Men's Health Awareness Month

Men's Health Awareness Month

By the age of 85, women outnumber men in the U.S. 2.2 to 1; this rises to 3 to 1 if they reach their 90s according to the CDC. Dr. Eric Svestka a SIMED Primary Care physician gives us some valuable advice on how men can take some steps to make healthier lifestyle choices.

What are some of the most common men’s health issues?

The most common issues we are going to talk about today are the ones we hear most in the news. The ones that we usually see family members and friends experience are the most common ones.

What are nutrition guidelines for men, and how do they change as men age?

The nice things about the guidelines is that they stay the same throughout the course of life. The problem is as men age in particular their energy expenses and calorie tend to decrease; we are not as active as we were in our 20's and 30's. Some good rules of thumb are to make sure you are getting at least one vegetable and fruit with each meal. You also want to keep portion size under control, some things we can think of for example would be meat. Meat is one of those areas where we seem to over eat. A deck of cards is the portion size of a healthy serving of meat. Then when it comes to pastas and things like that (carbohydrates), something the size of your fist is a good serving size there. Whenever you go out to eat you’re almost always getting double or triple the serving size that you should. So one of the things I have my patients do is when you order your food ask for half of the food to be boxed before it even comes out to the table so you don't even see it. Then you feel fuller and you have a free meal the next day.

What can men do to keep from experiencing high levels of stress?

Stress is one of those funny things a little bit is good and helps you perform at your top level but too much you start to feel overwhelmed or you begin to feel like you’re losing control of your situation that's when it begins to be negative on its impact. The main thing is really a support system, so support at work and at home just having someone you can talk with. Also staying connected socially so that you’re able to get away from your work. Talk with friends and other people see that people, are having issues with work and life and all those different endeavors. One of the main things you want to avoid actually are unhealthy coping mechanisms such as drugs, alcohol, those things. Sometimes it can seem like I'm done with my day it would be nice to have a beer or two to unwind, and yea a beer or two is alright but you have to be careful that doesn't become your new crutch on how you get through the day and then two becomes three and we go on from there.

What is low testosterone, and what are the symptoms?

Low testosterone is a pretty common problem for men about two to six million men in the United States suffer from this. It is really something that can be part of the normal aging process as you go through life your testosterone levels will start to go down. The signs and symptoms that it can be problem for you can be varied so it can be something as simple as feeling tired, maybe you get fatigued more quickly when you’re doing activities or exercise, you can be more irritable. Actually depression is one of the signs of low testosterone. Then you come to some of the more obvious things like erectile dysfunction or having a low libido those types of symptoms.

What are some of the top issues my doctor might address during an annual well-check visit?

So during an annual well check visit your doctor will try to cover all these bases so it is usually a lot of questions and answers. They will go over everything such as the preventative stuff so we are talking cancer screenings, recommendations for you with your family history, vaccines, body weight, blood pressure, look at some general labs, sugars, cholesterol those types of things and help you get a picture of the next 10 years of what things we can do to help keep you as healthy as possible and to decrease any of your risks. So that's what a lot of the annual visit would be about.

What health problems does having a sedentary lifestyle put men at risks for?

Sedentary lifestyle we all are victims to it. Everything is becoming technological. You don't have to get up to change the TV, you don't even have to get up to talk to people anymore. We Skype we do all these different things. So we're really engineering activity out of our lives. Even bicycles have motors and their so efficient now it's pretty easy. The main problems is weight gain. If you’re not being as active you’re not getting your heart rate up and getting it to work hard. It is not allowing the body to develop some of the physical fitness it needs, the muscle mass and all those issues. The main problem we see here are the blood pressure, cholesterol, sugars going up but actually we have a lot of studies linking decreases in exercise and activity levels to cancers and heart disease.

What medical effects can low testosterone have on a man’s physical and mental well- being?

The medical effects are similar to the symptoms that you’re having. So physically it can be harder for you to exercise, maybe you go out to exercise and then you feel tired for the next couple of days or maybe you get injured more easily you’re not recovering quite as well. So if your battling with those issues all the time it becomes hard to do the things we want to do, to get exercise that is recommended for men in particular. Mentally you can feel signs of irritability and depression. If it is truly a hormonal level that is making it hard for you to kind of brush things off or see the sunnier side of life we have something that can help treat that. So that is why when you are going to see your doctor he is going to ask you a lot of questions probably check some of the labs to make sure other things are not at play. Either things like your thyroid or other issues as well. But if it does turn out to be low testosterone then you can have a conversation about whether it would be beneficial for you to get that treated.

