-- Call us today --
(352) 394-4237

Friday, December 27, 2013

How to be Successful with your New Year's Resolution!

Estimates vary, but in general, the number of people who actually keep the resolutions they make on January 1 is low—roughly 1 in 10. In fact, most of us barely make it out of the gate: 75 percent of resolvers lapse in the first month or two. So what are 90 percent of us doing wrong, and how can we get it right this year? Here are the five most common missteps, plus experts’ make-it-stick solutions. Apply them to your 2014 resolutions to set the stage for success and a happy, healthy, prosperous New Year!

Your goal is too broad
Vowing to spend less, for example, is a wise but rather nebulous goal: Spending a penny less a day would make you successful, but it wouldn’t do you much good if, say, you were trying to build up a sizeable nest egg. “No change happens until your intentions and your goals are translated into behaviors.  Devise realistic and specific resolutions. So if your aim is to “save more,” set out to save $20 a week; if you want to feel more grateful, write daily about what makes you smile. “Focusing on the process rather than on the result will help you stay inspired.”

No one’s got your back
Did you tell anyone you were trying to be more eco-conscious or exercise more? If not, you may have set yourself for a slip. “You’re more likely to make good on promises when others can hold you accountable.”  So seek support from your friends and loved ones: Organize a carpool with coworkers to be good to the planet; add exercise to your schedule by meeting a neighbor for walks on set mornings. Chances are your friends will need your support keeping their own resolutions!

Everything else is the same
Maybe you’ve decided to cut calories, but your biggest temptation—mint chocolate chip frozen yogurt—is still calling your name from its usual spot on the top freezer shelf. Or you’re nixing cigarettes but continue to sip coffee in your favorite smoking chair. Those reminders of old habits are only making it harder to change, but switching up the scenery will help you stay the course. Behavior is often shaped more by our environment than pure willpower. Decide to eat your favorite frozen yogurt only when you’re at the ice cream shop, rather than spooning the treat out of the carton while watching TV, and move your smoking chair to a less cozy spot in the house.

There’s no backup plan
Hey, slip-ups happen to the best of us (and 75 percent of those who set New Year’s resolutions, remember?). But it’s not the lapse that matters most—it’s how you deal with it. “Successful goal getters use setbacks as motivation to recommit.” When a misstep happens, identify what caused it (you skimped on sleep, which made you snappish when you were trying to keep your temper in check) and use it as a learning opportunity to help you stay strong the next time and throughout the year (get to bed on time!). Then just get back on track.

You didn’t allow wiggle room
Specific goals are good; break-it-and-you-fail resolutions, not so much. No one can exercise every single day (your body needs a day or two off a week to recoup, and the flu happens, people!), and swearing off chocolate for the rest of your life will only make you want it more. When you set the bar so high it’s impossible to reach, failure is, well, inevitable. Build in some flexibility to your plan, so that when life gets tough—or your best friend want to split dessert on her birthday—you can still achieve your goal.

For a healthy start this year check out our Wellness Program and Nutritional Supplements.

Wednesday, December 25, 2013

Merry Christmas & Happy Holidays!

Happy Holidays from the entire staff of

 Total Family Healthcare!

Thursday, December 12, 2013

Congratulations Laura Hinson!

Congratulations to Laura Hinson in being our lucky winner in last months iLose for iPod Challenge. Our patients lost a combined weight of over 1,100 pounds last month, good work everyone!

Thursday, December 5, 2013

Happy Holidays!

In observance of this Holiday Season our office will be closed from December 24th to January 1st.

Please plan ahead to request any prescription refills prior to this time. Our physicians will be "On Call" to address any of your non-emergency health care issues that cannot wait until the office reopens on January 2nd.

We would like to wish you and your families a Merry Christmas and a safe and happy Holiday Season!

                            Dr. Edgar Cruz, Dr. Cara Jakob
                               and the entire staff of  Total Family Healthcare.

Ways to Avoid Holiday Weight Gain

Enjoy the holiday spirit without wrecking havoc on your waistline. Wishing you a Healthy and Happy Holiday!

1. Don't forget your exercise!
Regular physical activity throughout the holiday season will burn calories, tone your muscles and help you make smart food choices. Try to exercise for 5 days a week for at least 30 minutes per session.

2. Re-gift the edible gifts!
If you're watching your waistline and can't resist the temptation of sweet decadent treats in the home or office, get rid of them! Re-gift fruit cakes, breads, cookies and yes, even the chocolates! You'll save thousands of unnecessary calories over the holidays.

3. Never go to a party hungry!
Have a healthy snack before you go to the party, this keeps the edge off your hunger and keeps your blood sugar levels balanced. This way you can make better decisions at the party. The perfect pre-party snack should combine high quality, complex carbs with protein.

