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David Katzman, MD & Jennifer DeLaney,MD
Internal Medicine Specialists


Dear Friend,
The holiday season is winding down and most of us are probably left feeling a bit exhausted from all of the celebrating. Take a deep breath and make some time for yourself! Why don't you give yourself a gift--the gift of making healthy choices--a gift you won't regret and has priceless feel-good benefits! This New Year choose to have your annual physical check-up. Choose to eat better. Choose to incorporate exercise into your daily routine. Choose to be healthier!

Do I Need to Get a Pap Smear Every Year????
David Katzman, MD
I often get asked this question, with the hoped-for-answer being “no.” Traditionally the answer has always been “yes”. However, given our better understanding of the nature of cervical cancer and newer diagnostic technology, annual pap smears are no longer necessary for most women.
A pap smear screens for cervical cancer. The major risk factor for developing cervical cancer is the presence of the Human Papilloma Virus (HPV) which can be detected at the time of a pap smear (and also now vaccinated against, a topic for another article). This virus is more prevalent in sexually active younger women with over 40% of women getting infected with this virus at some point in their lives. Your body’s immune system typically clears the virus within 8-24 months of infection. Given that the inflammation will resolve when the infection is cleared, researchers found that more frequent testing led to false positive results and more unnecessary biopsies and invasive procedures.

In healthy women, it is now recommended that PAP smears begin at age 21, regardless of sexual activity. PAP smears are then performed every 3 years until age 30. After age 30 it is now recommended that PAP smears be performed every 3 years, or every 5 years if testing with both the PAP smear and HPV testing. At age 65, all PAP testing can be stopped if the prior 3 tests were normal, and the most recent test within 5 years—provided there are not any compelling risks for cervical cancer.
So do I need to see my GYN every year? I think for cancer screening the answer is “no” given the above recommendations, and the fact there is no reliable way to screen for ovarian cancer on exam. However, your Gynecologist is a great resource for other women’s health issues such as menstrual or peri-menopausal issues, breast and bone health, and sexual health issues to name just a few.

What Should My Blood Pressure Be?
Jennifer DeLaney, MD
29% of all adults in the US have high blood pressure, and more than half of all people over 65 have hypertension. Hypertension is defined as systolic, or upper number, greater than 140 and diastolic, or lower number over 90. Normal blood pressure is defined as 120/80 or less. A large recent study has suggested that people who are treated for hypertension whose pressures are kept in the normal range (120/80 or less) have fewer strokes and heart attacks than those whose pressure control is less strict. So what should you do to control your pressure?
• Exercise regularly
• Eat a diet that is high in potassium-- including leafy greens, potatoes, squash, yogurt, fish and bananas. The DASH diet has been shown to reduce pressures. Click here for the DASH diet overview
• Maintain your ideal body weight-- losing even 5 pounds can have a clinically significant impact on your blood pressure
• Eat a diet that is low in sodium--anything in a box, bag, or can has sodium in it. Be careful to read labels. Your goal is less than 3000 mg a day.
• Breathing techniques can significantly lower blood pressure. Click here for instructions on breathing techniques to lower pressure
• Control stress levels
• Avoid drugs that raise your pressure, like hormones, anti-inflammatories, decongestants, or medications for ADD.
• Monitor your pressure regularly if you do have high blood pressure. If you don’t, get your pressure checked at least once or twice a year.
• Call us if your pressures are consistently high. Remember, everyone’s pressure typically varies by 40 points in a day. Even people without hypertension will have occasional high numbers.

Book Review
 How to Live a Long and Fulfilling Life
 The Blue Zones Solution by Dan Buettner

