Diabetes Symptoms, Treatment, and Prevention

Diabetes fact with woman holding hands up like a question

More than 1 in every 10 adults 20 years and older have diabetes. Unfortunately, about one-fourth of adults with diabetes go undiagnosed. Learn the symptoms, risk factors, and treatment for diabetes and find out how you can prevent it with SIMED Primary Care Dr. Timothy Elder on World Diabetes Day (Nov. 14).

What is Diabetes?

Diabetes is a disease you can get when your blood glucose level is too high. The person has above normal blood sugar levels and might have difficulty managing their blood glucose levels.

There are two types of diabetes: Type 1 and Type 2. Type 1 diabetes is typically an insulin dependent diabetes and usually has a younger onset. Type 2 diabetes is more common and usually diagnosed in adulthood. We will be focusing on Type 2 diabetes.

What are the common symptoms of Type 2 diabetes?

The most common symptom Dr. Elder sees is fatigue or people coming in and saying they’re “just not feeling right.” A lot of people feel poorly and can’t explain why.

Other symptoms called the 3Ps include:

1. Polydipsia – increased thirst and fluid intake
2. Polyphagia – increased appetite
3. Polyuria – the need to urinate frequently

People might think they’re urinating a lot because they’re drinking more, but usually both happen as a result of diabetes. When the blood stream has too much glucose, the glucose can spill into the urine. To balance it out, the body will add more water to the urine. As a result, the person then needs to urinate more and feels more dehydrated.

How can I prevent or regulate diabetes?Infographic 5 common symptoms of type 2 diabetes

People can prevent Type 2 diabetes by:

1. Improving their diet and eating a low carb diet

Eating a low carb diet is one of the biggest issues. People with diabetes potential or who have diabetes should avoid foods that break down easily into simple sugars. When the carbs break down, they add to the sugar problem that already exists. 

2. Exercising

You can do any prolonged endurance cardio exercise. Current guidelines recommend at least 150 minutes of exercise a week which ends up being about 30 minutes a day. If you have decreased activity, you could develop acute metabolic syndrome which increases your risk of heart disease, stroke, and diabetes.

Something as simple as fast walking can be very good exercise. Your muscles will actually take sugar out of your bloodstream and won’t need insulin to do that. Your biggest muscles are your glutes and your thighs; if you’re walking, you’re making those muscles work and using up excess the sugar in your body.

3.Maintaining an ideal body weight

Fat affects your insulin’s ability to work as it should. With less fat, your insulin should work better.

What are the risk factors for Type 2 diabetes?

People usually get Type 2 diabetes as a result of lifestyle choices, and Type 2 diabetes can usually be prevented by changes in diet and exercise. More people are getting diabetes at a younger age because of the obesity epidemic in the United States.

Risk factors include:

  • Being overweight
  • Family history with diabetes
  • High blood pressure
  • Sedentary lifestyle
  • High cholesterol

What should I do if I think I have diabetes?

If you’re showing signs of diabetes, you should let your doctor know. Your doctor might do a basic glucose test or a urine dipstick to see if there is glucose in your body. The tests are easy, quick, and affordable. You can get them done right in the office.

What happens if I’m diagnosed?

When you’re first diagnosed, you’ll usually do baseline labs to make sure your kidneys are functioning well and can tolerate the medicines you’d need to start. You might also get another lab done called the hemoglobin A1C test which we consider a vital sign for diabetes. This lab test can tell us the average glucose level over the past three months.

You’ll also receive basic diabetes education from your SIMED doctor. The doctor will set you up so you can do your own glucose level tests at home. You will usually then be started on basic medicine. You will need to visit your physician to try to make your goal and keep your hemoglobin A1C at less than 7 percent. At SIMED, we typically see a patient back as soon as a few weeks after being diagnosed to review how the patient is adjusting and address new questions they’ll have accumulated since the initial visit.

What is a good glucose level?

A normal glucose level is between 80 and 100. Usually, diabetes is diagnosed with a hemoglobin A1C. In that situation, if the person’s level is over 6.5%, they can be diagnosed with diabetes.

What medication will I need to take when I’m diagnosed?

Usually you will start off taking oral medication. The medication amount depends on your glucose level. The biggest fear patients have is that they’ll have to be on insulin, but initially that’s not usually the case. The oral medications currently available work very well, and if people make appropriate diet and lifestyle changes, they may never need to be on insulin. Some oral medications are generic, and one of them is actually free at a lot of drug stores.

If I’m diagnosed, can I eventually get rid of the disease?

While you can’t entirely remove the disease, it can go into remission if you control your glucose levels with weight loss, lifestyle modifications, diet, and exercise. A few patients of Dr. Elder have been successful at keeping their diabetes in remission.

What happens if I don’t regulate my diabetes?

Left untreated or unmanaged, people with diabetes can have increased risk for heart disease, stroke, blocked arteries in the legs, nerve damage in the hands/legs which limits sensation or causes burning pain, and damage to the retina causing vision loss. Untreated diabetics can also develop damage to their kidneys leading to the need for dialysis. It’s best to get tested and start treating the diabetes if you show symptoms.

What else should I know if I have diabetes?

If you have diabetes, you should see your doctor every 3 months or as recommended. Also, make sure you are up to date on your vaccines.

If you believe you might have diabetes, visit a SIMED Primary Care doctor today in Gainesville, Ocala, Chiefland, Lady Lake, or McIntosh to get tested. You can call 352-224-2225 or request an appointment online.To schedule an appointment with Dr. Elder in Gainesville, call 352-372-8202 or fill out an appointment form online.

