Now there are certain risk factors that you can modify.  These include factors such as blood pressure, cholesterol, level of activity, diet high in saturated fats, diet high in salt, smoking.  Addressing these risk factors can have a positive impact and lower your risk in regards to heart disease overtime.
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When treating my patients I always encourage lifestyle change and modification if possible before considering medication.  Using resources such as a wellness coach or nutritionist are helpful resources to achieve your goal.  Unfortunately not all insurance companies cover such wonderful preventative measures.  Check with your insurance company to see if those things are covered and then discuss options of lifestyle changes with your provider.
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My nutritionist said it’s not what you do 20% of the time that counts but what you do 80% of the time that is key.  I have always advised my patients that depravation is not ideal for longterm sustaining lifestyle changes.  But making choices to make small changes to your lifestyle are important and can be helpful.  The goal of 30 min of physical activity 5 times a week recommended by the American Heart Association may be a lot to start off with so I recommend that my patients start off with 10-15minutes 7 days a week to create the habit and then slowly progress.  Schedule an appointment with your provider to discuss ways to slowly incorporate healthy choices in your lifestyle to make lasting changes to begin modification of some of the modifiable risk factors. 

Human Papillomavirus vaccines can help prevent infection from the high risk subtypes of human papilloma virus that can cause cervical canceler and also some of the low risk types that can cause genital warts.  Both men and women are recommended to be vaccinated.   If given in the preteen years only 2 doses of the vaccine are needed however the vaccination is available for both men and women up to the age of 45 years old.

Also more commonly known as the PapSmear is a test that is done to determine cell changes at the cervix cause by HPV.  Typically when this gynecological test is done co-testing is done for HPV virus is done as well which is an important way to determine if there is HPV present.

Personally in my practice I encourage women to try and do it 4 times a year.  If you find anything abnormal or concerning don’t panic but do report your findings to your health care provider who might then perform a clinical-breast exam before considering any imaging studies

If there is one thing that has come out of the pandemic for some of my patients, its a moment to take stock in their health.  I have had a influx of patients establishing care for the first time in years because they have realized as one patient put it, "My check engine light has been on for years."

P.C.P. stands for Primary Care Provider.  Provider is usually considered a physician however, a provider can be a nurse practitioner or a physician assistant.  You should check with your insurance company as some insurance provider preclude your P.C.P. being anything other than a physician.  

A question I sometimes get from patient is wondering if the care is the same between a physician, nurse practitioner and physician assistant.  Physicians go to medical school and residency focusing on primary care for a total of 7-8 years.  Nurse Practitioners who are also registered nurses undergo extensive training for 6-8 years depending on their focus which includes their education to become a nurse.  In 22 states (I believe) NP's (nurse practitioners) can function autonomously (or in other words have full practice authority).  Whether you are seeing a nurse practitioner, physicians assistant, or physician.  It is important to establish a relationship with someone that you feel you can trust.

I have always liked the moniker that I am a "Pediatrician for Adults".  It makes the scope of what I do a little easier for people unfamiliar with a PCP or internist to latch on to.  Having a PCP, in my view is like having a friend whom you can go to when you aren't feeling well or having a friend that you talk to yearly just to make sure you are on  track for the goal of being healthy.  My job as a provider is to help make sure that you have as much knowledge as I can to make the decisions that impact your current health and your future health.  

Deciding to get a PCP is easy finding one can be challenging and daunting.  My suggestion is to first ask around to friends and family that you trust.  Word of mouth referrals are a powerful tool.  I will also say that not every match is made if heaven but it is a good place to start.

As the United States reopens at various rates and stages I am frequently asked, “What can I do to protect myself?”  As a provider this leaves me in a very frustrating position because we do not have a vaccine at this time and we are still learning new presentations and manifestations of this illness. 

Here are 7 tips that I give to my patients that I thought I would share:

​1.    Hand washing:   While I am a proponent of soap and water for 20 seconds, hand sanitizer (if you can find it) is better than nothing.  Even as the restrictions for staying at home are lifted please remember the basic care is important.  Hand washing is fundamental!

