Many holidays focus on family & friends, but it's important to take time for oneself. Read Family Medicine physician, Dr. Lefkowitz's Healthy Holiday Tips.

The holidays tend to be a time of joy, abundance, and long-awaited social gatherings. However, this can come at the cost of over-indulgence, stress, and unhealthy lifestyle choices. The key to this is balance. Here are a few tips to help you and your families stay healthy this holiday season.

1. Plan ahead. Trying to coordinate travel plans, often with multiple different family members, can be quite stressful. Try to do this well in advance of your planned get-togethers. Having one (or two) “trip coordinators” can help minimize confusion between groups. Pick someone who wants the position, has the time to plan, and will be respectful of people’s requests. And when all is said and done, don’t forget to thank that person for helping to make everything a success!
2. Be aware of your food and drink intake. The key here, again, is balance. If breakfast is very heavy, then make sure lunch and dinner aren’t. If dinner is going to be a grand affair, then make sure that lunch (and snacks) are on the lighter side. Also, don’t forget the power of portion control. Portion control allows you to have a little of all that delicious food, but not a lot of it. Eat until satisfied, not full.
3. Don’t forget your exercise. If on vacation or away from home, it is often easy to skip physical activity (even if you’re used to doing it at home). This is the “vacation mentality.” Don’t fall for it. Stay active and you will feel better. Also, physical activity will help to offset some of those extra calories you take in if you slip up on tip #2!
4. Get your rest. Sleep is absolutely essential for not only feeling good, but for your body to function as it should. Your stress level will decrease and your energy level will increase if you choose to get adequate rest during the holidays. How much? The American Academy of Sleep Medicine recommends adults aged 18–60 years sleep at least 7 hours each night to promote optimal health and well-being.
5. Be mindful. Simply put, enjoy the moment. When you are gathered with friends and family, try to forget the stress of work and the daily grind. Forget the stress of planning the vacation (if you didn't follow tip #1). Forget having to “get back to reality” at the end of the trip. Live in the moment, take a look around, and enjoy the people gathered with you. After all, that is what the holidays are all about.

To make an appointment with Dr. Lefkowitz, click here.

The most common cause of hepatitis is viral hepatitis.

1. What is hepatitis? What are the differences between the types of hepatitis?

Hepatitis means inflammation of the liver. The most common cause of hepatitis is viral hepatitis, consisting of virus types A, B, C, D, and E.

Hepatitis A is primarily transmitted through contaminated food and water.  The contamination occurs when the virus travels out of an infected person in their feces, and gets into the community’s water system.  It is less commonly transmitted through sex. It causes an acute infection that’s self-limited, meaning the virus will run its course without causing chronic infection. “Most infected people get over the illness without a serious issue.  There are very few deaths unless one has a compromised immune system”, says Dr. Lefkowitz.

Hepatitis B is transmitted through body fluids like semen and blood, and through infected mothers to their babies during birth. “This type can cause both and acute and chronic illness, and twenty-five percent of people who develop a chronic infection, if left untreated will develop liver disease, cirrhosis, or liver cancer”, says Dr. Lefkowitz. Ninety-five percent of infants who are born with Hepatitis B transmitted from an infected mother, will develop chronic infection. Dr. Lefkowitz emphasizes this is the reason babies receive their initial hepatitis B vaccination right after birth.

Hepatitis C is transmitted through body fluids like semen and blood, with blood being the biggest risk. Hepatitis C can also be transmitted through infected mothers to their babies during birth, but less commonly than hepatitis B. “Seventy percent of the people who get acute hepatitis C will develop chronic infection; of those, fifteen to twenty percent, if left untreated will develop severe liver disease, cirrhosis, and liver cancer”, says Dr. Lefkowitz.

2. What are the symptoms?

Acute hepatitis symptoms include fever, body aches, and nausea/vomiting. More liver specific symptoms are jaundice, light to clay-colored stool, and dark urine. Hepatitis A is notorious for causing diarrhea.

However, Dr. Lefkowitz state “Patients with acute hepatitis A, B, and C sometimes don’t show symptoms, people with hepatitis C are usually unaware they’re infected with the virus.”

3. What can people do to prevent getting viral hepatitis?

Stay up to date on the Hepatitis A and B vaccines. Practice safe sex, like using condoms, and avoid sharing needles.

4. Is there any way for hepatitis to be treated?

Hepatitis A is self-limited, and will pass after the virus runs its course.

Hepatitis B has treatments but there isn’t a cure.

Hepatitis C has treatments for acute and severe cases, and most patients can be cured with treatments developed in the last ten years.Because of the higher risk of developing chronic problems from Hepatitis C, and the potential for cure, it is recommended those at risk for hepatitis C obtain lab testing to see if they have active infection.