Read More: Healthy Eating Tips with a diabetes diet
Read More: Cooking Hacks for a Healthy Heart  with recipe resources for diabetics
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Cooking Hacks for Healthy Heart

cooking with healthy ingredients in bowls with knife
We know our patients love cooking and eating, so we spoke with our resident chef in Gainesville, SIMED ARNP Michelle Green, about how to make great tasting healthy foods. 

Here are her top hacks for healthy cooking:

1. Take Advantage of Free Healthy Recipes on the Internet

Michelle’s favorite go-to website for cooking recipes is While no one in Michelle’s family has diabetes, the food on the website is guaranteed to be healthy and make her family happy. She’s spent hours on the website, browsing through the many recipes and learning health information.
Anyone with access to the internet can take advantage of the free cooking recipes on the site. Just visit the main website, click on the food and diabetes tab, and select recipes.
Another website Michelle recommends is by the American Heart Association which includes numerous dishes certified for a healthy heart. 
At, you can also access healthy meals that everyone will enjoy. You can create your own cookbook and browse through a collection of other cookbooks and recipes like “Healthy, Tasty, Affordable Latin Cooking” or “The 2016 Healthy Lunchtime Challenge Cookbook.”
Weightwatchers also offers an assortment of free cooking recipes from which you can choose.

2. Swap out fats for healthy alternatives from the Mediterranean diet

Instead of using cooking spray, use olive oil. Instead of having just your standard hamburger, consider making alternatives like black bean burgers or turkey burgers. Cook more fish and chicken and lean cuts of meat. You can even find creative recipes that don’t include meat but provide essential nutrients.

USDA infographic on cooking holiday recipes healthier and holiday food healthier

3. Crunched for time? Turn to frozen vegetables

Michelle has two teenage boys who are always on the run, so when she needs a quick meal she heads over to the frozen vegetables. Michelle warns against buying prepared meals and canned foods. When she’s getting frozen vegetables, she makes sure they don’t have sauce and are without added flavors.

4. Substitute rice for riced cauliflower

Michelle loves riced cauliflower. Available in frozen vegetable aisles in Walmart and Publix, riced cauliflower tastes almost exactly like rice, but provides many more health benefits. Riced cauliflower can be used in casseroles and other meals as a healthy cooking substitute for rice.  
Michelle understands that for most people, money can be an issue, and riced cauliflower is affordable. Walmart sells a Walmart brand version of the product. 

5. Look for food items that include five ingredients or fewer

The fewer ingredients there are the better. Eat as clean as you can, and always check any packed products to see what is inside of them. For example, if you’re making a dish with green beans, if the ingredients in a can of green beans are only green beans and salt for preservatives, it’s a healthy option.

6. Follow the 80/20 rule when grocery shopping

The 80/20 rule states that 80 percent of the food you consume should come from the perimeter of the grocery store (except for the bakery). From the perimeter, you can get fresh cuts of meat, dairy, fresh produce, and other healthy ingredients. About 20 percent of your food can come from the aisles. This includes packaged, canned, or bagged foods, which should in general be avoided, like RiceARoni. 

7. Reference the nutrition label

Most foods and recipes have nutrition information. Check the labels and see what percent of the recommended daily value the food contains of each nutrient before buying. In general, for healthy individuals, men should try not to eat more than 40 grams of fat and women should try not to eat more than 30 grams of fat. 
People who are trying to lose weight should consume less fat, and people who have preexisting conditions (who are overweight or have a disease) will need to figure out based on the label whether the food is right for them and at what portion size. 
In general, try to eat foods with less fat and less salt. Be careful when choosing frozen or canned vegetables, prepackaged foods, and packet foods. Learn how to read labels, especially if you have diabetes. You can take classes at North Florida Regional Hospital or UF Health. 

8. Boil vegetables in low sodium broth for added flavora healthy cooking meal consists of sweet baked potatoes instead of normal baked potatoes, veggies and a little bit of meat

When Michelle cooks vegetables, she puts them in a low sodium chicken broth or vegetable broth. For people who enjoy collard vegetables flavored with ham or bacon, boiling the veggies in a low sodium broth can add flavor without adding fat as a tasty healthy alternative. 

9. Substitute sour cream for Greek yogurt

If you’re cooking a recipe that requires sour cream like dips, you should substitute the sour cream for nonfat, nonflavored Greek yogurt. It’s an even exchange that adds protein and makes the food healthier. The food will taste almost exactly the same.

10. Substitute oil for apple sauce when making boxed cakes

If you’re making a cake out of the box, you can substitute oil for apple sauce as a healthy alternative. 

11. Avoid bread as much as possible

When you eat, cut out as much bread as possible from meals. You can substitute bread with vegetables. Bread acts as a filler and doesn’t provide essential nutrients.

12. Swap out potatoes for sweet potatoes

If you’re making a dish that includes baked potatoes, use sweet potatoes instead. They are more nutritious and healthy. 
Michelle Green works in SIMED Primary Care. If you could like to schedule an appointment with her office in Gainesville, call 352-376-2608 or request an appointment online.
If you could like to schedule an appointment with another primary care office in Gainesville, Ocala, Chiefland, or Lady Lake, call 352-224-2225 or schedule the appointment online.

It's Flu Shot Time Again (Already?)