What can we do to combat a sedentary lifestyle?

Honestly it is all about being intentional, it is very hard as we said earlier life is set up to be sedentary. So keep in mind some of the guidelines that recommended like men get two and a half hours, that's a hundred and fiftyminutes of aerobic exercise. That is your walking, swimming, biking, any of those types of things every week and you also want to get at least two days or more muscle strengthening. You don't have to do them at the same time, you can break it up, but those would be some of the really important things. So getting a schedule, or friend, a work out buddy or two, somebody that will help keep you accountable. Because it is always easy to convince yourself at six in the morning that those extra 30 minutes of sleep is going to do me better than that 15 minute walk, so someone there that is going to help push you through and these activities levels are not anything too strenuous. The guidelines say just moderate intensity for most men that's just getting your heart rate up to 60 to 90 beats. But before you start any of these activities you should touch base with your primary care provider just to see if there would be any issues that would either prevent you or that you need to build up to more gradually.

If you are interested in learning more about these issues, or any other men's health issue request an appointment with Dr. Svestka or on of our other SIMED Primary Care providers, an appointment online.

Melanoma/Skin Cancer Detection and Prevention Month

Melanoma/Skin Cancer Detection and Prevention Month

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

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

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

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

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

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

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

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

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

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

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

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

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

National Women's Health Week

National Women's Health Week

We sit down with SIMED Women’s Health gynecologist Dr. Meera Nair as she answers some questions about the benefits of keeping up with an annual women’s wellness exam as well as reminding us it is never too early or too late to take control of our own health. 

Why is it important to have an annual women’s health visit?

“An annual visit with your women’s health physician provides an excellent opportunity to evaluate your current health status and seek out advice about:

  • Identifying Medical Risks/Problems
  • Minimizing Health Risk Factors
  • Promoting Prevention Practices
  • Maintaining Healthy Life Style

Despite certain components of the annual women’s wellness exams no longer being recommended annually, like pap smears, a visit and exam with your physician is still important."

What occurs at an annual well-woman visit?

“An annual wellness women exam includes:

  • Health History – Yours and Family’s Screening Evaluation
  • Renew and Update of Immunizations
  • Specific Components Depend on the Age and Risk Factors Identified (cardiovascular, breast, genitourinary, pelvis, etc.)”

At what age should a woman begin having annual visits?

“Most adolescent girls should start visits between 13 and 15 years of age, subsequent visits annually. The care given depends on the sexual, physical, psychological and cognitive development of the girl. Usually the pelvic exam is avoided at the initial visit unless there is a specific indication.”

How do well-visits change at different life stages?

“Well woman care changes depending on the age and risk factors of the age group. For example during adolescence the visits focus more on counseling about mental health problems like:

  • Healthy Eating and Fitness Habits
  • Risk Avoidance Immunization
  • Safe Sex Counseling
  • Bullying
  • Substance Abuse

Pelvic examination may or may not be done depending on the specific situation of the patient. As age advances, the management of health care changes to include issues like:

  • Fertility Issues
  • Cancer Screening
  • Bladder Function
  • Sexual Function
  • Menopause
  • Osteoporosis

As a woman’s body changes through life, their mental health is an important component to their sense of wellbeing."

How is this addressed?

“An evaluation of mental health is an intercal part of a woman’s annual wellness visit. This evaluation can include (but not limited to) mental, emotional, behavioral and/or medical issues such as:

  • Relationship Issues
  • Domestic Violence (school or work related violence)
  • Sources of Stress
  • Depression
  • Anxiety
  • Sexual Health Related Issues

What are 5 wellness tips for women of any age?

Dr. Nair says that the top wellness tips for all women are:

  • Eating Healthy
  • Regular Exercise
  • Safe Sexual Practices
  • Continue Annual Well Woman Care and Screening
  • Maintain an Open Communication with the Physician in Case of Any Concerns

What are some of the most common health problems in women's health?

"The common health problems differ in different age groups but the most general are:

  • Heart disease is the leading killer of women, responsible for about 29% of deaths, reports the CDC 
  • Breast cancer is the most common cancer in women. It is second to lung cancer as the leading cause of death for women 
  • Depression appears to affect more women than men. The National Institute of Mental Health reports that about 12 million women are affected by a depressive disorder each year compared to about 6 million men.
  • Osteoporosis is common for all women as they age. Loss of height and hunched back can be prevented.
  • Decreased estrogen following menopause contributes to vaginal dryness and/or bladder dysfunction" 

Dr. Nair would like to see us take control of our health this year! If you’re not sure how to start or need help formulating a safe plan designed for your needs, start by scheduling an appointment with a Gynecologist or Primary Care physician today! Click here to request an appointment online.

