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


Finally, the weather's warm! Since one of May's awareness campaigns is physical fitness and sports, it's a great time to get outside and get more active. The American Heart Association recommends a goal of 150 minutes of moderate exercise or 75 minutes of intense exercise a week for most adults, along with 2 days of strengthening exercises. This can be broken up into small, manageable intervals -- such as a brisk, 10-minute walk around the block. As your outdoor activity increases though, don't forget to keep yourself safe while outdoors. Break out your sunscreen, as May is also skin cancer awareness month, and see below for tips on tick prevention. Here's to some happy, healthy outdoor fun!

Measles Vaccination: Who Should Get a Booster? 
Jennifer DeLaney, MD

There have been recent outbreaks of measles in New York, Washington State, and California due to a combination of both international travel bringing the virus and unvaccinated people. There have been 700 cases in the U.S. this year.

The current recommendations are that people born before 1957 do not need to be tested for immunity. Ninety-nine percent of people who received 2 shots of the live MMR vaccine in childhood are immune. People born between 1963-1967 may have received the inactivated vaccine, which is less effective. If you were born between 1963-1967 and you do not have your vaccine records, we can check your blood to see if you are immune to the virus. All women who have been pregnant and received obstetric care during pregnancy were tested for immunity to measles during their pregnancy. Therefore, if you are a woman who has been pregnant and received routine prenatal testing, you do not need to get a titer drawn to assess immunity to measles unless you are a healthcare worker.

At this point, the only people who need testing or a booster vaccine are people who were not vaccinated in childhood, those born in 1963-1967 who are either male or have not had a pregnancy with prenatal blood testing, college students who do not have documentation of vaccination, and healthcare workers. If you fit into any of these categories, please let us know and we can arrange for testing and possible vaccination. 

Sleep and Your Health
David Katzman, MD  

There are many ways that we can alter our behavior to improve the quality and length of our lives. While proper nutrition and exercise are often the focal points, getting insufficient sleep often gets overlooked. Although experts recommend 8 hours of sleep per night, 30% of adults report sleeping 6 hours or less. While we all have likely experienced the fatigue, irritability, and decreased attention that inadequate sleep brings, the long-term health effects are often underappreciated.

Insufficient sleep is associated with accidents and workplace errors. Drowsy driving is the cause of substantially more car accidents than alcohol. Studies also suggest insufficient sleep may contribute to several chronic diseases, including cancer, heart disease, and dementia. Inadequate sleep depresses the immune system, which leads to an increased incidence of cancer, infections, and slower wound healing. Inadequate sleep also promotes inflammation, leading to increased risk for cardiac disease, high blood pressure, and high cortisol levels. Finally, fatigue slows your metabolism and leads to poor food choices, which contributes to obesity.

We can improve our lifespan and healthspan by allowing at least 8 hours of sleep per night. In addition, for these 8 hours to promote the restorative and health benefits of sleep, we also need to get the proper phases of sleep including REM sleep and deep sleep. This can be achieved by practicing good sleep hygiene and avoiding sleep medications and alcohol, which seemingly help sleep but in reality disrupt the normal stages of sleep.

Two additional points are worth mentioning. First, caffeine has a 6 hour half-life. This means 12 hours after it is consumed, there is still 25% in your system. In other words, it's like you are drinking 1/4 of that 10 a.m. Starbucks at your 10 p.m. bedtime. Second, you cannot store sleep. "Binging" sleep on the weekends does not restore your health after 5 days of "limited" sleep received during the week.

If you would like to learn more about all of this, feel free to contact us or check out the fabulous book Why We Sleep by Matthew Walker, PhD. 

An Uptick in Tickborne Disease
Jane Kozlowski, RN

As temperatures rise, so do our outdoor activities. But we're not the only ones who enjoy the warmer temperatures. Ticks are warm weather fans, with their peak season being from April to October.

Tickborne disease has more than doubled in the U.S. from 2004 to 2016. This increase is attributed to overall warmer temperatures, an increase in the number of hosts, reforestation of suburban areas, and human travel. The uptick continues as the CDC reported a record number of cases in 2017; there were over 10,000 more cases than 2016. The most common types of tickborne disease in Missouri are: Rocky Mountain spotted fever, ehrlichiosis, tularemia, Lyme, Heartland, and Bourbon virus. So when heading outdoors don't forget to think about tick prevention.