Don't get sick. Get the flu shot. A woman blows her nose.
It may seem like we just finished up the last Flu season however it’s time to start considering getting this season’s Flu shot.  We asked SIMED Primary Care physician Dr. Daniel Duncanson some questions about the Flu season and the Flu shot.

Can it already be time for another Flu shot?

Yes.  The “Flu season” in the United States runs from fall through winter.  In some parts of the world, Flu season is year round so we can consider ourselves lucky to have an “off season.”

What is the Flu?

The flu illness is caused by an infection of the Influenza virus. 
First, the virus enters the air around us in droplets when someone infected with the virus coughs, sneezes, or talks.  
Second, droplets are inhaled, entering our body through the lining of our respiratory system in our nasal passages, sinuses or lungs.  
Once the flu is in our system, we start to feel sick 1- 4 days later.
The symptoms can vary but usually are a combination of fever (or feeling of fever), chills, cough, sore throat, sinus congestion, runny nose, headache, and fatigue (often much more so than with other viral illnesses).  Children commonly have vomiting and diarrhea associated with an Influenza illness.

Who is at risk of getting the Flu?

Everyone.  We’re all breathing, and if the droplets are around, anyone can inhale them and develop the flu.  Those that have been vaccinated tend to have a much less severe illness and some don’t develop any noticeable illness.

Are there people who are at higher risk of getting the Flu?

Some people are at an increased risk of having a more serious illness when exposed to the Influenza virus.  These people include the very young, those older than 65 years, those with chronic medical conditions (for example asthma, diabetes, heart disease), and during pregnancy and up to two weeks after delivery.

Flu Season infographic about the flu shot and how you get the flu

You stated those who received the Flu shot have a less serious illness.  Tell us about the Flu shot.  When should we get it?  Why do we need to get it every year?

The Influenza virus is different than many other viruses because it can frequently alter its outer envelope.  The outer envelope is what our immune system recognizes and uses to fight the virus.  
When you are administered a vaccine, you are enhancing your immune system’s ability to respond aggressively to the virus. For a virus like the chicken pox virus, the outer envelope doesn’t change much over time so a single vaccination cycle provides excellent life-long protection from illness.  However, because the Influenza virus changes often, we have to update our immune system’s response based on the recent years’ Influenza events.  
The vaccine changes year to year and provides protection against the 3 or 4 Influenza virus strains infectious disease and epidemiology experts predict will be most prevalent in the upcoming Flu season.
Each season’s Flu shot (Influenza vaccines) tend to become available in late summer and can be administered into the early spring.  Flu season tends to peak in the US during the colder weather months.  
It takes about 2 weeks after receiving the vaccine before protection begins, and the protection lasts for several months.  The vaccine, a single dose injection, is advised for everyone over the age of 6 months except people who previously had a serious adverse reaction to an Influenza vaccine dose.
The Influenza vaccine is cultivated in eggs, and a small amount of egg protein may be contained in the vaccine.  Regardless, people with egg allergies are now advised to receive the vaccine.  People with egg allergy symptoms that go beyond hives (for example, people who develop angioedema, respiratory distress, light-headed, recurrent vomiting, or previously required epinephrine administration due to the allergy) are advised to have the vaccine administered in a health care setting with a health care provider supervising who has the ability to recognize and manage severe allergic reactions.

I see pharmacies all over the place advertising the Flu shot.  Does it matter whether I receive the vaccine from my pharmacist versus my doctor’s office?

No, it doesn’t matter where you receive the vaccine. The important thing is to receive the vaccine each season.  As a physician, I prefer my patients get it from our clinics.  That way, we can get the administration information and update our immunization record on each patient.  
Wherever you decide to receive it, make sure you have a single entity maintaining your immunization record.  Your medical record at your Primary Care physician is a logical place for your complete immunization record to be maintained, so wherever you receive any immunization, make sure your Primary Care physician’s office is aware of this information.

What is the difference between the “high-dose” vaccine and the regular vaccine?

For decades the annual Influenza vaccine was a trivalent vaccine.  Trivalent refers to the three different strains of Influenza viruses that were covered in each vaccine.  
A few years ago, studies showed those at high risk of serious illness fared better by receiving a quadrivalent vaccine, containing protection against four strains of Influenza viruses.  Thus, the “high-dose” refers to the 4 strains vs. 3 strains of virus protection.
People who should receive the quadrivalent, “high-dose” vaccine include anyone 65 years old and older and anyone else at risk of serious illness from the Flu.

If everyone else at home and work receives the Flu shot, why should I?

Because receiving the Flu shot doesn’t mean you can’t get the Influenza virus and won’t spread droplets.  In fact, the opposite is true.  People who get the Flu shot can still feel ill from the Influenza virus, but the illness is much less likely to be severe.  They can still develop a milder cough, runny nose, congestion, etc. and spread droplets.  Their illness is likely to be mild and of shorter duration with complete recovery.  If you don’t get the Flu shot, you can get the Flu from them.

So, if I get the Flu, what can be done?