World Immunization Week

SIMED Primary Care physician, Dr. Robert Balbis, uses his global perspective to provide input on World Immunization Week.

This week is World Immunization Week. Even though certain vaccinations have been developed, they have yet to become readily available in some countries. The World Health Organization has dedicated this year to "closing the immunization gap."

SIMED Primary Care physician, Dr. Robert Balbis, uses his global perspective to provide input on this topic. Dr. Balbis has traveled during his military career and mission trips to Panama, Iraq, Saudi Arabia, Kuwait, Ethiopia, Guatemala and Nicaragua.

The Most Impactful Vaccine

"Most of my peers have not seen a pretty horrific disease called Polio," Dr. Balbis said. "I've been able to see Polio in Ethiopia and Central and South America. It is debilitating. It doesn’t have to kill; it can leave you non-ambulatory with an extremity that’s withered."

Dr. Balbis's opinion is that the Polio vaccination has been the most impactful immunization for humanity.

"I've seen the impact one child with Polio has on a whole village," Dr. Balbis said. "It's not just one individual who's affected by Polio – it’s the whole family that has to provide for this child to live, because there isn't a social system prepared to help people with these disabilities."

In 1988 more than 125 countries were endemic with polio. Now the World Health Organization has determined that only 2 countries (Afghanistan and Pakistan) remain polio-endemic. "On a global scale, Polio has been mostly eradicated, but it's still in existence in some areas, and to see that makes you realize how much of an impact it has made in this world to be able to immunize people from Polio," said Dr. Balbis.

The Vaccine With Potential

A more well known vaccine in Western societies is the Gardasil vaccine which immunizes against Human Papilloma Virus (HPV). HPV is the "most common viral infection of the reproductive tract," stated Dr. Balbis.

"There's currently a lot of ongoing research on the HPV virus and the Gardasil vaccine," said Dr. Balbis. "That has a very big impact, on a global scale. HPV is more than genital warts. Almost all cervical cancers are associated with HPV. Also people with HIV have diminished ability to fight HPV infections.”

"Another aspect of HPV that many people don’t realize" said Dr. Balbis; "is that if more people were HPV vaccinated, the prevalence of throat and neck cancers would likely decrease, since a lot of throat cancer is HPV mediated."

The Vaccine We Need

"I think right now, a vaccine against malaria would be huge. We're talking thousands of children dying from it," says Dr. Balbis. "The top killers in the world are TB, malaria, and diarrhea."

The Vaccine You Need

When it comes to what vaccinations you should consider getting, Dr. Balbis wants patients to talk to their healthcare provider about their individual lifestyle.

"As a physician, I take into account each person's individual needs," Dr. Balbis says. "For example if your sister has a baby, she would want you to be vaccinated towards diseases that would be devastating for the child, like diphtheria and pertussis (whooping cough).

Most immunizations work by exposing your body to a little bit of the disease process – not the entire disease process, so that your body's immune system develops antibodies against that portion. The next time your body is exposed to the disease, it’s more capable of fighting it. The portion exposed to your body during the immunization is not enough to cause the disease.

SIMED offers a variety of vaccinations to patients in North Central Florida. Here is a list of the most common vaccinations offered:

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

Schedule an appointment with a SIMED Primary Care physician to review what immunizations are appropriate for you. Click here to request an appointment online.

Sleep and Heart Health

Sleep and Heart Health | SIMED Health

According to the National Sleep Foundation over 18 million Americans suffer from some type of sleep disorder. SIMED Sleep Medicine’s Dr. Larissa Lim weighed in on how quality of sleep can have serious implications on your overall health.


Sleep and heart health are closely intertwined.  A study has shown that adults who slept less than six hours per night were twice as likely to have heart attacks or strokes as people who slept six to eight hours per night.  Patients with untreated obstructive sleep apnea are at higher risk of developing congestive heart failure.  Obstructive sleep apnea has also been linked to hypertension and cardiovascular disease.