4. Wear something fabulous and fitted!
If you feel good about the way you look you are less likely to sabotage yourself. Of course, your clothing being a little snug helps to remind you to be good.

5. Sit with the Talkers, not the Eaters!
Remember that a party is about more than food, find those people who want to have a great conversation or those that engage in other activities like cards, ping pong or pool. Eating is contagious, you don't want to surround yourself with people there just to pig-out.

6. Watch the hors d'oeuvres!
Don't use up all your calories at the beginning of the party. Pick TWO of anything you want, then stick with less caloric items like shrimp and grilled chicken skewers.

7. Fix your plate with the right items!
Half of your plate should be veggies, divide the rest with protein and a complex carb. It also helps to use a smaller plate, that way you can go back for seconds without doing a lot of damage.

8. Eat Slow!
It has been shown that slow eaters take fewer calories at a meal than people who eat quickly.

9. Be selective!
To splurge or not to splurge. Decide which foods you really want and enjoy them in moderation, go out of your way to skip the rest.

10. Alternate alcoholic drinks with other options!
Alcohol contains many calories and also stimulates your appetite and reduces your willpower. If alcohol is a must, cut the calories by mixing it with club soda or a low calorie mixer. decide ahead of time to only have one or two drinks, alternate between alcoholic and non alcoholic drinks.

Monday, November 11, 2013

Veteran's Day, Thank You

We would like to take a moment to thank all of our Veterans for your outstanding service and all the sacrifices you and your families have made to keep our country and our families safe.

Thursday, November 7, 2013

Thanksgiving Day Survival Guide

Here are a few tips on how to eat and not feel guilty this Thanksgiving.


Save some calories from the days leading up to Thanksgiving, you do not really miss an extra 100 calories a day if you have something to look forward too. Never think you will make up for those extra calories later because it never works out that way, even with our best intentions.

Try to have an early dinner around 1-2pm and don’t skip breakfast that morning it will only slow your metabolism.

Use a normal portion size for everything you eat. Just because you love mashed potatoes does not mean that you should eat 2 cups of them right off the bat when a normal serving size is 1/2 a cup.

If there will be appetizers decide if they are really worth the calories. On average a one bite appetizer has over 200 calories!

Going to have a drink at Thanksgiving? A standard rum and coke has 350 calories, that’s more than a slice of pie!


Look at all the food before you begin eating the food.

· Are there healthy foods available?

· Is that food worth the extra calories?

· Are there low calorie beverages available?

· Are there places to sit away from the food before and after dinner?

· Are there other activities to do other than just eating?

Dinner Time:

I know it is crazy, but use a smaller plate at dinner. Dinner plates have increased in size 23% over the years, just an extra 50 calories per day on your plate can cause you to gain 5 pounds over the year. Not only does a smaller plate size keep you from over filling your plate, but it tricks your brain into thinking you eat more than you did. This is called the Delboeuf illusion, yes there really is a name for it. It even applies the  color of the plate, you will put more pasta on a white plate than a contrasting blue or green plate. Last thing, REMEMBER WHAT A SERVING SIZE IS, LOOK WHAT IS ON THE SERVING SPOON NOT THE PLATE!

After Dinner:

Look at all the food before you begin eating the food.

· Don’t snack on the leftovers as you bring them from the table to the kitchen and put them away fast.

· Don’t eat that last spoonful of mashed potatoes even if it does not fit in the tuperware, it is OK to through it away. Really!

· Getting ready to fix another plate 2 hours after dinner? Your body may be getting confused between hunger and thirst. A Thanksgiving Day Dinner has a lot of salt, I mean a lot of salt, more than you should eat in 3 days. Try dinking a big glass of water first, then let your body tell you that it is hungry or you just want to eat again because it was so good!

· Go play with the kids, go for a walk outside! Get away from the food and put your attention back on your family. Your family loves the time and attention you give them more than the food you make them!

· Food is a big part of our  Holiday Traditions. It is OK to change some of your recipes even though Mom has made it a different way all of your life. You work to hard to eat healthy and stay fit, -don’t let the Holidays or other people set all that hard work back. See our Thanksgiving recipes on our Facebook page  to help you make it through the Holidays without feeling like you are missing something. 


Monday, October 28, 2013

Types of Allergy Tests: What to Expect

Whether your allergies are seasonal or year-round, antihistamines and decongestants can only go so far. If you’re ready to seek long-term treatment for your allergy problems, below are some details on what to expect.

Initial Diagnosis
In many cases, an allergy sufferer visits his or her physician, explains symptoms, and is recommended a mild daily  over the counter allergy drug, such as Claritin or Zyrtec. This is for mild, seasonal cases and is intended as a short-term solution.

