Are You At Risk For Colon Cancer?

colon cancer,

March is Colorectal Cancer Awareness month. This is the third most diagnosed cancer in the United States and the 2nd leading cause of cancer-related deaths. Each year 140,000 Americans are diagnosed with colorectal cancer, and over 50,000 people die from this preventable cancer, according to the National Foundation for Cancer research.

As we get older, the risk of developing colorectal cancer increases. 90% of colorectal cancers are diagnosed in people 50 or older. However, if everyone 50 or older were screened for colorectal cancer, 60% of the deaths from this cancer could be prevented.

Here, SIMED Primary Care provides insight into this disease and offers tips to lower risks.

Risk factors for colorectal cancer include:

  • A family history of colorectal cancer or polyps in the stomach and intestines 
  • Lack of physical activity 
  • Weight gain
  • Diets high in red meats and processed meats (cold cuts) increase risk
  • Smoking/using tobacco 
  • High alcohol consumption
  • Type 2 diabetes 
  • Inflammatory Bowel Disease (Chron’s Disease, Ulcerative Colitis)

Unfortunately, colorectal cancer often doesn’t cause symptoms early on and patients don't know they have colon cancer until later on.

If you have any of the following symptoms, you should make an appointment with your primary care physician to evaluate the symptom source:

  • Blood with bowel movements
  • Unexplained abdominal pain
  • Change in the size of stool
  • Any change in bowel movement habits

With adequate screening, colon cancer it is preventable and treatable.

SIMED Primary Care recommends that anyone 50 or older discusses a colorectal cancer screening with their primary care physician.

Contact SIMED Primary Care to make an appointment.

Viral Hepatitis with Dr. David Lefkowitz


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.

Lose Weight and Eat Healthy: Learn How

Eating a healthy breakfast can lead to weight loss

Eat Healthy and Lose Weight: New Year’s Resolution

Thank you to everyone who submitted their New Year’s resolution for the Health Goals 2018 Project. New Year’s Resolution #3 was submitted by Nina of Ocala. Nina wants to “lose belly fat and eat healthy!”

Dr. Eric Svestka, a SIMED Gainesville primary care physician who loves healthy eating, provided advice on how to achieve weight loss and a healthy food lifestyle.

How to Lose Weight

The one way to lose weight and belly fat is through dietary restrictions. Evidence has shown that you can’t exercise off weight because exercise only burns a minimal amount of calories when compared to your much larger basal metabolic rate. Exercise is still a cornerstone of a healthy lifestyle and reduces your risk of heart disease, high blood pressure, high cholesterol, cancer, and similar issues.

There are two ways to approach weight loss through dieting. The first way could be called nuclear change. On day one, the individual would change everything about their entire diet. The second, more effective way, is to make gradual changes.

Making Gradual Changes


Making gradual changes is more likely to stick in the long term. To do this, you would pick a small victory or adjustment to make to your diet each week. For example, you could add a vegetable to every meal or try not to get calories from liquids (aside from milk). Only tackle one change at time. When you have successfully made that change for a period of time, approach an additional change, like eating fruit for dessert instead of a cupcake.

Your goal is to limit and remove as much processed food as possible and substitute it for unprocessed natural foods. You should also be limiting how much you actually consume.

How to Make Healthy Eating Affordable

1. Drink water. – Water is free. If you increase your water intake, you’ll feel fuller. Drinking 16 ounces of water before a meal will make the meal feel more fulfilling to you. Studies have shown that drinking water right before a meal can lead you to lose up to four pounds.
2. Buy healthy food in bulk. – Plan ahead and make batches of snacks. Package your lunches for the week in advance to make sure you don’t end up calling a fast food place at lunch time. When you wake up, just grab your prepackaged lunches and go.
3. If you’re planning to indulge, make the food at home. – Instead of buying brownies or cookies, make them yourself. There’s less sugar, fat, and salt in homemade baked desserts. While eating desserts isn’t going to help you lose weight, homemade is a better alternative to store-bought.

The Difference Between Healthy Eating and Eating to Lose Weight

Losing weight only pertains to calories. Healthy eating means giving your body high quality fuel, ideally in the form of unprocessed foods. In an ideal situation, you would combine the two.

Reusable water bottles like those below are perfect for weight lossMonitor Your Liquids

Liquids are one of the biggest problems for both unhealthy and overweight eaters. Liquids don’t make you feel as full but still give you calories. Drinking milk and black coffee is okay, but everything else should be avoided or considered with discretion.