Proper sleep hygiene is important. Many Americans suffer from chronic sleep deficit. Dr. Lim has some tips for proper sleep hygiene:

  • Set a bedtime and wake-up time allowing at least 7-8 hours of sleep with 30 minutes set aside for falling asleep
  • Avoid caffeine after lunch 
  • Sleep in a dark, quiet, and cool room 
  • Avoid alcohol at bedtime 
  • Limit use of electronics at bedtime including computers, TV’s, smartphones, and tablets as they tend to delay bedtime

The warning signs of obstructive sleep apnea include loud snoring, daytime sleepiness, waking up gasping or choking, waking up with morning headaches or dry mouth, getting up to urinate, and frequent awakening.

If you have disturbed sleep, or are waking up tired after a night of sleep, a diagnostic polysomnogram, i.e. sleep study is the gold standard test to evaluate for a sleep disorder. There are a few different options for treatment of sleep apnea. Most patients find continuous positive airway pressure or CPAP provides the best method for returning to a long restful night of sleep.  

Sleep is important not only to your heart but your health in general.  Thankfully, achieving good sleep is something we all can do. Contact your SIMED physician to talk about your risk factors for sleep disorders. Set up an appointment at SIMED Sleep Medicine to discuss your questions and concerns with one of our board certified sleep medicine specialized physicians.


Author: Dr. Lim, ABIM Board Certified in Internal Medicine and Sleep Medicine 

Women and Heart Disease - Could You Be At Risk?

Women and Heart Disease - Could You Be At Risk?

Each year, heart disease, kills over 400,000 American women, which is "approximately the same number of women as the next three causes of death combined, including all forms of cancer," according to the American Heart Association.

SIMED Physician, Dr. Timothy Elder, suggests women should know their risk, so they can be proactive about preventing or slowing the progression of heart disease.

"It is very common to have heart disease," says Dr. Elder. "A lot of times, women hear about breast cancer and not about heart disease. I think it's important to understand that it is a big issue."

Dr. Elder says it’s critical for women to know their risk factors, since many of them do not have obvious symptoms. The most typical risk factors are being overweight, having a family history of cardiovascular disease, having diabetes, high blood pressure, high cholesterol or use of tobacco.

Why focus so much on risk and prevention?

Because heart disease is not curable.

"I always compare it to a car being in a car accident. You can get the fender and everything fixed, and it looks good, but the car still has some damage to it. You can definitely live with heart disease – you just have to do the right things to modify your risks. There are things that we can do to decrease the severity of it, but it never goes away."

While you can decrease plaque build up in arteries with certain medications, the better option is protecting yourself, starting at an early age.

Dr. Elder recommends that younger women get into a regular exercise routine, understand what their weight should be for their height, and aim to maintain that. He also recommends being more aware of what you eat.

"A lot of American's diet can be improved upon. Understanding chloric intake, and paying more attention to nutrition and diet [is important] because it lays the foundation for the rest of your life," says Dr. Elder.

In addition to those preventative measures, Dr. Elder wants middle aged women to take other steps towards living a heart-healthy life.

"As you're getting older, diet and exercise are still very important, but also checking in with your doctor and doing the basic labs and preventative wellness visits, monitor how effective your efforts have been and to discuss things you could do to improve," says Dr. Elder.

Maintaining a healthy diet, a regular exercise routine, low cholesterol, managing chronic comorbidities– such as diabetes, heart disease, hypertension, and avoidance of tobacco are key.

"It's all about risk factor modification," says Dr. Elder. "The risk factors are pretty common things, and they're easily treatable. The earlier one begins, the easier to control those comorbidities."

If you're concerned about your heart health the first step is to visit your doctor and voice your concerns.

"I always recommend being very straight forward and honest with your doctor, ask 'what is my risk for heart disease?' and 'What can I do to decrease my risk? I think those are good starting points for patients to talk about with their doctor," says Dr. Elder.

If you haven't discussed heart disease and your risks with your physician recently, do not wait. Take an active role in your health and make an appointment today.

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Dr. Noone's New Year's Weight Loss Resolution Tips!