If your allergies are more severe or year-round, your physician may recommend allergy testing. Even if you do not suffer from chronic allergy symptoms you may choose to do this testing anyway, as it gives a complete picture of your specific allergens. While you’ve likely heard stories about thousands of needle pricks, allergy testing is not anything to be afraid of. There are several types of allergy tests and each test is done under close supervision.

Skin Tests
To determine the substances causing your symptoms, your doctor will likely first try the skin scratch test. A small amount of each possible allergen is placed on the patient’s skin, lightly scratching the skin with the needle to allow the allergen to go further into the skin. The doctor then waits to see if the skin swells or reddens. Since results are seen within 15-20 minutes, the patient is closely monitored during this time. However, it should be noted that occasionally the patient sees results hours after testing occurs.

If a scratch test is unsuccessful in determining a patient’s allergens or if a specific allergen needs to be tested, physicians may order an intradermal skin test, where the allergen is injected into the skin. Like the scratch test, the doctor then waits to see if there is a reaction.

A third type of skin test is called a patch test. Allergens are attached to the skin and left for up to 48 hours. This method is used when a doctor needs to test skin reactions to certain items and the doctor will usually check the skin after 24 hours, then again after 48 hours.
Naturally, the biggest danger in all of these tests is that a patient will react to a large number of allergens at once. Itching, dizziness, and occasional fainting have been reported as a result of these tests.

Process of Elimination
Elimination tests are used primarily with food allergies. The physician has a patient remove certain items from his or her diet to determine if symptoms abate. Once the item has been absent from the patient’s diet for a period of time, the physician will then have the patient gradually add the item back into his or her diet and see if symptoms return.

Elimination tests can be especially difficult in children whose parents aren’t always in control of what they eat. One simple slip-up can negate all test results, so parents need to understand the importance of making sure the child sticks to the diet at all times, even while at school or out with friends.

Blood Tests
If skin testing is not an option, a physician may prescribe a blood test to determine the presence of antibodies to certain allergens in the blood. Since this test requires only one needle, some patients prefer this method. This test, called ImmunoCAP, compares well against traditional skin tests in studies.

However, in a University of Chicago study, a few allergens were not detected as well. Those included Aspergillus fumigatus, English plantain, oak tree, lamb’s quarter, and white ash tree. The study was successful in detecting many major allergies, however, including giant ragweed and Timothy-grass.

In some instances, a patient is tested by directly exposing them to the allergen. This may be done through having the patient inhale or ingest the substance in a controlled environment, under direct supervision by a physician.

In some cases, the patient may engage in a double-blind test, where the allergen is disguised within other substances. The patient then tries a placebo and the allergen to determine if the allergic reaction is mental or physical. While this can be effective, it will require multiple visits if the patient is allergic to more than one substance. It can also be more dangerous and should only be done under medical supervision.

Once you’ve completed allergy testing, you will receive a detailed analysis of your allergens. This can help a physician develop a course of treatment that may involve creating an inoculation to help you begin the path to eliminating your allergy, as well as avoiding the substance in your day-to-day life.

If you are interested in being tested for allergies, you can make an appointment online of call us at (352) 394-4237.

Wednesday, September 25, 2013

Belly Fat! Why it is Such a Problem for Men

We think of belly fat as being a storage depot for energy that can be accessed during times of low food supply, but researchers are learning that fat is much more than that. Fat also produces hormone-like compounds called cytokines that increase inflammation. This is especially true of visceral fat. These inflammatory compounds can trigger the type of low-grade inflammation that plays a role in heart disease, metabolic syndrome, and type 2 diabetes.

How much is too much?
If you're a male, how do you know if you have too much? You don't have to be overweight to have too much visceral fat. In fact, relatively thin men can have problems with visceral abdominal fat and not know it, since visceral fat lies deep in your pelvic cavity.
The best indication? A waistline greater than 40 inches in circumference. Combine that with elevated lipid levels (triglycerides or LDL cholesterol) and high blood pressure and you almost surely have a problem with visceral fat. A 40-inch waistline is an arbitrary cutoff point for a higher risk for health problems, but it's important to take an expanding waistline seriously. A 38-inch waist can very quickly turn into a 40-inch one unless you make the appropriate lifestyle changes.

