Dr. Gupta's tips to achieve and maintain a healthy weight.
Family care physician, Dr. Anubha Gupta, discusses the benefits of a healthy weight, and body mass index (BMI). A healthy weight depends on factors such as sex, genetics, body frame, medical history, and lifestyle habits. Hear Dr. Gupta's tips to achieve and maintain a healthy weight through diet, physical exercise, and mental health! To schedule an appointment, click here.
1.) What is the difference between type 1 and type 2 diabetes?
The most common types of diabetes you hear about are Type 1 and Type 2. In Type 1 diabetes a person's body becomes unable to produce enough of its own insulin. Since insulin is required to process the body's blood sugar (glucose), this leads to high levels of sugar circulating in the bloodstream. In type 2 diabetes, the body is able to produce some or all of the insulin it needs; however the cells within the body are resistant to the insulin and therefore are unable to use it effectively.
2.) Who is most at risk for type 2 diabetes?
Although diabetes is present across all patient populations, the risk is higher in some more so than others. There is higher risk amongst those who are obese, live sedentary lifestyles, with strong family histories of diabetes, and who had elevated blood sugar problems during pregnancy (gestational diabetes). Also, those who have chronic mildly elevated blood sugars otherwise known as "pre-diabetes," are at higher risk of progressing to Type 2 diabetes, as well as certain ethnicities.
3.) What are some things a person can do to prevent development of diabetes?
Although one cannot change certain risk factors like family history, age or ethnicity; there are things you can do to help reduce the likelihood of developing diabetes or possibly prevent it all together! Take action by improving your lifestyle habits such as eating a healthy diet, getting regular physical exercise, and getting regular preventative checks with your health care provider.
4.) Why is it important to treat diabetes early?
You might be wondering, "Why should I be concerned about my blood sugar? I feel fine!" In the early stages of type 2 diabetes, there may be few or no symptoms. However, over time high levels of blood sugar, either from Type1 or 2, can cause damage to small blood vessels in the eyes, kidneys, brain, and heart; eventually leading to complications like stroke, heart attack, neuropathy, kidney failure, loss of vision, and loss of arterial circulation leading to higher risk of wounds and amputations. Early control of elevated blood sugar slows the progression and even prevents some of these complications. Talk to your healthcare provider about what is best for you.
Family Medicine Physician, Dr. Jenny Chen discusses the risk factors, diagnosis, and treatment for breast cancer.
1.) What are the risk factors for developing breast cancer? Does age, gender, or race affect risks?
Globally, breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer death in women, and in the US, it is the second leading cause of cancer death in women, trailing only lung cancer. While men can also get breast cancer, women are approximately 100 times more likely to get breast cancer than men. The highest breast cancer risk occurs among white women, although breast cancer remains the most common cancer among women of every major ethnicity and racial group. There are many other risk factors for breast cancer, including postmenopausal obesity, aging, family history, alcohol use, smoking, and menopausal hormone replacement therapy. In addition, earlier age at starting periods, and later age of menopause are also associated with an increased risk. Conversely, breastfeeding, increased physical activity and a diet rich in fruits, vegetables, fish and olive oil (Mediterranean diet) are associated with a decreased risk of breast cancer. Lastly, a meta-analysis showed dietary fiber intake was associated with a 12 percent relative risk reduction in breast cancer incidence.
2.) What are early signs of breast cancer?
A breast lump or mass is a common early sign of breast cancer. In countries with established breast cancer screening programs, most patients present due to an abnormal mammogram. However, up to 15 percent of women are diagnosed with breast cancer due to the presence of a breast mass that is not detected on mammogram. Other signs include breast skin changes such as dimpling and red discoloration, nipple retraction or inversion, localized pain or swelling, or enlarged axillary lymph nodes.
3.) Do self-breast exams make a difference in early diagnosis of breast cancer? What about breast exams by physicians?
Trials evaluating clinical breast examination (CBE) and breast self-examination (BSE), with or without mammography have not demonstrated efficacy in early cancer detection or improved outcomes. Therefore we no longer suggest using clinical breast examination (CBE) or breast self-examination (BSE) as part of screening of average-risk women. Screening CBE may be helpful, however, in resource-limited settings where there is limited mammogram imaging availability. Mammography is the recommended modality of breast cancer screening for the vast majority of women. The starting age and frequency of screening mammography depends on the individual’s risk, including genetic risk. No screening guideline recommends routine
screening for average-risk women (defined as less than 15 percent lifetime risk) who are under 40 years of age. Most United States expert groups encourage shared decision-making for women in their 40s for average-risk women, although European screening guidelines recommend starting screening at age 45. Regular mammograms are recommended for all women ages 50-75.