As soon as possible, visit your Primary Care Physician’s office, or if they aren’t available, go to an urgent care center (like SIMED’s First Care in Gainesville).  
Testing can be done to confirm the illness is from the Influenza virus, and if confirmed, there are medications that can be prescribed to decrease the duration of illness and reduce the risk of serious complications.  
These medications are:
1. Tamiflu (oseltamivir) taken as a pill or in liquid form
2. Relenza (zanamivir) an inhaled powder
3. Rapivab (peramivir) dosed intravenously usually in a hospital setting.  
Tamiflu is also approved for prevention if a household contact has been diagnosed with an Influenza illness. This medication has been shown to decrease the risk of others exposed to Influenza from becoming ill.
All SIMED’s Primary Care locations and First Care are stocked with this season’s Flu shot.  If you are already a patient of SIMED, no appointment is needed to receive the immunization.  Walk-ins for the Flu shot are accepted at First Care.
If you’d like to establish with a SIMED Primary Care physician, call 352-224-2225 to schedule your initial appointment or contact us with an appointment request online via our website 
First Care is SIMED’s Gainesville urgent care center and is available for walk-in visits.

Healthy Eating Tips for the Heart

Two Heart Shaped Bowls of Healthy Fruit
We understand the importance of maintaining a healthy lifestyle. September is National Cholesterol Month, and September 29th is World Heart Day.  Join us as we look into the best foods for a strong heart and healthy cholesterol level.
We interviewed Dr. Muhammad Ali, a SIMED Primary Care physician, to get the details on the best diet for a healthy heart. 

The Mediterranean Diet: Key to a Healthy Heart and Body

The main nutrients everyone needs to live are carbohydrates, protein and fats. The carbohydrates help with energy production, the fat molecules influence hormone activity in the body, and the protein is necessary for muscle growth. The body also needs micronutrients like cobalt, zinc and iron.
The Mediterranean diet is healthy for the heart because it does not include artificial sugar and unhealthy foods that lead to a higher cholesterol level and heart rate. The Mediterranean diet uses more grains as carbohydrates and more fresh fruits and vegetables instead of refined sugar, and includes all essential nutrients.
The Mediterranean diet focusses on eating more unprocessed foods, whole grains and fish and poultry. Before we go into what exactly the Mediterranean diet consists of, we need to look into why it’s the best diet.

cute mice huddled together with statistics about mice and healthy eatingThe Mediterranean Diet: An Evolutionary Stand Point

The Mediterranean diet consists of food people have eaten for centuries.
The diet avoids sugar and sugary drink which are not good in large quantities and lack nutrients. People, until recently, did not drink fruit juices or consume a lot of sugars. The sugar they consumed came from fresh fruit that they ate as it was available to them. Sports drinks and soft drinks are not natural because they contain refined sugar that is quickly used up and don’t contain other vitamins and nutrients.
A relatively recent invention was the use of hydrogenated fats (fats that had chemicals added to them to make them hard at room temperature). Foods that are hydrogenated include bacon, margarine, and fried food. In the past, humans had not been exposed to hydrogenated fats or foods that include saturated fats that raise the blood cholesterol and increase risk of heart disease.
In the past people would only eat fish and small birds because those animals were more easily obtained.  Poultry and fish also contain less saturated fat and more unsaturated fats which is good for the heart. Red meat, which people in the past would only eat about once a month, contains saturated fat and is not a part of the Mediterranean diet. 

What foods are in the Mediterranean diet?Infographic about what foods are in the Mediterranean diet

- Carbohydrates – The Mediterranean diet includes more whole grains and fruit instead of refined sugar and flour. The whole grain foods and fruit are released and consumed by the body more slowly than refined sugar and flour and contain more nutrients.
- Proteins – Instead of eating red meat, focus on a diet of fish, poultry and beans. Legumes and nuts are also a good option. Fish should be eaten at least two times week.
- Fats – Instead of eating food like bacon and pork, eat fish. Use olive oil or grape seed oil instead of butter or margarines. Also make sure to eat nuts.
- Micronutrients – Eat fresh, unprocessed fruits and vegetables. Avoid smoothies and sports drinks that lose the healthy nutrients when they’re made and significantly increase the body’s insulin levels. Also try to avoid vitamins which contain free radicals and may give you an unhealthy amount of nutrients.
- Red wine – One glass of red wine a day is beneficial for the heart. Red wine contains antioxidants that scientists believe increase levels of good cholesterol and protect against cholesterol buildup. 

Why Moderation is Important

Moderation is another important key to a healthy diet. The amount of food you consume is dependent on your energy level. An athlete like Michael Phelps who burns 4,000 calories daily in preparation for the Olympics won’t be eating the same amount of food as the average person. 
When more energy is stored because it isn’t used, we gain more weight and have heightened risk of high blood pressure and a high heart rate. The people in the U.S. have not had a chance to adapt to the convenience of processed foods which is part of the reason why obesity and diabetes is prevalent. 
In the past, being fat meant you had food stored up to use later and was seen as a good thing. Because food is now conveniently available, your body no longer needs to store the food and you can consume less more frequently.
In a study done in 2008 published in Science Daily, a group of mice was starved and another group of mice was able to eat whatever it wanted. The mice that starved lived longer because they were not able to overeat. 
Every time we eat food, we consume nutrients our bodies can use and free radicals that are not healthy for our body. 