Since visceral fat produces cytokines that are pro-inflammatory, it can quietly do harm, like cause blood vessel inflammation that leads to heart disease and high blood pressure, increase insulin resistance, and promote the growth of tumor cells. There's another problem too. Some of the excess fat can deposit around the liver, leading to a common condition called fatty liver. In some people, fatty liver progresses to liver inflammation and then cirrhosis. That's another reason to keep belly fat under control.
What can you do about it?
Fortunately, if you're a male with excess visceral abdominal fat, you can reduce your risk by making appropriate lifestyle changes. Here are some things you can do to tame belly fat:
  •  Lose weight if you're overweight.
  •  Do vigorous exercise several times a week. All exercise helps to reduce visceral fat but high-intensity exercise appears to be best. Start out walking but as you build up your fitness level, alternate walking with short periods of running, gradually increasing the intensity over time. Don't forget about the importance of resistance training to help improve body composition.
  • Choose the right kinds of carbs. Avoid processed carbs that are rapidly absorbed and choose more whole foods that are naturally high in fiber, like fruits, vegetables, and whole grains. Cut back on sugar, soft drinks, and "white" foods like white rice, potatoes, and bread made with white flour. Avoid foods with high fructose corn syrup or trans-fats, present in many packaged foods. Fill up on vegetables! Veggies contain natural compounds that help reduce inflammation.
  • Cut back on saturated fats in animal foods and full-fat dairy products. Instead, choose healthier forms of fat like monounsaturated fats in nuts, olive, and avocados, and omega-3 fats in fatty fish. Substitute plant-based protein and fish for a portion of the meat you eat.
  • Cut back on alcohol. Drinking three or more drinks a day can increase visceral fat. 
The Bottom Line
If you're a man, you may have too much visceral belly fat and not know it. Measure your waistline every few months and make sure it's not expanding. If you're approaching 40 inches, it's time to make some lifestyle changes. The good news? A combination of diet and exercise will go far toward decreasing belly fat. So take a closer look at your diet -- and get moving!

Total Family Healthcare has an individualized, medically supervised weight loss program to help you get those unwanted pounds off and more importantly keep them off! Give us a call today to schedule your free consultation, (352) 394-4237.

Thursday, September 19, 2013

Signs of Adult ADHD

You routinely forget appointments and miss deadlines, you can’t stand to wait in line, and other people complain that your mind always seems to be going in a dozen directions at once. Are you just a little scattered and impatient? Or could the problem be adult ADHD?
Attention deficit hyperactivity disorder (ADHD) begins in childhood, causing trouble paying attention, difficulty controlling behavior, and/or hyperactivity. Although it’s often outgrown, the disorder persists into adulthood in as many as 60 percent of cases, according to the National Resource Center on ADHD.

Challenges in Everyday Life
Many with adult ADHD don’t know that they have a disorder. They simply know that they find it extra-challenging to get out of the house in the morning, make it to meetings on time, check off items on a to-do list, sit through a long movie, or cope with many other demands of daily life.

You may be thinking that this description could apply to you—and almost anyone else—at one time or another. But ADHD is only diagnosed when there are multiple, long-lasting symptoms that are severe enough to cause serious problems at home, work, or school. One study found that people with ADHD do about three weeks less work per year, on average, than those without the disorder. Some of that is due to more sick days, but most is due to decreased productivity on the job.

Warning Signs to Watch For
DSM-IV-TR, the standard diagnostic manual for mental health professionals, divides the symptoms of ADHD into three main categories:

* Inattentiveness. You may find it difficult to tune out distractions, stay focused, get organized, and follow through on instructions. Or you may be chronically forgetful, lose things you need, and make careless mistakes.

* Hyperactivity. You may be prone to fidgeting, squirming in your seat, and talking a blue streak.

* Impulsiveness. You may have trouble waiting in line and sitting in traffic. Or you may butt into conversations and blurt out answers prematurely. In some cases, problems with impulse control lead to angry outbursts.

Stressed Jobs, Strained Relationships
Such symptoms tend to be more clear-cut in children. In adults, they may be vaguer and more varied. Often, it’s the consequences that get noticed instead: lost jobs, unstable relationships, traffic accidents, impulsive spending sprees. Because the symptoms of ADHD resemble those of several other disorders, it’s important to see a health professional for an accurate diagnosis.

It’s also wise to heed the comments of those around you. A recent study in European Psychiatry found that adults tend to underestimate their own ADHD symptoms. You may not be fully aware of how you unfocused, restless, or impulsive you seem. But if your partner, friend, and coworker all say, “That sounds just like you,” you might want to listen.

If you would like to be evaluated for ADHD just give is a call to schedule an appointment, (352) 394-4237.

Tuesday, September 10, 2013

What Do Your Cholesterol Numbers Mean?

Your cholesterol levels are more than a routine medical test.  Stay heart-healthy by knowing what your cholesterol numbers mean and how to keep them in check. High cholesterol is a major risk factor for heart disease. For that reason, each September celebrates Cholesterol Education Month as a reminder to keep your number in a healthy range.