4.) 1 out of 8 women will develop breast cancer, and most of them survive the disease. What treatments are contributing to breast cancer survival?
Breast cancer mortality has dropped dramatically since the 1980s, and both earlier detection through screening and improvements in breast cancer treatment are responsible for this reduction in mortality. Medical treatment of breast cancer using endocrine therapy, and chemotherapy have increased the survival rates of breast cancer patients in the past few decades. For example, estrogen receptor-positive breast cancer patients benefit from the use of endocrine therapy with anti-estrogen drugs. More recently, advancement in genetic testing and immunotherapy are also transforming the way we treat breast cancer. Immunotherapy is a type of cancer treatment that helps our immune system fight cancer. These modern medical treatments, along with advances in surgical technique and radiation oncology equipment have helped more, and more women become breast cancer survivors.
Classes resume for fall semester, and the flu season is right behind it. August is Immunization Awareness Month and we heard from Dr. Kamal Singh about vaccines.
Vaccines train the body to fight an invasion without developing significant illness. When the body is exposed to foreign pathogens, such as viruses or bacteria, the immune system produces antibodies allowing it to defend itself. “These antibodies attack the invading pathogens, also known as an antigens, and protect against further infection”, says Dr. Kamal Singh, a SIMEDHealth Primary Care Internal Medicine physician.
When facing the invader for the first time, there is a delay of sometimes days between the body’s exposure to the invader (antigen) and developing the antibody attack response. “For severe antigens like the measles virus or the Pertussis whopping cough bacteria, a few days delay is too long”, emphasizes Dr. Singh. “The infection can rapidly spread throughout the body, before the immune system can fight back. Unfortunately, this delay can sometimes result in death.”
Every year millions of healthy adults and children are given vaccines to prevent serious diseases. In the United States available vaccines go through many years of rigorous testing prior to being made available to the public, including:
Multiple levels of clinical trials determining the vaccine’s effectiveness, tolerability and safety.
Food and Drug Administration (FDA) evaluation and review of the data, and upon the FDA’s approval, the Centers for Disease Control and Prevention (CDC) must go through its own evaluation, review and approval process.
Infants, children, adults, and senior citizens are evaluated and reviewed separately, as are males, females, and more recently ethnicity, race, and social determinants of health to best determine the vaccine’s effect, tolerance, and safety in these subgroups.
Even after FDA and CDC approval, the vaccine production facility continues to submit reports to the FDA on the quality and safety of the vaccine, to ensure the vaccine continues to meets the required standards.
“The U.S. has one of the most advanced systems in the world for tracking vaccine safety”, says Dr. Singh.
Many people, especially new parents can be overwhelmed with keeping up with immunizations. Dr. Singh reports, "Vaccine schedules have been developed by the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians covering all current vaccine guidelines." Vaccinations keep you, your family, and others safe from potentially deadly diseases by significantly decreasing or eliminating the severity and spread of disease.
Some vaccines have precautions associated with them. “ Dr. Singh explains, “these are things which may happen in some subgroups of people, however the benefit of receiving the vaccine may still outweigh the precaution consequences, and the vaccine can be received. A contraindication, however is a very specific situation in which the vaccine will likely result in more harm to the person, than the benefit expected to be received.” He continues, “while all vaccines have precautions and contraindications, they are usually only applicable to a very small number of people, and vaccines overall are generally very well tolerated. Some precautions and contraindications are only for very brief periods of time, and the vaccination can safely be received once the period has lapsed”
If you have questions about vaccines and the appropriate vaccine schedule for you or your loved one, contact your Primary Care physician or advanced care provider who can discuss the details with you.
Heart Disease occurs 10 to 15 years earlier in men than in women.
Males have higher death rates for heart disease, cancer, and unintentional injuries. With advancement in technology and prevention screening, why are the death rates in males higher than women? Even in today’s society, stigmas still exist about men’s health. June is men’s health month and we discussed these questions with Primary Care Physician Kamal Singh, and heard from him about the importance of routine health care for men.