In the fight against COVID-19, testing is key. But there are several types of tests that can be confusing for those who don’t know the difference. We talked to SIMEDHealth Primary Care Physician David Lefkowitz, MD, about what makes these tests distinct and what tests SIMEDHealth offers.

1. What is the difference between an antibody test, an antigen test, and a viral test?

Dr. Lefkowitz says, “Antibody tests look for antibodies to a particular pathogen, in this case, SARS-CoV-2 (the COVID-19 virus). Antibodies are proteins made by your immune system in response to a pathogen. So, if you test for COVID-19 antibodies, you are trying to see if someone has been exposed to COVID-19 already. It may take days or even weeks for antibodies to become detectable. So antibody tests are not useful to diagnose an early active COVID-19 infection. The test itself is done either via a blood draw or with a drop of blood from your finger. Note, these tests are also referred to as serologic tests.”

“Antigen tests look for pieces of the virus and are typically done via a nasal swab,” Dr. Lefkowitz replied. “The nice thing about these tests is the rapid turnaround time, usually about 15 minutes. The downside is they are not as sensitive as the PCR test described below, and so they may miss people who do have the virus. Therefore, if there is a high suspicion someone has symptoms of COVID-19, such as fever, cough, shortness of breath, but they have a negative rapid antigen test, they would likely be well served to also receive a PCR to be sure whether they have COVID-19. This type of testing is also known as POC (point-of-care) testing, and it is often done  where a lot of testing needs to be completed in a short period of time, such as in medical facilities, schools, military facilities, and even airports.”

“Viral tests look specifically for the RNA of the COVID-19 virus,” explains Dr. Lefkowitz. “Depending on the type of test, viral tests use a nasal swab, oropharyngeal swab, or saliva.” He adds, “These tests can be used to diagnose active COVID-19 infection. Note, this type of testing is also known as a molecular test or a PCR test. It remains the ‘gold standard’ for diagnosing COVID-19 infections, meaning it is the most accurate.”

2. Who should get an antibody test? Who should get a viral test?

“Active infections are diagnosed with viral and antigen-type tests. These tests are also useful for screening asymptomatic people who may have COVID-19, so they don’t unknowingly spread the virus.” Dr. Lefkowitz continues, “Antibody tests are generally useful only for those who want to know if they had previous exposure to the virus. They are not useful for recent exposure. However, it is important to note that even if you test positive for the presence of COVID-19 antibodies, it doesn’t mean you have immunity against COVID-19. We don’t know yet what kind of protection these antibodies give you, or for how long. So, you still need to wear a mask, physically distance, and wash your hands. Antibody tests are also used by scientists and researchers who are studying patients who have had COVID-19.”

3. What kind of COVID-19 testing does SIMEDHealth do?

“At SIMEDHealth, we do PCR testing and antibody testing. Dr. Lefkowitz says, “Previously, we had to send the nasal PCR swabs to an outside lab, which delayed getting results. Fortunately, our SIMEDHealth laboratory has recently acquired the capability to process the PCR tests and give a timely, highly accurate result. We aim to have results out in 45 minutes. As you can imagine, both patients and our staff will find the rapid turnaround time very useful in fighting against the spread of COVID-19.”

Lastly, Dr. Lefkowitz adds, “There has been much discussion regarding COVID-19 testing since the beginning of the pandemic. We have come a long way, but there is still progress to be made. I want to remind everyone to continue to take this virus seriously, especially as we enter the colder months and flu season. If you have symptoms or have been in contact with someone tested positive for COVID-19, or the Influenza virus, you should be tested. If you have concerns, call us, we can help you.” Click here to schedule an appointment with Dr. Lefkowitz today. 

Ah, caffeine. The substance we all love to love. March is Caffeine Awareness Month and with 54% of Americans over the age of 18 consuming caffeine on a daily basis, awareness is important. We talked to Dr. David Lefkowitz about the good and bad effects of caffeine. 

How Does Caffeine Work?

Caffeine is a compound in the stimulant class. It works on certain receptors in your nervous system to cause the effects we discuss in the questions below.  It is the most widely consumed stimulant in the world, the reasons for which are a multitude.  It is relatively cheap, its effects help us perform and feel less tired, and it is found in drinks that billions of people enjoy every day: coffee, tea, and soda.

What Are Some Of The Good Effects Of Caffeine?

Caffeine is most beloved for its ability to enhance mental performance including alertness, arousal, and focus. It is also known to lessen the drowsiness that comes from lack of sleep.  This is why so many people enjoy a morning cup of coffee (or tea).  It can also be useful for treating headaches (in fact it is an ingredient in some headache medicines).  There are other possible benefits of caffeine (such as protecting the liver or reducing the risk of Parkinson’s Disease), but the studies are not clear on this and so more research would need to be done for us to know if this were factual or not. 

What Are Some Of The Bad Effects Of Caffeine?