So, what do all of the numbers mean? Let's simplify it.

What is measured?
blood cholesterol screening looks at HDL cholesterol, which is the good cholesterol; LDL, the bad cholesterol; and your triglycerides.

The good
HDL is the good cholesterol your body needs to help keep cholesterol from building up in the arteries. Ideally, your HDL level should be over 60mg/dL.

The bad
LDL represents the main source of cholesterol build-up and blockage in the arteries. Your LDL level should remain below 100 mg/dL.

The ugly
Triglycerides are another form of fat in your blood. Your triglyceride levels should remain at 150 mg/dL or lower.

The score
Your cholesterol level is calculated by adding your HDL plus your LDL plus 20 percent of your triglyceride level. A desirable cholesterol level is below 200 mg/dL, which lowers your risk for coronary heart disease. The higher your level, the higher your risk. Cholesterol levels at 240 mg/dL and above are considered to be high blood cholesterol.

The choices
When you have high cholesterol, you physician may prescribe medication. However, you can help keep your levels in check with these lifestyle choices:

· Exercising at least 30 minutes a day, three days a week

· Losing weight

· Eat a diet low in fat and rich in fruit, vegetables, whole grains and lean protein

If you need to lose weight, you do not have to do it alone. The Total Family Healthcare & Wellness Centers can help you reach your weight-loss goals. Call us today to schedule your free consultation.


Tuesday, August 27, 2013

Get Ready For Flu Season!

Edgar Cruz, MD
Influenza (the flu) is a virus that infects the nose, throat, airways and the lungs. It is very contagious and is transmitted from person to person during coughing, sneezing, and even while speaking at a very close distance. The infection with the influenza virus occurs during the period from October through April.

The typical symptoms of the flu include fever, chills, muscle aches, nasal congestion, runny nose and difficulty breathing. In some instances, in vulnerable people like young children and older adults, it can even cause fulminant pneumonia. Every year in the United States approximately 200,000 people are hospitalized and 36,000 die from complications of the infection. Because of the fact that the infection is caused by a virus, it cannot be successfully treated with antibiotics.

Since the 1940’s a flu vaccine has been available to reduce or eliminate the symptoms of the flu. There are two types of vaccines. The vaccine with inactivated virus is developed in eggs. It is purified and it is administered as an injection. The vaccine with attenuated (debilitated) virus  ”Flu Mist”, is also produced in eggs. This vaccine is administered as a nasal spray. Because the virus is attenuated, it cannot grow in the lungs but it can grow in the nasal cavity were it produces an excellent protective immune response. Both vaccines include the 3 most frequent types of virus that cause the infection during that year. The flu vaccine is administered each year because the circulating virus are different each year.

For the most part the flu vaccines are safe. There is a secondary effect that could be very serious. Because the vaccines are produced in eggs there might be a small amount of egg protein. The people that are allergic to eggs might develop an allergic reaction that is rarely fatal but that it can be very severe. For this reason people that are allergic to eggs should not receive the flu vaccine unless they are in a very high risk population and that the benefits of receiving the vaccine outweighs the risk of getting a severe flu infection.

The flu vaccine is usually administered right before the flu season starts during September and November. The vaccine can be administered during the flu season even through March. In a phone conversation with CDC (centers for Disease Control) personnel we were informed that as long the vaccine has not expired there is no definite time limit to administer the vaccine.

The vaccine could protect 70 to 90 of every 100 people from contracting a moderate to severe infection. Talk to your doctor about getting your flu vaccine this year.

Friday, August 23, 2013

Which Matters More: Body Fat or BMI?

Cara Jakob, MD
Both are ways of estimating how “fat” a person is. BMI calculation is a simple indirect measurement based on only weight and height.  BMI does not consider gender, age, or muscle mass.  Body fat percentage is a more useful tool because it distinguishes between the weight of fat and that of your lean body mass—bones, organs, muscle and connective tissue.

There are several different methods of assessing the percentage of fat and lean mass of an individual.  These methods are referred to a Body Composition Analysis.  Some of the most common measurements include skin fold thickness, underwater weighing, and bioelectrical impedance.

 Impedance is the method used by the body-fat scale you stand on at Total Family Wellness. Also known as bio-impedance analysis, it sends an alternating current through your body from one foot to the other. The faster the electrical signal travels, the more muscular you are. That's because water conducts electricity, and muscle contains significant amounts of water; fat contains virtually no water, so it impedes the signal. The scale uses the speed of the signal to calculate your body-fat percentage.