Other General Tips

1. Take Time to Enjoy Your Meal
People who follow the Mediterranean diet take time to eat their breakfast, lunch and dinner. Because they concentrate on eating, they are less likely to overeat and more likely to eat healthier foods.
2. Avoid Fried, Processed and Unhealthy Food
Prepare food by baking it instead of frying. Most foods in the Mediterranean diet don’t need to be fried. Avoid fried foods which usually are more processed. While red meat is fine in moderation, an excess of red meat can have a negative effect on the body.
In areas where people live longer, there isn’t a “magic food” they eat to live longer. Instead they avoid unhealthy foods like burgers and processed cheeses. They also use more natural ingredients. 
3. Exercise Regularly
Exercising is another important part of maintaining healthy levels of cholesterol and a healthy blood pressure. It’s good for the heart and good for blood circulation because it keeps arteries and blood vessels clean. 
If you’re having problems with your cholesterol or blood pressure, schedule an appointment with a SIMED Primary Care physician at our Gainesville, Ocala, Chiefland, Lady Lake or McIntosh locations by calling 352-224-2225 or requesting an appointment online.
To schedule an appointment with Dr. Ali, call 352-332-7770 or request an appointment online. 
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Tips on Healthy Aging

Tips on Healthy Aging

The United States is aging. According to the CDC (Center of Disease Control), longer life spans and aging baby boomers will combine to double the population of Americans aged 65 years or older during the next 25 years. September is healthy aging awareness month and as the weather cools it’s a good it’s time to start working on improving your physical, mental and social well-being. SIMED Primary Care’s Board Certified Family Medicine physician and geriatrician Dr. Seth Perkins answered a few questions to give you a better piece of mind on how to age healthy.

1) How much exercise do seniors need?
In general, adults over 65 years of age need at least 150 minutes weekly of moderate-intensity aerobic exercise such as brisk walking. Additional exercises that works to strengthen all the major muscle groups in the body should be added in at least 2 days a week. For those who prefer more vigorous aerobic exercise such as running, 75 minutes a week is recommended. Aerobic exercise refers to any activity that gets your heart pumping harder. As for the muscle-strengthening exercises, 2-3 sets of 8-12 repetitions are recommended during the day. This can include exercises such as weightlifting, stretching against resistance, push-ups, sit-ups, and even heavy gardening and yoga. Talk to your doctor if you’re not sure what exercise regimen is right for you to see which exercise plan is right for you.

2) Do sleep “needs” change as we age?
The need for sleep and the amount of sleep recommended does not change as we age. However, it can take longer to fall asleep and waking up during the night is more common. Additionally less time is spent in REM sleep, the period of sleep when dreams occur. Other factors contributing to unfulfilling sleep include increased incidence of snoring, increasing weight with age and general change in sleep patterns that leads to falling asleep and awake earlier than in the past. Your physician can evaluate any sleep disturbances issues and work with you to achieve healthy restorative sleep. Some of the solutions can be simple, such as reducing the timing of caffeine consumption. Other sleep issues may require an overnight sleep study to determine the best approach.

3) Is memory loss always a part of aging?
How much loss is considered normal? Some forgetfulness can be seen with age. For example, many patients will complain to me that they forget why they walk into a room, or they will say that there is a word or phrase that they just can’t remember even though they should know it. Even forgetting something you have just read can be seen with the forgetfulness of aging. However, there is concern when this forgetfulness begins to interfere with life. Things like language and judgment may begin to change. People with memory disorders may have difficulty doing everyday things such as paying bills or practicing appropriate hygiene. They may become lost easily, even in well-known places. Perhaps one of the key differences is that people with “normal” memory loss are able to remember instances when they were forgetful, but people with memory loss disorders often cannot remember these. If these memory issues become concerning to you or to a family member, talk to your doctor.

4) How should my eating habits change as I age?
How do I know I’m getting enough nutrition? Healthy eating is especially important as we age. Healthy foods can reduce the risk of diseases such as heart disease and diabetes, and they can also keep the mind sharp. Fruits and vegetables, calcium (through dairy products or non-dairy sources such as tofu, broccoli, or almonds), fiber, healthy fats (salmon and other fatty fish, as well as walnuts, almonds, avocados, and olive oil), and protein (fish, beans, eggs, nuts, and dairy products) are all important to a healthy diet. You may also need to increase water consumption, as our bodies are not as good at telling us we are thirsty. Vitamin B-12 and vitamin D-3 are also important. Metabolism decreases with age, so we need to be aware of what we eat to avoid undesired weight gain. Digestion can take more time, and certain vitamins such as vitamin B-12 and vitamin B-6 may not be digested as well. Supplements may be necessary. Our taste buds, especially our salty and bitter taste buds, will decrease in sensitivity. Resist the urge to add salt to food! Our sweet taste buds tend to stay sensitive longer, but do not use that as an excuse to turn to sugary snacks. Lastly, talk to your doctor to make sure that medications are not playing a role with any eating problems.

5) Why will I get shorter as I age?
We typically get shorter as we age. This is because the discs in our spine lose fluid and flatten, our arches in our feet flatten, and we lose muscle mass. From age 40 to age 70, men will lose on average 1.2 to 1.5 inches in height, and women will lose 2 inches. However, some people may lose more due to diseases such as osteoporosis or bad habits such as smoking, drinking too much alcohol or caffeine, and not exercising. Good diet and exercise can help prevent some of the height loss. How important is it for me to have a social life? Keeping up with your social life is important not just because it is enjoyable, but also because it helps to promote good health habits. When people eat alone they are at increased risk of either overeating or not eating what is recommended having meals with others can reduce this risk and may lead to further friendships. Even in nursing homes, eating in common area can have positive benefits. In addition to better eating habits, a good social life may have a positive effect on memory decline. It may not eliminate this risk, but it may slow the decline. I have had people tell me that they like to keep their minds sharp by doing crossword puzzles. While I agree that these are wonderful, I learned in my geriatrics training that another activity that had a positive effect on memory was dancing. Taking a dance class may help you meet new people, the activity can help you stay healthy, and remembering the steps can keep your memory intact.