Smoothies are a really good opportunity to work healthy fruit and vegetables into your diet. Try to add in vegetables like kale and spinach and proteins like almond butter and peanut butter to diversify and add more nutrition to your smoothie. Be cautious of how many calories you’re putting in as you can quickly reach and top 500 calories with only 3 or 4 ingredients.


If you would like additional advice on weight loss and healthy eating, you can schedule an appointment with Dr. Svestka in Gainesville. You can reach him at (352) 377-1874 or by requesting an appointment online.

To see another SIMED primary care doctor in Gainesville, Ocala, Chiefland, Lady Lake, or McIntosh, call (352) 224-2225 or schedule an appointment online.

Thank you Nina for submitting your resolution. We can’t wait to see you achieve it.

Weight Loss Tips for Healthy Weight

Weight loss and maintaining a healthy weight are important to avoid health problems

January 18 – 24 is Healthy Weight Week, and at SIMED, we want to help make sure you reach and maintain your healthy weight.

We spoke with Dr. Eric Svestka, a SIMED Primary Care doctor in Gainesville, about when, why, and how to lose weight and succeed. Dr. Svestka answered and helped with some of the common problems and questions people have when they realize they might want to lose weight.

How can I tell if I should lose weight?

Finding your healthy weight isn’t a one size fits all situation. It varies depending on the person.

Talk to Your Doctor

If you’re worried about your weight, you should probably meet with your primary care doctor and go over what would be good for you. Any SIMED Primary Care doctor can help you figure out a weight loss plan.

Depending on whether or not you have issues with blood pressure, blood sugar and/or heart disease, you might find that staying overweight is fine for you or you could find that you need to be more aggressive and bring your weight down.

Calculate Your BMI

A BMI calculator can indicate whether you’re in the normal weight range for your height. You can find a BMI calculator for free online. An overweight BMI falls between 25 and 29.9 on the scale. An obese BMI is 30 and above.

Everyone benefits from getting out of the obese range, but your goals beyond that may differ. For example, a football player may need a higher BMI than a rock climber, but both are still healthy weights.

Consider Your Wellness

If you have no health problems, you may not see a benefit in losing enough weight to bring you into the normal range, but you could still benefit from a healthy lifestyle.  However if you have a health issue like diabetes, losing weight could help you ease off the medications. Or maybe you just want to be more comfortable with your physical appearance. Whatever your motivation is, losing weight in the end could still improve your overall wellness, so if you’re considering it, you should go for it.

Think about Your Overall Health

Your healthy weight could be a little bit more than average. That's why it's important to talk to a doctor. An overweight woman is smiling confidently.

If your weight is causing diseases like high blood pressure, diabetes, high cholesterol, heart disease, or others, losing weight could help you become healthier.

Your weight could also be limiting your activities.  For example, you might not be able to get down on the floor and play with your children or play pickup softball with your friends. You might even find that you can no longer bend down to tie your shoe. A heavier weight increases your risk for diabetes, sleep apnea, heart disease and other health problems so changing your lifestyle could go a long way.

How Do I Start Losing Weight?

 SMART Goals

SMART stands for Specific, Measurable, Actionable, Realistic, Time-based goals. Let’s break that down.

  • Specific – Typically a standard goal for most people is to lose about 5% of their body weight over a three to six month period.
  • Measurable – Weight is measurable. You would measure your weight in pounds or kilograms.
  • Actionable – To lose weight, you are going to diet. Dieting is the only action that will work.
  • Realistic – Setting a goal to lose 5% of your weight in six months is realistic. If you weighed 300 pounds and tried to lose 100 pounds in six months, that wouldn’t be very realistic. You could change that goal to five years, and you’d be back at losing about 5% of your weight in six months.
  • Time Based – Usually a three to six month period is a pretty good amount of time to see results. Losing about a pound or a half a pound a week is a sustainable goal.

Track Your Weight

If you have a scale you should:

1. Weigh yourself once a week
2. Weigh yourself first thing in the morning when you’re undressed
3. Record your weight and track it over time

Keeping a log will help you hold yourself accountable and see whether what you’re doing is working for you. If it isn’t working, that doesn’t mean you’re doing it wrong. It just means you haven’t found the right method of weight loss that works for you. Don’t get frustrated or become hard on yourself. Just try a new method of weight loss and avoid the one that didn’t work.