This method of testing is very sensitive: How well-hydrated you are when the test is done, and your temperature, prior exercise and meals, all can affect results. Also, impedance devices are typically less accurate for people who are very obese or very lean. For best results, get tested first thing in the morning, before you've eaten or exercised but about a half-hour to an hour after you've had a glass of water. Even then, take the results as an estimate.


*American Council on Exercise
Women (% fat)
Men (% fat)
Essential Fat
32% plus
25% plus


Don’t get confused when you see a BMI chart and try to insert your Body Fat Percentage.  You will be discouraged.  Body Mass Index and Body Fat Percentage are two different numbers!  A woman with a Body Fat Percentage of 30 is in the acceptable range.  A BMI of 30 is considered overweight!


Weight Status
Below 18.5
18.5 – 24.9
25.0 – 29.9
30.0 and Above

Wednesday, August 21, 2013

Migraine Triggers

Cara Jakob, MD

What causes a migraine is still a mystery, but doctors are aware of a variety of factors that have been shown to initiate migraines. These factors are called triggers, and for people with migraines, avoiding them may be the only way to avoid a migraine. Each person’s triggers will be different. For some migraine sufferers, only one trigger sets off a headache. For others, the trigger responsible for the headache may change from migraine to migraine. Here, the many factors that are known to make migraines more likely to occur.


The Most Common Triggers

The most common triggers for migraines include:
  • Sleep changes: Getting too much or too little sleep may trigger a migraine.
  • Stress and anxiety: Emotional or mental stress and anxiety can trigger migraines.
  • Medications: Certain medications may increase your chance for a migraine. These include oral contraceptives and vasodilators.
  • Bright lights/photophobia
  • Loud noises/phonophobia
  • Strong odors: Such as perfumes or secondhand cigarette smoke
  • Foods: The most common food offenders include aspartame, an artificial sugar substitute; foods that contain tyramine (a substance that forms as foods age), such as aged cheeses, hard sausages, and Chianti wine; foods that contain monosodium glutamate or MSG, a key ingredient in many broths, Asian foods, and processed foods; caffeinated or alcohol drinks, particularly beer and red wine; and foods that contain nitrates, such as hot dogs, bacon, and salami. Skipping a meal or fasting may also increase your likelihood for a migraine.
  • Changes in the weather and barometric pressure
  • Hormonal changes: This is a particularly troublesome trigger for many women—fluctuations in estrogen, caused by menstruation, pregnancy, or menopause, may cause a migraine. Hormone medications, including oral contraceptives and hormone replacement therapy, can trigger or even worsen migraines, too.
  • Physical activity: Physically exerting yourself—whether through exercise, sexual activity, or physical labor—may cause a migraine.

Other Risk Factors

  • Genes: Research suggests your genetics may play a role in who is likely to suffer from migraines. After all, 90 percent of people with migraines have a family history of the severe headaches. If your parents, siblings, or children have migraines, you’re more likely to have them.
  • Gender: Seventy percent of migraine sufferers are women. However, in childhood, boys are more often affected than girls. The gender switch begins around the time of puberty.
  • Age: Most people will experience their first migraine in adolescence, but they can occur at any age.
  • Weight: Women who are mildly obese or obese have a greater risk for migraine headaches than women with a lower BMI.

How You Can Find Your Triggers

Pinpoint your migraine triggers by keeping a headache diary. Each time you have a migraine headache, record it. Also, be sure to record the time of day your headache started; what you ate or drank in the 24 hours preceding the migraine; where you were and what you were doing when the symptoms of the migraine began; and finally, if you had any other conditions that might have triggered the migraine. For example, if you’re a woman, write down if you have your period. If you take any medications to ease symptoms, record what and how much you took. Also note if that medication helped and how quickly. If your doctor has prescribed a medication to treat your migraines, having a record of its effect on your headache will be especially helpful for him or her to determine if you’re taking the right medicine for your condition.
Take this journal with you to your next doctor’s appointment. Having your doctor review your headache journal may help him or her pinpoint possible triggers. Start by avoiding those triggers as best you can to avoid another migraine. If one occurs anyway, record that information and share it with your doctor. If you find that avoiding the triggers helps your headache, it is possible you’ve found the triggers for your headaches, and avoiding them from now on will help you avoid migraines.

Avoiding Triggers

You can’t always avoid what causes your migraines, but for those risk factors where you do have control, avoiding them may help you prevent migraines and live a pain-free life. Keep away from any food or drinks that make headaches worse. If you know a particular perfume or scent brings on a migraine, avoid that. If possible, establish a daily routine and environments (at home and at work) that are less likely to initiate a migraine headache for you.

Wednesday, August 7, 2013

Diabetes Overview

What is Diabetes?

