Cleveland, OH-Ho! Day 2: Living Well & Thriving @ the Cleveland Clinic Wellness Center

 I arose at 0600 EST (0300 PST) and brewed coffee, fully nuked – caffeine is my friend. The excitement of spending time at the Cleveland Clinic Wellness Center all but mitigated my fatigue. Icy showers with temperatures in the forties were forecast. I dressed in layered business-casual in my belief the east is more formally attired and my consistent experience of freezing in climate-controlled buildings.

As an aside, when I first arrived at my new digs in Kaiser-Fair Oaks, my office was frigid while the rest of the building wanted for cooling. I telephoned engineers to inform them of the problem. I phoned again when no engineer seemed forthcoming. Finally I left this message, “The forecast in my office is for snow. There are icicles on my computer. Please help.” They did not find my message as amusing as I thought it was or they might. Given that we summon engineers only to fix the broken, I thought they might enjoy some humor. Not for the first time, I thought wrong. Nonetheless I DID get a response!

When they were unable to stop the arctic blast down my back and through my bones, I took matters into my own hands. Hmm… I recently relocated to Kaiser- Folsom (Sierra view, two miles from home, saves 90-minutes/day and $240/month in gasoline). I should perhaps telephone the new occupant of my old office and have him remove the heavy visqueen taped inside of the vent cover. :-D But I digress – as I am wont to do.

I stepped into the hall and eased my door shut. The doors of the Hilton are weighted such that, left to their own devices… I’d listened to numerous doors slam shut during the night.

The robust aroma of coffee wafted down the hall, tumbling through the Concierge Club’s door each time someone entered or departed. At 0730, breakfast was in full swing. Cleveland talking-heads delivered morning news on their large, flat-screen, HDTV. People sat in onesies or twosies holding quiet conversations, reading or watching the news.

Continental breakfast offerings were extensive: oatmeal, hardboiled eggs, pastries, bagels, toast, yogurt, freshly sliced fruit, cereals, juice, milk, tea, and coffee. I glanced at the USA Today while eating yogurt and fruit. I packed an apple for mid-morning, a bottle of water, and headed to the lobby for my shuttle.

Google Maps located Cleveland Clinic’s Wellness Center a straight shot and four miles north. We drove past brick colonials and wooden split-levels. The lots were large, the homes surrounded by spacious lawns and unfenced yards that flowed one into the other, in utter contrast to the fenced, postage-stamps of California.

No stucco and tile, the architectural theme was one of front gables and columns with decorative capitals, porticos and colonnades, corniced eaves and wide friezes, architectural features popularized during the Greek Revival and Italianate periods of colonial America.

My driver Martin said these were expensive neighborhoods but that a friend had recently purchased a three-bedroom, two-bath home for $115,000. He hoped to do the very same, very soon.

We passed entire city blocks of uncut forest, thickly wooded lands, their understory tangled with bramble and briar and no doubt, innumerous creatures therein.

Mid-block we turned left, west off the main thoroughfare. There was no signal, no fanfare, just a sign, an understated combination of stone and wood: The Cleveland Clinic Wellness Center. A long and winding road rambled over hill then through wooded dell, and the world of roads and malls and hotels and business became obscured and remote.

Wild geese paddled in a pond ringed by wooden benches. I imagined them pleasant perches in the verdant springtime sylvan. Under a gray sky, the sprawling lawns and scattered benches brought immediate peace and calm, reminiscent of the proverbial sanitarium, where peace and calm were thought to be requisite for wellness. Sanity – a clean and uncluttered mind. Maybe they were on to something.

The van labored up a steep hill that when crested, revealed a modern structure of glass, girders, and wood painted to blend with the forest. We circled the gravel drive that popped and crunched beneath the weight of the vehicle. I was let out in the roundabout, 45-minutes early.

The lobby was spectacular, like a Hyatt, with a soaring glass ceiling that fell at an acute angle from the third floor. The flagstone pond at my right funneled to an abrupt edge, sending water freefalling three stories below grade, to land yet again, in another flagstone pool. Flowing, falling water filled the lobby with music. Potted trees, and shrubs, and ferns encircled chairs arranged in conversational clusters.

I stopped at the security desk just inside the front door. They pointed across the sunlit lobby to a woman sitting alone at a four-top.

“Jackie is over there. She’ll check you in.”

I veered left, rounding the central stairwell as the ceiling plunged to touch down in the cafeteria’s dining area. Southern exposed, it was awash in early light. Gigantic, tubular, metallic mobiles hung overhead. I wondered if they would awaken, enliven, and animate as air warmed in the apex above.