The leading causes of death for males are
Heart Disease
Cancer
Unintentional Injuries
Higher death rates
Many stigmas involving men’s health still exist, like the necessity for routine medical care. Multiple factors contribute to why males experience more difficulties with these diseases. Lifestyle, society beliefs, and other masculine behaviors all contribute to a man’s decision making process.
Avoid the risks
Even with a higher risk for these diseases, there’s still ways to reduce this risk. Routine medical care like screening for blood pressure, cholesterol, heart disease, colorectal cancer and prostate cancer can help lower health risks. Maintaining a healthy lifestyle like exercising daily and eating a healthy diet can also contribute to lowering risks.
Importance of regular checkups for men
Routine medical care is important because certain diseases can be prevented. For example, when high cholesterol is caught early, lifestyle changes and medications can be prescribed to prevent health events from happening. But after an event occurs, you have higher chances of developing a disability and other disease process related to the event, and be more likely to be prescribed multiple more medications than would have been prescribed for preventive measures.
When to seek medical care for an injury or a new symptom
Don’t wait to seek medical attention. If new symptoms or new changes develop, reach out to your medical team. Prevention measures exists for our own benefit, take advantage of them. If you’re the head of the household, you may have family members who depend on you. Taking care of yourself will benefit you and those who look up to you.
SIMEDHealth Primary Care is happy to welcome Dr. Gupta to the team! To learn more about her, watch the video below, then scroll down to read her tips on healthy aging.
Healthy Aging Month Tips
Healthy aging is about creating the environments and opportunities that enable people to be and do what they value throughout their lives. Every September, Healthy Aging Month is observed and focuses on various aspects of growing older. Healthy aging revolves explicitly around a holistic approach to aging for people 50 years of age and older. This incorporates individuals' physical, mental, and social well-being and allows them to reflect on the past with motivation to improve their health in the future. With the toll of the COVID-19 pandemic on everyone's work, family, and social life, there is even more of an urgent need for us to reflect on the various aspects of our health.
It is never too late to start working towards a healthier goal. So, let's reinvent ourselves and take control during the National Healthy Aging Month by creating an environment that enables us to do what we value in our lives. A few things I believe will allow you to get moving in the right direction:
Age: It's a state of mind. Think about when you felt the healthiest and try to think and act that way. The bottom line is – POSITIVE THINKING works. So be optimistic in life and turn your focus to positive things. Imagine the glass to be half full rather than half empty.
Stay active and exercise: These are an integral part of healthy aging. Studies suggest exercising allows people to live longer, healthier and better. It reduces your risk of developing various diseases like diabetes, high blood pressure, and disability with aging. In addition, exercise improves muscle strength and balance, thereby reducing the risk of osteoporosis and falls. One easy way to make exercise part of your routine is to stay active in your daily life by taking the stairs, walking your pet, gardening, etc. Or, develop an exercise schedule with a good mix of endurance exercises that will allow you to achieve the above goals. Yoga and meditation may also be a great way to begin your journey to stay active and healthy.
Consult your physician if you are unsure which activities are okay with your medical condition.
Smart food choices: This plays an integral part in how people age. There is a lot of evidence connecting unhealthy food choices and micronutrient deficiencies to various medical problems. Making smart food choices collectively as a family makes it easier and more fun. A few things which need to be avoided are processed foods, high-calorie snacks, refined grains, red and processed meat, fast food, soda, and solid fats. Instead, substitute them for high-fiber cereal, low-fat dairy, non-white bread, whole grains, beans, vegetables, fruits, and snacks with no added sugars. Keep track of what you eat and hold yourself accountable.
Additional attention must be paid to adequate intake of micronutrients and vitamins as their deficiency can be associated with various medical problems like muscle atrophy, poor physical activity, weak bones, and back pain.
Mental health: It's not uncommon for people to have mental health issues like depression with aging. It is essential to recognize the warning signs. These issues can complicate management and worsen health in people with chronic health conditions like diabetes, heart disease, and chronic pain. Some of the warning signs of depression may include changes in mood, energy level, or appetite. Other warning signs include difficulty sleeping or sleeping too much, fatigue, poor concentration, tearfulness, sadness, hopelessness, anger, feeling stressed, and suicidal thoughts.