Try practicing these tips to help prevent tick bites:

  • Avoid bushy, overgrown areas: Ticks hang out on vegetation, waiting for a host to brush past them. When walking in wooded areas try to stick to the center of the path. 
  • Wear proper clothing: Lightweight, light-colored long sleeves and pants are recommended. Tucking your pants into tightly-woven socks adds extra protection. 
  • Clean up your landscaping: Ticks like tall grasses and leaf piles in shady, humid environments. Make sure to mow your yard and rake up those leaves that accumulated over the winter. 
  • Use bug repellent: The CDC recommends using repellent with 20% DEET and to spray your clothing and shoes with permethrin. There are several essential oils that can be used as well, such as a combination of lemongrass and eucalyptus oil. Here's a recipe to make your own. The Farmers' Almanac also suggests these oils as good deterrents as well. 
  • Inspect for ticks: Ticks vary in size from young nymphs as little as a poppy seed to adults the size of an apple seed. Check your shoes, clothes, and any gear you had with you before heading inside. Don't forget to check your pets too before letting them in. Using a handheld mirror, inspect yourself, paying particular attention to backs of knees, armpits, hairline, and groin area.  
  • Wash them away: Take a shower after being in possible tick environments to wash away any that haven't attached. Either wash clothes in hot water or toss them in the dryer on high heat for 10 minutes or low heat for 20 minutes. Heat kills ticks. 
Try to remove any ticks within 24 hours if possible. The longer the tick is attached, the higher the risk of infection. If you do get bit, follow these recommendations:
  • Safely remove the tick: Clean fine-tipped tweezers and use them to grasp the tick close to the skin. Pull upward using a steady, even pressure. Don't jerk it or twist as this could leave the mouth attached. Don't use your fingers, petroleum jelly, a hot match, or nail polish as these are not effective. After you remove the tick, clean the area with soap and water or rubbing alcohol. Either submerge the tick in rubbing alcohol or place it in a sealed bag. You may want to hang on to it for identification in case you do develop symptoms later. Wash the tweezers and your hands once finished. 
  • Mark the date of the bite on the calendar.
  • Monitor for symptoms: Watch for symptoms for up to 30 days. Symptoms include: fever, headache, fatigue, muscle aches, chills, nausea, vomiting and diarrhea. You may develop a rash as well. 
Ticks will stay on their host until full, and then pull off on their own after several days. Since they have an anesthetic in their saliva, you may not feel the bite, and there's a chance the tick may get away undetected. This is why frequent inspection is so important. If you didn't notice a bite but develop the above symptoms after being in a potential tick environment, let your doctor know of possible exposure.

Office News

Please Note: Our office will be closed Monday, May 27 in observance of Memorial Day.

Dr. Katzman/DAK Associates' Invoices: The mailing address for Dr. Katzman's billing has changed. If you currently use an automated payment method to pay your office fees, please contact your bank to change to the new address. It is listed below. As always, please include the invoice number on your check.  

David Katzman, MD
DAK Associates
8505 Delmar Boulevard
Suite C
Saint Louis, MO 63124

Updating Information: Have any changes in your insurance or personal information? Please let us know when any of your information has changed, such as email, phone number, or insurance, so we can update your file appropriately. This will help not only with better communication from our office, but also with proper authorization and billing of your lab work, medications, or outside tests. Please call the office or email Marsha with any updates. Thank you for your diligence with this! 


Medicare Issuing New ID Cards: Medicare is stopping the use of Social Security numbers for identification. This move required by law was enacted  to discourage identity theft. The new cards will be mailed to you directly with new Medicare Beneficiary Identifiers (MBIs). Please bring in your new card or let us know you have received a new card when requesting any diagnostic testing, labs, medications or other services. We will not be able to obtain authorization for services needed in a timely matter without correct card information.Thank you!

United Healthcare and Quest:
United Healthcare contracted with Quest for laboratory testing starting back in January 2019. If you have your labs drawn in our office, they should be covered according to your usual plan benefits. 

Billing Concerns and Questions: Please remember to continue to write your invoice number(s) on every check. It is ok to pay multiple invoices on one check as long as they are for the same doctor. Tonya can be reached via e-mail if you have any questions, and she is available to return your calls on Tuesday afternoons and Wednesdays.

Florida Blue and EPO's: If you have the Medicare supplement plan
Florida Blue please check the website to find out if you are covered outside of Florida. If you have coverage, check if you need to have an in network primary care physician designated to order all of your diagnostic tests. Dr. Katzman and Dr. DeLaney are not in-network. There are many health insurance plans that are considered an EPO (exclusive provider organization). This is a managed care plan where services are only covered if you go to doctors, specialists, or hospitals in the plan's network. This means you may have to pay the full cost of services provided if you use a physician out of network. Dr. DeLaney and Dr. Katzman are not in network and will not be able to order any diagnostic services for you even if the facility is in network.

Please visit our website if you missed past newsletters. The newsletter archives can be found by hovering your mouse over the "Medical Links" tab. 
Mediterranean Chickpea and Zucchini Salad

May is Mediterranean Diet month as well. Research has shown that the Mediterranean diet offers many health benefits including a decrease in: weight, cardiac disease, strokes, type 2 diabetes, and premature death. A quick google search will bring up many mediterranean recipes, but here's a tasty one from allrecipes to try.
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