6) Are immunizations still necessary?
Ask your doctor if your immunizations are up to date. Some vaccinations you received when you were younger need to be repeated. There are a few vaccines recommended to prevent illnesses that threaten older people, like pneumonia, shingles and flu.

With a little extra care and some key questions to your medical providers, your body can continue to serve you for decades to come. If you have any other questions feel free to request an appointment online or contact SIMED Primary Care to schedule a visit at one of our many locations including Lady Lake (The Villages), Gainesville, Ocala, Chiefland and McIntosh. Dr. Seth Perkins or one of our many SIMED Primary Care physicians would love to answer all of your questions to help you age healthy.

Get some relief this Ragweed Season

Get some relief this Ragweed Season

Fall is just around the corner. As the season changes we trade I the sweltering hot days of summer for the cooler, crisp days of autumn. The humidity drops, the days get shorter and the nights longer. Being outdoors becomes much more comfortable. The fall season brings changes to the weather, but other things in the environment change as well.

For people with allergies, the fall season can lead to increased suffering. At SIMED Allergy & Asthma autumn triggers Ragweed Season and a significant increasing allergic reactions. Ragweed Season usually begins in the late summer, peaks in mid-September and lasts into November. For some people ragweed pollen is simply a nuisance creating a little sniffle, but for others it can interfere with daily living and comfort resulting in constant runny nose, sneezing and/or itchy eyes. Some may even develop asthma symptoms.

What could you do if you have ragweed allergy?

The best way to minimize ragweed allergy symptoms is to stay indoors in an air-conditioned environment. When outdoors activities occur try to minimize being outdoors early in the morning and wash off quickly once coming indoors. Over-the-counter, long-acting, non-sedating anti-histamines are good for treating the itchy eyes, nasal drip and sneezing. Taking anti-histamines daily starting just prior to and throughout the season works best at preventing the symptoms from building. The best medications for treating airborne allergies are the nasal steroid sprays.

If medications aren’t controlling symptoms, or you are not a fan of taking pills there are methods to desensitize your allergies. Desensitization uses allergy shots to reduce your response to ragweed exposure.

SIMED’s allergists have specialized training and expertise above and beyond any other medical or surgical specialty to evaluate your allergies and develop a treatment plan for your individual condition. The goal is to enable you to lead a life that is as normal and symptom free as possible.

For more information about our allergy division please visit SIMED Allergy & Asthma, or to schedule an appointment at any of our locations including Gainesville, Ocala, Chiefland and Lake City please click on this link to request an appointment online.

Be prepared this year with Immunization & Vaccines

Be prepared this year with Immunization & Vaccines

August is National Immunization Awareness Month (NIAM) The goal of NIAM is to increase awareness about immunizations across the lifespan, from infants to the elderly. August is an ideal time to make sure everyone is up-to-date on vaccines before heading back to school and to plan ahead to receive flu vaccine. Getting vaccinated is an easy way to stay healthy all year round. During the month of August, take the time to make sure that you and your loved ones have received all of the vaccinations you need.

- "National Immunization Awareness Month."

Dr. David Lefkowitz, a Family Medicine physician at SIMED Primary Care answers some questions and brings some light on the importance of immunizations and how they prevent you and your family from getting sick.

1. Will you give a brief explanation of what immunizations are?

Immunizations are the “shots” we have all come to expect when we go to the pediatrician; they are also called vaccines. Of course, these vaccines are not just for kids but are recommended for adults as well. Vaccines stimulate your own immune system to create antibodies against diseases.

2. Why is it important to get vaccinated?

There are two reasons:

  • One, it helps protect you from getting severely sick from the bacteria or virus you are getting vaccinated against. Having antibodies ready-to-go is like having an army of soldier’s ready-to-fight the disease as soon as possible.
  • Second, it helps protect folks who can’t get vaccinated (for example patients who are on chemotherapy) by decreasing the potential spread of disease to them.

3. What are some of the most common immunizations?

The most common immunizations depends on whether the vaccines are for children or adults.

  • For children, some common vaccines include Hepatitis A and B, MMR (Measles, Mumps, and Rubella), Polio, Varicella-Zoster (Chicken Pox), Diphtheria, Tetanus and the Flu vaccines.
  • As for adults, the most common vaccines include Flu shots, Pneumonia shots, the Shingles shot, Hepatitis A & B and Tetanus boosters. Of course there are many other vaccines but these are the most common.

4. How can someone get a vaccination?

A visit to their primary care doctor is usually all that is needed. Some of the less commonly used vaccines, for example those associated with traveling to third world countries may not be carried at your primary care office. However these can commonly be ordered in to receive at a later time, or the local health department can be a good source of the travel vaccines.

5. Can a shot make you sick?

It is possible, but thankfully rare. The overall benefits of vaccinations clearly outweigh the possible short term risks. However, local reactions (arm soreness, redness, and swelling) can be seen but are not dangerous and usually resolve on their own after a short period of time. Low grade fevers can be seen for the first 24-48 hours following immunization.

6. What are some other preventative ways of not getting sick?

Wash hands, wash hands, wash hands! Avoid close contact with people who are sick. Be sure to cover your mouth and nose when you cough, try not to touch your eyes, nose or mouth. To avoid spreading the sickness, stay home from work if you are sick.

7. Why do some vaccines require boosters?

When you get a vaccine, your immune system makes antibodies. Over time, these antibodies can decrease in number. A booster shot does what it sounds like: it “boosts” the number of antibodies so that you have plenty of soldiers to fight the disease.