It is essential to realize that mental disorders can be treated and don't hesitate to ask for help. If you are unsure about your symptoms, talk to your health care provider, someone you can confide in, or call the Alachua County Crisis Center (352-264-6789). If you feel you are in a crisis, you can also call 911 or the National Suicide Prevention Line at 1-800-273-TALK (8255).
Connect with family and friends: It's been hard for people to connect during the pandemic due to social distancing and other restrictions. Thanks to various ways to electronically be in touch like Zoom, Skype, WhatsApp, Facebook, etc. – we can stay connected with our friends and loved ones. Start today by contacting a friend, family member or make a special interest group to connect with people.
Hobbies: Think about what you like to do and explore new activities which are fun and relaxing. Studies have demonstrated that people involved in hobbies and social and leisure activities may lower their risk of developing specific health problems. This may be reading, gardening, spending time with family, participating in social activities, and being part of a social group. Others may feel more productive by engaging in activities like volunteering in the community or working towards a social cause. Find what motivates you, and don't be afraid to pursue it.
In summary, healthy aging is a process that incorporates various aspects of mental, social, and physical well-being, and it's never too late to start working on this process. As your physicians and Primary Care clinicians at SIMEDHealth, we take pride in helping guide our patients through this process. We will be happy to discuss any of these with you to help kickstart your healthy aging journey.
Click here to schedule an appointment with Dr.Gupta.
In the fight against COVID-19, testing is key. But there are several types of tests that can be confusing for those who don’t know the difference. We talked to SIMEDHealth Primary Care Physician David Lefkowitz, MD, about what makes these tests distinct and what tests SIMEDHealth offers.
1. What is the difference between an antibody test, an antigen test, and a viral test?
Dr. Lefkowitz says, “Antibody tests look for antibodies to a particular pathogen, in this case, SARS-CoV-2 (the COVID-19 virus). Antibodies are proteins made by your immune system in response to a pathogen. So, if you test for COVID-19 antibodies, you are trying to see if someone has been exposed to COVID-19 already. It may take days or even weeks for antibodies to become detectable. So antibody tests are not useful to diagnose an early active COVID-19 infection. The test itself is done either via a blood draw or with a drop of blood from your finger. Note, these tests are also referred to as serologic tests.”
“Antigen tests look for pieces of the virus and are typically done via a nasal swab,” Dr. Lefkowitz replied. “The nice thing about these tests is the rapid turnaround time, usually about 15 minutes. The downside is they are not as sensitive as the PCR test described below, and so they may miss people who do have the virus. Therefore, if there is a high suspicion someone has symptoms of COVID-19, such as fever, cough, shortness of breath, but they have a negative rapid antigen test, they would likely be well served to also receive a PCR to be sure whether they have COVID-19. This type of testing is also known as POC (point-of-care) testing, and it is often done where a lot of testing needs to be completed in a short period of time, such as in medical facilities, schools, military facilities, and even airports.”
“Viral tests look specifically for the RNA of the COVID-19 virus,” explains Dr. Lefkowitz. “Depending on the type of test, viral tests use a nasal swab, oropharyngeal swab, or saliva.” He adds, “These tests can be used to diagnose active COVID-19 infection. Note, this type of testing is also known as a molecular test or a PCR test. It remains the ‘gold standard’ for diagnosing COVID-19 infections, meaning it is the most accurate.”
2. Who should get an antibody test? Who should get a viral test?
“Active infections are diagnosed with viral and antigen-type tests. These tests are also useful for screening asymptomatic people who may have COVID-19, so they don’t unknowingly spread the virus.” Dr. Lefkowitz continues, “Antibody tests are generally useful only for those who want to know if they had previous exposure to the virus. They are not useful for recent exposure. However, it is important to note that even if you test positive for the presence of COVID-19 antibodies, it doesn’t mean you have immunity against COVID-19. We don’t know yet what kind of protection these antibodies give you, or for how long. So, you still need to wear a mask, physically distance, and wash your hands. Antibody tests are also used by scientists and researchers who are studying patients who have had COVID-19.”
