-inflammatory effect, just to name a few.


Acupuncture for Pain

WN: I have a herniated disc, level C5-6, and two bulging discs on other cervical levels, as well as osteoarthritis in several areas. Will acupuncture help with pain relief? I can no longer take NSAIDs. I've had two nerve root steroid injections with some relief, but would like more relief.

Jamie_Starkey,_LAc: I’m sorry to hear about the pain you’re experiencing in your neck due to herniated discs and arthritis. Acupuncture is indeed a great option for you in terms of pain relief. Specifically for your condition, acupuncture works two-fold to get you the results you need: first, it acts as an analgesic by manipulating the nervous system to promote a pain-relieving effect through the release of endorphins. Second, many studies have shown acupuncture’s anti-inflammatory effect, which is optimal for you since you can no longer take NSAIDs. Acupuncture works well with your conventional treatment, so you can seek out acupuncture treatment even after you’ve had the steroid injections. A large meta-analysis published by Vickers et. al. in the Archives of Internal Medicine (2012) looked at nearly 18,000 patients in chronic pain, including neck pain. Their analysis showed that acupuncture was superior to both sham and non-needling control groups in decreasing pain.

zman949: I have a daughter who has a condition called occipital neuralgia, where she gets pain in the back of her head. Would acupuncture help this condition or if not, is there anything else you might recommend?

Jamie_Starkey,_LAc: Acupuncture would be a fantastic option for your daughter. Please be sure she sees a clinician who comes highly referred and is willing to be a team player with your daughter's neurologist. I may also suggest she seek out a physician who practices integrative or functional medicine to be sure there are no underlying causes of this condition that may have been overlooked by standard conventional doctors. A good massage therapist and chiropractor may also provide some benefit.

suzyq: Can chronic pain be treated without knowing what its origins are?

Jamie_Starkey,_LAc: Many times, our patients who come in with chronic pain have seen a myriad of specialists yet the origin of their pain is still unclear. Acupuncture can be used to address chronic pain by manipulating the nervous system to promote a pain-relieving response through the release of endorphins (body's natural opiate), local neurotransmitters influenced by the needling process to help promote pain relief. If you have exhausted conventional pain management approaches, it would be worthwhile to seek out the help of an acupuncturist.

TippyR: I've had tension knots in my shoulders/neck for years. Massage helps but has never fully "broken up" the knots. How could acupuncture help this?

Jamie_Starkey,_LAc: Acupuncture needles can be inserted into the various active trigger points. The acupuncturist can manipulate the needles to elicit a twitch response, which automatically resets the muscle, alleviating the spasm.

sareptatj: I have severe chronic neck and shoulder pain, and a few weeks ago decided to seek acupuncture treatment from a highly recommended practitioner. After a quick exam, he said I had both fibromyalgia and arthritis, which could be treated with acupuncture. The insertion of the needles did not bother me, and I was pleased to find there was no problem due to the fact that I am on Coumadin. Heat from a heat lamp was added to the treatment and I was fine with that, but then without warning, the acupuncturist began doing very deep and very painful muscle massage in my back and neck area. I am not unusually susceptible to pain, so the intensity of pain came as a real surprise to me. I would like to continue acupuncture treatment but am afraid to go back and face that pain again. Is this kind of painful deep-muscle massage a usual part of acupuncture treatment? Would it be reasonable to ask him to just do the acupuncture with no massage?

Jamie_Starkey,_LAc: I’m so sorry you experienced the discomfort during the treatment. In a typical acupuncture treatment, the patient lies either on their back or stomach and fine, hair-thin needles are placed into specific areas of the body predetermined by the acupuncturist. The needles are then retained for approximately 30 minutes while the patient rests comfortably in a room that is often enhanced with ambient lighting and soothing music. Massage is not a typical modality incorporated into an acupuncture treatment. It is possible your acupuncturist also has a license in massage therapy, in which case it is their own unique treatment style to incorporate massage techniques, but this is definitely not the norm. If you have a follow-up visit scheduled, I would let the practitioner know that the massage portion of the treatment was very uncomfortable and to omit that from the treatment plan. Any acupuncturist should be very open to your feedback and adjust the treatment style accordingly.


Specific Disorders

nt014: Can acupuncture help in alleviating sinus drainage?

Jamie_Starkey,_LAc: Acupuncture is quite an effective treatment for symptoms of seasonal allergies. In fact, a study published in Annals of Internal Medicine in 2013 looked at 422 patients with seasonal allergic rhinitis. The study compared acupuncture with an antihistamine to just an antihistamine alone. After eight weeks of treatment, results showed statistically significant improvements in the acupuncture group with seasonal allergy symptoms (nose symptoms, eye symptoms, overall quality of life symptoms) in addition to decreased antihistamine use. I encourage patients to come in for weekly consecutive treatments about eight weeks prior to their worst allergy season to get a head start on their symptom management.

sw4health: Has acupuncture been used to treat Raynaud's phenomenon? If so, please describe the treatment process. Thank you.