8. Why is there a new flu vaccine every year?

The influenza virus is a tricky one. It has the ability to mutate into many different strains. Each year, the CDC (Center for Disease Control) decides which strains will be prevalent for the upcoming flu season and puts those strains into the flu vaccine. It’s somewhat of a guessing game (more a prediction based on data) but there’s no other way to manufacture millions of vaccines in time for flu season.

9. How do vaccines fight viruses and bacteria?

The Vaccines do not actually fight any viruses or bacteria off, they stimulate your own body’s immune system to fight off the disease. Your immune system recognizes the vaccine as “foreign” and it makes antibodies against the vaccine thus strengthening your own body’s immune system. These antibodies are then ready to fight the real disease if it gets into the body. SIMED Primary Care offers a variety of vaccinations to patients in our North Central Florida community. Here is a list of the most common vaccinations offered:

  • Influenza (Flu)
  • Hepatitis A
  • Hepatitis B
  • Pneumovax - 23 (Pneumococcal bacteria)
  • Prevnar - 13 (Pneumococcal bacteria)
  • Gardasil (HPV)
  • Varicella (Chicken Pox)
  • Zostavax (Shingles)
  • Tetanus, Diphtheria, Pertussis (Tdap)
  • Menomune/ Meningitis
  • Typhoid

Schedule an appointment with Dr. David Lefkowitz or any of our SIMED Primary Care physicians at one of our locations in Gainesville, Ocala, Chiefland, McIntosh, and Lady Lake (The Villages) to review what immunizations are appropriate for you or your family. Click here to request an appointment online.

College Safety Survival Guide

College Safety Survival Guide

The start of a new college semester can be a very exciting time in a young adult’s life. It’s the beginning of a new chapter in one’s journey through college, filled with new classes, living arrangements, friends, jobs, and life experiences. These new experiences will help shape the student’s future and mold them into the adults they will become.

For many students a new semester can mean living away from home the first time. This can lead into a very stressful time in a young adult’s life and leave students with many questions especially about health and safety. Dr. Calvin Martin of First Care, SIMED’s Urgent Care facility gives us a few pointers on how students can tackle their health and safety like an adult.

Staying healthy is a plus:

By living a healthy and active lifestyle young adults will be ahead of the curve in terms of health. Make sure to follow a diet and exercise program keeps one accountable and helps them stay on track with their health plan (Adults on average need around 2 hours and 30 minutes of exercise per week). Avoid sugary drinks such as sodas that may be adding extra empty calories that the body does not need. Think outside the box and get creative on how to sneak some exercise into your daily routine. Walk or jog to class, take the stairs instead of the elevator, ride a bicycle instead of driving, or join an intramural sports team such as flag football, softball, basketball, soccer, tennis or volleyball.

Don’t stress it:

According to the CDC (Center of Disease Control) suicide is the 3rd leading cause of death for young adults between the ages of 15 to 24, so feelings of distress or depression are not to be taken lightly. The proper amount of stress is healthy for us as it keeps us on track and motivated but too much stress can lead to unhealthy traits and habits. Ways to manage stress include getting adequate sleep, avoiding drugs and alcohol, get perspective by connecting socially with peers and also making sure to getting enough “me time” for oneself. If feeling overwhelmed from stress it’s a good idea to reach out to one’s family doctor or contact a local psychologist to help cope with the stress levels.

Stay protected:

The college years may be associated with new or risker sexual activity, leading to increase prevalence of STD’s among college students. Many sexually transmitted diseases can be prevented, most are treatable and also curable. According to the CDC nearly half of all new sexually transmitted diseases (STD’s) occur amongst young adults under the age of 25. It is advised for sexually active young adults to be tested for STD’s including HIV and learn how to protect them and their partners. According to the CDC one in 5 college women have been sexually assaulted. Women are encouraged to protect themselves by staying in groups, never leaving a drink unattended and being aware of resources available to them should they become victim of assault.

Be cautious of the binge:

College life is known for its extracurricular activities including social events that involve alcohol at Greek social parties and bars. The CDC confirmed that 90% of drinking by youth under the age of 21 is binge drinking. Binge drinking is generally defined by 5 or more alcoholic drinks for a male and 4 for a female in a short period of time, usually considered within 2 hours. Binge drinking increase chances of problematic situations because it impairs ability to make decisions and react rapidly to situations which can lead to vehicle crashes, DUI, violence, alcohol poisoning, risky sexual behavior and death.

Just Say No:

One of the most common problems in college amongst young adults is substance abuse and smoking. According to the CDC in 2013 around 21% of 18-25 year olds reported use of illicit drugs in the past month. Heroin use more than doubled among this age group in the past decade. 99% of cigarette smokers have reportedly at least tried smoking by the age of 26. Vaping has recently become very popular as a “safer” smoking alternative, be cautious however because many vaporizer pens have much stronger levels of nicotine intake per inhalation than a cigarette. For need help with substance abuse contacting 1-800-662-HELP can get you in touch with people and information to assist you with recovery.

Establish a health care provider:

Remember it is important stay connected with a primary care doctor, soon after moving into town establish a relationship with a primary care physician. SIMED Primary Care has multiple family medicine and internal medicine physicians to choose making it easy to establish with a doctor and schedule an appointment. SIMED First Care is an urgent care facility located in Gainesville in case of an emergency or if you are just seeking a walk in appointment.

