Understanding Diabetes with Dr. Seth Perkins

30.3 million people in the U.S. are living with diabetes. That's 1 in 11 people! November is American Diabetes Education Month, and we talked to Dr. Seth Perkins, one of our SIMEDHealth Primary Care Physicians serving our Lady Lake community. Dr. Perkins filled us in on the difference between the types of diabetes, what its symptoms are, and what patients can do to try and prevent diagnosis. 

1. What is diabetes, and what is the difference between type 1 and type 2?

"Diabetes is a disease where the body does not properly break down carbohydrates (i.e., sugars and starches), and sugar levels are high in the blood and the urine," says Dr. Perkins. Type 1 diabetes is a condition where the body is not producing enough insulin, a hormone that causes sugar to move into the cells of our bodies to be used for energy. Type 2 diabetes is when the body has a resistance to insulin and requires more and more insulin to be produced, exceeding our body's capacity to do so. The main treatment option for Type 1 patients is insulin. Type 2 patients take oral medications initially and may require insulin or other injection medications as time passes. 


2. What causes diabetes for both types?

Dr. Perkins says, "Type 1 forms because of the destruction of cells in the pancreas that produce insulin." Typically, but not always, patients receive a Type 1 diagnosis at a younger age. Type 2 has causes related to multiple issues, including genetics and the environment in which someone grew up or presently lives. Patients usually receive a Type 2 diagnosis at an older age. "Diet and lifestyle play significant roles in the causes of type 2 diabetes," explains Dr. Perkins.


3. What are its symptoms?

Dr. Perkins says, "The most frequent symptoms of diabetes include frequent urination even at nighttime, increased thirst resulting in drinking more fluids than usual, blurry vision, and unexplained weight loss. Type 2 diabetics, however, if caught early, can often present without symptoms."


4. What can people do to prevent it?

The best way to prevent diabetes is to lead a healthy lifestyle. Regular physical activity is particularly important. Dr. Perkins states, "A minimum of one hundred fifty minutes of moderate aerobic exercise is recommended per week. Moderate aerobic exercises include walking briskly, dancing, and swimming." Additionally, a healthy diet is essential. A diet focused on eating a wide variety of healthy foods is more likely to be followed long-term. Weight loss improvement is also highly recommended, as obesity is a potential risk for developing diabetes. Smoking doesn't cause diabetes, but if it is present, smoking dramatically increases the long term complication risks.


5. After being diagnosed, what can patients do to stay healthy?

The above recommendations of physical activity, healthy diet, weight loss, and smoking cessation are helpful for people who are diagnosed. Dr. Perkins says, "Once diagnosed, diabetes education classes can give additional guidance. Meeting with a dietician or nutritionist is also an excellent way to develop a plan for staying healthy. Controlling blood pressure and cholesterol levels is essential, as it can increase the risk of developing heart disease. Not smoking or stopping smoking, as mentioned above. Most importantly, people that have been diagnosed should discuss this with their doctors, who will work with them to develop a personalized plan to help them make healthy decisions."

High Cholesterol: Protecting You and Your Children

About two-thirds of adults say they have had their cholesterol checked within the last five years, according to the CDC. However, about 33.5% of American adults are living with high cholesterol. September is National Cholesterol Education Month and primary care physician Dr. Gabriele DeMori about what patients and their kids can do to keep themselves healthy. 

1) How can a person tell if they have high cholesterol? 

Cholesterol is a fat that comes from the blood. The liver produces fat, but it can also come from foods like meat, fish, and dairy. The only accurate way to tell if a patient's cholesterol is high is to have it checked. Dr. DeMori says, "After turning 20 years old, cholesterol levels need checking as a baseline measurement. Along with maintaining overall health, testing is necessary if there is a family history of heart disease or high cholesterol."

2) How often should someone get it checked? 

Dr. DeMori says, "The American Heart Association recommends that all adults over the age of 20 have their cholesterol checked every 4-6 years. After age 40, along with testing, patients can use the ASCVD risk quiz to estimate the risk of disease or stroke for the following ten years." This exam takes into factor a patient's gender, age, blood pressure, family history, along with other things to make the patient and doctor aware of dangers for the future and start an early intervention if necessary. 

3) Is it possible for children to experience high cholesterol?