A stone rimmed pond nestled against the building. Ducks floated on its glassy surface colored silver by the new day.

Jackie sat at the edge of this scenic, utilitarian space just beyond the sun’s reach. Her table was strewn with stacks of binders and folders and nametags. Jackie is Dr. Esselstyn’s secretary.

I exchanged numerous emails with Jackie prior to my arrival in Cleveland and it was nice to put a face to the gracious woman who responded to my requests.
 I'm glad you could come," she said, handing my materials over. "We are down the hall." She extended her left arm, gesturing toward the hall, its external wall of glass circumnavigating the duckpond. "The bathrooms are on the right. Dr. Esselstyn and Ann are already down there.”

I entered the room.

“Well hello young lady.” Dr. Esselstyn smiled, reaching to hug, pulling me into his crisp, starched, white, lab coat. “This is my wife Ann.”

“Wonderful to finally meet you,” I said, reaching for her hand and covering it with my own.

Dr. Esselstyn is an engaging, commanding figure, standing a full six-foot-two with a thick thatch of white hair. He is long, and lean, and authoritative - though warmly so.

I first met Dr. Esselstyn via videoconference from Kaiser Permanente (KP) -Santa Rosa, approximately eighteen months ago. He spoke of heart disease as a “reversible, food-borne illness and a toothless paper-tiger that never need happen.”

At that time, five of my patients had engaged their diabetes and diets such that, we had weaned them from insulin. I knew he spoke truth, evidenced-based truth. I spoke to patients about driving their disease into remission. Dr. Esselstyn spoke of driving disease into submission. That he had come all the way from Cleveland to stand in Dean Ornish country and espouse a plant-based diet was entertaining to me.

Let me give you the back-fill. Back in the early 90’s men like Esselstyn (Cleveland Clinic) and Ornish (Santa Rosa) began studying their patients with the hypothesis that heart disease was a lifestyle disease and thereby reversible. They were quickly labeled “quacks” until their research bore out their hypothesis. Men like Esselstyn and Ornish forever changed our paradigm of heart disease. It wasn’t long before that hypothesis - that many of our diseases (in fact, the top five killers) are brought on by lifestyle - was applied to other disease states. The ones of Essy’s focus include heart disease, it's cousin type-2 diabetes, and erectile dysfunction.

I conversed with Essy last fall at Kaiser’s annual COAST (Cardiovascular and Surgery) Conference. For a full accounting with backfill visit my blog at: http://lorinzmuze.blogspot.com/2010/09/falls-reflections.html

That conversation culminated in an invitation to Cleveland Clinic, to the induction day of his program.  Here’s how it works. Every patient that enters Cleveland Clinic for a heart problem: intervention (angioplasty, stents), surgery (valve repair/ replacement, coronary artery bypass grafting), acute myocardial infarction (heart attack), etc. is offered a complimentary, one-hour consultation with a representative of the Wellness Program. During that consultation they are introduced to the benefits of a plant-based diet and the program of support. For patients who choose participation, Essy holds a monthly workshop to deliver the “why”, while Ann delivers the “how”. It was for this induction day that I journeyed to Cleveland.

Ann is petite, with bright blue eyes, porcelain skin, straight, light hair, and blond brows, all the features - sans height, of them I’ve label “blond and blue from up there.”

“You mean northern Europeans?” My cardiology buddy teased, smiling through ruby lips and rosy cheeks against porcelain skin, his blue eyes laughing beneath light hair.

“Yea, like you,” I pointed, “Blond and blue from up there.” More specifically, blond and blue from up there refers to Scandinavians. Ann fit my picture of an elder Scandinavian beauty. She was trim and spry and full of vigor.

After greeting me Anne announced to the sparsely filled room, “This is Lorin, she came all the way from Sacramento.” I made the rounds, greeting participants. As each couple arrived, they did the same. Participants had come from as nearby as Chicago and as far away as Florida and Arizona. All in all there were nine patients, nine spouses, three health-care providers, and Essy’s team.

The patient demographics of this group included seven men and two women. The women exceeded 60 years of age; the men were under 55, some under 45. All the patients were lean, their spouses - not necessarily so. Every patient had experienced a catastrophic cardiac event that provoked seeking.

I visited with Joe and Nancy from West Palm Beach, Florida. He was long and lean with a cleanly shaven head and olive skin. Joe cycled 200-miles each week. Nancy and I were similar in size.