Jennifer DeLaney, MD
People often ask how to live a long and fulfilling life. Here is a book that will help you achieve this goal. Dan Buettner is an investigative journalist who studied the behaviors and diets that are associated with the 5 cultures that have the most people living beyond age 100. The communities included an Island in Greece, Sardinia in Italy, Okinawa in Japan, Costa Rica and Loma Linda, California. These communities had numerous traits in common including active lifestyles, stress reducing habits like meditation, having a purpose in life, having a strong social circle and family ties, moderate alcohol consumption, and eating a predominantly plant based diet with only occasional meat consumption. Buettner then took these ideas and implemented a program to enhance the health of a sedentary town outside of Minneapolis. Interventions included establishing social groups based on common interests, enhancing community spaces to encourage physical activity, and cooking classes to name just a few. The results were remarkable. This book is easy to read and inspiring. It also includes numerous recipes that help you plan healthy plant based meals so you can implement these changes at home.  
Is Testosterone Supplementation the Fountain of Youth?
David Katzman, MD
I think it is generally the case that as men age, their energy, muscle mass and function, and libido and sexual function will often diminish. Testosterone levels decline naturally with age, although they generally remain in the normal range. This has led to the anti-aging industry to promote testosterone replacement to restore men’s youth. However scientific research does not clearly show that testosterone replacement changes these bothersome symptoms of aging and studies have not shown benefit for sexual satisfaction, erectile function, or muscle strength with testosterone treatment.
Testosterone use certainly comes with significant risks. Testosterone supplementation has clearly been shown to worsen symptoms of BPH and can increase your risk of prostate cancer, worsen sleep apnea, and increases the risk of heart attack and stroke, particularly in men who take it via injection.
So what to do? I think if one has “significant” quality-of-life problems with energy, libido or sexual function it is reasonable to check testosterone levels. If three such levels are below normal then it may be appropriate to consider supplementing the testosterone if you do not have significant cardiovascular risk factors, high risk of prostate cancer or problems urinating. Supplement users would need to carefully track their symptoms to see if the benefits of the drug outweigh these risks. Many men don’t notice any symptom improvement on testosterone, and those men should not continue treatment. If the benefits to the quality-of-life are great, continued therapy would likely outweigh the risks outlined above. If not, then the symptoms are likely due to aging rather than testosterone deficiency and the supplementation should be discontinued.
Men who are maintained on testosterone replacement, need an initial evaluation and regular follow up for assessing BPH symptoms, prostate cancer, cardiac risk factors and blood abnormalities that can be induced by testosterone supplementation.

Office News
*Holiday Office Hours:                                                              
Closing at Noon on December 31st.
Closed on January 1st. 
*Drug Recall
A voluntary recall of all Auvi-Q and Allerject epinephrine auto-injectors.There is concern that the devices may deliver inaccurate dosages, or may fail to deliver any drug at all. Please return these devices to your pharmacy! Call 1-866-726-6340 or visit the website for questions and reimbursement information. 
*Insurance Card Updates
The office will be asking to see your insurance cards at your next visit. We apologize for the inconvenience, but it is necessary to have the correct and updated information so we can get approval for your medications and diagnostic testing in a timely matter. 
*Be Careful in Choosing Your Individually Purchased Insurance                          If you are in an HMO or have purchased an HMO based Medicare Advantage plan such as Medicare Complete through a private insurance carrier we may not be able to order any diagnostic testing or refer you to a specialist. Only the primary care physician assigned by your HMO can manage those services needed. This can be very frustrating and time consuming for all parties involved. Please check with your insurance carrier if you have any concerns.
*Billing Questions
Please Contact Tonya for any questions concerning your account. She will be available to return your calls on Wednesdays and can also be reached via e-mail
*Office Website
Please visit our website if you missed last month's newsletter! The newsletter archives can be found by hovering your mouse over the Medical Links tab. You will also find here links to several reputable websites with the latest medical news and health information. 

HMO (Health Maintenance Organization) vs. PPO (Preferred Provider Organization)
Be careful when choosing your individual health insurance plan. Unlike a plan through an employer, individual health insurance is something you select and pay for on your own. Seniors can also get their health coverage either through Original Medicare or a Medicare Advantage plan which is sold by private insurance companies. The most common types of plans are either an HMO or a PPO. If you have a choice between these two types of plans, consider your medical needs, income and take a close look at the network to determine if the choices of doctors and medical facilities meet your needs. HMO’s tend to be more affordable, but you’ll usually get less coverage and more restrictions.

An HMO insurance plan consists of a network of doctors and facilities from which you can receive treatment. Visiting a physician or facility outside of that group of providers means you foot the entire bill yourself, except in the case of an emergency. HMO plans can also be limiting because they require you to select a primary care physician who will refer you to specialists when you need additional treatment. Your insurance won’t cover specialist visits without a referral. Basically if you go out -of -network for service, those charges won’t be covered at all!

PPO’s are more flexible and provide greater coverage, but may come with a higher price tag and most likely a deductible. PPO plans offer customers a more extensive network of doctors and hospitals to choose from and you aren’t restricted to a single primary care doctor, which also means you can visit a specialist without first getting a referral. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers and will still pay if you see a non-network provider, although it may be at a lower rate.

Medicare Complete is the brand name for United Health Care’s family of Medicare Advantage Plans, many of which also carry the AARP brand. At a minimum, they offer the same coverage as Medicare Parts A and B, and in some cases include a prescription drug component as well.
Medicare Advantage plans are substitutes for the Original Medicare coverage and were authorized by Congress to shift some of Medicare’s cost burden to private insurance companies. Medicare participants who enroll in a Medicare Advantage are covered directly by the private insurance company offering it, to which Medicare pays a premium.
Many of these plans also offer vision, hearing, and dental-that aren’t included in Original Medicare. Some also offer preventive care and wellness programs. Do your homework! The benefits offered by each plan vary greatly, depending on their service area.

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