Everything You Need to Know About Cholesterol

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

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


What is cholesterol?

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

How does it affect our health?

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

Is there good cholesterol and bad cholesterol?

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

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

What are symptoms of high cholesterol?

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

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

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

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

Are their any foods that might help to lower cholesterol?

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

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

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


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

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


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


SIMEDHealth Electronic Check-in Now in Gainesville Primary Care

You may have noticed a few changes in our clinics, as SIMED has transitioned to SIMEDHealth. The biggest change so far is our new electronic check-in system.

After testing this system in our Gainesville Neurology, Neurosurgery and newly renovated primary care suite, we are excited to announce the addition of this system in our Urgent Care clinic and Gainesville Primary Care clinics.

This E-check-in system allows for less paperwork, secure transfer of health information and an improved patient experience. It may seem complex but is actually fairly simple.

As appointment times approach, patients will receive a reminder notification and be prompted to fill out paperwork via text message or email. Once patients arrive, they’ll need to briefly complete their registration on an electronic pad (shown above). This allows our patients to spend less time in a waiting room and more time with their providers. With less paperwork to sift through, clinic staff and physicians can focus on delivering personalized care to patients.

Our E-check-in system also allows patients to verify insurance coverage before exams and pay all remaining balances on their accounts.

The system is held to the Payment Card Industry Data Security Standard (PCI DSS), is registered as an approved solution with Visa and MasterCard, and uses top encryption and security technology to protect your financial information. Your credit card information will never be saved in the system, and staff members will also only be able to see the last four digits of your credit card number to ensure the data is unusable in the event of a breach. The new electronic check-in system meets the strict security requirements of the healthcare industry to ensure patients are protected. All the information you enter is private, secure, and never stored in a physical location.

At SIMEDHealth, we are always looking for new ways to make our patient experience more efficient and personalized. We’re excited to be able to offer this new feature in our Gainesville Primary Care and Urgent Care clinics and look forward to keeping our patients in the best of health.

Keep an eye out for more announcements about our E-check-in system as we introduce it to more clinics in our practice.

Have questions? Contact us here

Need an appointment? Click here

Simed Opens Clinic of The Future

SIMED, Primary Care, Clinic

Over one month ahead of schedule, SIMED has completed the renovation of its primary care clinic. The new offices of Dr. Lefkowitz, Svestka and Roque open Wednesday, February 28, and feature updates to help doctors and staff deliver the highest quality of care.  

“I will miss my colleagues in suite 11, but I am looking forward to working with the new staff in Suite 7 and working with a new system that will enhance patient care and the patient experience,” said Dr. Shelley Roque referring to SIMED's new electronic check-in system.

With this system, patients can securely check in for appointments, fill out paperwork and send their medical history directly to their primary care doctor. They will also be able to verify health insurance and securely pay for their visit.  

The patient's medical and financial information is private, secure and never stored in a physical location. Click here for more information on this technology.

"I am most excited about beginning the process of shifting our patients' time at their doctor's office to a more welcoming, relaxed and enjoyable experience," said Dr. Eric Svestka 

Suite 7, in SIMED's Gainesville 4343 location, has been redesigned to improve convenience and accessibility for primary care patients. With a new color scheme and lots of sunlight peering through the windows, this suite will provide a calming atmosphere to current and future SIMED patients.


Take a look at the new primary care suite below!


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

Drinking smoothies with vegetables like those in this colorful photo helps to lose weight.

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

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.