Children can have high cholesterol. "The majority of the time elevated cholesterol levels in children and teens comes from parent or family member, diet, and obesity," says Dr. DeMori. If a patient has high cholesterol, it may be in their best interest to get their children tested. The earlier kids and teens develop it, the higher risk they are at for getting heart disease later in life.

4)  What can a patient do to lower their cholesterol?

Dr. DeMori states, "The best way to lower cholesterol is to reduce one's intake of saturated fats which are in most animal products. Eliminating trans fats is a helpful way to cut back. Also, one can increase their intake of food rich in omega-three fatty acids which are in fish and nuts."

Starting to exercise, quit smoking, and losing some weight increases HDL or "good cholesterol" levels. If all these methods are not enough, then one might need medication, explains Dr. DeMori. 

5) What are the effects of having consistently high cholesterol over a long period? 

Having unchecked high cholesterol for a long time produces fatty deposits in the blood vessels. Dr. DeMori describes, "Over time, these grow and cause blockages in the blood vessels. Also, one of these deposits can break off and potentially cause a heart attack or a stroke."

Dr. DeMori sees patients in Gainesville 7 AM-5 PM Monday through Friday. Click here to schedule an appointment with Dr. DeMori today! 

Toni Baldwin-Dufour, DNP Joins SIMEDHealth Primary Care!

We are happy to report Toni Baldwin-Dufour as of today has started seeing patients in our Chiefland location! Baldwin received her undergraduate degree in nursing from the Memorial Hospital School of Nursing and went on to earn her masters and doctorate in nursing from Valparaiso University.

Along with being a Doctor of Nursing Practice, she is also a board-certified family nurse practitioner, a trauma nurse specialist, and DOT certified medical examiner. Click here to schedule an appointment with Baldwin today!  

Why Everyone Should Get Their Immunizations

It is August, which means school is right around the corner, and flu season will be upon us before we know it. Now is the time to make sure you and your children are up to date on your vaccinations.  We spoke to primary care physician Dr. Kamal Singh about immunizations and how they spread.

Vaccines are like a training course for the immune system. They prepare the body to fight disease without exposing it to symptoms. When foreign bacteria or viruses enter the body, immune cells respond by producing antibodies. "These antibodies fight the invader known as an antigen and protect against further infection," says Dr. Singh.

Unfortunately, the first time the body faces an invader, it can take several days to ramp up this antibody response. Dr. Singh says, "For severe antigens like the measles virus or whooping cough bacteria, a few days is too long." The infection can spread and kill the person before the immune system can fight back.

Vaccines are safe and given to millions of healthy people - including children - to prevent serious diseases. Every licensed and recommended vaccine goes through years of safety testing, including:

  • Testing before it's licensed by the Food and Drug Administration (FDA) and approved for use by the Centers for Disease Control and Prevention (CDC).
  • Monitoring the safety after approval for infants, children, and adults. Once it is approved, it continues testing. The company that makes the vaccine tests batches it to make sure the vaccine is:
    • Potent
    • Pure
    • Sterile

The FDA reviews the results of these tests and inspects the immunization producing factories. These inspections ensure the vaccine meets standards for both quality and safety.

Dr. Singh says, "The U.S. has one of the most advanced systems in the world for tracking vaccine safety." Each of the infection systems below supplies a different type of data for researchers to analyze. Together, they help provide a full picture of vaccine safety.

By understanding how people can catch an infectious disease, you can then take effective action in preventing their spread.

Infectious diseases have different ways of spreading from person to person. Through the air, through direct contact, and contaminated objects or surfaces are the three primary ways.

Childhood immunizations can seem overwhelming when you are a new parent. Dr. Singh says, "Vaccine schedules recommended by the agencies and organization, such as the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians cover about 14 different diseases."

Vaccinations not only protect your child from deadly diseases, but they also keep other children safe by eliminating or significantly decreasing dangerous illnesses.

Dr. Singh says, "Contraindications or conditions in a recipient that increases the risk for a severe adverse reaction and precautions to immunizations are good reasons not to receive a vaccine." Most contraindications and precautions are temporary; vaccinations often can be conducted later when the condition no longer exists.

Every vaccine has a list of contraindications based on the profile of the vaccine. For example, severely sick persons generally should not receive live vaccines. Also, the presence of moderate or severe acute illness and a personal or family history of seizures are precautions to the administration of vaccines.

