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

Flu season's on the near horizon, please see below for our update on flu vaccinations. (Thank you for your patience with the high-dose vaccine!) It's hard to believe, but the holidays really aren't too far away either. In light of the increased amount of food soon to be placed before us, please check out Dr. DeLaney's article on intermittent fasting. Heard a lot about vaping in the news lately? Read Dr. Katzman's article on the recent health concerns associated with vaping. And lastly, National Drug Take Back Day is October 26. More information on this is below as well. Wishing you a happy and healthy fall! 
Flu Shot Information and Update

It's estimated that during the 2017-2018 flu season, the flu shot prevented 7 million illnesses and over 100,000 hospitalizations. An annual influenza vaccination (flu shot) is recommended for all people 6 months or older who do not have contraindications. It's particularly important for anyone 50 and older and /or those with a compromised immune system or chronic health condition, those who are pregnant, those living in a long-term care facility, and those living with or caring for people in these categories. The flu season tends to peak starting in December, so it's important to get your flu shot before that time.

For those 65 and older, we are still waiting on the high dose vaccinations to arrive. We apologize for the delay and appreciate your patience. We will be in touch as soon as those come in.

If you are younger than 65 and have not yet received your flu shot, please call us to schedule an appointment. We still have two flu shot clinic dates approaching: Tuesday, 10/22 and Wednesday, 10/23 both from 9:00-11:45 a.m. and 1:15-3:45 p.m.
Intermittent Fasting and Restricted Feeding
Jennifer DeLaney, MD  

Many people struggle with weight gain, high sugars, and abnormal liver tests associated with fat in the liver and abdomen. Abdominal fat, elevated sugars and fatty liver are caused by problems in your metabolic response to food and stress. People with excess abdominal fat are at higher risk for cancer, diabetes, heart disease, cirrhosis from fatty liver and many other health problems.

There are several ways to improve your health and lose that abdominal fat. Daily exercise, adequate sleep, and a diet that is low in sweets and starch can often help. But, as many of us can attest, conventional good behavior may not be enough to correct abdominal fat and the associated inflammation and disease risk that comes with it. 

Extensive medical research into longevity and health has shown that the time honored practice of fasting can help where other strategies fail. Time restricted feeding (reducing meals to an 8 hour window a day) can help reduce cholesterol, abdominal fat, blood sugar and fatty liver. Longer periods without eating, like eating one meal a day 1-2 days a week can be even more successful at combating metabolic problems.

There are several good books on altering diet composition and timing to help with health. These include The Longevity Diet by Valter Longo, PhD, a scientist at USC, and The Complete Guide to Intermittent Fasting by Jason Fung, MD.  

Vaping and Serious Illness 
David Katzman, MD

Electronic Cigarettes (e-cigarettes, "vaping") are electronic devices that usually deliver nicotine, but can also deliver THC and CBD, the active ingredients in marijuana. They consist of a cartridge containing a liquid with dissolved drug and possibly a flavoring, and a heating/vaporizing element. Most e-cigarette users perceive them to be a tool to reduce or quit their smoking or reduce the harmful effects of cigarette smoking.

No studies have examined the long term harmful effects of vaping, but the risk of cancer is likely to be much lower than with traditional smoking. Data from long term studies of chronic users of nicotine replacement products (gum, patches) do not suggest that chronic nicotine exposure increases heart disease or cancer.

However, this year over 1,000 cases of severe lung injury linked to vaping have been reported, including several deaths (one at Mercy hospital here). In most cases, the substance inhaled was THC though many also had inhaled nicotine, and some nicotine only. The exact cause of these illnesses are still unclear but likely stem from the vapor exposure. 

It is strongly recommended that recreational use of e-cigarettes not be initiated. If already using, they should not be purchased on the street or have any substances added to the commercially available product. It is also suggested that current users transition to other nicotine delivery systems, such as the patch or gum, with attempts at weaning off of these as well. 
National Medication Take Back Day

Do you have any expired and/or unused prescription or over-the-counter medications lying around your house? Wondering what to do with them? Should you flush them or throw them away? There's a better and healthier solution. National Drug Take Back Day will be held on October 26. This is a great chance to properly dispose of these unwanted medications.

Why is this important? Whether it's a grandchild thinking it's candy, a teenager looking to distribute opioids at school, or a family pet digging in the trash, these meds can wind up in the wrong hands. Getting your expired or unneeded meds out of your house can help to protect those you love. Flushing your medicine down the toilet might seem like a good way to do this. But did you know that when medications are flushed down the toilet, they leach into the water supply? This can affect our drinking water, shower water, and the water in local streams and lakes. To protect not only our general health and wellness, but also that of the world around us, the FDA discourages the flushing of most meds.

Help keep your loved ones and our environment safe by taking your meds to one of these locations on October 26. If you aren't able to take them back on this particular day, there are many local collection sites that will take your meds year-round. Just remember to pull off the sticker with your personal information before turning them in. 

Office News

Please Note: We recently switched phone carriers. Our main number 314-993-1200 and our fax number 314-993-1240 will remain the same. If you have any of our alternate office lines saved in your phone, please change that number to our main number. You will soon be getting an out-of-service message if you attempt to contact us by those older numbers. We apologize in advance for any inconvenience.

Secondary Address: If you have more than one address, please make sure we have both on file here at the office. This is helpful when trying to get prior authorizations approved or ordering durable medical equipment. Otherwise, these may get denied by your insurance. Please call our office if you need to update this or email Marsha


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. I
f 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. 
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