4.     Be selective and thoughtful:  As states lift restrictions it is imperative that careful consideration is given to gatherings.  I would  advise anyone to avoid going out and congregating in areas where social distancing is not possible.  I would recommend that as you resume your routine activities; such as going to the barber/hair stylist or even going to your healthcare appointments; inquire what policies and practices they are engaging in to promote social distancing.

2.     Wear your mask:   As restrictions loosen, I continue to recommend that you wear your mask in large gatherings with others that you don’t know intimately.  You cannot assume that everyone will be COVID-19 free.  So protect yourself and your loved ones.

3.   Avoid touching your face:  I know it is so hard to do it after you have been asked not to do it.  The eyes, nose, and mouth are entry routes for infectious organisms particularly COVID-19 which is spread as respiratory droplets. If you do touch your face just wash your hands and try again!

6.     If you feel ill STAY HOME:  Very simple request but I know as a provider it is very hard to do.  Having a strong work ethic I have the tendency to work and see patients even when I am ill.  However,  because this virus is new and we are still learning about how it presents.  It is imperative for all of us to have a  low index of suspicion when we feel ill and to  stay  home and quarantine--until we have more widely available testing options. 

5.     Take care of your chronic medical conditions:  If you don’t have any make sure you have seen a primary care provider (PCP) for your yearly checkup—if you suffer from chronic health conditions such as diabetes, heart disease, asthma it’s important that you ensure that your chronic health disease are managed and under control.

7.  Stay informed through reputable sources:  There is a ton of information on the internet and unfortunately a lot of it is not accurate.  Be mindful where you are getting your information from.  Please make sure it is from reputable sources.  Just as you would vet your doctor, dentist, or any other health care provider please vet the information sources discussing COVID-19 recommendations.  The spread of incorrect information is just if not more dangerous than the virus that we are fighting. 

Viruses are infections that cannot be treated with antibiotics.  Viruses can only replicate inside of a living organism.  Coronaviruses are a class of virus which have  many types; some causes disease or illness in animals or people.  COVID-19 was named due to it origination in China in 2019. 

The presumed symptoms are emerging as we learn more about this infection and how it operates.  As of now the most common symptoms are:

*Cough
*Fever
*Shortness of breath
*Muscle aches
*Sore throat
*Loss of taste or smell
*Diarrhea
*Headache

Pretty general right?  Exactly these symptoms are not considered specific to COVID-19 which is why it’s been very important as practitioners that we obtain a very thorough history of our patients and families.

In severe cases of the illness patients can suffer from respiratory distress, kidney problems and even death.

It’s not easy!  Until there are more lab tests available the main method of diagnosing the illness is clinical.  This means the diagnosis is made by your provider having a thorough history of your symptoms, risk or exposure or history of exposure. 

Laboratory tests--specifically the nasal pharyngeal swab--can confirm the diagnosis but the diagnosis is made based on symptoms at presentation.  This is why mild cases can sometimes appear similarly to a flu or bad cold.

As of April 21, 2020 when I was typing out this post there were 823,786 confirmed cases in the US with 44,845 deaths.  This means that 778,941 cases that have been tested have resolved!  While the deaths are staggering the numbers of individuals who have recovered are hopeful.  Also what is hopeful is that not everyone has been tested.  While this is very much a frustration for most statisticians, providers, and individuals it also means that potentially there are cases that have not been confirmed that have also resolved due to lack of available testing.

Stay in place!  Stay away from others.  Wash your hands routinely and clean routinely uses surfaces in your home frequently (e.g. tables, door knobs, countertops, phones, computers and keyboards, etc). Things you can use to clean—basic soap and water.

Next disinfect surfaces—you can use diluted bleach on appropriate surfaces or other house hold disinfectants like (lysol, windex, comet, etc).

Treat your symptoms—Tylenol for fever.  Stay hydrated.  If you have a fever you are loosing more water than you think so hydrate hydrate hydrate!

Monitor your symptoms—if you should start to notice:

*trouble breathing
*persistant chest pressure
*confusion or excessive sleepiness or difficult to awaken
*bluish lips or face

Or other symptoms that have you concerned contact your primary care provider