Jamie_Starkey,_LAc: Hi. I do have several patients that I treat for Raynaud's. Generally, you would see an acupuncturist for a first visit consultation, at which point the clinician would formulate a Chinese Medicine diagnosis and treatment strategy. I generally recommend eight to 10 consecutive weekly treatments as one full course. I will then stop and re-assess therapeutic efficacy after that course is complete and then visits are tapered. It is very common that patients with Raynaud's need to come in much more frequently in the colder months. We work to help increase blood flow in the limbs in addition to addressing any pain. Thanks for your question.

sw4health: Can acupuncture be used in the prevention of calcium oxalate kidney stone formation? How about stones that have already formed and currently "reside" in the kidney? Thank you.

Jamie_Starkey,_LAc: Thank you for your question. Unfortunately, acupuncture cannot address stones that have already formed, nor do I promote this therapy to prevent stone formation. It can, however, be incredibly effective in addressing renal colic, pain associated with the kidney stone. I hope this information helps.

Gail Ann: Is there anything in Chinese medicine that can be helpful in ridding oneself of kidney stones? Thank you for answering my question.

Jamie_Starkey,_LAc: Assuming you are being closely followed by your urologist, I would also recommend Chinese herbal therapy to help in terms of prevention. It might also be beneficial for you to seek out a consult with a physician who practices integrative or functional medicine, who will look at your condition through a slightly different lens than your conventional physician to try to pinpoint any underlying causes for the chronic kidney stones.

u775kelly: Have you seen acupuncture provide relief for fibromyalgia?

Jamie_Starkey,_LAc: Fibromyalgia pain is a very common complaint we see at the Center. Acupuncture is an excellent pain management treatment option for many different types of conditions. We aim to decrease pain scores and also manage triggers that may exacerbate pain, such as decrease stress and help improve sleep. Evidence-based guidelines for the treatment of fibromyalgia vary amongst different countries. As reported in the Journal of Evidence-Based Complementary and Alternative Medicine, Germany and Israel recommend the use of acupuncture in addition to hypnosis/guided imagery and Tai Chi.

Gail Ann: Can acupuncture and/or Chinese medicine help with hypothyroidism? Thank you for answering my question.

Jamie_Starkey,_LAc: Chinese herbal therapy would be a better option to address hypothyroidism, but the Chinese herbalist should work very closely with your endocrinologist. Thank you for your question.

Valpat: I have osteoporosis and my back discomfort is helped with acupuncture, but I was wondering if acupuncture can actually have an impact on bone density? If so, which meridians would best affect bone density, how often should one have acupuncture to achieve results and does electro-acupuncture or cupping enhance the effect? Are there other Traditional Chinese Medicine treatments that have been researched in relation to building bone density? Thank you.

Jamie_Starkey,_LAc: In my clinical practice, I don’t generally recommend acupuncture to specifically help with bone density. Acupuncture is most appropriately used for pain that may be associated with osteoporosis, such as back pain. The clinical evidence is not strong. I only know of one small study in China showing favorable effects of acupuncture on bone mineral density in postmenopausal women and one study using electro-acupuncture in the rabbit model. I would strongly encourage you to use conventional medicine to address osteoporosis concerns, enhanced with a regular weight training and exercise program, which have been shown to help preserve bone density. Use acupuncture and other Traditional Chinese Medicine treatments as an adjunct treatment for pain control.

5862141: Has any attempt been made to see if acupuncture can help patients who have Parkinson's disease? If so, what was the result?

Jamie_Starkey,_LAc: Last year, in the Journal of the Neurological Sciences, a group from Korea analyzed 11 studies looking at acupuncture’s effect on Parkinson’s disease. The group concluded there was not enough evidence showing the effectiveness on acupuncture for treating Parkinson’s. The studies were of mixed design and results. Three studies did show that patients using acupuncture with conventional drugs reported beneficial effects of acupuncture. Our acupuncture team at the Tanya I. Edwards MD Center for Integrative Medicine see Parkinson’s patients as an adjunct to their conventional western medical treatment plan. Empirically, we see that acupuncture coupled with their standard treatment helps to improve stress levels, sleep and general quality of life. All improvements indirectly work toward managing tremor activity and other symptoms of Parkinson’s. We also encourage our patients to maintain a regular exercise regimen and follow a clean healthy diet.

Yolan: I have lupus and I know acupuncture can help with my inflammation. Do you know if there is any Chinese medicine or nature diet for lupus and how can I get it?

Jamie_Starkey,_LAc: A combination of acupuncture and Chinese herbal therapy would be a good option. If you pursue Chinese herbs, the skill of the herbalist and quality of the herbs are imperative. Additionally, having a consultation by a physician who practices integrative medicine would be recommended, as they could provide you with dietary and supplement advice. You should always seek out someone who is state licensed, who comes highly referred. If you’re interested in someone who practices Chinese Medicine, you can go to the National Certification Commission for Acupuncture and Oriental Medicine's website and search a practitioner by ZIP code.

charlyfu: Can acupuncture help in relieving bile duct spasms?