“Why are you here?” they asked. I told them of my work at Kaiser, of my patients who had weaned themselves from many of their medicines. I told them of my kidney failure and my improved tests and function after switching to a 99% vegetarian diet.

They told me their story. Joe’s bicuspid aortic valve failed – as they are wont to do. Bicuspid aortic valve disease affects only 2% of the population and is more prevalent in males than females. Present at birth, it is thought to be the symptom of an underlying connective tissue disease.

Normally, the aortic valve has three small flaps or leaflets that open and close securely to regulate blood flow, allowing blood to flow from the heart into the aorta and preventing backwash into the heart. (Remember forward-flow from Day-1 Getting There?)

Joe’s aortic valve had only two leaflets and was replaced last year. During the pre-surgical assessment he was found to have mild triple-vessel disease resulting in triple coronary artery bypass grafts. We call it the incidental bypass, not severe enough to crack a chest but since we’re there, chest already cracked… incidental bypass.

Post-operatively Joe and Nancy were perusing Borders bookstore, scanning the shelves, looking for answers.

“Essy’s book literally fell onto the floor in front of us. We picked it up to put it back, looked at the title and thought, maybe we should read this.” In retrospect, they felt the hand of God directed his book in falling to the floor. They contacted Essy through his website and within 24-hours he was on the phone hearing their tale.

Essy’s book, Prevent and Reverse Heart Disease is filled with recipes and reason. Joe and Nancy adopted the program and lost weight: 37 pounds for he, 32 pounds for she. They are lean and feel great – more energy, more stamina, more gusto, more vitality, more aliveness. It’s a good thing you know, being alive while you live.

We were assigned seats; I sat at the back table with Moira, a registered dietician and her mother Debra, a charge nurse for KP-Orthopedics.

Essy shrugged off his white coat, “Let me get out of this costume so we can begin.” He dove into a four-hour power-point presentation including the who: societies with a prevalence of heart disease and diabetes and those without.

The what:  the pathophysiology of endothelial (inner-most layer of blood vessels) disruption, cholesterol crystals, plaque formation, plaque rupture, cardiac ischemia (asphyxiation), pathogenicity (creating sorrow/tragedy) of the western diet, retrospective data/studies (i.e. decreased incidence of heart disease in Norway during WWII when all meat was consumed by the German army and Norwegian citizens were forced into plant-based diets and the subsequent rise of disease once dietary meat was reintroduced.)

The how: mechanisms that promote endothelial healing and disease reversal.

About halfway through, Moira, our in-situ registered dietician raised her hand. “What if you are vegetarian four-days a week and the other three…” her voice trailed off, her point made and question asked.

“Are you going to be a problem?” Essy asked with a wink and a smile. “Moderation kills,” he said. “Animal proteins ignite a state of inflammation in your body and in your endothelium. You restrict animal proteins and inflammation starts to subside, your body starts to heal. After a few days you re-introduce animal proteins and re-ignite the fire.” A picture of firemen pouring gasoline on a house-fire filled the screen at the front of the room.


He confirmed that which I have observed with my own patients: exercise is preferred but not requisite. Even the sedentary can extinguish their smoldering endothelium.

Then he said something that almost got past me. He mentioned autoimmune diseases and improved symptomatology with the introduction of a plant-based diet. He moved on and my brain hiccupped. Did he just say what I think he said? My hand shot into the air.

“Lorin?”

“Dr. Essy let me ask you to backtrack. You said something about plant-based diets and autoimmune diseases. I’ve heard you speak twice, this is the third time, and I have never heard you say anything like that. Can you say more?”

“Yes. Autoimmune diseases are those in which the body attacks itself. Remember macrophages and lymphocytes, the soldiers of the bloodstream? These soldier-cells misidentify a body protein as,” he raised his hands and pulsed pointer and middle fingers of each in quotation marks, “The enemy and attack. It likely started with eating an animal protein. There is a theory about gut-leak, whereby an unusually large protein molecule leaks from the digestive tract into the bloodstream. Macrophages and lymphocytes identify it as harmful and destroy it. Later, they encounter a similar but normal and useful body protein and attack.”

“In the case of rheumatoid arthritis, that body protein is the synovial fluid of the joints. There was a small but significant study involving patients with MS, multiple sclerosis, who experienced significant reversal of their symptoms once they began a plant-based diet.”

I drew a star in the margin of his syllabus, for future conversations with a few good men. Pictures of stars, keys, and the first letter of names are my recurrent marginalia. I constantly and consistently annotate for future conversations. This held more urgency for me than most.