If you don’t have a scale:

1. Weigh yourself when you visit the grocery store
2. Know your weight will fluctuate based on time of day and what you’re wearing
3. Look for overall patterns when recording your weight

Again, keep a log, and if something isn’t working. Don’t give up; just try a new method.

Reach your healthy weight infographic with tips to lose weight and stay a healthy weightHow Do I Maintain a Healthy Weight?

1.Establish the habits

You don’t want to think about making healthy choices for the rest of your life. It should become a part of your daily routine. Just as you shower and brush your teeth, you can establish a habit of eating healthy.

Make sure you’re staying away from refined sugars and processed foods. Eat fruits for desserts and vegetables with every meal. You can treat yourself when it’s a special occasion, but every night does not deserve cookies.

Eating healthy is easier than it sounds. The more you work on eating clean, the more your pantry should reflect the goals you’re trying to meet. You shouldn’t have chips, cookies, and candy or other packaged foods in your cabinets. Instead you should have foods like nuts (almonds, for example), dried fruits and vegetables, you can even make your own home made trail mix. In your fridge, you should have fresh fruits and vegetables like, broccoli, cauliflower, carrots, sweet potatoes, and other healthy foods.

You’re going to do whatever is easiest and most convenient for you no matter how strong willed you are. Make eating healthy easy and accessible and put barriers between you and your “weak spots”. If unhealthy food isn’t in your house, you can’t eat it.

2. Drink Water

Always keep a bottle of water with you. You should drink a minimum of a half a gallon of water a day and make water your default beverage of choice. Not soda, not tea, not coffee, just regular water.

3. Exercise

While exercise might not be key to losing weight, it is very important for maintaining weight. Exercise 30 minutes a day regularly every week. Similar to the dieting rule, what you like best is what you should stick with.

If you enjoy carbs, you probably shouldn’t go on a carb free diet. If you enjoy red meat, you don’t have to cut that out. The same thing applies to exercise. If you hate running, then don’t run. If you’re someone who loves to run, keep running.

High Intensity Interval Training

Scientifically the type of exercise doesn’t matter, but the way you do it does. You could begin to practice high intensity interval training where you do short bursts of high energy exercise and then rest.  The goal during the bursts is to get your heart rate near your maximum.

For example, you would jump rope for a minute, then rest for a minute, then jump rope for a minute, then rest for a minute. Or you could sprint for thirty seconds and then walk for 30 seconds and repeat.

Exercising with high intensity interval training has proven to be the most effective way to burn calories. You even continue to burn more calories after you’re done exercising.  You should check with your Primary Care doctor first, to ensure your health condition allows, but if you’re trying to maintain your healthy weight, it can help.

Strength Training VS. Cardio

There isn’t really a difference in overall health benefits between anaerobic (like lifting weights) and aerobic (like running) exercises. In fact, anaerobic exercise might be more beneficial for you because it increases lean muscle mass and increases your basal metabolic rate. The misconception is that the person running is more in shape, but that’s not necessarily the case.

4. Maintain a Clean Diet

1. Avoid Restaurant food 

Both fast food and sit down restaurants could hurt your health. Restaurants don’t want to help you lose weight. They want you to come back so they can sell you more. Restaurant food is usually high sodium, has high levels of bad fats, and has high levels of carbs because those foods are addicting. Even the green or healthy options at restaurants can still be oversized and full of salt.

2. Foods in cans and bags

While a can of beans is acceptable, food that has a long shelf life and is highly processed should be avoided. Try to keep the shelf life under a week to reduce the amount of food with sodium and preservatives. So don’t go for the can of Chef Boyardee.

3. Buy fresh produce and eat home cooked mealsCooking vegetables in a pan to lose weight and be healthy

Establish a routine of eating home cooked meals. You only need to know three recipes to make the first few weeks of your diet bearable. From there you could add an additional meal a week to build up your options. You want to plan to make sure you’re ready before you start trying to lose weight. Try a few recipes and figure out what out what you like so when you switch to a healthier, more sustainable diet, you set yourself up for success.  You could even delay your plan to eat healthier food a week or two to prepare, find recipes you like, meal plan out your entire first week and have you pantry and fridge stocked with these healthy options.  Don’t forget that what you don’t buy can be just as important as what you do, so let you pantry run out of things like candy, chips and cookies.

What Happens if I Feel Like It’s Not Working?