Jamie_Starkey,_LAc: I would not recommend acupuncture as a primary treatment option for bile duct spasms. The pain may be relieved through acupuncture, so it's definitely worth exploring, but I would be most concerned that the underlying issue for the spasm be determined and addressed appropriately by your physician. There are no clinical studies that I know of looking at acupuncture for bile duct spasm.


Managing Treatment Costs

roni50: Why don't more insurance health care providers recognize this form of treatment? I have lower back issues and would absolutely love to try this as an alternative treatment; however, it is not on the list of treatment options.

Jamie_Starkey,_LAc: I absolutely agree and feel just as frustrated as you. Unfortunately, health coverage is variable depending on company, state, plan, etc. You can have one health insurance company cover acupuncture in New York but not touch it in Ohio. Low back pain is the top condition we treat at the Center for Integrative Medicine. The data surrounding acupuncture's effectiveness in treating low back pain was so convincing that Germany makes acupuncture standard of care for low back pain treatment. The landscape of health care coverage is ever-changing. I'm hopeful that with more patient demand, more clinical trial data and more data to support the cost-effectiveness of acupuncture, we will eventually see more widespread coverage.

nt014: Can you tell me what costs are covered with the Cleveland Clinic health plan?

Jamie_Starkey,_LAc: Unfortunately, our Cleveland Clinic health plan discontinued acupuncture coverage back in 2011. The Tanya I. Edwards MD Center for Integrative Medicine charges $100 per visit, and Cleveland Clinic employees receive a 20 percent discount ($80 out-of-pocket expense). To offset the out-of-pocket expense, I created an acupuncture shared medical appointment (SAMA), which drops the price point down to $40 per visit. Many patients seek acupuncture treatment in this shared appointment setting for the cost savings. An acupuncturist would need to evaluate you to determine if you qualify for the shared appointment, so all first visit consultations must be done in a first visit appointment setting. Common conditions we see in the SAMA setting include: hot flashes, pain (especially migraine, fibromyalgia, knee, ankle, etc.), allergy symptoms, side effects due to chemotherapy and radiation, and stress/anxiety/depression. Our acupuncture team sees patients throughout the entire Cleveland Clinic health system: main campus, Lyndhurst, Broadview Heights, Strongsville and Avon. The SAMA clinics are at Lyndhurst and Avon campuses only.

Yolan: Would you know how I can get my insurance to pay for acupuncture treatments? I will like to know how I can find an acupuncture doctor near the 45424 ZIP code and how can I check if they are certified?

Jamie_Starkey,_LAc: You would have to call your insurance company directly to see if acupuncture is a covered benefit. Sometimes, a letter of necessity provided by your doctor can be accepted by your insurance company to cover the cost. Again, this conversation should be had directly with your insurance carrier. You can go to the National Certification Commission for Acupuncture and Oriental Medicine's website to do a practitioner search by ZIP code. I would then go to your state's medical board website to be sure the acupuncturist is indeed state licensed. Word of mouth through trusted family/friends/physicians is the best way to go.


General Information

pnmdirect: What are the qualifications for an individual experienced in the performance of acupuncture?

Jamie_Starkey,_LAc: Training as an acupuncturist is a minimum graduate-level degree, minimum of three years of schooling, with 1905 hours of training. Beyond the core curriculum, acupuncturists must maintain their medical degree by fulfilling continuing education credits throughout their entire career. If you are interested in this curriculum, you may want to visit The Accreditation Commission for Acupuncture and Oriental Medicine's website to search for accredited schools by state.

If you are interested in finding an acupuncturist in your area, you can visit the National Certification Commission for Acupuncture and Oriental Medicine.

suzyq: Is acupuncture available at the Weston Florida location?

Jamie_Starkey,_LAc: Unfortunately, it is not available at this time, but it's being discussed. Stay tuned!


Closing

Moderator: That is all the time we have today for questions. Thank you everyone for participating today; and thank you, Jamie for your insightful answers to our questions about acupuncture and Chinese Medicine.

Jamie_Starkey,_LAc: Thank you all for joining me today. Your questions were excellent, and I hope my answers were beneficial to you all. If you need any further resources on acupuncture or Integrative Medicine, please feel free to visit the Tanya I. Edwards MD Center for Integrative Medicine.


For Appointments

To make an appointment with Ms. Starkey or any of the other specialists in our Center for Integrative Medicine at Cleveland Clinic, please call 216.986.HEAL (4325). You can also visit us online at clevelandclinic.org/cim.


For More Information

On Cleveland Clinic

At Cleveland Clinic’s Center for Integrative Medicine, our team of experts is well-versed in natural products. They can offer this treatment approach for chronic illnesses or troubling symptoms, such as fatigue, insomnia, nausea, pain, anxiety and stress. By addressing these key components of health and focusing on prevention, they can help you enjoy a better quality of life.

On Acupuncture & Chinese Medicine - Health Information

Online information is available through your state oriental medicine association and/or the National Certification Commission for Acupuncture and Oriental Medicine's website. To look for a certified practitioner in your area: http://www.nccaom.org/find-a-practitioner-directory/.

On Your Health

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A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2014. The Cleveland Clinic Foundation. All rights reserved.