3. What kind of COVID-19 testing does SIMEDHealth do?
“At SIMEDHealth, we do PCR testing and antibody testing. Dr. Lefkowitz says, “Previously, we had to send the nasal PCR swabs to an outside lab, which delayed getting results. Fortunately, our SIMEDHealth laboratory has recently acquired the capability to process the PCR tests and give a timely, highly accurate result. We aim to have results out in 45 minutes. As you can imagine, both patients and our staff will find the rapid turnaround time very useful in fighting against the spread of COVID-19.”
Lastly, Dr. Lefkowitz adds, “There has been much discussion regarding COVID-19 testing since the beginning of the pandemic. We have come a long way, but there is still progress to be made. I want to remind everyone to continue to take this virus seriously, especially as we enter the colder months and flu season. If you have symptoms or have been in contact with someone tested positive for COVID-19, or the Influenza virus, you should be tested. If you have concerns, call us, we can help you.” Click here to schedule an appointment with Dr. Lefkowitz today.
Currently, in the US, a cancer diagnosis is made every 23 seconds. February is National Cancer Prevention Month, and we talked to Robert Balbis, DO about preventable cancers and what lifestyle changes people can make to reduce their risk.
What cancers are considered to be the most preventable?
Breast, colon, endometrium (uterus), gastric, skin, and kidney cancers are all considered to be the most preventable. There is level one evidence that shows that if people keep a healthy lifestyle, they have a much lower risk of getting these cancers.
Dr. Balbis emphasizes that there is no 100% preventable cancer. Still, if you do get diagnosed, having a healthy lifestyle will prepare you to take on the treatment and give you the best chance possible for recovery.
What are some things people can do to prevent cancer?
1. Avoid Obesity
Balancing caloric intake with exercise and avoiding excessive weight gain is one of the best things people can do to lower their risk. There is evidence that obesity is a risk factor for breast, colon, endometrium, gastric, cardia, and kidney cancers. Plus, if someone is overweight going into cancer treatment, there is a poorer chance of full recovery. Dr. Balbis suggests maintaining a healthy body mass index throughout life through a proper diet and exercise.
2. Be Active
According to many studies, having a consistently active lifestyle helps reduce the risk of breast and colorectal cancer. Dr. Balbis recommends, “at least 30 minutes of moderately intense physical activity per day at least five days a week." Some activity examples are briskly walking, yoga, biking, dancing, and swimming.
3. Eat a Healthy Diet and Avoid Alcohol
There are two key factors in maintaining a healthy diet, portion control, and plant sources. There is a strong connection between colorectal cancer and red meat, so it is a good idea to limit beef, pork, and lamb. Fruits, vegetables, and whole grains have essential vitamins and nutrients that will keep your body healthy.
4. Do your preventative screenings
Preventative screening tests done at the recommended intervals can detect "pre-cancerous" lesions or find newly formed cancers in their earlier stages. Thereby increasing the chances of effective treatments and cures. The American Cancer Society now recommends everyone start screening for colorectal cancer at age 45. Regular PAP smears and HPV immunizations should eliminate cervical cancer. Using SPF 15 or higher at all times when outdoors and getting regular skin exams can significantly reduce the risk of developing skin cancer or identify them early.
If you would like to talk about your risk, how to reduce the risk, and hopefully prevent cancers, click here to schedule an appointment with Dr. Balbis or one of our other SIMEDHealth primary care providers.
Did you know 1 in 3 deaths are caused by cardiovascular disease every year in the United States? February is American Heart Month and aims to shed light on the dangers of cardiovascular diseases. We sat down with SIMEDHealth's Primary Care Physician Jenny Chen, MD, to discuss the most prevalent of the heart diseases, coronary artery disease.
1. What is Coronary Artery Disease?
"Coronary artery disease (CAD) is the most common type of heartdisease and is caused by atherosclerosis plaque building up inside the heart arteries (coronary arteries). The plaque is composed of cholesterol, fatty deposits, and other material on the inner walls of the arteries", explains Dr. Chen. "These inner artery wall deposits result in narrowing or potential obstruction of the space for the flow of blood."
"A heart attack occurs when a coronary artery supplying your heart muscle is blocked, leading to loss of blood flow and oxygen to the muscle cells. If the blockage lasts too long, that part of your heart muscle dies."
2. What are the factors that could lead to CAD?
Dr. Chen says, "Many factors can contribute to coronary artery disease. These risk factors include but are not limited to high cholesterol, diabetes, high blood pressure, sedentary lifestyle, smoking, obesity, family history/genetics, and aging."