1.Don’t Beat Yourself Up. It’s Totally Okay.

We need to stop criticizing ourselves and beating ourselves up if we don’t lose weight on the first thing we try. We’re our worst critics. Keep up the mentality that you still want to lose weight and realize that while what you were doing wasn’t working for you that doesn’t mean losing weight isn’t for you

2. See How You Can Fix Things.

Sometimes you can sabotage yourself. Make sure to check serving sizes. Were you accidentally taking two servings without realizing it?

You might also need to reduce your daily caloric intake even more. With dieting and weight, there is no one size fits all. People have different metabolic rates, even if they are the same height and weight. We all have that friends who never exercises, eats the worst food, and is still the same size as they were in high school, and there are also people who must consciously think about everything they eat. Your path to health may be more or less challenging than those around you and that’s ok.

having an accountability buddy or friend to tackle healthy eating and weightloss3. Have an Accountability Buddy

Have a partner who is also on board with you who you can understand when you feel frustrated. You can both go through everything together and inspire each other to stay the course on the journey.

Humans are relational creatures so if you feel like you’re on an island and there’s no other person with you, you’re going to want to leave. That’s the reason why programs like Weight Watchers and Jenny Craig are so successful. It’s not because of some magical dietary formula, but because it’s a community where your voice is heard and you can feel accepted.

Having a social support system or someone that will cheer you on and help you stay on top of your diet can guarantee success. Whatever happens, don’t give up on trying to be a healthy weight. Stay with it, and try new things.


If you have more questions about your weight and weight loss, you can schedule an appointment with Dr. Svestka or any of our other Primary Care doctors in Gainesville, Ocala, Chiefland, Lady Lake, McIntosh, and Lake City. Call (352) 225-2225 or schedule an appointment online today.

AIDS: Learn Symptoms, Prevention, More

Image of woman with red shawl against a brick wall and statistics about HIV infection.

On December 1st, 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?Graphic on how to prevent aids with stop sign

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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Common Cold: Guide to Treatment and Medication

Tips to Treat Your Common Cold

As we approach winter, you might have noticed people coming down with the common cold. You might even experience symptoms like a cough, sore throat, or runny nose. Even if you don’t have a cold yet, it doesn’t hurt to be prepared.

We talked with Colleen Crabbe, a SIMED Primary Care ARNP in Gainesville, about what a cold is and how you can treat the symptoms.

Symptoms of the Common Cold

The symptoms of a cold include:

  • Runny nose
  • Cough
  • Congestion
  • Sore throat
  • Headache
  • Malaise

If you have these symptoms, you probably have a cold, but you might also have the flu.

Flu VS. Cold: What’s the difference?

It can be tough to differentiate the common cold from the flu because both have similar symptoms like cough, runny nose, congestion, headache, sore throat, and malaise (ill feeling). Flu symptoms, however, tend to be more severe and likely to cause fever and body aches.

Three Basic Elements to Treating the Common Cold

You’ve figured out you have the common cold. Now what?

1. Get rest
2. Drink plenty of water
3. Use over-the-counter medicine

These are the best things you can do if you have the common cold.

Medications: What Should You Look For?

There are many choices of medications at the drugstore these days, and finding what you need can be overwhelming. Looking at the “active ingredients” on the back of the box or bottle can help you choose medications that have been proven in research to work for symptoms of the common cold and flu.