Dr. Singh sees patients in Gainesville, and you can click here to schedule an appointment with him!

Dr. Antje-Mareike Floegel Joins SIMEDHealth Primary Care

We are excited to announce one of our new doctors, Dr. Antje-Mareike Floegel, starts accepting patients in our Gainesville location today! Dr. Floegel is from Germany and earned her medical degree from the Humbolt University School of Medicine in Berlin, Germany. She went on to complete a family medicine residency at Tallahassee Memorial Hospital and a geriatric medicine fellowship at the Malcolm-Randall VA Medical Center here in Gainesville. 

This board-certified physician is an expert in adult and geriatric primary and preventative care such as cold and flu treatment, blood pressure management, cholesterol management, diabetes management, vaccinations, general physicals and more. 

Click here to schedule an appointment with her today!

Health Myths: Busted

Myths are often created to give an answer to something we couldn't explain. But even after the tales are disproven, they continue to be prevalent. We talked to physician and CEO Dr. Dan Duncanson about some of the more common health myths and why they are not real.

Health-Related Myth Number 1: Deodorants Cause Breast Cancer.

There are many different claims in this myth. For example, the aluminum in antiperspirants can seep into the skin through microtears created by shaving, get into the lymph nodes, and cause cancer. It is also said that parabens are another concerning ingredient in deodorants. And that breast cancer is most common in the area found close to the armpit because this breast region is closer in proximity to the armpit lymph nodes that are exposed to antiperspirants.  

Dr. Duncanson tells us that parabens and aluminum are not anything that anyone needs to worry about. Parabens are a group of compounds found in lots of different products whose primary function is to preserve whatever the product is. Makeup, skincare, and some food products contain them. 

A 2004 study done found parabens appeared in some samples of breast tissue, but the study did not show how they got there or they caused or contributed to cancer. 

A similar result occurred when testing the aluminum in antiperspirants. Only a small fraction of the aluminum in this product is absorbed. Even then, the study did not find a higher amount of aluminum in breast cancer tissue compared to healthy tissue. "The available research does not show a correlation between deodorants and breast cancers," says Dr. Duncanson. 

There is also not any hard evidence showing the location of breast cancers is related to using antiperspirants. Breast cancers typically occur in an area that has the most amount of breast tissue. For the majority of people, that would be the upper outer quadrant, the area closest to the armpit. 

Health-Related Myth Number 2: Green Mucus Means You're Sick.

Dr. Duncanson says that our mucus is our protection. "It keeps our mouth, nose, sinuses, throat, lungs, and gastrointestinal tract hydrated and is part of our defense system. When we aren't sick, our phlegm tends to run clear. But if we get a cold or sinus infection, our mucus can turn an unpleasant yellow, white, or green color. The change in color in the snot comes from an increase in white blood cells present in the phlegm, which are breaking down whatever is causing the infection," says Dr. Duncanson. 

The issue with this myth isn't that its completely untrue, its because it isn't always accurate and shouldn't be the measurement people judge their illnesses by. There may be instances where a patient's mucus is green or yellow for no reason at all. Unless a person is showing other signs or symptoms of being sick, they shouldn't assume they are ill just because of the color of their mucus. 

Health-Related Myth Number 3: Sugar Makes People Hyper.

This myth probably stemmed from a diet created by a doctor in 1965 that he thought would help children with ADHD or other attention and behavior issues. He theorized that hyperactivity was caused by artificial preservatives in foods and high amounts of sugar. This idea caught on, but research overtime did not find evidence supported it. 

In the 1990s, researchers did a study where they gave 35 boys aged 5-7 a drink with an artificial sweetener that contained no real sugar. They told half the parents that they gave the boys real sugar. Upon surveying the parents about their children's energy, those that were told their sons had real sugar reported they were more hyper than the parents who were told the sweetener contained no sugar.

Situations where kids and adults are taking in high amounts of sugar are commonly at social events like birthday parties, carnivals, or Halloween. Dr. Duncanson says this sugar high is actually just the parents' perception, and the hyperactivity may be more due to the situation than what was ingested.

Health Myth Number 4: Cracking Joints Causes Arthritis.

It seems reasonable that consistent and deliberate cracking of finger joints would down the line cause problems, for example, arthritis. Fortunately for people that crack their joints, this not valid.