“In the beginning,” Essy asserted, “They said a plant-based diet wouldn’t work. But there is good, hard science behind it now, this is evidenced-based medicine. Now they say, patients won’t do it. We haven’t found that to be true. There are many patients interested in disease reversal.”

We broke for lunch. I stood in line with a pasty and pockmarked, obese and elderly man in coveralls and flannel.

“My wife had a heart attack,” he said, “They put in some stents. But I don’t have any heart disease in my family,” he justified, “So I think I’m okay.”

Really? I wondered if his heart-healthy predecessors had sported an extra fifty pounds. “Based on the lecture this morning, I’d say if we are eating typical American fare, we are all in trouble.”

“Well, that might be true,” he acquiesced.

Denial is a powerful, albeit temporary, survival tool.

Our plant-based luncheon buffet was a delicious combination of: kale/humus/cilantro wraps, carrot/ginger soup, lentil chili, water chestnut/onion/cilantro/tofu pot-stickers, and decaf ice tea.

During the afternoon Ann taught shopping and food preparation: how to de-spine and use kale, reliable brands at Whole Foods, eating and travel, reading food labels, useful websites. I found her presentation extremely helpful because while many of us can agree with “the why”, “the how” stops us. There is little convenience in a plant-based diet.

Their son Rip is the national spokesman for Whole Foods. Ann held a copy of his book high for all to see, The Engine 2 Diet: The Texas Firefighter's 28-Day Save-Your-Life Plan that Lowers Cholesterol and Burns Away the Pounds. On the cover, Rip squatted in fireman fatigues. He was svelte and sported the familial thick thatch of white hair. Ann beamed, “He’s an awesome man; we’re proud of our son.”

“Let me wrap it up by saying this,” Essy said, “I’m 76 years old. I have no disease. I’m on no medication. I’ve been eating this way for 27 years. I hope to keep on going until one day I get pneumonia and die. But I don’t expect I’ll suffer with chronic disease. My wife and son are similarly healthy. As I said, much of chronic disease is a toothless paper-tiger that need not happen.”

A lengthy question and answer period ensued. We discussed heredity and children – some had very young children.

“Genes load the gun,” Essy said, “Lifestyle pulls the trigger.”
Lifestyle pulls the trigger...

Class ended all too soon. Our induction-day was over. Patients made arrangements for routine follow-up via email and forwarding lab results to Essy. He and Ann would be available via phone and email to offer dietary support and advice.

He signed books. People requested photos.

“Let me put my costume on.” Essy lifted his white coat and shrugged it into place. I waited until the paying public had their fill.

“Well young lady,” he turned his luminous smile on me, enveloping me in warmth and tenderness, “Was it worth the trip?”

“Absolutely! Thank you for the invitation.” I hugged them both.

“I will be speaking at the University of California Davis on June 22nd,” He said. “Let me check with my hosts but I’d like you to bring as many Kaiser people as you want.”

My mind whirred with the possibility.

I returned to the grotto in the lobby to reflect and plan my afternoon. The Rock and Roll Hall of Fame is in Cleveland and the late afternoon and evening were available for exploration. I sat in the sunlit cafeteria jotting notes into my tablet. I stared through the glass; the pond glimmered with afternoon sun, inviting me outdoors. I had to be honest with myself; I have little appetite for exploring a strange city alone.

I am a denizen of the suburbs, uneasy in cities, and more so in unfamiliar cities. In them I feel small and vulnerable and anxious. I would rather be alone in the wilderness with wild mountain goats than alone in a city. I would not venture into Cleveland city proper to seek out the Hall of Fame.

I stepped outside (my Heaven) and balancing stone to stone, circled the pond. I ducked beneath a branch where a single, curled, dried, brown leaf clung like a chrysalis, trembling in the light, warm breeze. At the tip of every twig, a tightly bound bundle of green was ready to explode.

While the rest of Cleveland wrestled with winter’s grip, the Eden-esque lands round the Wellness Center were well-groomed, well-nourished, and well-on-their-way to spring. Tall stands of stately trees, long and gracefully bent were bursting to bud. The grounds had the faintest patina, the promise of resurrection and life anew.

I shouldered my backpack and began walking.

You can visit Essy’s website at: http://www.heartattackproof.com/

See Essy on utube with Wolf Blitzer, President Clinton, and Dr. Dean Ornish in the Situation Room at: http://www.youtube.com/watch?v=s2yaaypVmaI