  • Treating the Cough with Dextromethorphan.
    • This ingredient can help reduce your cough. It is found either alone or in combination, liquid, or pill formulations.
    • Dextromethorphan won’t make you drowsy like prescription cough medicine can.
  • Reducing Fever and Aches with Analgesics
    • Analgesics like Acetaminophen and ibuprofen can help with reducing fever and aches.
    • Acetaminophen tends to have fewer side effects, but both have risks to those with certain conditions. Discuss the use of these medications with your physician prior to use.
  • Relieving Congestion with Decongestions
    • Decongestions are commonly used and commonly feared over-the-counter medicines.
    • Pseudoephedrine is more effective and can be found behind the counter where you will need to show your identification.
    • Phenylephrine is not as effective as pseudoephedrine and is found in many over-the-counter cold medications.
    • Both pseudoephedrine and phenylephrine can help with symptoms of cough, congestion, ear pressure, and pain. Use them with caution if you have high blood pressure or heart conditions.
    • Make sure to check your active ingredients to see whether the medication has pseudoephedrine or phenylephrine.
    • Topical formulations in sprays such as Afrin or generics can improve nasal congestion, but should be used a maximum of twice a day for 3 days.
  • Improving Sleep with Antihistamines
    • Common antihistamines like Benadryl (diphenhydramine) and chlorpheniramine or doxylamine are found in many nighttime cold medicines and sleep aids.
    • The medications help with drying and can sooth congestion, runny nose, and cough while sedating to improve sleep.
    • There is some evidence that using antihistamines with decongestants is more effective for moderate to severe cold symptoms.
  • Reducing Mucus and Cough with Guaifenesin
    • Guaifenesin is a popular expectorant in Robitussin and Mucinex products and can also be used by itself. It helps with coughing and thinning of mucus.
  • Reducing Congestion and Cough with Saline Sprays
    • Saline sprays irrigate the nostrils during a cold and can provide relief of congestion and cough in combination with other therapies.
  • Other Possible Remedies Include:
    • Vitamin C, Vitamin D, Echinacea, zinc, and heated humidity have limited evidence for improvement in cold symptoms and need more research.

Medications and Home Remedies for Cold Symptoms

Treat Your Symptoms of the Common Cold Flat Design Infographic

Here is a summary of different treatments that will work for each of the common cold symptoms.


  • Dextromethorphan
  • Antihistamines
  • Honey
  • Warm Liquids

Sore Throat:

  • Salt-water gargles

Aches, Pains, and Fever:

  • Acetaminophen
  • Ibuprofen

Nasal Congestion:

  • Saline nasal spray
  • Humidified air
  • Topical or oral decongestants
  • Antihistamines in combination with
    • Decongestants
    • Guaifenesin

If these treatments aren’t working and you feel your symptoms worsening, you might want to consider the next step.

When You Should See a Doctor

For most people with colds, symptoms are self-limited, meaning they will go away on their own eventually. Because the cold is caused by a virus, antibiotics will not help, but some people can have complications from the cold like acute sinusitis, pneumonia, bronchitis, and ear infection. These complications may need additional prescription medicines from your provider or even antibiotics depending on the patient.

You should see a doctor if you:

  • Develop significant face pain
  • Have symptoms prolonged over one week
  • Experience shortness of breath
  • Wheeze
  • Have another unmanageable symptom

Those who are most at risk of these complications are diabetics, smokers, and those with poor immune systems.

Avoid Transferring the Cold

Colds can spread quickly amongst family, friends, and people in a work place. Take these steps to ensure you avoid giving and getting a cold:

  • Wash your hands often
  • Cover your coughs and sneezes
  • Avoid others until you feel better

Following those tips, you will be able to reduce the spread of the cold virus. If you have a fever or an uncontrollable cough and sneezing, you should consider staying home from school or work to help reduce the spread of the cold.

To schedule an appointment with Colleen Crabbe, ARNP, in Gainesville, call (352) 332-7770 or schedule an appointment online.

For SIMED Primary Care in Gainesville, Ocala, Chiefland, Lady Lake, or McIntosh, call (352) 224-2225 or request an appointment online. If you could like to schedule an urgent care appointment for cold or flu symptoms, call (352) 373-2340 or request an appointment online.

If you have the flu or a cold, we hope you feel better.

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Construction Begins on New Clinic with Improved Patient Care

Construction began at Gainesville SIMED building 4343 on the new and updated primary care unit
As SIMED continues to grow to meet the needs of our community, we are excited to announce the construction of our new “clinic of the future”. 
Suite 7 in our 4343 Building in Gainesville is being redesigned and will become a Primary Care suite and the future Gainesville location for Drs. Lefkowitz, Svestka, and Roque.  These physicians and their staff have agreed to participate in a new pilot program which will introduce new technologies and clinic efficiencies into our workflow.
“We are always implementing ways which we can provide higher quality care to our patients, and we believe these new technologies and clinic design will improve patient access, flow, and convenience.  We’re hopeful that we will be able to expand the successes of this new clinic throughout all of our patient care areas,” said Daniel Duncanson, MD, Chief Executive Officer for SIMED.
Construction begins on December 4th and is expected to be completed in only 135 days. Our staff will be making every effort to minimize any inconvenience to our patients. 
SIMED Primary Care Physicians Dr. Svestka, Dr. Lefkowitz, and Dr. Roque break ground on the new improved primary care unit in Gainesville

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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