Dr. Duncanson says the "cracking" noise happens for a couple of different reasons. One is due to the movement of gas and fluid bubbles in the joint. The other, which is common in the knees, is the tightening due to the movement of tendons-over tissue near the joint - a "snapping" effect occurs. 

All of this to say, as long as there isn't any forceful attempt to manipulate the joints in directions they don't want to go, there is a minimal chance any purposeful cracking is going to cause any injuries or long term ailments. 

Health Myth Number 5: You Should Drink Eight Glasses of Water a Day

In this instance, drinking eight glasses of water a day shouldn't be the standard but instead just staying hydrated should. Dr. Duncanson made it very clear that everyone is different, and everyone will need different amounts of water based on their weight, measure of physical activity, the heat outside, and more. Along with that, we get water from the foods we eat and other liquids we drink. 

Dr. Duncanson says, "It is important to stay aware of your thirst,"  and that will be the best measure for how much fluid needed per day. "Remember, anything you drink is mostly water, so drink enough fluid so that you don't become thirsty."

Click here to learn more about SIMEDHealth primary care!

Hepatitis: The Symptoms and The Vaccine

In 2016, 1,715 people died from Hepatitis B also know as HBV. May is Hepatitis Awareness Month, and we got the low down from Dr. Eric Svestka, board-certified primary care physician, to increase understanding about what this disease is.

What is hepatitis? What are its symptoms?

Hepatitis is an inflammation of the liver, but reasons for that inflammation are different between the three types.

Hepatitis A, or HAV, is very different from B & C and spreads through contaminated food. Dr. Svestka says, most people do experience symptoms from it like initially nausea, vomiting, abdominal pain, and fever. Though later, most people will develop jaundice, which is yellowing of the skin and whites of the eyes.

Symptoms are usually mild or non-existent early in the infections of B and C. This is spread primarily through contact with infected blood – most commonly sex or sharing needles. This is how the virus spreads around so quickly as most individuals don't develop symptoms, and therefore, don't seek treatment.

In the US, the incidence of new HAV infections has been slowly increasing since 2010. New cases of HBV are relatively steady. However, the CDC estimates that there are between 850,000 – 2.2 million people with chronic Hepatitis B infection in the US.

Unfortunately, new cases of HCV have been steadily increasing over the last decade. The most recent estimates have 3.5 million Americans living with this chronic illness.

Why is hepatitis the epidemic it is?

With HBV and HCV, there is a possibility of it turning into a chronic infection, which means it'll last for longer than six months. Liver failure or liver cancers are possibilities if it develops into a chronic disease. 

Dr. Svestka says, "HAV does not become a chronic infection, unlike Hepatitis B & C, and about 95% of people who contract HAV will recover within 2-3 months."

What are the differences between all the vaccines?

Currently, there are vaccines available for HAV and HBV, but no vaccine for HCV. Children are now routinely vaccinated for both and most professions that carry a high risk of exposure also require the vaccines. Your primary care provider will be able to tell you if you are vaccinated and a blood test can tell you if you are protected against both HAV and HBV. HepA vaccine is recommended by the CDC for almost all travel outside of the United States.

If you are unsure about whether or not you've gotten the HAV or HBV vaccine or would like to discuss it more, you can make an appointment with Dr. Svestka for a screening here.


Caffeine: Should We Quit?

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

SIMEDHealth Welcomes Dr. DeMori - Now Accepting New Patients!

SIMEDHealth Primary Care welcomes Gabriele DeMori, MD to our team. Dr. DeMori received his medical degree from the West Virginia University School of Medicine.  He completed his Internship and Residency in Internal Medicine at Shands Hospital at the University of Florida and is Board Certified in Internal Medicine. Dr. Demori will be available to see patients in our Gainesville office location beginning January 2nd

He is an expert in adult primary and preventative health and can help to diagnose and treat for: acute illness, cold/flu, blood pressure, diabetes and cholesterol management, vaccinations and physicals.

To schedule an appointment with Dr. DeMori, click here or please call SIMEDHealth Primary Care at (352) 224-2225.


Everything You Need to Know About Cholesterol

We hear it all the time: high cholesterol causes health problems. According to the CDC, 78 million U.S. adults (nearly 37%) have cholesterol levels where experts recommend cholesterol medicine or had other health conditions putting them at high risk for heart disease and stroke. We know that too much cholesterol is bad, but what exactly is cholesterol and how can we keep it under control?