Edgar Cruz, MD
Diabetes is a common group of chronic metabolic diseases that cause high blood sugar (glucose) levels in the body due to defects in insulin production or function. Diabetes is also known as diabetes mellitus to distinguish it from a relatively rare metabolic disorder called diabetes insipidus that doesn't affect blood sugar. Symptoms of diabetes occur when a lack of insulin or insulin resistance stops glucose from entering the cells and fueling and energizing the body. The resulting spike in glucose can result in symptoms such as increased hunger and thirst, weight loss, fatigue, and frequent infections. Long-term complications include kidney failure, nerve damage, and blindness.


Types of Diabetes

Diabetes is categorized into two main categories and one subcategory, but all are typified by problems of insulin resulting in high blood sugar levels in the body. The categories are:

Type 1 Diabetes

This type of diabetes is categorized as an autoimmune disease and occurs when the body's misdirected immune system attacks and destroys insulin-producing beta cells in the pancreas. Although genetic or environmental triggers are suspected, the exact cause of type 1 diabetes—once referred to as insulin-dependent or juvenile-onset diabetes—is not completely understood. Type 1 accounts for only five to 10 percent of diabetes cases in the United States, and while it can occur at any age, most patients are diagnosed as children or young adults. Those with type 1 diabetes must take insulin daily to manage their condition.

Type 2 Diabetes

This type most often develops gradually with age and is characterized by insulin resistance in the body. Because of this resistance, the body's fat, liver, and muscle cells are unable to take in and store glucose, which is used for energy. The glucose remains in the blood. The abnormal buildup of glucose (blood sugar) can result in hyperglycemia and impaired body functions. Type 2 diabetes occurs most often in people who are overweight because fat interferes with the body's ability to use insulin, but it also can occur in thin people and the elderly. Family history and genetics play a major role in type 2 diabetes, and inactivity and poor diet can also increase the risk.

Gestational Diabetes

Gestational diabetes is defined as blood-sugar elevation during pregnancy and is known to affect about three to eight percent of women. Left undiagnosed or untreated, it can lead to problems such as high birth weight and breathing problems for the baby. Gestational diabetes usually resolves in the mother after the baby is born, but statistics show that women who have gestational diabetes have a much greater chance of developing type 2 diabetes within five to 10 years.


This condition is marked by blood sugar levels that are too high to be considered normal but are not yet high enough to be in the range of a typical diabetes diagnosis. Prediabetes increases not only your risk of developing diabetes but also heart disease. 

Sunday, August 4, 2013

Eating Well for Better Eye Health

Cara Jakob, MD
There are lots of reasons you have been told to eat a healthy diet. Eating plenty of leafy greens and omega-3 rich foods are well recognized for their role in cardiovascular health, cancer prevention and weight management , but vegetables also contribute a significant source of vitamins and nutrients for your eye health. Research shows that several diseases of the eye, including cataracts, glaucoma and macular degeneration—all of which are more common as you age, can be reduced with a healthy diet that includes fruits, vegetables and some types of fish.

Vitamin C: Protects some parts of the eye from the damaging effects of ultraviolet (UV) light. Most men and women meet the basic daily requirements for vitamin C (between 75 and 90 milligrams per day), but some people may need higher doses to help prevent some eye conditions. Your doctor will be able to guide you further.

 Sources for vitamin C: strawberries, brussel sprouts, broccoli, mango, and raspberries

 Vitamin E: A powerful antioxidant, vitamin E may play a role in the prevention of macular degeneration, and the formation of cataracts. Vitamin E is a fat-soluble vitamin and how much you take will be guided by your doctor. You may be able to take in enough vitamin E through diet and not need an extra vitamin.

 Sources for vitamin E: cottonseed oil, hazelnuts, almonds, fortified cereal, and sunflower seeds

 Zinc: This trace mineral is highly concentrated inside the eye and supports the health of the retina—an area of the eye that collects light. Levels seem to drop as you age, so it is important to take in more through your diet.

 Sources for zinc: garbanzo beans, black-eyed peas, sunflower seeds, milk, beef and chicken

 Omega-3: Found in every cell in the body, these healthy fats are essential for the health of many systems. Omega-3 rich foods have been shown to slow the progression of macular degeneration, diseases of the retina, and improve dry eyes.

 Sources for omega-3: seafood, flaxseed oil, nuts and seeds, spinach, broccoli and fish oil supplements

Thursday, August 1, 2013

Welcome Dr. Cruz

Edgar Cruz, MD
Total Family Healthcare welcomes Dr. Edgar Cruz as our newest board certified family physician.  Originally from Mexico, he earned his medical degree at the Universidad Autonoma de Nuevo Leon School of Medicine in Monterrey, Mexico. He completed his residency training in Family Medicine at Henry Ford Health System in Detroit, Michigan, where he served as chief resident. After residency, he acquired a small private practice, which merged 3 years later with the Henry Ford Macomb Hospital. Dr. Cruz has been the medical director and practicing family physician in a primary care center in Washington, Michigan, where he saw patients of all ages; from newborns to our most older adults, men and women alike.