Consuming high levels of caffeine can be associated with negative short-term effects, including anxiety, tremors, elevated blood pressure, and insomnia.  A high level would be more than 400mg of caffeine a day. For reference, an average cup of coffee has ~100mg of caffeine, a 12oz Coke has ~35mg caffeine, and an 8.3oz Red Bull has ~80mg caffeine.  Also, taking in too much caffeine can cause arrhythmias (irregular heart rhythms) and, paradoxically, can actually cause headaches.  Yes, I know earlier I said that we use caffeine to treat headaches, but its use can also cause them. In fact, the number one side effect of caffeine withdrawal are headaches. 

If Someone Wants To Cut Back On Their Caffeine Intake, What Is A Healthy Way For Them To Make That Happen?

Cutting back on caffeine can be tricky because caffeine withdrawal is a real thing. Again, headaches are the main side effect reported, but people also complain of fatigue, irritability, and depressed mood.  If you want to cut back or need to cut back (for example in pregnancy it is recommended to consume no more than 200mg of caffeine per day), I would suggest gradually decreasing your consumption over one to two weeks.  If you do go through caffeine withdrawal, it will typically last less than ten days. However, if you “wean” yourself down slowly you really shouldn’t have much of a problem.

Dr. Lefkowitz is a primary care physician, and to make an appointment with him click here. 

On December 1^st, we celebrated World AIDS Day by bringing awareness to AIDS, a virus that impacts people all over the world and from all walks of life. We asked SIMED Primary Care Dr. David Lefkowitz to give us the details on AIDS so we can gain a better understanding of the disease and how to prevent and avoid it.

What is AIDS?

AIDS stands for Acquired Immunodeficiency Syndrome. It is the disease that results from untreated infection with HIV, or Human Immunodeficiency Virus. To understand AIDS, you have to understand HIV.

HIV is a type of virus that attacks our immune system. Because of this, we can’t fight infection or cancer like we normally do. If untreated, it leads to the disease we call AIDS. This can be thought of as advanced-stage HIV infection. At this stage, the immune system becomes so weak it cannot fight off certain germs called opportunistic infections. The actual diagnosis of AIDS is made either when a person with HIV develops opportunistic infections, or when their blood counts drop so low that their immune system can’t fight these infections.

How Do People Get HIV or AIDS?

HIV is spread through body fluids such as semen and blood.  Because of this, the most common methods of spreading the virus are through sexual contact and through needle sharing (of IV drug users). It can also be spread via breast milk and other body fluids. The infected bodily fluid has to come into contact with a mucous membrane (such as inside the vagina) or directly into the bloodstream (such as with a needle). You can’t get it if the fluid contacts unbroken, healthy skin. It is also not transmitted in saliva, sweat, or urine

How Can We Treat HIV?

There is no cure for HIV, but fortunately there has been great progress in treatment. We call HIV treatment Antiretrorviral Therapy, or ART. Current ART is effective at preventing HIV from turning into AIDS.  It also helps to prevent transmission of the virus to non-infected individuals. The medicines that we use for ART are many, and they are used in combinations aimed at attacking the virus from different angles.

How Can People Prevent HIV?

Like I said, sex and dirty needles are the most common ways of spreading HIV. Therefore, condom use (in sexually active people) and clean needle use (in those who are IV drug users) are the best methods of preventing the spread of HIV.  Certainly, abstinence and avoiding needles altogether would be even safer. Condoms are usually available for free at local health departments and some cities now have needle exchange programs.

Transmission from infected mothers to their unborn babies (either through the placenta or after delivery through breastfeeding) is possible, but with ART the transmission rate is now extremely low.

Some populations are considered very high risk for getting HIV. Examples would include those who are IV drug users as well as those who have an HIV positive sexual partner. For these folks, Pre-Exposure Prophylaxis (known an PrEP) can help reduce their risk of acquiring the virus. PrEP involves taking a daily ART medicine as well as regular visits to the doctor.

What Is Life Like For People with HIV?

I think you would have to ask someone who has lived through the diagnosis and treatment first-hand to get the real answer to that question. From a medical standpoint, I am happy to say that prognosis and quality of life have drastically improved with our advances in ART. Whereas HIV used to be 100% fatal, life expectancy for someone with treated HIV is now almost the same as for someone without HIV. 

How should people use this information?

HIV is still an extremely important and devastating disease worldwide. It is important to remember it is often preventable. It is also important to get tested. Some patients have an “I’d rather not know” mentality, but if they don’t find out if they’re positive, they will not be able to get early treatment and could potentially risk passing the virus on to others. Talk with your doctor if you have questions about prevention, testing, treatment, or PrEP.

To schedule an appointment with Dr. Lefkowitz, call (352) 375-6279 or request an appointment online. If you would like to see another primary care doctor or have concerns about contracting HIV, call (352) 224-2225 or request an appointment online.

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