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.

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
Classification	Women (% fat)	Men (% fat)
Essential Fat	10-12%	2-4%
Athletes	14-20%	6-13%
Fitness	21-24%	14-17%
Acceptable	25-31%	18-25%
Obese	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!

 

BMI	Weight Status
Below 18.5	Underweight
18.5 – 24.9	Normal
25.0 – 29.9	Overweight
30.0 and Above	Obese

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.

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.

Prediabetes

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. 

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

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.