Sources for this article where cited from the CDC Office of Women’s Health: Family Health (/family) March 7, 2016 for more information regarding College Health and Safety please visit

Essential Facts to Know About Diabetes

Essential Facts to Know About Diabetes

Diabetes is not uncommon in America. According to the American Diabetes Association, about 10% of Americans have been diagnosed with diabetes.

Dr. Gregory Geiger specializes in Family Medicine at SIMED Primary Care. “Diabetes is defined as a condition where your blood glucose runs higher than what is considered normal. Common symptoms of diabetes include increased thirst, increased urination, changes in eyesight, numbness and tingling in hands and feet and sudden unexplained weight loss. Diabetes could also affect your vision, your kidney function, your nervous system, and your cardiovascular system.”

Dr. Geiger goes on to explain, there are three different types of diabetes: Type One, Type Two, and Gestational.

  • Type one: Known as juvenile diabetes, is commonly found in children and young adults. According to the American Diabetes Association, only about 5% of people diagnosed with diabetes have type one. In diabetes Type 1 is when the pancreas doesn't’t make insulin, therefore your body has no way of getting the glucose, sugar in your bloodstream into the cells of your body where it is needed for energy. Insulin therapy, is required to live with Type 1 diabetes.
  • Type two: This is the most common form of diabetes. In type 2 diabetes the pancreas continues to produce insulin, however your body does not properly use the insulin. This is called insulin resistance. In the beginning, due to persistently higher glucose levels your pancreas produces extra insulin to try and make up for it. But, eventually the pancreas can’t keep up and isn’t able to make enough insulin to maintain normal blood glucose at normal levels.
  • Gestational: This type of diabetes effects women during pregnancy – usually around the 24th week. Many women develop gestational diabetes. However a diagnosis of gestational diabetes is only temporary, resolving after the delivery of the baby. It is important to maintain appropriate blood glucose (blood sugar) levels during pregnancy, to increase the chances of a healthy baby at delivery.

According to Dr. Geiger, early detection is key to avoiding complications. We use blood or urine testing to diagnose and monitor diabetes.

The best way to keep your diabetes under control is to have a healthy diet, restrict carbohydrates, maintain a healthy weight, obtain routine aerobic exercise, and if applicable compliance with medication.

SIMED is a participant in the American Medical Group Association’s Diabetes: Together 2 Goal campaign, which is a national campaign to improve diabetes care.

The health care providers at SIMED Primary Care are available and committed to working with you and encouraging you to prevent diabetes and for those already diagnosed with diabetes help you manage the condition. Request an appointment online or call us at (352)-224-2200 to take control of your health today.

Melanoma/Skin Cancer Detection and Prevention Month

Melanoma/Skin Cancer Detection and Prevention Month

SIMED Primary Care's Dr. David Lefkowitz touches base with us on how we can use this month to raise awareness about skin cancer and help people take action to prevent or detect it, both at home and in our North Central Florida community. While melanoma is the least common form of skin cancer, it is still the sixth most common cancer in North America. The National Cancer Institute estimates that over 10,000 people will die from melanoma this year.

There are 3 major types of skin cancer: melanoma, squamous cell carcinoma and basal cell carcinoma. Of the three, melanoma is the most concerning and most dangerous. It is the one most likely to spread (metastasize) and once it has spread, the chances of a cure go down significantly. As with most cancers, melanoma is best to catch early.

Melanoma, like all cancers, occurs when cells begin multiplying out of control. In melanoma, the out of control cells are the melanocytes that normally live in the epidermis (outer layer of skin). Melanocytes are what give your skin its color. We aren’t 100% sure what causes the cells to go haywire but it is likely a mix of genetic and environmental factors.

If you are fair-skinned, have excessive ultraviolet (UV) light exposure, have many moles, or have a family history of melanoma you could be at an increased risk. The biggest environmental risk factor is UV exposure, which is completely preventable with proper precautions.

Avoid tanning beds and prolonged sun exposure. If you are going to be in the sun, wear sunblock (SPF 15 or higher), UV-blocking clothes, wide-brimmed hats, and sunglasses.

Many people are born with moles and the vast majority of them are harmless. The best way to be sure is to have a skin exam by your physician.

Your primary care physician is able to examine skin for possible cancers. If there is ever any question, he or she will do a biopsy of the area or refer you to a dermatologist for their opinion.

To prepare for your physician visit, be equipped with your family history (remember genetics play a role in melanoma risk) as well as other history (e.g. do you tan, do you or family notice any moles changing?)

During the exam the skin will be examined and any skin lesions will be evaluated using the “ABCs of melanoma”:

  • A - Asymmetry: one side of the lesion does not mirror the other
  • B - Borders: borders are irregular, jagged, or shaggy
  • C - Color: the lesion has multiple colors, varying shades, and/or the pigment is not uniform
  • D - Diameter: the lesion is bigger than 6mm (about the size of a pencil eraser)
  • E - Evolving: the lesion is changing or growing

Treatment depends on the stage of the cancer. Cancers detected early may require only surgical removal. Later stages may require other treatments including surgeries, radiation, and/or chemotherapy.

Patients with melanoma that have been treated are at increased risk for developing a recurrence of that melanoma or developing another, separate melanoma. Therefore, close surveillance is needed (via visits for skin exams with your primary care doctor or dermatologist).

If you have any questions or concerns about possible skin cancer, or if you just want a good skin exam, schedule an appointment with your SIMED Primary Care physician. For more information on skin cancer I recommend or the American Association of Dermatology website