3. What are some ways to prevent CAD?
"There are many ways to prevent or slow the progression of CAD," says Dr. Chen. "If you are a smoker, there is nothing more important in preventing the progression of CAD than stopping smoking. For those with diabetes, its very important to keep glucose under control through diet, exercise, and possibly medication. Eating a healthy diet, including numerous fruits and vegetables per day, minimizing trans-fat, saturated fat, and refined carbohydrates, can all help prevent developing CAD. Also, keeping one's blood pressure well-controlled can help reduce the risk. This means periodically monitoring one's blood pressure and following doctors' instructions on diet, and taking the correct medications if needed. Cardiovascular exercise, if one is healthy enough to do so, can also reduce the risk of CAD. The goal is at least 10 min per session and at least a combined 150 minutes per week of aerobic activity."
4. What are the symptoms of a heart attack in men and women? Why are some of the symptoms different in women?
"Classic symptoms of a heart attack which both men and women can experience include chest pain, an aching sensation in your chest or left arm that may spread to your neck or jaw. Patients can also experience sweating, shortness of breath, palpitations, severe fatigue, nausea, upset stomach, or abdominal pain," says Dr. Chen.
She also adds, "Women are more likely than men to report non-classic symptoms of a heart attack. For example, a woman having a heart attack may complain only of nausea, vomiting, and abdominal discomfort rather than chest pain."
5. What else can I do?
A visit with your primary care physician can help you identify the CAD risk factors that may apply to you. If not done recently, lab testing can be done to evaluate your cholesterol and glucose. Together you can then develop a plan to lower your CAD risks over time. By taking control of the risk factors, you can do a lot to prevent your chances of developing heart disease.
Click here to schedule an appointment with Dr. Chen or one of our other Primary Care physicians and nurse practitioners.
Did you know a single car accident victim can require as many as 100 pints of blood? January is National Blood Donor Month, and to spread awareness, we talked to Jenny Chen, MD of SIMEDHealth Primary Care in Ocala. We discussed the benefits and the process of donating.
1. Why is it important to give blood?
"Blood donation is essential for saving lives!" explains Dr. Chen. "Having stored blood available is necessary for surgeries, cancer treatment, certain blood disorders, and traumatic injuries. Benefits for donors include a free medical check-up satisfaction of helping others, and free cookies, juice, and sometimes promotional items."
2. What are the requirements to give blood?
According to the US Food and Drug Administration (FDA) regulations, donors are eligible to donate no sooner than 56 days (eight weeks) after their previous donation. However, not all donors qualify at this minimum interval, as it depends upon how rapidly the person's body can replenish its red blood cells.
You must be in good health and feeling well
You must be at least 16 or 17 years old in most states
You must weigh at least 110 lbs
3. How long does the donation process last?
Dr. Chen says, "The entire process takes about 1 hour and 15 minutes, but the actual blood donation takes 8 to 10 minutes. However, the time varies slightly with each person depending on several factors, including the donor's health history."
During the donation, a needle is put into a vein in the upper extremity. This is done by skilled medical personnel in such a way to minimize possible symptoms such as lightheadedness. One pint of blood is withdrawn, approximately 500 mL, which is equivalent to one "unit". The donor is monitored during the donation and for a few minutes afterward. Juice and snacks are provided to help decrease post-donation symptoms.
4. Are there any side effects of donating blood?
According to the National Center for Biotechnology Information, 1.2% of donors suffered from an adverse reaction. Dr. Chen assures, "The vast majority had mild reactions such as agitation, sweating, pallor, cold feeling, sense of weakness, nausea. Only 0.2% had more severe disorders, including vomiting, loss of consciousness, and fainting."
"It is important to note that, donating removes iron from the body, and can result in a temporary iron deficiency if the lost iron is not replaced," explains Dr. Chen. "The risk of iron deficiency is highest in teenage donors, menstruating women, and individuals who donate frequently." For some, just eating iron-rich foods is not sufficient to replenish lost iron. Many donation organizations recommend taking an iron supplement or a multivitamin for 60 days to replace the iron lost through each donation.
Schedule an appointment with Dr. Chen or one of our other SIMEDHealth Primary Care physicians today!