Dr. Cruz strongly believes in preventive care, education and patient centered medical care. He helps the patients to participate, as the most important member of the team, in their healthcare. As a very strong Christian person he understands that health is the balance of body, mind and spirit. Being an immigrant himself, and completely bilingual in English and Spanish, he is always aware of cultural differences and is always compassionate and very professional.

Dr. Cruz has a passion for community involvement and enrichment. He frequently organizes educational talks, health fairs, and performs sports physicals for sports participants through the high schools in the community. He has received several recognitions for his community involvement. The Dr. Martin Luther King “Keep the Dream Alive Award” by the Archdiocese of Detroit, also the “Diversity Hero Award” through Henry Ford Health System.
Dr. Cruz is completely sure that moving to Florida has been orchestrated by God and he is very excited about joining the family at Total Family Healthcare in Clermont.

Thursday, June 13, 2013

Summer Salad Bar

Cara Jakob, MD

On those late summer nights when dinner time has come and gone and you are drawing a blank on what to feed your family, don’t head for the drive thru!  Try a home salad bar.
A home salad bar is a perfect way to use up your leftovers.  Fill a main bowl with lettuce or any type of greens that you have on hand, baby spinach, romaine, arugula and the like.   Chop up leftover chicken, steak or shrimp and put it in a bowl.  Fill other bowls with cheeses, nuts, fruit, chopped onion, chopped peppers, carrots, celery…you name it.  Anything goes.  For your kids you can add tortilla strips and ranch dressing.
The great thing about a salad bar, everyone gets to create their own!  You can easily stick to your plan with protein and veggies.  It is also a great way to make sure your family eats their veggies.  So clean out the fridge tonight and have Salad for dinner.

Wednesday, May 15, 2013

High blood pressure/hypertension- what is it and why you should care...

Tasmia Ahmed, MD
We have all likely heard of high blood pressure, or "hypertension", at some point in our lives. Our grandmother may have been taking blood pressure medicines. We may have checked our own blood pressures out of curiosity at those little machines at our local pharmacy.  Or, perhaps our own doctor has mentioned high blood pressure to us.
  But, what exactly is high blood pressure, and why such a big deal about it?  Let's start with some numbers. High blood pressure, or "hypertension," is defined as repeated blood pressure above 140/90mmHg. Normal blood pressure is blood pressure up to 120/80mmHg.  The blood pressures in between 120/80-140/90mmHg are considered "pre-hypertension."
  How do these numbers affect our health?  According to the Centers for Disease Control, heart disease is the current leading cause of death in the United States.  About one third of all deaths above age 35 is due to heart disease, and hypertension is a major risk factor in the development of heart disease. Hypertension also increases risk for stroke, heart failure, and kidney disease.
  Just imagine trying to water your lawn using a garden hose that has a kink in it. You'll be working harder and struggling to push the water past the high pressure in the hose, and those flowers in your garden will suffer from the poor supply of water coming through. That is a simplified version of the way our hearts are working to pump blood through our arteries to feed our body's organs like the brain, eyes, kidneys, etc. With hypertension, our vital organs are suffering the damages of a high pressure system.
 The good news is that healthy lifestyle changes like regular exercise, lower sodium diet, and weight loss can significantly lower blood pressure, thereby decreasing the risk for stroke, heart attack, and heart disease.
  Aerobic exercise regularly can lower blood pressure by 5-15mmHg, and the intensity of the workout is more important than its duration. An easy way to improve our diet to a lower sodium diet is to limit or cut out the processed foods and canned foods. Eating fresh foods, and preparing your own meals can help reduce that excess salt in our diet. As for weight loss, there are many benefits to reaching a healthy weight, and better blood pressure is one major benefit. Every few pounds we lose can improve our blood pressure by as many points. Some people may also need medications to treat their hypertension and its risks.
 Now that we know more about hypertension, let's be on the lookout for it, and take healthy
 steps to help combat it. Talk with your doctor about your blood pressures and whether you have hypertension. Together, you can develop an individual health plan to keep you at your best.
Clermont Office
3115 Citrus Tower Blvd., Suite A
Clermont, Florida 34711
Toll-free: (866) 212-2943
Orlando / MetroWest Office
1507 Park Center Drive, Unit 1H
Orlando, Florida 32835
Toll-free: (866) 212-2943