We sat down with Dr. Shelley Roque of SIMEDHealth Gainesville Primary Care to learn more.


What is cholesterol?

A substance found in the blood that your body uses to build cells. The liver makes all the cholesterol for your body, the rest comes from animal products, such as meat, poultry, butter, cheese, and milk.  Some oils, such as palm oil, palm kernel oil, and coconut oil, can also trigger your liver to make more cholesterol. Foods high in saturated and trans fats cause your liver to make more cholesterol than normal, potentially bringing a person’s cholesterol level from a normal one to an unhealthy one.

How does it affect our health?

Since cholesterol circulates in the blood, if you have too much of the bad kind or not enough of the good kind, the cholesterol can slowly build up in the inner walls of arteries. This cholesterol build-up in the arteries can join with other substances to form a thick, hard deposit, potentially blocking arteries.  The narrowing  and decreased flexibility of arteries from the cholesterol build up is called "atherosclerosis". Atherosclerosis causes decreased blood flow to the organs that the arteries feed, putting people with atherosclerosis at a higher risk of heart attacks, strokes, and other health problems .

Is there good cholesterol and bad cholesterol?

Some call LDL cholesterol the “bad” cholesterol because having high levels can lead to atherosclerosis, and  increases your risk of heart attacks, strokes, and peripheral vascular disease (disorder of the circulatory system outside of the brain and heart) .

Some call HDL the “good” cholesterol because people with high HDL levels tend to have a decreased risk of heart attacks, strokes, and peripheral vascular disease. It is believed that HDL helps  carry excess LDL cholesterol away from arteries and back to the liver, where LDL is broken down and removed from the body. But only 1/3-1/4 of blood cholesterol is carried by HDL so it does not completely remove LDL.

What are symptoms of high cholesterol?

Sometimes people do not have any symptoms of high cholesterol since it can take time for cholesterol to build up enough in the arteries to become those hard atherosclerotic plaques, and start to cause significant blockages in the circulatory system. Overtime, however, as the blood flow to certain organs starts to decrease, organs will receive less and less oxygen. Your body needs oxygen, so when parts of your body do not get the oxygen it needs, it will not work as well.

So, for instance, if there is decreased blood flow to the heart, a person may start to feel chest pain. If there is decreased blood to the brain, depending on which part of the brain is affected, a person may start to feel numbness, tingling, weakness, slurred speech. If there is decreased blood flow to the legs, a person may start to notice skin changes, such as darker skin, less hair, pain. There is a wide array of symptoms a person can feel from high cholesterol. It all just depends on the extent of build up in the arteries, and which organs are being affected by the blockages.

What are common myths (if any) associated with cholesterol?

LDL is not really a bad cholesterol. We actually need that cholesterol  to help make protective walls around cells and certain hormones, so it is necessary for our body to have. However, having too much of it is what makes it “bad” since its build up in the arteries is what can set off the cascade of events that cause atherosclerosis  (i.e. plaque build up in arteries, see above ).

Are their any foods that might help to lower cholesterol?

There are foods you can avoid, and those are the ones that have a lot of saturated fat, such as red meat, butter, fried foods, cheese. Foods that can help lower your cholesterol are those that have more soluble fiber, such as fruits, oats, barley, beans, peas.

Technically, a vegan diet doesn’t have any animal products, so that could help lower your cholesterol if you really wanted to avoid dietary cholesterol. However, being vegan is not for everyone,  so generally a healthy diet includes a lot of fruits, vegetables, whole grains, beans, peas, lentils, chickpeas, nuts, some fish, and some milk and milk products.

I often recommend a Mediterranean-style diet for my patients with high cholesterol because it is the closest to the American Heart Association’s dietary recommendations.


What tips can you provide to help patients keep their cholesterol in check?

Stay active, try to exercise regularly. Work on losing weight if you are overweight. Avoid foods high in saturated fats. Avoid other risk factors that can make cholesterol build up in arteries worse, such as cigarette smoking and high blood pressure. Finally, follow up with your primary care physician regularly to see if you need to have your cholesterol checked.


If you need help keep your cholesterol in check, be sure to request an appointment with your SIMEDHealth physician.