SIMED's Primary Care Dr. Noone's New Year's Weight Loss Resolution Tips!
Some of the top New Years resolutions of 2015 were to lose weight, to enjoy life to the fullest, and to get fit and healthy. The percentage of people who achieve their new year’s resolution is only 8% (; this leaves a lot of room for improvement! SIMED's Primary Care Tenley Noone, MD gives us some pointers on how to succeed at achevieng our New Year's goals for 2016.
Dr. Noone's simple rules to help you for weight loss. Avoid all the 'white' foods such as pastas, potatoes, rice and breads. This rule works because carbohydrates are directly metabolized to fat. Instead include lots of protein and raw and fresh fruits and veggies. Raw fruits and veggies have more fiber can help negate some carbohydrates. I recommend that when you need to, have a small amount of pasta over a bed of fresh spinach to keep your carbohydrates low and get the fiber which will help keep you fuller longer. Another tip is to remember it takes roughly 10 calories to maintain one pound of body weight, so if you're hoping to weigh 150lbs., that means taking in 1500 calories per day. This can help you avoid pitfalls like sodas, sweet tea, and that piece of cake with its 300 calories that is only feeding your 3 extra pounds.
Feed Your Brain!  Enjoying life to fullest isn't possible without a happy healthy brain, and the best way to help keep your brain help is to feed it. Reading is a great way to start improving memory, challenge yourself to tackle a book a month. Moderate cardiovascular exercise is the best way to increase blood flow to your brain, challenge yourself to try something you haven't done before such as yoga. Yoga can be a great way to get both your blood flowing and your mental focus sharpened, not to mention improve your balance, length your muscles and improve circulation and can help achieve the third most popular new years resolution of staying fit and healthy.
Let's Go Streaking!  No, not that kind of streaking!  A new trend in fitness called “streaking” works well here too. Streaking refers to going on a workout 'streak', seeing how many days in a row you can work-out. As long as you vary the intensity and type of workout this can be a very healthy, challenging goal and a good mental work-out as well. Keys to success here are finding a good group of workout buddies for motivation and keeping your mental drive strong. Lots of groups are available online and locally, just look for anyone involved in running clubs, walking clubs, or workout classes. Some tricks to help keep you going are to visualize where you'll be one year from now, or to commit to a distant goal like a 5K race, a surf vacation, a mountain hike, or yoga retreat, and probably the most important is surrounding yourself with motivating pictures, quotes, and any excuse-kicking material you enjoy.
Breathe In.  Breathe Out.  Another weight loss tool to incorporate in your program is lung strengthening and conditioning. Your lungs are your weight loss wonder. We metabolize lost weight into carbon dioxide which we exhale in our lungs, so try to include an exercise that gives your lungs and work, like deep breathing or running, and try to avoid things like smoking which is damaging to your best weight loss organ.
And finally please recruit your family physician at SIMED Primary Care to help guide you to your goals as they can be a very value resource of information and motivation.
To schedule an appointment with a SIMED Primary Care provider please contact (352) 224-2225 or to request an appointment online please click here.     

Beat the Heat!

SIMED Primary Care explains how we can manage "Exertional Heat Illness" and reduce our risk during the growling dog days of summer.

Living in Florida means we are no strangers to hot and muggy days especially in the summer months, but as the temperature climbs so does our risk of heat illness. SIMED Primary Care's Eric Svestka, M.D. looks into what ways we can manage "Exertional Heat Illness" and reduce our risk during the growling dog days of summer. 


Exertional Heat Illness is a continuum, from irritating muscles cramps to life-threatening heat stroke.  The American College of Sports Medicine has guidelines to help recognize who is at the greatest risk and what we can do to prevent falling victim to the heat.

Some factors that increase your odds of being affected include:

  • Being active outdoors on warm, humid days
  • Poor physical fitness
  • Dehydration
  • Being over weight
  • Certain medications

The way to stay out of trouble with the heat is to plan ahead and follow these simple rules:

  • Gradually increase the duration of time spent in the heat and the intensity of the work you are doing.  It takes about two weeks for your body to adapt.
  • Hydrate before going out into the heat and keep hydrating through out your activity.
  • When possible try to plan your outdoor activities when temperatures are at their coolest, early mornings are best.
  • Wear clothes that are designed to help keep your body cool.
  • If you are beginning to feel exhausted or lightheaded while you are outside STOP what you are doing.  Go inside, or get to a shaded area, and cool off with a cold water or sports drink. 

When beginning a new workout program, or just increasing your activity level, be sure to include a chat with your Primary Care Physician in your preparations.  Not only can they help you come up with a personalized plan, but they can help you recognize potential risks in your medical history and with any medications you may be taking.


Whether we are out having fun in the sun, exercising, or our jobs have us working in it, let's come up with a plan to beat the heat!


For locations and contact info please visit us at SIMED Primary Care or to request an appointment online with Dr. Svestka please click on link online appointment request.